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According to T. Franklin Williams, director of the National Institute on Aging, it is only recently that doctors have begun to make this shift, tailoring geriatric research and practice to keeping disability at bay. The reorientation has been emotionally difficult because it flies in the face of traditional medicine, which has always been based on a different approach: physicians diagnose an underlying illness, make a brief medical intervention, and hope to effect a dramatic cure.

This single-shot cure-oriented treatment sometimes works with chronic disease, as when a doctor operates to remove cancer or clean out clogged coronary arteries. But in many cases a curative approach is not effective, because most chronic illnesses by definition cannot be cured. Rehabilitation is needed to deal with these illnesses of aging, increasing the patient’s ability to function given an unchangeable diagnosis, an illness that will never totally go away. Unfortunately, attacking disability involves using techniques that doctors have been trained to see as less important – exercise, improved nutrition, physical therapy, psychological help, and changing the person’s environment to make getting around easier. In addition, these treatments must be chronic too, undertaken for life. And because they cannot make an older body new but can only halt the downward march to a nursing home, they are less exciting than producing a magical, lifesaving cure.

According to Williams, adopting this new approach has also been difficult for many doctors because it means sharing their authority. Social workers, nurses, physical therapists, and dietitians all have vital roles in rehabilitative care.

How important is it for doctors to genuinely collaborate with these lower-status health-care workers in treating older people? According to the findings of this study Williams describes, extremely important. Several teams made up of a physician, a nurse and a dietitian were formed to treat the large group of diabetic residents in a nursing home. Each group met regularly to review its cases and make treatment decisions. Videotapes of the sessions showed that the doctors on the various teams differed markedly in their ability to share decision making with the other group members. In some groups the doctor always had to have the final say. Others were run much more democratically; the doctor was able to see the other group members as true colleagues.

The quality of the care patients received turned out to be directly related to a doctor’s leadership style. Doctors who were able to really collaborate with their fellow team members had patients who were healthier and less incapacitated by their disease.

Williams also cautions against another blind spot that doctors tend to have: giving up on older patients.

My doctor wants to get lid of me. Last time I made an appointment because my leg hurt when I walk down steps, and he gave my complaint one minute at the most. He wrote a prescription and rushed me out. I wanted a more thorough examination. Maybe he could have done something for what is wrong. Would there have been a way to deal with the problem without doping myself up! Is there anything I could do on my own that would help? I think it’s because I’m eighty and he feels what I have is not worth his time.

People frequently complain that because they are older, their doctors give them short shrift. Unfortunately, scientific evidence supports their claim. About a decade ago researchers at the Rand Corporation clocked the average amount of time physicians in seven specialties spent in visits with patients of various ages. They found that people over sixty-five were seen for the least amount of time. Whether the doctor was an internist or a cardiologist and whether the visit took place in a private office, hospital, or nursing home, the upsetting result was the same – time spent examining and talking to elderly patients averaged significantly less than for other groups. Considering that after age sixty-five we tend to be in worse health and so should need more time and attention, this is unfair indeed.

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GENERAL HEALTH