ESSAY- Granny Rx: A little-known way to help the elderly


How hard could this be? I keep hearing that we have the best health care on planet Earth, so how hard could it be to find a doctor who specializes in the care of old people?


Seriously. I figured I'd just let my fingers do the walking through the Google pages, and I'd easily help my father-in-law up in Massachusetts find a new doctor.

 I've become the family expert in such matters since my mother moved to Charlottesville over four years ago.

Her Yale-educated internist in Massachusetts served her well for many years, but as the infirmities of aging piled up, her doctor dismissed her array of symptoms with a wave of his hand, saying, "Mrs. Jaquith, what you've got is a case of A-G-E."

 Until now, I'd had no idea how lucky we were, upon my mother's arrival in town, to have found an available geriatrician to care for her. Dr. Diane Snustad is a geriatrician's geriatrician: As a professor of geriatric medicine at the University of Virginia, she shows medical students how it's done.

 Now, if only a whole lot more med students would sign up for geriatrics, we'd be all set.

 A geriatrician is a primary-care doctor who's trained to care for the elderly. Old folks can be challenging patients who frequently have several chronic conditions and take a raft of medications.

 If you want to figure out what's going on, and discover the steps necessary to keep an elderly person as independent as possible– as well as minimize any pain and prolong quality of life– it takes a doctor who's willing to allow sufficient time with each patient. Time to listen, time to unravel the knots.

 The problem is that there's not a whole lot of money in it. Becoming a geriatrician requires a year or two of training beyond residency; and young doctors, as they stagger under the monster debt of student loans, are likely to give geriatrics a pass in favor of more lucrative specialties.

 After all, when reimbursement for your services comes exclusively through Medicare and Medicaid payments from Uncle Sam, you make far less money than your colleagues who're treating younger patients and receiving higher payments from private insurance companies.

 Dr. Snustad listened to my mother's litany of symptoms, and not only did she refuse to chalk them up to "sucks to get old" syndrome, she also discovered that several of Mum's complaints were caused by water on the brain: Normal Pressure Hydrocephalus, a condition that can progress to the stage where it's easily mistaken for Alzheimer's disease.

 The diagnosis led to a surgeon installing a shunt to relieve the pressure on her brain– and abatement of the symptoms.

And now, as a 92-year-old who will happily offer her opinion of the current political landscape, Mum wonders how her previous doctor could have dismissed her symptoms as unworthy of investigation.

 This is what happens when you take time to listen to an elderly patient: You learn something. You solve a puzzle. You improve a life.

 Now that my father-in-law's health is failing, our family is struggling to find a geriatrician in the Boston suburbs to care for him.

Dave is in the hospital as I write this. He has multiple chronic conditions and takes so many medications that we worry about drug interactions making matters worse.

Unfortunately, his current internist does not return phone calls from the hospital staff. And since losing a Medicare patient is no great financial loss– in fact, it frees up time for higher-profit, younger patients– this doctor has little incentive to coordinate Dave's care.

This man is a stellar example of a patient who could benefit from the expertise of a geriatrician.

 Alas, these doctors are scarce. Plus, they're overburdened by a growing elderly population and a diminishing supply of geriatricians– and precious few are taking new patients.

 And watch out, because the baby boomers are fast approaching retirement age. America is about to experience an elder boom.

 Thanks to decades of reluctance to raise taxes and make eldercare an attractive option for medical professionals, we boomers have created a perfect storm for ourselves: There are way too many of us, and far too few of them to take care of us

(The health insurance reform law will increase reimbursement to primary-care docs by 10 percent. You think that will lead to a stampede of med students to the geriatrics department? Me neither.)

As I stare at my computer screen and sift through the search results, I'm thinking that by the time I'm ready for Medicare, it'll take more than a Google search to come up with effective health care for me. It'll take a miracle.


Free Union resident and Baby Boomer Janis Jaquith often finds that her essays have been picked up for audio broadcast on area public radio stations.