March 24, 2025
Old People Deserve Different: Don't Just Rip the Bandaid Off!
When a loved one ages beyond typical medical concerns into what Dr. Warren Wong calls "the decade of frailty," everything changes—including how we should approach their care. In this episode, geriatrician Dr. Wong reveals why elder care requires specialized knowledge that many family doctors don't possess.
Have you ever wondered why traditional medical appointments focus almost exclusively on disease management rather than your aging loved one's changing abilities? Dr. Wong explains how geriatric medicine mirrors pediatric care—but in reverse. While pediatricians track developmental milestones as children gain abilities, geriatricians monitor functional states as elderly individuals gradually lose certain capacities.
The conversation takes a surprising turn when Dr. Wong reveals common caregiving practices that can actually harm elderly skin.
For caregivers feeling overwhelmed, Dr. Wong offers a powerful concept: establishing "a line in the sand" as a necessary boundary for well-being. This acknowledgment that caregivers must recognize their limits—even as those limits may shift over time—provides both permission and wisdom for the caregiving journey. As host Jay Smiles reflects, this conversation reminds us that our efforts aren't in vain—professionals like Dr. Wong see our struggles and are working to improve support systems for caregivers everywhere.
Visit drwarrenwong.com or look for his forthcoming book "The GOLD Book: Getting Older with Love and Dignity" to access more of his practical wisdom for the caregiving journey.
Host: J Smiles Comedy
Producer: Mia Hall
Editor: Annelise Udoye
#EndAlz, #dementiacare, #dementia, #alzheimers, #alzheimerscare, #comedy #podcast, #warrenwong, #paceprogram, #eldercare #gerontology #geriatrician
"Alzheimer's is heavy but we ain't gotta be!"
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Chapters
00:56 - Band-Aids Can Actually Harm Elderly Skin
04:24 - Understanding Geriatric Care vs. Regular Medicine
10:44 - Parenting Up: Caregiving Adventures with Jay
18:31 - How Geriatricians Differ From Family Doctors
23:08 - The Decade of Frailty: Aging Through Your 80s
33:17 - Supporting Caregivers: The True Healthcare Angels
39:37 - Difficult Stories From Geriatric Practice
51:33 - The GOLD Book: Getting Older With Love
58:10 - The Snuggle Up: Lines in the Sand
Transcript
WEBVTT
00:00:00.560 --> 00:00:02.346
I'll just give you a very simple tidbit.
00:00:02.346 --> 00:00:06.248
When a child gets an owie, you put a band-aid on it.
00:00:06.248 --> 00:00:14.586
Well, that's probably the worst thing to do for a frail, older person whose skin is no longer like the skin of a healthy little baby.
00:00:14.586 --> 00:00:16.257
There's actually a term for it.
00:00:16.257 --> 00:00:18.667
It is adhesive associated injury.
00:00:18.667 --> 00:00:26.452
When you buy band-aids and they say that they stick really well, those are bad band-aids.
00:00:26.452 --> 00:00:28.320
And they say that they stick really well, those are bad band-aids for older people.
00:00:28.320 --> 00:00:46.134
Because chances are, when you take that band-aid off, especially if it's the forearm or the hand, there's a good chance you're going to tear the skin off too whoa, whoa, doc, wait a minute, look where I'm from.
00:00:46.173 --> 00:00:57.850
We would say you're coming in hot Doc Attempting to use a typical wound care bandage.
00:00:57.850 --> 00:01:00.875
I could actually take the skin off.
00:01:01.115 --> 00:01:07.632
Yes, especially if your arms or forearms have been exposed to sun damage for years.
00:01:07.632 --> 00:01:13.626
Your skin is a lot thinner when you get very old.
00:01:13.626 --> 00:01:22.486
Even these non-stick pads can be a little bit, sometimes stick and still cause problems.
00:01:22.486 --> 00:01:42.489
So a lot of times what I recommend is it's just a very simple thing People would come in and there'd be bandages all over these horrific skin tears that frequently are dog-eared skin tears and we would just show caregivers how to actually correctly manage a wound.
00:01:42.489 --> 00:01:49.891
And you can guess, jay, how old does a child have to be before they know how to use a fork and a knife?
00:01:50.280 --> 00:01:51.364
Okay, I'm going to guess.
00:01:51.364 --> 00:01:58.349
Okay, I don't have kids, I'm going to guess three.
00:02:00.024 --> 00:02:04.483
No, so you don't have kids Usually using a fork and a knife is about seven or eight years old.
00:02:04.501 --> 00:02:07.465
Yeah, listen so I told you, Doc, I don't know kids Usually using a fork and a knife is about seven or eight years old, yeah, Listen.
00:02:07.465 --> 00:02:09.066
So I told you, Doc, I don't know what the hell I'm doing.
00:02:09.066 --> 00:02:11.048
Listen, I got my mom.
00:02:11.048 --> 00:02:13.669
My mom is my first baby and I got her at 63.
00:02:14.431 --> 00:02:14.751
You know.
