Do attitudes toward older patients even matter?

Rajvinder Samra is a Lecturer in Health and Social Care at The Open University. She is interested in healthcare professionals’ attitudes towards older patients. If you’re interested in this topic at all, get in touch with her at Rajvinder.samra@open.ac.uk

Does it matter if doctors like older patients? Is there any point in working out if doctors have positive or negative attitudes towards older patients? Surely it’s irrelevant because doctors are professionals that can separate their personal and professional feelings. Maybe they can, but that’s not the point as to why these questions are important.

The US has a long history of looking at medical students’ and doctors’ attitudes towards older patients and seeing if this is related to their likelihood of working in specialties like geriatrics. It seems like you are more likely to consider geriatrics if you have more positive attitudes towards older patients than people with more negative attitudes. Well, that seems obvious, doesn’t it?

We, in the UK, don’t have this history of research into doctors’ attitudes and maybe not even an interest in the question, because…why do the personal qualities of the doctor matter? In an interesting contrast, UK nurses have not been afraid to take on this question and we have lots of work exploring nurses’ attitudes towards older patients. So is that it? Is dealing with older patients the nurse’s job, and are attitudes only interesting if its nurses who hold them? Of course not. I’m not sure why we haven’t really looked into doctors’ attitudes towards older patients, but I am confident that they are not irrelevant to the medical encounter. Here’s why…

Attitudes towards older patients are not personal qualities, they are a reflection of your professional life. We are not talking about how much you love your grandparents, we are talking about how you think, feel and behave towards older patients. I suspect doctors don’t grow up as young children playing in the park whilst also dreading taking a history of an older patient. This attitude can come about as a result of the job they do and the system in which they have to do it. They were not born with attitudes toward older patients, they develop them and sometimes these attitudes will help them cope with difficult work.

If we ask about the thoughts and feelings that arise from treating older patients, we may be in a better place to make changes or improve training to alleviate negative attitudes or foster positive ones. If we don’t look at attitudes and continue assuming that they reflect the doctors’ personal qualities and not the system, we risk blaming healthcare professionals for the system in which they have to work, as well as missing the opportunity to allow them to influence their training and continuing professional development needs.

We did a study on doctors’ and medical students’ attitudes toward older patients in acute settings and it quite clearly indicated that the majority of the attitudes directly related to the medical encounter and treatment and discharge of older patients (essentially, professional attitudes). Additionally, frustrations with treating older patients largely related to how badly suited the acute system was in dealing with this patient group which resulted in doctors providing care that was unsatisfactory to them. These are not personal qualities that doctors can hide in the medical encounter. These attitudes may dictate how the medical encounter goes and they will reflect the doctors’ past experiences of medical encounters with older patients. The harm in not looking at attitudes (because we think they are personal) means that we won’t get to the bottom of how we can change the system to help doctors develop professional attitudes towards older patients that are more positive for them as well as the patient.