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Bitter Pill: How The Medical System is Failing The Elderly
       By John Sloan, MD
       Toronto: Greystone Books, 2009    
       Dr. Sloan's book is a wonderfully intriguing book. In it, he talks about the state of the medical system for the elderly. Dr. Sloan's alarming yet informative book investigates why the medical system, with its one size fits all prevention strategy to hospitalized patients that doesn't benefit everyone, is failing old people who are in a fragile state of health, and what can be done about it. According to Dr. Sloan, today's elderly are seen as have-beens, a burden, and excluded from active life and often are isolated even from their
families because of their illnesses. However, elderly patients are more than a collection of symptoms. They have unique personalities and have unique needs. Furthermore, Dr. Sloan expresses a healthy skepticism about the widespread use of medications for the
prevention of illness among the elderly.
       What comes across for the reader is Dr. Sloan's combination of intuition, commitment, rigorous science and humanity. He has a love for this largely ignored, misunderstood and sometimes neglected segment of our society. The main problem with health care for the elderly is a dissociation between the solutions and programs universally accepted in the medical system and the characteristics of this group of patients. No one can predict what's going to happen to elderly patients when they get ill. Each elderly patient has a unique response to treatment, and no two will react exactly the same way to a particular medication. Overall, these patients just aren't similar or fundamentally predictable psychologically, socially or biologically like most other patients. The medical system, for Dr. Sloan, is designed to benefit younger patients. He suggests that doctors and hospitals should stop thinking about everything that an elderly patient experiences as disease. Instead, they should take the time to listen to what the elderly people are saying, in terms of their needs.
       Doctors should try to treat elderly people individually and determine what their unique needs and wants are. Most of the fragile elderly are women. Everyone working with the fragile elderly know that, at some point in each person's life, solutions offered by modern scientific medical care won't work anymore. Part of the reason for this may be that physicians insist on conventional medical care for the elderly way beyond when it stops working. Doctors are uncomfortable about being unable to say just when typical treatments and medications aren't useful anymore.
       According to Dr. Sloan, the fragile elderly don't want to be a burden, suffer, become a nonperson or isolated. Many patients may not be able to appreciate that they are a burden either because they are experiencing dementia or because they've just never been the kind of person who worries about anyone else. An older patient who is in misery because of pain, breathlessness, itching, or anything else that is hard to make better,  usually doesn't think about much else.  Most importantly, elderly patients want to be heard and psychologically supported.
       The best way to care for the elderly is to be open and honest with them as much as possible. Sometimes, elderly patients only need encouragement. Other times, they need someone to really listen to them and try to understand their individual predicaments. The human side of caring for the elderly is to change the things that we can, accept the things that we cannot change, and to have the wisdom to know the difference. This is hard for many doctors to achieve. But it is a goal definitely worth pursuing.
       This book will be most relevant to doctors who care for the elderly, to caregivers, and the fragile elderly themselves. The elderly need to feel cared for individually. This can be done by changing the medical approach for the elderly from one of objective evaluations to a subjective assessment of an elderly patient's needs and wants. Only then will doctors be gearing the treatments to the individual patients.  And that will make the elderly patient feel cared for.

       Irene S. Switankowsky, University of Wales, Lampeter