Attitudes and opportunities: Medical students’ and doctors’ attitudes towards older patients

Dr Rajvinder Samra is a Chartered Psychologist working as a Lecturer in Health and Social Care at The Open University. She enjoys researching the influence of attitudes and personality in medical settings and tweets at @RajvinderSamra Read her Age and Ageing Paper.

Social psychologists have been interested in attitudes for about 90 years now. Debate rages on about how much of what we do can be predicted from our attitudes. No doubt, over the past year, you will have read newspaper articles about how much someone’s attitude to a prominent issue covered in the media predicted their likelihood to vote for Brexit or Trump. This is an example of the attitude-behaviour link and the media trying to establish patterns so we can understand society better. The influence of attitudes on healthcare are frequently overlooked, but doctors’ or patients’ cognitive reasoning, preferences, values and emotions (i.e. all the things that come together to make up attitudes) can have a significant and meaningful impact on how services can, or should be, delivered.

Medical research often tells us what works and what doesn’t. But, regardless of the efficacy of a given procedure, pill, or model of care – it is human beings that undertake the behaviours that shape our health service. Given how they influence behaviours, attitudes have a role to play here. Until we replace healthcare professionals (and pretty much everything and everyone) with Artificially Intelligent (AI) robots, attitudes will need consideration.

We can start with doctors’ and medical students’ attitudes towards older patients, because we have just done a study on it. We conducted a systematic review on doctors’ and medical students’ attitudes towards older patients to look for the patterns within the published research.

We looked at 37 studies. We found that medical students who entered medicine mainly to help others (were intrinsically motivated) reported more positive attitudes towards older patients, whereas medical students who entered medicine for prestige or financial reward (were extrinsically motivated) were more likely to have negative attitudes. Respondents who had high quality personal relationships with older people were more positive in their attitudes. However, if the contact was superficial (e.g. they just tended to meet or visit a lot of older people in their personal lives), there didn’t seem to be a link to their attitudes. Fortunately, medical students who wanted to work with older patients in their future career had more positive attitudes. Doctors’ age, work experience or seniority didn’t seem to show any relationship with their attitudes. Gender, meanwhile, interacted with attitudes in a complex way but, if we look at only the high quality studies, four out of five found female medical students and doctors reported more positive attitudes than their male peers.

What to make of all of this? Well, we might as well start working out what could be going on with female medical students/doctors and older patients? It’s becoming the elephant in the room. (Of course, as a woman myself, I don’t like to be likened to an elephant and I’m sure that elephants feel the same way about being compared to me). A recent US study has highlighted that older patients’ cared for under female doctors show lower mortality and readmission rates than those cared for under male doctors. It’s not clear why this is. It could be related to the fact that female medical students report more positive and stable socially responsible attitudes than males. Or it could be that there is something that females are more or less likely to do that makes them better-suited to dealing with older patients.  It could be, for example, that they are better at coping with uncertainty in medicine, which may be important when dealing with complex older patients. If we can understand why particular cohorts of doctors think or behave differently, we can undertake work to help develop the optimal skills and attitudes in others.

Since our results did not show clear relationships between positive attitudes and doctors’ age, their work experience or seniority, we can let go of the idea that getting older yourself (or gaining greater professional experience) somehow systematically changes your attitudes towards this patient group or that inexperienced doctors (or medical students) are likely to have more negative attitudes.

We need to further explore the factors that link with positive attitudes towards older patients, and try to understand what’s going on here. Given that we have an ageing population, we might want to support those who are best suited to working with older adults and encourage them to find the area of medicine that suits their interests, attitudes and skillset. Or alternatively, and less optimistically, when we all get replaced by sentient AI, we might as well teach the robots what attitudes work better when supporting complex older patients.

The systematic review by Rajvinder et al can be read in full on the journal website.