December 6, 2012 0 Comments

We See and Yet Are Blind

Being a doctor can give a person a very warped perspective on life and illness. We tend to see people when they are sick and see the sickest patients more often than the healthier ones (rightly so!). As a result, our impressions are based on one (during a hospitalization, for example) or a series (in outpatient care) of small snapshots not only of people’s experiences of illness but, more importantly, of their lives. And sometimes, as we accumulate these snapshots from rotation to rotation (in the case of medical students and residents) or over years in practice, we begin to assume that because we have seen so much, we know the whole story.

In that regard, and however well intentioned, we are almost always wrong.

Here’s an example:

On Halloween, while teaching 140 practicing health professionals from the La Clinica health system, I asked what percentage of older adults they thought live in nursing homes. As usual, I got a broad range of answers:

“Forty,” said a young community health educator.

A nurse disagreed. “Seventy,” she said.

Heads nodded. I waited.

“Twenty?” asked one of the physicians.

“More,” offered someone I couldn’t see. “Fifty percent at least.”

Finally, I gave the answer: Less than 5% of older adults live in nursing homes, though 20% will require nursing home care at some time in their lives.

Why do health professionals – from students to those with years of experience – always get this answer wrong?

Because the healthy elder aren’t coming to see us – at least not very often. They are at work, or caring for their grandchildren, or at the gym, or volunteering, or doing the laundry, or making dinner, or fixing their cars. Because they are living their lives.

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