Tuesday, 12 June 2012

Jim Bob reminded me of ageism

When Digby Jones, former director of the CBI, appeared on Desert Island Discs, he rather touchingly dedicated his final song selection to his wife. Many, however, felt that his sentiment was rather undermined by his choice of ballad. No one can deny that Bryan Adams’ ‘Everything I do, I do it for you’ was a popular song, but some, perhaps many, were disheartened by the barefaced cheesiness of it. A bit like using glucose-fructose corn syrup instead of honey.

For a while, I have harboured a wishful ambition to one day appear the show. I know that it’s a long shot, but just in case I get the chance, I am keen to avoid a Digby, and try to keep a running list of my top songs to take a long. Most of the sure-fire choices are great songs that also have some personal salience for me. Stevie Wonder will definitely be there, but whether it will be ‘Superstition’ or ‘Master Blaster’ will largely depend on how important the individual memories they are each associated with stand the test of time.

Once in a while, however, I rediscover a tune that makes me consider taking the risk, and gives me a sense of the ‘Oh sod it’ moment that Digby must have had when he decided on the final make-up of his discs. I recently had one such experience, when I chanced across an old recording of a Carter USM album, that took me hurtling back to 1991, and reminded me of at least the suggestion of the development of a political sensibility. If you have never heard the band, take a look at them here: http://goo.gl/eTE82

I never forgave Jim Bob (the genius lead singer) for his haircut, but I was prepared to overlook it on account of some his lyrics. Much of the band’s stuff was in bad taste, but a lot of it referenced a true, perhaps mischievous, sense of anti-establishment, that is alluring to the 13 year old boy trying to make his way at a boy’s boarding school. But beyond that, Jim Bob reined in a rather florid way with words to highlight some issues that did mean something, and on listening it again, still mean something.

The song that I have posted a link to references inequality to healthcare, and pensioner poverty. It would be hackneyed to quote it directly. My particular favourite, Sheriff Fatman gives a nod to elderly abuse, mocks the faux sympathy given to society’s vulnerable, and highlights greed and selfishness as perennial issue, all through a great comic-book characterisation of Sheriff Fatman.

I have no idea what Jim Bob is doing now. I thought about finding out, but didn’t want to risk the disappointment of finding out that my hero is not the man I thought he was. I want to still believe that he is still ostentatiously down at heel despite the fortune that comes with having hit records living in a squat in early 90s Brixton. But I did think about what the Jim Bob of my youth would have said about the new government policy to ban patients being denied treatment purely on the basis of age.

No one should be denied treatment on the basis of their age. But I rarely find that the issue of appropriateness for treatment is a simple matter of age. The landscape is usually a lot more complex than that. For many elderly patients, who have other medical problems, who are frailer than younger counterparts, medical and surgical treatments are associated with higher risks of complications and side effects. As a doctor, you can only ever advise on the overall risk, and you never know whether the patient that you are talking to is going to be one of the 10, 20 or whatever per cent who will experience the bad outcome you need to warn them about.

In having conversations with patients about how to manage their care, one of the challenges is to get a feel for who the patient is, and what their style is. What is their attitude to risk, how do they feel about their overall quality of life, and so on. Approximating the overall style and attitude of a patient in the type of medical care they receive is one of the tricks of being a good geriatrician. It relies on empathy, and communication. It almost never hinges on age.

I also know that the elderly often get a poor deal. But this is not just in health care. They get a poorer deal from society in general. If you don’t believe me, then spend a month shadowing me, and count the number of patients I meet who live in loneliness, with no one to check in on them and chat to them.

Ageism in health care reflects society’s attitudes to the elderly in general. There are things that we can do in hospital to mitigate it, and there are many excellent geriatricians, GPs and nurses who spend an awful lot of time doing just that. But we don’t get it right all the time, and we’re not going to.

The spectre of punishment for being seen to deny elderly patients care may result in elderly patients getting care that they don’t actually want. The reality of caring for elderly patients is that we are not always in the business of saving their lives - sometimes we are in the business of allowing them a dignified death. Provoking anxiety in health care professionals on this issue may undermine their readiness to have the difficult conversations about the end of life,and opt instead for treatment which offers false hope and discomfort.  And for many patients, that would be a shame.

Jim Bob wouldn’t be afraid to make this point. And perhaps just to remind me, I’ll risk a Digby, and take one of his songs to my desert island.

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