With the aging of the US population, there may be a need for an increased number of geriatric doctors, and for more medical school education on aging and older adults. Medical school curricula are, in fact, incorporating more geriatric training to address this need. Despite the increased exposure to geriatric training, however, survey research on medical students and medical residents suggests that these doctors-in-training continue to hold negative attitudes toward working in geriatrics. A research study in the Journal of Aging Studies suggests that physicians-in-training may learn or retain negative attitudes about working with older patients.
The article is based on ethnographic research in academic hospitals in California. Ethnography is a qualitative research method in which the researcher learns about a social group by spending time interacting with them in real-world settings and through interviews. The researchers spent time following medical teams (which included an attending physician, residents, and medical students) on their hospital rounds. By observing the rounds and later interviewing the physicians and physicians-in-training, the authors were able to observe the interactions among clinicians and patients, and record the clinicians’ reflections on these interactions.
The authors found that conflicting and paradoxical attitudes about aging are expressed in both formal teaching and in the hidden curricula of medical training, the term used for the behaviors and assumptions that are informally passed on during social interactions among clinicians. Clinicians in the study found older adult patients more cooperative and respectful than younger patients. At the same time, clinicians experienced frustration with what they viewed as the high demands and needs of older patients, which conflicted with the institutional expectations for doctors to work quickly and efficiently. The authors found that the types of clinical activities that are useful for older patients, such as maintenance of chronic conditions and social interactions, were viewed as less valuable within the culture of medical training than the skill-intensive medical interventions that younger patients tended to be seen for. The authors argue that their findings suggest that adding lectures or courses on geriatric care to medical care would be insufficient to alter negative attitudes regarding working with older patients.
Higashi RT, Tillack AA, Steinman M, et al. Elder care as “frustrating” and “boring”: understanding the persistence of negative attitudes toward older patients among physicians-in-training. Journal of Aging Studies; (2012). 26: 476-483.