An Inside Look at Health Care for the Elderly and Medicare

As doctors we often chase numbers, measuring them and then fixing them. It is very tempting to think that we can help people by "fixing" their numbers. We check sugar, blood pressure, pulse, weight, labs of every variety, cholesterol, bone density, mental capacity, and so many more numbers. If those numbers fall outside some preordained level of normal, we label our patients as having a disease (high blood pressure, diabetes, osteopororis, dementia, ect), and then offer me

In its new report, "Dying in America," the Institute of Medicine takes a critical look at our flawed American medical system that makes end of life care both expensive and contrary to patient's wishes. The report states: "Current financial incentives encourage a reliance on acute care settings [hospitals] that often are costly and poorly suited to the needs, goals, and preference of patients and their families. The committee recommends a major reorientation of payment syste

This is a sign in front of our local hospital, and it is a piece of wisdom that my frail elderly patients should heed. Not that it is a substandard hospital; in fact, it is excellent in many ways. But as most of us who practice geriatric medicine know well, hospitals can be very dangerous for elderly patients. In my book I talk about the data that demonstrates a very pervasive falacy in medical care: that thorough, aggressive care given to the frail elderly will help them

Today Medicare reform is all about keeping doctors like me accountable. Quality is defined by having us fill out an abundance of forms to prove that we are following quality indicators, that in fact have no correlation to real quality among the elderly. Cost savings are supposed to be derived by forcing us to use expensive compter systems that do little to improve quality and which cost the doctors a great deal of time, money, and sanity. We are told we have to demonstrat

The passage of Medicare in 1965 was a crucial boon to our country's elderly and heralded a new era of American health care provision. All of the initial fears of Medicare faded quickly; it was not socialized medicine, did not destroy the doctor-patient relationship, and did not dissuade people from becoming doctors. But like a white water river (such as this picture of my son on the upper Yough in Maryland, a class V haven), Medicare has tossed us down continuous rapids and