Gilliam’s orthopedic surgeon, who managed previous difficulties with her left knee, saw her that afternoon but told her: “I don’t do ankles.” He referred her to an ankle specialist who ordered a new set of X-rays and an MRI. For convenience’s sake, Gilliam asked to get the scans at a hospital near her home in Sudbury, Mass. But the hospital didn’t have the doctor’s order when she called for an appointment. It came through only after several more calls. Meanwhile, scheduling physical therapist visits for her knee and ankle several times a week took hours of her time.
“The burden of arranging everything I need — it’s huge,” Gilliam told me. “It leaves you with such a sense of mental and physical exhaustion.”
The toll the U.S. health-care system exacts is, in some respects, the price of extraordinary progress in medicine. But it’s also evidence of the poor fit between older adults’ capacities and the health-care system’s demands.
How specialty medicine complicates care
“The good news is, we know so much more and can do so much more for people with various conditions,” said Thomas H. Lee, chief medical officer at Press Ganey, a consulting firm that tracks patients’ experiences with care. “The bad news is the system has gotten overwhelmingly complex.”
That complexity is compounded by the proliferation of guidelines for separate medical conditions, financial incentives that reward more medical care and specialization among clinicians, said Ishani Ganguli, an associate professor of medicine at Harvard Medical School.
“It’s not uncommon for older patients to have three or more heart specialists who schedule regular appointments and tests,” she said. If someone has multiple medical problems — say, heart disease, diabetes and glaucoma — their health-care interactions multiply.
Ganguli is the author of a new study showing that Medicare patients spend about three weeks a year having medical tests, visiting doctors, undergoing treatments or medical procedures, seeking care in emergency rooms, or spending time in the hospital or rehabilitation facilities. (The data is from 2019, before the covid-19 pandemic disrupted care patterns. If any services were received, that counted as a day of health-care contact.)
That study found that slightly more than 1 in 10 people 65 and over, including those recovering from or managing serious illnesses, spent a much larger portion of their lives getting care — at least 50 days a year.
“Some of this may be very beneficial and valuable for people, and some of it may be less essential,” Ganguli said. “We don’t talk enough about what we’re asking older adults to do and whether that’s realistic.”
Victor Montori, a professor of medicine at the Mayo Clinic in Rochester, Minn., has sounded an alarm for years about the “treatment burden” that patients experience.
In addition to time spent receiving health care, this burden includes arranging appointments, finding transportation to medical visits, getting and taking medications, communicating with insurance companies, paying medical bills and following recommendations such as dietary changes.
Four years ago — in a paper titled “Is My Patient Overwhelmed?” — Montori and several colleagues found that 40 percent of patients with chronic conditions such as asthma, diabetes and neurologic disorders “considered their treatment burden unsustainable.”
When this happens, people stop following medical advice and report poorer quality of life, the researchers found. Especially vulnerable are older adults with multiple…
Read More: A new treatment plan may help patients streamline their medical visits
