By Kathleen Byrne, CanadianHealthcareNetwork.ca April 7, 2014
An Interview with Dr. Michael Gordon
Dr. Michael Gordon, the medical programs director at Toronto’s Baycrest centre for geriatric care, is the co-author of Parenting Your Parents: Straight Talk about Aging in the Family (Dundurn Press, 2013). Now in its recently released third edition, the book—part advice manual, part resource guide and part memoir—uses case histories and autobiographical sketches to offer practical, straightforward and humane advice on a range of issues concerning elder care. Dr. Gordon spoke with CanadianHealthcareNetwork.ca about the book in March.
Toronto geriatrician’s book examines challenging situations and offers practical, straightforward advice
CHN: What is the most difficult aspect of dealing with aging patients and their families?
Dr. Gordon: The big issues are people not planning what they would want to do. These conversations are difficult, but not impossible, and I find that for many older people, (the conversations are) welcome. They want the security of knowing that those who are going to make decisions on their behalf will make the right decisions.
CHN: You refer to “respecting a patient’s autonomy.” How difficult is this?
Dr. Gordon:It’s hard. It’s complicated. Autonomy is the most recent addition to the whole construct of what we call ethical decision-making. When I did my training, you didn’t go around asking people what they wanted—you told them. The world changed in the ’70s, when this idea of autonomy got translated legally into the idea of consent, but beyond consent was now this discussion about what (the patient’s) preferences are. The good part of that is we now listen to people. The bad part is sometimes people make really bad decisions, and you can’t just ignore them, you have to take them into account.
CHN: It seems these family discussions on clinical matters often move into the realm of family counselling or psychiatry. How do you handle this?
Dr. Gordon: Categorizing things into domains is very common in medicine because it helps us speak the same language. (But) we are there to help people make decisions, whatever the subject is. I see lots of patients with late-stage, late-onset complex-associated depression; it’s part of my bread and butter. I rarely send them to a psychiatrist; it would be foolish, it would be a waste of resources. I know when I don’t know, or when I need something that I can’t do. As for counselling, to me all of medicine is counselling. But being comfortable dealing with families, as well as patients, that’s an attribute that we in geriatrics must have as part of our repertoire.
CHN: Do you find it difficult to get patients to tell you what is really going on, if their experience differs from what other family members tell you?
Dr. Gordon: The way I try to set things up is, the first interaction is with the parent and the children together. But then the opportunity to examine the patient for some period alone is important because then you can say, “From your perspective is there anything that’s going on that we haven’t discussed?” And every now and then, something comes out, so you know there’s another layer. And as a doctor doing geriatrics you have to be prepared at least to field everything, and then, depending on the situation, you may refer to somebody who has the time to go into the details. . . . I use social workers a lot.
CHN: What changes would you like to see in terms of government policy related to senior care?
Dr. Gordon: Oh, boy. That’s a 10-year sequence of meetings. The problem is, you have this feeling that for many people in government the problem is the elderly. They’re what’s doing in the economy, etc. But the projections of what the elders are going to do to our economy completely overlook that (these people are) a most phenomenal resource. I often say they are a “non-renewable” resource. Once gone, they’re gone, and the grandchildren will not have the grandparents and all that comes with that. So, we want at least to have the governments be neutral. Don’t start banging away on the elderly as the problem.
CHN: If you had to sum up the most important piece of advice you had for families, what would it be?
Dr. Gordon: Find ways to communicate as openly and honestly as possible; try to find what (your parents’) deep feelings and wishes are about what they want in the future. Do as much of your own planning as possible to make sure whatever resources required are there. Understand the nature of what’s available where you live; if you need help, (find out) what the agencies are, and get help when you need help, rather than waiting for a crisis. Crises are not good times to make serious and difficult decisions.