I am writing this article based upon two factors: I have not seen it addressed often in the healthcare literature and I have personally experienced both and have had an epiphany. My wife diagnosed my problem as we interacted concerning my attitude concerning my healthcare. She suggested that I learn about ageism. Based on her past performance in my life, I took her advice as she has a motto that she repeats all too often, “my wife is always right.”
Ageism is frequently discovered in the workplace and I originally thought began around age 50. We observe opportunities for early retirement, transfers to less desirable roles or positions, we may be told by our superiors that we no longer have the skillset for our job, our performance reviews begin to crash, and we see an influx of young, intelligent and capable replacements being placed in our roles. What has changed? We have become a year older and have been placed in a sub-set of society. At this time, we are confused. We may or may not observe discrimination. We acknowledge that the younger replacements may lack experience but they make up for it in education, contemporary knowledge and certain skills. I became keenly aware of this in the operating room where I was the senior PA but the newly minted PAs were more familiar or skilled in laparoscopic surgery because they grew up with gaming devices.
This week I discovered the genesis of an age-old problem which was demonstrated in the first two decades of both PA and NP practice. Patients initially challenged being seen by anyone other than a physician for diagnosis and treatment of their medical condition. Unfortunately, a number of patients still have this attitude although both professions have been in existence for more than fifty-five years and have used PR platforms to extol their capabilities. They entertain that these new young professionals could take their vital signs and perhaps even their histories but lacked the training and knowledge, and most of all, the experience of their physician counterparts.
My medical condition consists of HCM and A-Fib for which I had a capable cardiologist, Janice Mc Cormack, M.D., that I had personally known since she was a resident. She referred me to two internationally known cardiologists in NYC who were published in all of the HCM literature; Mark Sherrid, M.D. and a pioneer in the Watchmaker procedure, Vivik Reddy, M.D. I moved to Charlotte, N.C. and realized that I had no influence on my medical care. I joined a system, studied the biographies of the cardiologists and was admitted to the practice of the chief of Cardiology with a referral by Dr. Mc Cormack. He treated me like a colleague because of my early history in CTS and gave me his personal cell number. He was to become fully engaged in administrative work and referred me to his colleague, the Director of the CHF department, Dr. Symanski. He, too, read my history the night before my consultation, was aware of my progress, ordered specific testing for my HCM due to the fact that they were regional specialists and at a certain point felt that I only needed to be seen annually and just for re-evaluations of treatment. The following year I was seen by a new cardiologist who was young and presented himself very differently than my past cardiologists. Six months later, I was scheduled to be seen by an NP in their department.
Being a past advocate for PA and NP practice, I was horrified that I developed the same misconceptions as those patients who had once questioned me. Was I no longer good enough to be seen by a physician? Am I being treated differently because I am in my seventh decade of life? I understood the word discrimination, only to change my misconceptions after our consultation. She was everything that I feared: young, intelligent but, due to her age, certainly lacking in experience. How was I going to handle this situation? I was honest and shared my history of epic physicians and my present feelings of not having the appropriate management. Did I disarm her? Did I frustrate her? Did I fail to acknowledge her ability? How did she react? The provider took my comments to heart, but reassured me. She marched forward in the presence of adversity and explained her role and how the department went over the charts of all those that were seen the following morning. She courageously marched forward. Every patient encounter has two handles. She could have possessed the handle of anxiety, doubt, nervousness or the handle of confidence in her abilities, and a purpose that challenged my misconceptions. She chose the latter. Lucy Rashid, APRN, NP-C, met my criteria in her examination, her concerns, her treatment plan which included an echocardiogram the following week.
I am ashamed that I engaged in an attack of what could have been her vulnerability but instead she created a metamorphosis and created confidence instead of an attitude that many would have entertained, anger. I had assumed that her white coat was a suit of armor and became apologetic, received her as my cardiology specialist and told her that my article for this coming month would focus on this encounter.
In conclusion, I can understand why misconceptions can lead to breakdowns in medical care and initiate litigations: if a person feels discrimination and lacks trust and has a negative outcome, or for that matter no problem in their care. Please understand that malpractice insurance is required, to defend your actions against misconceptions. Yes, read carefully, you do not need to make a medical error to become embroiled in a lawsuit. Patients may just feel like performing reverse ageism and attack a new healthcare professional. That litigation may be based on your own combativeness, your final farewell to the patient and that the fact that misconceptions create adversity without a poor outcome. The Oxford definition of misconception is, “a belief or an idea that is based on faulty thinking or information.” Ageism refers to stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or towards oneself, based on age. Based upon these findings, I think it wise to be prepared for legal actions, not because of inferior care that led to a complication, but because we still need to have a defense, a defense is very costly, and the best defense is a personal liability insurance policy. I made the decision to speak up in my situation, which is the first comment of advice in an article I recently reviewed.
Personally, I discovered that you are never too old to change your attitude, dream a new dream and respect all of our colleagues who engage in patient care.
Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor
ageismmalpractice insurancenurse practitionerphysician assistantprofessional liability