Age and Judgment

I was struck recently by the concluding sentences of an article written by Nathaniel Morris, a Harvard Medical School student. Note his final words. “. . . health care providers must discern when to apply the powerful instruments at their disposal and when to carefully hold back. It often just comes down to clinical judgment, a skill I’ve yet to learn but I’m hoping to find in my education.”

Here is a student at the beginning of his career, recognizing something he calls judgment, a palpable skill he hopes to discover not in school, if we take him literally, but in his education. It seems obvious that what young Mr. Morris perceives as a need represents a strain of wisdom that comes only with age and experience, a perspective that one’s culture may teach, although ours often fails in this one respect. Continue reading…

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Call the Concierge

My mother recently got a letter from her doctor informing her that he is going into “concierge medicine.” If she wants to keep him as her doctor—and she does (she’s 88 and has known him for years)—she will have to sign up for his new plan, paying a retainer fee of $3500 a year on top of what she pays for Medicare A, Medicare B, and Medicare D. I know what her doctor will get from this arrangement: if he succeeds in limiting his practice to 400 people, he will collect an additional $1.4 million of revenue a year, minus whatever he loses by shrinking the size of his panel. But what would my mother get? Continue reading…

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See, Hear, and Speak no Evil in Medicare

Although I was very grateful that Medicare was available when I retired two years ago, I’ve also been surprised and concerned about some of what it doesn’t cover. These concerns are especially in the areas of our eyes, ears, and mouth. 

For my mouth, the timing could not have been worse. I had excellent dental coverage with my prior academic medical center work, but rarely needed it. Yes, I knew that basic Medicare did not cover dental work. One could purchase some sort of supplemental coverage, but that seemed to me to be more costly than the coverage was worth. 

Apparently, my good dental health was timed to end when I was just over 65 and had Medicare. Two painful episodes close together with two root canals. A chipped front tooth, not painful, but making me look a little weird. A molar impinging on another tooth that needed to be pulled. Old cavity fillings that failed. Many, many thousands of dollars later, many questions arose. 

How had Medicare avoided dentistry, I asked my dentist? Continue reading…

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The Wisdom of Old Curmudgeons

The bad reputation of elderly curmudgeons is well known: angry guys raging at the declining world, their failed, decadent society, the younger self-centered generation, the crooks elected to public office, and the local trash pick-up dictatorship forcing the sorting out of bottles and newspapers. At the risk of being outed as one of those guys, I have some comments to make: maybe those aspiring curmudgeons of our age now need to pay more attention to the future than the past. Continue reading…

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Albert Schweitzer’s Advice about Aging

A friend recently quoted a saying from Albert Schweitzer that was especially meaningful to him as he approached his 70th birthday:

The meaning of maturity which we should develop in ourselves is that we should strive always to become simpler, kinder, more honest, more truthful, more peace-loving, more gentle and more compassionate.

 This advice captured my aspirations for the over 65 phase of life eloquently. To me it seems obviously true. But the skeptic in me asks – “Why should these be our goals?” Didn’t Dylan Thomas urge us not to “go gentle into that good night“? Continue reading…

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A Caregiver’s Near-Suicide

An article on “caregiver burden” in the March 12 issue of JAMA (Journal of the American Medical Association) opens by describing a painful, nearly fatal, situation:

Mrs. D, at 84 years of age, was the primary caregiver for her functionally impaired 86-year-old husband and shot herself 3 times in a suicide attempt. Mrs. D’s family did not perceive the severity of the caregiver burden as a family picnic was planned for the day of her attempted suicide. Mrs. D did not leave a note and later stated she fully intended to kill herself. While recovering in the hospital, she expressed relief at not having caregiver responsibilities. Two months later, her husband died, which Mrs. D described as a release for her.

What stands out for me as a psychiatrist is that despite the depth of depression that led to Mrs. D’s potentially lethal suicide attempt, when she no longer felt trapped in the caregiver role, suicidality and depression lifted without psychotherapy or medication. Changing the situation provided the “cure.” Continue reading…

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Shift Retirement Plans Away from Employers

Lots of proposals have been put forth for a new and better retirement system, but they don’t answer the question of how we get from here to there. (For examples of proposals, see the SAFE plan or the Guaranteed Retirement Accounts proposal.) We have a fairly extensive – albeit far from perfect – 401(k) system that people have just begun to understand.  In my view, it makes more sense to transform 401(k) plans into our ideal rather than to superimpose a new system on top of what we already have.  But figuring out just what steps to take is hard.  I am beginning to think that the single most important step is to shift the responsibility for sponsoring and administering retirement plans from employers to independent entities. Continue reading…

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Is 70 the “Right” Retirement Age?

I keep thinking about this notion that 70 is the “real” Social Security retirement age.  It is the age at which people get maximum monthly benefits, and if they work beyond this age they see their lifetime benefits decline.  But is 70 the right age? 

“Right” can mean a number of things.  One issue is how 70 in 2014 compares with 65 in 1940 in view of the increase in life expectancy.  Another is how to rationalize it given the large dispersion in life-expectancy gains between high- and low- income groups.

People are certainly living longer in 2014 than they did in 1940. The increase for those age 65 has been about seven years for both men and women.  How should these additional years of life expectancy be spent?  Continue reading…

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Writing your Own Eulogy

“Begin with the end in mind.” (From Stephen R. Covey: The Seven Habits of Highly Effective People: Restoring the Character Ethic.)

Did you ever wonder about the veracity of the eulogies given at funerals? Was this really the same person you thought you once knew?

I know, I know. Eulogies are meant to convey the best of the deceased person, to leave us with happy memories. Eulogies are a way of honoring the person. Most people deserve to be honored in some way, do they not?

Now, maybe this is just the psychiatrist in me, but there may be some drawbacks, side effects if you will, in this practice, too. Continue reading…

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