Earlier this year I traveled to see an extended family member that was taken to the emergency room, then admitted, because the individual had excessive swelling and fluid retention in their lower limbs, making walking nearly impossible.
This individual is over 70 years old, lives at home alone, and is on Medicare Part A and B. They own their home outright and have not seen a primary care provider in over 40 years. Yes, forty years. That said, this person has been to the doctor in the past, mainly due to life events such as a car accident; this person has always been mobile, their mental faculties are fully intact, complete with sarcasm, wit, and verbalized annoyance at being in the hospital. They are regularly seen outdoors weeding their lawn, cooking meals, and keeping a keen eye on their neighborhood. Amazingly, this person knows everything that is going on with their friends, family, and community.
The individual admitted to the hospital and others that they increased their frequency when taking a particular medication, which shortly after resulted in this unwanted hospitalization.
My concerns are this: the individual has never been prescribed any type of medication in the past, nor have they complained about any health-related issue whatsoever beyond situations often caused by others (such as being a passenger in a car accident). However, this person has been told they now have congestive heart failure, low blood pressure, are prediabetic, and while visiting I witnessed several medications being administered. It made me think about an article written in 2022 by Reen Abelson and Margot Sanger-Katz that highlight how often insurers exploit Medicare for billions of dollars. According to their report, “Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to over diagnose their customers crossed the line into fraud.”
This is NOT the individual referenced. This is a stock photo.
I remained silent during this visit, a choice I am still grappling with. I don’t know enough about the specifics of the individual’s health history, and culturally it is rude to insert myself into an extended family member’s business (especially an elder). Yet, I still wish I had asked more questions in the moment rather than run home to the solace of my keyboard to turn the events ‘round and ‘round in my head, replaying comments and rethinking the entire encounter.
On one hand, this person is as stubborn as they come, an earned right of anyone that has lived and experienced so much, more than I can imagine. It’s one of the reasons they refused to ask for help. Their distrust of the medical system is very real through experiences that live fresh in their mind.
As I think through my drive to bring novel therapies, research opportunities, and preventive measures to diverse communities, and the individuals and families in those communities, I pause when I consider what I am up against. It’s not lack science, or not enough tools, it’s the lived experiences of individuals who have been on the receiving end of discrimination, bias, downright in-your-face racist behavior, and the uglier side of humanity that I am up against. This individual was willing to face pain and uncertainty in their home alone, rather than go to the emergency room willingly – and I get it - one environment is trusted and the other is not. One environment is controlled and the other is not.
It does not help that when the individual gets there – suddenly they have all these additional chronic conditions they have never experienced or heard of before. Given medication they have never been given before. This person grew up in an era where doctors were not questioned – you do what the doctor says, so they don’t know what questions to ask or if they can ask at all. Of course, the medications prescribed need recurring refills (essentially) forever – this person lives on a fixed income – how is this added expense going to factor into their lifestyle?
I left this visit very conflicted, and in that moment of uncertainty I said nothing. Torn between the reality of aging alone in this country, and the distrust of incorporating any type of preventive or medical care into a lifestyle when the system itself is untrustworthy.
I don’t know how to address this issue, nor can I say the hospital did anything wrong. What concerns me is this exacerbated gap in care, the gap in information, and the unstated (in this instance), but felt fear the elderly experience when encountering a medical facility or healthcare professional. It’s the unknown: I don’t know the person’s health history enough to comment. I don’t know the hospital system or healthcare professional enough to comment. I arrived a day or two after the incident, so the recap given of hospital admittance was third party and anecdotal, not a medical record or chart note. My heartstrings were certainly pulled at hearing how much the individual just wanted to go home.
When a nation’s healthcare system is largely based on profit, it is unclear where the truth lives. Were there unnecessary tests done? Was the individual over diagnosed? My own bias and experience say both are highly likely, but my logic says I do not have enough information to make an assessment. And, like so many, I stood quietly, paralyzed by over-analysis and indecision on whether to speak up or stay silent.
This is me, Dr. Tania M.