General


The Passing of the Generations

Probably like everyone else, the older I get the more conscious I become that I am part of a generation whose time came – and is going. My parents died some years ago as did my uncles and aunts. The “greatest generation” is rapidly dying off. The tears and memories of parents whose children died […]

Magical Thinking, Overtreatment, and Neglect of Patient and Family Values

My friend and college classmate Ted Marmor (see his recent post here) and Jonathan Oberlander have a short but illuminating article in a recent issue of the Journal of General Internal Medicine – “From HMOs to ACOs: The Quest for the Holy Grail in U.S. Health Policy.”  They offer a chastening analysis of our almost […]

Struggling to Meet Seniors’ Behavioral Health Needs

In July the Institute of Medicine issued a report, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?  The point of the report was to call serious attention to the growing inability of the health care workforce to meet the behavioral health needs of the senior population.

Trying to Practice What I Preached: Helping my Parents at the End of Their Lives

Once again, the challenge of how to constrain rising health care expenditures has caught the public interest, stimulated by concerns over rising federal debt and limited ability to generate tax revenues. I recently chronicled my unsuccessful efforts at stimulating medical cost containment from both academic and foundation positions (1971–2002) in the April 23, 2011 issue […]

Medicare and Social Security: Conjoined Twins

Although I grew up in a middle class family in Washington, D.C., my father, one of the pioneers in the early days of radio, was in and out of jobs over the years, usually fired. We went from elegant parties with small orchestras in our home one year to taking in a boarder the next. […]

Screening Paid Caregivers: “A False Sense of Security”

A recent article described what happened when researchers at Northwestern School of Medicine, posing as prospective clients seeking a caregiver for an elderly adult relative, contacted 180 agencies and asked about hiring, screening, and supervisory practices. Their findings aren’t pretty.

A Lesson in How to Die and How to Live

In the summer of 2005, my mother was 82 and had been in frail health for a while. Angina, hypertension, and chronic congestive heart failure were under control following an aortic valve replacement six years previously. Upon her return to Boston from a trip to New York for our daughter’s wedding, we noticed that her […]

A Time for Everything

I am the mother of two young children and the primary care physician of a thousand or so aging patients. Twenty-four hours a day I am either “on-call” for or providing care directly to needy, dependent little people. And about ten hours a day plus some nights and weekends, I am caring for needy, ailing […]

Living and Learning: The Academy of Aging

I entered the Academy of Aging – an informal but ancient and rigorous school – the easy way, reading and writing about it. I was drawn to the subject in my mid-50’s by working on the future of Medicare and its predictable economic crisis in the years ahead. I gained a good academic knowledge of […]