In August 2012 I wrote a review of the book “My Mother, Your Mother” by Dennis McCullough, MD. Dr. McCullough serves as a faculty member in the Department of Community and Family Medicine at Dartmouth Medical School. His book resonated with me given I have parents in their mid-80s and my wife’s parents are not far behind. In his book, McCullough talks about the growing slow medicine movement:
“Slow Medicine is a special commitment undertaken by families and health professionals working together to achieve the very fullest understanding of aging loved ones and their complex, ever-evolving needs. This, in turn, leads to wiser decision-making regarding formal medical interventions.” (p.xxi)
Never has this been more relevant than over the last few days. My wife and I had an elderly relative undergo hip replacement surgery last Monday. This individual is in her mid-70s, in poor physical shape and has what to me appears to be an early stage of dementia. When I heard about the plan for the surgery I shared Dr. McCullough’s book with my wife and she read it from cover to cover. We were both concerned that this surgery was not appropriate given our relative’s physical and mental condition. One of the challenges that we face within our society, that will become more and more prevalent over time, is that we have the ability to address so many health issues in elderly patients, but as a culture we don’t ask, or aren’t prepared to ask if the procedure, surgery or intervention is the right thing for the patient’s quality of life. This is tough territory to travel.
There is no doubt that our relative had a hip joint that was seriously diseased. But there are alternatives to surgery. Would it have been better to encourage this individual to use a walker or a scooter to preserve her mobility? Or what about prescribing physical activity and an exercise regimen along a healthy diet? What I know about hip replacement surgery is that a person’s overall health and activity level are more important than age in predicting a hip replacement’s success. This individual leads a largely sedentary life and has pulmonary fibrosis, fibromyalgia and is taking an interesting variety of medications for various conditions including memory loss. To me, the lay person, that does not sound like an ideal candidate for major surgery – especially elective orthopedic surgery.
Most of us don’t want to be put in the position of having to determine when surgery is warranted and when it is excessive. One thing I do know is that we’ve got to slow down and ask a lot of questions prior to agreeing to putting an aging member of the family through a dramatic procedure, particularly if there is a high probability that they will not have an improved quality of live following the procedure. We have to be willing to have honest and open conversations with family members about the potential negative consequences of performing such a procedure on an elderly patient with existing health issues. And we have to have that conversation with the elderly family member. Our family member who recently went through the hip replacement never thought she was going to emerge from the surgery as a new woman. Now she is facing a reality that looks far different. She has a long road to travel if she is going realize an improved quality of life.