Elsevier

Journal of Aging Studies

Volume 26, Issue 4, December 2012, Pages 476-483
Journal of Aging Studies

Elder care as “frustrating” and “boring”: Understanding the persistence of negative attitudes toward older patients among physicians-in-training

https://doi.org/10.1016/j.jaging.2012.06.007Get rights and content

Abstract

Objectives

This study explores the attitudes of physicians-in-training toward older patients. Specifically, we examine why, despite increasing exposure to geriatrics in medical school curricula, medical students and residents continue to have negative attitudes toward caring for older patients.

Methods

This study used ethnography, a technique used by anthropologists that includes participant-observation, semi-structured interviews, and facilitated group discussions. Research was conducted at two tertiary-care academic hospitals in urban Northern California, and focused on eliciting the opinions, beliefs, and practices of physicians-in-training toward geriatrics.

Results

We found that the majority of physicians-in-training in this study expressed a mix of positive and negative views about caring for older patients. We argue that physicians-in-trainings' attitudes toward older patients are shaped by a number of heterogeneous and frequently conflicting factors, including both the formal and so-called “hidden” curricula in medical education, institutional demands on physicians to encourage speed and efficiency of care, and portrayals of the process of aging as simultaneously as a “problem” of inevitable biological decay and an opportunity for medical intervention.

Discussion

Efforts to educate medical students and residents about appropriate geriatric care tend to reproduce the paradoxes and uncertainties surrounding aging in biomedicine. These ambiguities contribute to the tendency of physicians-in-training to develop moralizing attitudes about older patients and other patient groups labeled “frustrating” or “boring”.

Highlights

► We examine attitudes of physicians-in-training toward older patients. ► We use an ethnographic approach to understand student opinions. ► Physicians-in-training receive contradictory messages about aging.

Introduction

Preparing physicians to meet the needs of the “gray tsunami” (Kirchheimer, 2008, in Diachun, Van Bussel, Hansen, Charise, & Rieder, 2010) has emerged as a priority in US medical education. Although geriatricians generally report very high job satisfaction when compared with other subspecialties, the number of physicians choosing to pursue geriatrics as a career remains inadequate given the anticipated rise in numbers of older adults requiring medical care in the US (Adelman et al., 2007). In order to insure proficient treatment of older patients by young physicians, the Association of American Medical Colleges in 2007 instituted minimum geriatric competencies for fourth-year medical students (AAMC, 2007, in Eskildsen & Flacker, 2009).

However, despite much research on the topic, it is still not entirely clear what the “best” approach to geriatric-focused education entails. Efforts at reforming medical school curricula involve such interventions as introducing geriatrics-specific learning objectives and lectures, facilitating student encounters with older adults earlier in the process of medical training, encouraging longitudinal care of seniors that includes home visits, and encouraging the development of geriatric-specific communication skills (Diachun et al., 2010, Thomas et al., 2003). The impact of these revisions on students' attitudes and knowledge of geriatrics has been mixed (Adelman et al., 2007, Diachun et al., 2010, Eskildsen and Flacker, 2009, Kishimoto et al., 2005, Perrotta et al., 1981, Shue and Arnold, 2005), and negative perceptions of caring for older patients continue to persist among medical students, residents, and faculty (Krain, Fitzgerald, Halter, & Williams, 2007).

In the face of increasing education about the negative impact of ageism on care of older patients and the rising importance of providing competent geriatric care, why do ageist assumptions persist among physicians-in-training? This study specifically seeks to explore the attitudes of physicians-in-training toward older patients. Based on ethnography and narrative analysis, we found that the majority of physicians-in-training expressed a mix of positive and negative views about caring for older patients. We argue that physicians-in-trainings' attitudes toward aged patients are shaped by a number of heterogeneous, paradoxical and frequently conflicting factors, including both the formal and so-called “hidden”1 curricula in medical education, institutional demands on physicians to move patients through the hospital as quickly and efficiently as possible, and portrayals of the process of aging as both as a “problem” of inevitable biological decay, an opportunity for medical intervention, and a pathological state that can be slowed or reversed through “anti-aging” science. In order to navigate these ambiguities, uncertainties, and contradictions that surround aging and caring for the elderly in the U.S., we suggest that medical trainees must develop individual approaches to care that attempt to balance caring for and meeting the needs of older patients while also conforming to the structural and institutional requirements for efficiency and fast patient turnover.

