Doctors and ageism.

Ageism, defined as "discrimination against the old on the grounds of their being old,"' emerged as a concept in the United States in the 1960s and promptly joined racism and sexism in the rogues' gallery of social attitudes unacceptable to pressure groups. The Grey Panthers, having found their demon, fought it with commendable zeal and effect. People, it seemed, could be made to feel uncomfortable if accused of even quite recently identified discriminatory attitudes or practices. The idea of ageism is less familiar in Britain, but that should not make us complacent. Though to many an uncouth neologism, the word at least invites us to examine our prejudices, and the intended analogy with racism suggests an illuminating exercise. Would we dare translate our less amiable generalisations about elderly patients, our more exasperated reactions to them, directly into terms of colour? ("Don't you find it depressing working with black patients all the time?" "Twelve new admissions last night and only three of them white." "How canI be expected to run a teaching medical ward with all these beds blocked by, ahem, ethnic minorities?") The point need not be laboured. Perhaps some doctors are ageist, some of the time at least. Such systematic research as has been carried out on the subject, mainly among medical students, confirms that a problem exists.23 A negative attitude to the elderly-"a medical prejudice against old patients"2-is worrying simply because so many patients are old and many clinical encounters will therefore be vitiated if doctors are reluctant, ambivalent, or hostile towards them. Older patients have too many diagnoses and insufficient respect for the traditional specialty boundaries of medicine. They may offer slow and elusive histories and may.have, in most cases through no fault of their own, social problems. Their proper diagnosis and management may be less than straightforward for busy doctors in general practice and in the single organ specialties, where many contributing factors, ignorance of the basics of geriatric medicine perhaps included, may combine to produce frustration, exasperation, withdrawal, or rejection. "We come to clinical medicine with humanity and after three years they have educated it out of us," observed a medical student quoted by Gale and Livesley in a 1971 study which showed that junior hospital doctors' attitudes to the care of the elderly were much less favourable than those of clinical medical students.4 Teaching hospital ageism, which can reasonably be held to account for the difference, is hard to resist but may not go on forever. The present generation of teachers is the last not widely exposed to undergraduate education in geriatric medicine,5 and recent evidence from the evaluation of such teaching efforts suggests that a better understanding of the special needs of elderly patients results in more positive attitudes towards their care.6 7