population philosophy

Video and transcript inside: Dr Karen Hitchcock: "My core message is that we really need to think about our ageing population as a triumph and really rethink what it means to be old and what it's possible to do when you're elderly. Most elderly people are not sick, most of them are not in nursing homes, but I think we can do a lot more to integrate elderly people back into our communities and try and reimagine what it is that we want our communities to be. I think we need to start from an ethical perspective of what we want our community to be, and then from that, imagine our society and then find ways to create it and fund it, rather than starting from an economic position." Congratulations to the 7.30 Report, Karen Hitchcock and Quarterly essay for criticising the appalling depiction and treatment of Australia's elderly, implicitly and explicitly advocated by the growth lobby in the mainstream media and government. See, for instance, "Should Jeannie Pratt and Elisabeth Murdoch downsize to high rises in Activity Centers to give young people more room?" The negative message about the elderly has been so overwhelming that most of us find it exhausting to fight. The ABC has often also carried this message uncritically. Perhaps it took a woman-led news commentary program - the 7.30 Report - to try to break this mould. Dr Karen Hitchcock (who is a staff physician in acute and general medicine at a large city public hospital) is a very effective ambassador for the elderly, although she is a young woman herself. Her work deserves our collective support and promotion.

Video and transcript originally broadcast and published from the ABC 7.30 Report at http://www.abc.net.au/7.30/content/2015/s4196703.htm on 12 March 2015.

Elderly 'have internalised' message they're a burden on society, says physician Karen Hitchcock

Transcript

LEIGH SALES, PRESENTER: By 2050, about five per cent of Australia's population will be over the age of 85, with many of us expected to live to our mid-90s. The challenges of the ageing population are something we've been hearing a lot about in the past couple of weeks, since the Federal Government released its Intergenerational Report. The message is that more old people and falling budget revenues are going to put a huge strain on our health and welfare systems. But now one doctor is raising concerns about the way we're discussing the ageing population. She believes we're sending older Australians a message that they're an intolerable burden.

Karen Hitchcock is a staff physician in acute and general medicine at a major public hospital in Victoria and she's written the latest issue of the Quarterly Essay. It's entitled Dear Life: On Caring for the Elderly, she joined me from our Melbourne studio.

Karen, we've been talking a lot recently about the economics of health care as the country deals with an ageing population and declining budget revenue. When you listen to economists and politicians talk about the ageing population and the growing pressures on the budget and sustainability and so on, as a doctor, what do you hear?

KAREN HITCHCOCK, PUBLIC HOSPITAL PHYSICIAN & AUTHOR: What I hear is that the fact of our ageing population is an overwhelmingly negative development. The elderly are portrayed as being a burden on their families and on the state and a drain on the economy.

LEIGH SALES: And what message do you think that the elderly hear?

KAREN HITCHCOCK: Oh, I think that they've completely internalised this message that they're a burden. I see evidence of this every day on my hospital ward. Patients, elderly patients apologise for being sick, for being in hospital, for taking up a hospital bed that should be apparently for somebody else.

LEIGH SALES: How does that translate then in terms of the type of care that they want?

KAREN HITCHCOCK: Well, I think that sometimes it can mean that they feel reluctant to accept the care that they need.

LEIGH SALES: Like, give me an example of, say, a patient where you've seen that.

KAREN HITCHCOCK: Um, well, I've - there's a lot of patients, but recently I looked after an elderly gentleman who said that he wanted to die and that he didn't want to be in hospital and that he was a nuisance and when I sat down and talked to him, it turned out that his wife had recently died, his dog that was his remaining companion had died and he felt that he had no place in society anymore and that he was a burden.

LEIGH SALES: And so how, as a doctor, did you address that?

KAREN HITCHCOCK: I called him a couple of weeks after he left hospital, given that he had said he never wanted to come back to hospital, just to try and work out a plan for him and he said to me that he says silly things when he's sick. Of course he wants to come back to hospital and that he was very, very happy because he'd managed to get another dog, go back to his part-time work.

LEIGH SALES: What's your attitude towards advanced care directive, which are documents that people sign giving instructions about the sort of treatment that they would like if they're faced with potential end-of-life issues, which of course is often things that older people sign?

KAREN HITCHCOCK: They're being heavily promoted at the moment as something that should be universally adopted and I think that they do have a place, particularly if people have advanced malignancy and are going to die imminently or particularly when people have particular treatments that they don't want to have. But I think that saying that every single citizen in Australia should have an advanced care directive is dangerous and I think that to say that they're unambiguously good sort of relies upon an understanding of the human subject that is breathtakingly simplistic. People change their mind. It's very difficult for us to know how we're going to feel as we become increasingly dependent and debilitated. I mean, my grandmother, for example, she was a fiercely independent woman who, in her 80s, developed a lung disease that meant eventually she was house-bound and oxygen dependent. And if someone had've asked her a year prior to that development whether or not she would rather die or be house-bound and oxygen dependent, she definitely would have said she'd rather be dead. But when it came down to it, she was very happy with her life. She still had her family. She said that she would play in her memories. She was very happy to be alive.

LEIGH SALES: So if you see this idea that we are giving elderly people the impression that they're a burden as being a problem, how would you like to see the debate around some of these issues and the discussion reframed?

KAREN HITCHCOCK: Well I think that our focus should be on how can we improve the life of our elderly patients, not that we should be so keen to offer them death.

LEIGH SALES: And so, practically, how would you go about doing that?

KAREN HITCHCOCK: Um, I think that we - it would be really helpful if we could somehow integrate medical and social services so that we can encourage elderly people to remain independent and in their communities. If we could somehow integrate services and offer preventative treatment before people need to come to hospital, that would be a really great development and there are international examples of care programs like this where there are community-based, what's called medical homes, that are staffed by GPs and specialists and full allied health to enable people to stay in the community longer and to stay well and independent.

LEIGH SALES: How about the interaction between nursing homes and hospitals, how well does that work?

KAREN HITCHCOCK: It works very poorly. Many elderly people come to hospital as a result of medication side-effects, having too many tablets or etc., and they come to hospital, we stop their tablets and they're discharged back to their nursing homes and they have to continue on the tablets that they were on prior to coming to hospital, sometimes the tablets that caused them to come to hospital, until they can get a doctor to come to the nursing home and rechart their medicine.

LEIGH SALES: You are a busy doctor, yet you've taken the time out to write this lengthy piece of work around these issues. What is the core message that you're hoping to get out there based on your experience working in hospitals?

KAREN HITCHCOCK: My core message is that we really need to think about our ageing population as a triumph and really rethink what it means to be old and what it's possible to do when you're elderly. Most elderly people are not sick, most of them are not in nursing homes, but I think we can do a lot more to integrate elderly people back into our communities and try and reimagine what it is that we want our communities to be. I think we need to start from an ethical perspective of what we want our community to be, and then from that, imagine our society and then find ways to create it and fund it, rather than starting from an economic position.

LEIGH SALES: Just before you go, Dr Hitchcock, there's been a lot of discussion around this week about sexism in medicine. A senior surgeon raised some concerns around the issue of sexual harassment and whether or not raising that impacts on female doctors' careers. Just in your experience, do you think that there is a problem in medicine with sexism?

KAREN HITCHCOCK: I've obviously not worked with every doctor in every hospital in Australia and I'm sure there are individuals. However, one thing I do know is that there is certainly not a pervasive culture of sexism in medicine. I've never been discriminated against because I'm a woman in medicine. In fact I've been enormously supported and encouraged.

LEIGH SALES: Dr Hitchcock, thank you very much.

KAREN HITCHCOCK: Thank you.