Ageism in Healthcare

INTRODUCTION

An elderly woman Viola Simpson, 84 years old, has been receiving angina treatment for over two years despite recently learning that she actually had a leaky valve instead of angina. When she requested for the leaky valve to be treated, the doctors disregarded her and made inappropriate comments about her age before they eventually treated her after she was persistent. Viola Simpson’s overall experience during the process was that of feeling disregarded by the doctors.

DESCRIPTION

Three main problems arose from Mrs. Viola Simpson’s case which included age discrimination, medical misdiagnosis and medical neglect.

Mrs. Simpson was wrongly diagnosed two years prior to her toe surgery as having angina instead of having a valve leak. Medical misdiagnosis occurs when an incorrect diagnosis about a patient’s disease is made (Holmes et al., 2020). Misdiagnosis might lead to more complex symptoms as wrong disease is being addressed, might increase cost of care and lead to interventions such as surgeries that might be otherwise unnecessary (Bari et al., 2016). In our case study, Mrs. Simpson was also denied care by the doctors despite her raising the need for treatment after her misdiagnosis was discovered. Ventura et al. (2018) defines medical neglect as the lack of health care providers to provide the required medical care to patients. A patient is said to be neglected when the basic needs such as shelter, food, safe environment and medical needs are not met. Finally, the remarks by the doctors about Mrs. Simpson’s age in relation to their ability to treat her condition are classified as age discrimination. Age discrimination occurs when substandard care or treatment is withheld from a person based solely on their age. Substandard care could be in the form of health care providers expressing ageist attitudes and behaviours, stereotype old adults and dismiss disease pathologies as effects of old age (Salway et al., 2017).

Mrs Simpson experienced all these issues in succession from having been given a wrong diagnosis in which she underwent treatment for over 2 years to being dismissed by the doctors and finally experiencing age discrimination. This essay will cover how ageism, misdiagnosis and neglect are presented in health care systems, their health impacts and ways in which they can be reduced or eradicated.

DISCUSSION

Katzuu and Chatterjee (2012) define angina pectoris as discomfort and pain in the chest due to heart diseases such as myocardial ischemia, which occurs when there is insufficient blood flow to the heart either due to arteries becoming too narrow or blocked. Leaky heart valve, also known as valve regurgitation on the other hand refers to blood in the heart leaking back into the heart chambers during heart contraction due to prolapsed mitral valves allowing blood backflow or cardiomyopathy where the heart’s muscles strain to pump blood around the body (Adams et al., 2010).

Misdiagnosis of the two conditions meant that a patient receives treatment and undergoes procedures that are not aligned with the actual condition that they have. Angina treatment includes medication such as anticoagulants and beta blockers while the main treatment for leaky heart valves is through surgical repair or replacement and medications like diuretics, blood thinners and anticoagulants (Katzuu and Chatterjee., 2012). However, for complex leaky valves, repair or replacement is most ideal according to Samad et al. (2012).They argue that medication is only viable for minor valve leaks which pose no threat to the patient but suggest surgery as the best option as their studies showed patients who underwent early surgery had higher survival rates than those who had late surgery and patients who were strictly on medications.

When a medical condition is poorly diagnosed the diseases might go untreated, treatment hindered or wrong treatment administered. Mrs. Simpson had been receiving angina treatment over two years which meant that her actual medical condition had gone untreated over the same duration. The life expectancy of people with leaky valves according to Adams et al. (2012) is five years if no surgical intervention is undertaken within the first two years of developing symptoms. The leaky valves were discovered right on time for the right interventions to be taken to avoid risk of suffering more severe complications like heart failure, hypertension and even death by Mrs. Simpson were it to be left untreated. The effects of administering wrong treatment after misdiagnoses pose greater risk for the patient developing severe complications from the treatment and lack of change in their health despite adhering to the treatment. Misdiagnosis also increases the cost of health care to the patient and to the National Health Service in terms of malpractice lawsuits which fall into millions of pounds every year (NHS, 2019).

Medical misdiagnosis is often prevented by the physician conducting thorough investigations on the patient before making a medical diagnosis. Studies by Greenfield et al. (2012) found that for conditions exhibiting similar symptoms, second opinion from different physicians sought provided for more accurate results and diagnoses of patients symptoms.

Duty of care refers to the obligations that a service provider has towards a service user and is often established when a patient gets admitted to hospital. Physicians owe patients duty of care to ensure that no harm is brought upon the patients under their care. When this is breached by the doctor, patient negligence occurs (Bryden and Storey, 2011). Understaffing and increased workload were listed by Restiputri et al. (2019) as one of the major reasons for negligence in hospitals by both physicians and nurses. Heavy workload means that the ratio of physicians to patients reduces therefore one physician is expected to cater for more patients than they are expected to. Increased workload in health facilities also decreases the quality of care administered as more emphasis is placed on quantity of patients attended to (Bryden and Storey, 2011).