Section snippets

Background

In America and in many other societies, biomedicine and the health care system have emerged as the dominant frameworks to both understand the process of aging and attempt to manage and treat the medical and social conditions associated with old age (Kaufman, 1994, Kaufman et al., 2004). The emergence of gerontology as a medical specialty in the early 20th century marks the separation of the aged into a distinct category of patients that are seen to require different types of care than other

Methods

This article is part of a larger anthropological investigation of how physicians-in-training are socialized to determine patient “worth” and how this determination shapes the time and effort spent on an individual patient's care. This study utilizes the techniques and methods of ethnography, a qualitative approach to research developed by anthropologists that includes participant-observation and semi-structured interviews. Fieldwork was conducted at two urban teaching hospitals in northern

Ageist assumptions

In this study, participants were asked whether older patients, as a group, were more likely to receive lesser care or be less enjoyable for staff to treat medically. Whereas some types of patients (i.e., drug addicts, non-adherent patients, the homeless— see [primary author] et al., in press) were described by participants with strong feelings of frustration, anger, or resentment, older patients, by comparison, were described as mildly frustrating, or simply less interesting. A few participants

Discussion

In all, most participants felt some combination of frustration and warmth toward older patients. Negative perceptions of the elderly by the study population, including that they were inherently ‘end of life’ patients, that they were cognitively impaired, that their medical problems were complex and unlikely to be resolved, and that they were socially ‘needy’ and ‘slow’ to interact with, were tempered by views of older patients as more accommodating, deferent, and more willing to listen to

Conclusion

While a large number of studies have focused on the broad issue of ageism in medicine, this paper seeks to understand how perceptions of aging patients as “boring” are both supported and contested by physicians-in-training and impact their approach to care of geriatric patients. This paper argues that it is the attitudes of senior physicians, the increasingly ambiguous and complex understanding of the process of aging in biomedicine, and the constraints, requirements, and organization of the

Acknowledgments

The authors would like to thank Sharon Kaufman, Nancy Burke, and Brian Dolan for their comments on drafts of this paper, as well as the anonymous reviewers. This research was made possible by a University of California, Berkeley Mentored Research Award [RH] and funds provided by the UCSF Department of Anthropology, History, and Social Medicine [RH and AT] and the UCSF Medical Scientist Training Program [AT].

References (26)

  • J.A. Vincent et al.

    The anti-aging enterprise: Science, knowledge, expertise, rhetoric and values

    Journal of Aging Studies

    (2008)
  • R.D. Adelman et al.

    Introduction to the older patient: A “first exposure” to geriatrics for medical students

    Journal of the American Geriatrics Society

    (2007)
  • Association of American Medical Colleges

    Geriatric competencies for medical students: recommendations of the July 2007 geriatrics consensus conference [on-line]

  • R. Butler

    Ageism: Another form of bigotry

    The Gerontologist

    (1969)
  • A. Cribb et al.

    Towards the reflexive medical school: The hidden curriculum and medical education research

    Studies in Higher Education

    (1999)
  • B.A. Davenport

    Witnessing and the medical gaze: How medical students learn to see at a free clinic for the homeless

    Medical Anthropology Quarterly

    (2000)
  • L. Diachun et al.

    “But I see old people everywhere”: Dispelling the myth that eldercare is learned in nongeriatric clerkships

    Academic Medicine

    (2010)
  • M.A. Eskildsen et al.

    A multimodal aging and dying course for first-year medical students improves knowledge and attitudes

    Journal of the American Geriatrics Society

    (2009)
  • C.L. Estes et al.

    The biomedicalization of aging: Dangers and dilemmas

    The Gerontologist

    (1989)
  • E.H. Gaufberg et al.

    The hidden curriculum: What can we learn from third-year medical student narrative reflections?

    Academic Medicine

    (2010)
  • B.J. Good

    Medicine, rationality, and experience: An anthropological perspective

    (1994)
  • M.G. Green et al.

    Ageism in the medical encounter: An exploratory study of the doctor–elderly patient relationship

    Language & Communication

    (1986)
  • F. Hafferty et al.

    The hidden curriculum, ethics, teaching and the structure of medical education

    Academic Medicine

    (1994)
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