Miscommunication is amongst the leading cause of negligence with 80% of all medical malpractices occurring because of poor communication according to Nagpal et al. (2010). Physicians with great communication skills are able to listen attentively to patient’s fears, be empathetic to their situations, educate the patient on treatment options and address any concerns that they might have (Huntington and Kuhn, 2013). Mrs. Simpson’s doctors failed to effectively communicate with her despite her raising her concerns about the need to address the leaky valve diagnosis that she had just discovered. Miscommunication causes patient frustration leading to unpleasant reaction by physicians that are often wrongly assumed to be dismissive, rude or arrogant. Dismissing patients without addressing their concerns in spite of the outcome that might not be pleasing to them negates their experience in hospitals and might hinder them from seeking medical intervention in future (Nagpal et al., 2010).

The effects of patient negligence in the health care system lead to worsening of health conditions as would have occurred in the case of Mrs. Simpson. With low survival rates of valve regurgitation, delayed treatment response exposes the patients to risk of worsening the symptoms and increasing risk of death (Adams et al., 2012). Worsened health conditions consequently lead to increased cost of medical cost to the patient in terms of seeking further health care for the developing symptoms.

In order to minimize cases of negligence in health care institutions, policies and procedures should be improved to ensure that all patients are treated equally without discrimination based on age, gender or race as the procedures set will apply to all patients (Senger, 2019). The Care Act UK (2014) safeguards people at risk from abuse and neglect from service providers and outlines how at risk adults should be cared for and indicates the patient’s rights. These rights include empowering patients to be autonomous, preventing patient harm, protecting patients from neglect and abuse and improving care as well as support from their care givers.

Increasing empathy training to physicians to be more understanding of patients’ condition and ensure that they have a meaningful and insightful encounter to promote the patient’s well being. Encouraging patients to speak up if they feel disregarded by physicians in a health facility and instead seek treatment in different hospitals if unsatisfied with the care being provided minimizes risk of serious harm and death (Bari et al., 2016). Mrs. Simpson spoke up about needing treatment for the leaky valve in her heart and was adamant until a doctor’s appointment was made for the valve to be fixed.

Age discrimination in hospitals often occurs due to negative attitudes towards elderly people by health care personnel. Misconceptions made by physicians about treatment hierarchy in the hospitals often put older patients at a disadvantage as they prioritize younger patients first. Salway et al. (2017) argues that by prioritizing young patients, old people are then perceived to be of less value to the society. The Equality Act (2010) states that no person should be discriminated solely based on their physical attributes, that is; age, gender, sex, sexual orientation and religion. The Equality Act therefore advocates for the fair treatment of all service users. Generalizing of medical conditions often exhibited by elderly patients is also regarded as ageism and cause poor diagnosis as assumptions are made about patients’ condition based on prior or similar experiences exhibited by a different patient (Dobrowolska et al., 2019).

The effects brought about by ageism in the health care system include risk of wrong diagnosis or withholding treatment from a patient leading to their health deteriorating. Ageism prevents physicians from obtaining accurate patient history to aid in their treatment plan (Dobbs et al., 2008). It alters physician-patient relationship as it results in poor communication that might lead to cases of poor diagnosis or poor treatment (Nagpal et al., 2010). In the case of Mrs. Simpson, the relationship with her physician was severed when the response to her asking if the leaky valve could be treated was negative in regards to her age.

Intervention measures that could be taken to reduce ageism in the workplace include advocating for patient centred care, changing patients’ attitudes about self-ageism and promoting trainings and education in health institutions. Patient centred care is tailored to meet patient’s needs to ensure that the expected treatment objectives are met and that the patient’s is satisfied with the care provided by physicians (Equality Act, 2010). Internalized ageism which is gotten from how the society negatively perceives elderly people and eventually shapes how physicians eventually view older patients (Dobbs et al., 2008). Promoting educational training to improve physician-patient interaction to reduce incidences of ageism ensures that older patients receive the same treatment as other younger patients.

CONCLUSION AND RECOMMENDATIONS

From Mrs. Simpson’s case study, ageism, negligence and misdiagnosis were shown to have negative impacts to her health. The wrong diagnosis she had gotten two years prior meant that she had been receiving the wrong treatment and utilized resources that could have been useful in other aspects of her life. Being discriminated against because of her age also meant that there was a possibility of her missing out on treatment that would have further worsened her condition. Had she not persisted for the leaky valve to be treated before her toe surgery was done, the valve would have been left untreated posing risk for developing stroke and in extreme cases, death.

The main recommendations that I would make to ensure that misdiagnosis, negligence and ageism in patients is at a minimal is by improving training and education of health care practitioners, educating patients on the need to speak up and for both doctors and patients to seek second opinions when they question the diagnosis or the symptoms are similar to other conditions.

Training and educating programmes promote good physician-patient communication practices. These include attentive listening and addressing any concerns and fears that the patient might have to establish a good rapport that will improve patient centred care. Empathy training carried out during medical training enables physicians to understand patient’s emotions and respond appropriately thus leading to proper treatment outcomes, reduced medical errors and reduced cases of lawsuits by patients. Seeking second opinions by patients after receiving diagnosis ensures that they receive the right treatment and confirms the diagnosis given. Physicians who encounter similar symptoms of different conditions should first investigate patient’s history and also seek second opinions from their peers to obtain accurate diagnosis.

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