00:02:14.751 --> 00:02:20.175
So think of it this way that if I asked you, can your mom use a knife and a fork?
00:02:20.175 --> 00:02:26.629
You would know the answer right away, or you would know no, and so she cannot anymore.
00:02:26.629 --> 00:02:31.040
And so that tells you something.
00:02:31.040 --> 00:02:34.405
When I say, look at that, aha, she's not at the level where she can use a knife and a fork.
00:02:34.405 --> 00:02:36.007
What is she at the level of?
00:02:36.007 --> 00:02:37.049
Can she use a fork?
00:02:37.049 --> 00:02:38.349
Can she use a spoon?
00:02:38.349 --> 00:02:42.415
Those are the kinds of questions that a geriatrician is very likely to ask.
00:02:46.560 --> 00:02:52.133
Parenting Up caregiving adventures with comedian Jay Smiles is the intense journey of unexpectedly being fully responsible for my mama.
00:02:52.133 --> 00:03:03.712
For over a decade, I've been chipping away at the unknown, advocating for her and pushing Alzheimer's awareness on anyone and anything with a heartbeat.
00:03:03.712 --> 00:03:07.688
Spoiler alert this shit is heavy.
00:03:07.688 --> 00:03:09.826
That's why I started doing comedy.
00:03:09.826 --> 00:03:11.866
So be ready for the jokes.
00:03:11.866 --> 00:03:19.498
Caregiver newbies, ogs and village members just willing to prop up a caregiver.
00:03:19.498 --> 00:03:21.960
You are in the right place.
00:03:21.960 --> 00:03:25.012
Hi, this is Zeddy.
00:03:25.012 --> 00:03:30.570
I hope you enjoy my daughter's podcast.
00:03:30.570 --> 00:03:32.414
You got, okay.
00:03:37.800 --> 00:03:40.669
Today's supporter shout out comes from Instagram.
00:03:40.669 --> 00:03:47.792
Okay, it's only me Quote I love that you refer to your mom as your favorite girl.
00:03:47.792 --> 00:03:53.709
I called my mom the same as well Emoji heart eyes.
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Emoji blush cheeks.
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You are so welcome.
00:03:58.515 --> 00:04:01.021
She is my favorite girl.
00:04:01.021 --> 00:04:14.227
Now, if you want to receive the special supporter shout out like, review us on Apple Podcasts, instagram or YouTube.
00:04:14.227 --> 00:04:16.230
Thank you.
00:04:16.230 --> 00:04:22.000
Today's episode old people deserve different.
00:04:22.000 --> 00:04:23.834
You can't just rip the band-aid off.
00:04:23.834 --> 00:04:24.420
Old people deserve different.
00:04:24.420 --> 00:04:29.125
You can't just rip the band-aid off.
00:04:29.125 --> 00:04:30.226
Parenting up family.
00:04:30.226 --> 00:04:35.153
I know y'all are probably sick of me telling you we did it again, but it's not even me.
00:04:35.153 --> 00:04:36.454
I didn't even do it.
00:04:36.454 --> 00:04:48.262
The caregiving gods just decide to give me really cool people who know really, really cool stuff about the space that we're in.
00:04:48.262 --> 00:04:53.093
And here it is again Dr Warren Wong.
00:04:54.035 --> 00:04:54.836
How you doing Doc.
00:04:54.836 --> 00:04:56.680
Hey, jay, I'm so happy to be here.
00:04:57.985 --> 00:04:58.425
Thank you.
00:04:58.425 --> 00:05:03.380
Now y'all are probably wondering, like Jay, so why is Dr Warren Wong cool?
00:05:03.380 --> 00:05:04.663
Well, first of all, he lives in Hawaii.
00:05:04.663 --> 00:05:06.305
In Hawaii how damn cool is that?
00:05:06.305 --> 00:05:09.050
How many of you have ever lived in Hawaii?
00:05:09.050 --> 00:05:09.853
I know I haven't.
00:05:09.853 --> 00:05:11.581
I have been there, but it's.
00:05:11.581 --> 00:05:15.288
It's cool just to say you've ever visited there.
00:05:15.288 --> 00:05:17.250
But he actually lives there.
00:05:17.250 --> 00:05:20.000
And then he's a geriatrician.
00:05:20.000 --> 00:05:32.345
Now, all right, that's a fancy word for saying he actually, on purpose, specializes in elder care and then he cares about caregivers.
00:05:32.966 --> 00:05:38.420
How many people out there actually care about us, right?
00:05:38.420 --> 00:05:43.747
Usually physicians, anybody in the medical field.
00:05:43.747 --> 00:05:49.041
They're trying to take care of our LOs and, yeah, I like that.
00:05:49.041 --> 00:05:52.649
But hell, we're the ones doing the heavy lifting.
00:05:52.649 --> 00:05:53.151
Come on now.
00:05:53.151 --> 00:05:54.283
Y'all know I'm a comedian.
00:05:54.283 --> 00:05:55.588
We're the ones doing the heavy lifting.
00:05:55.588 --> 00:05:56.855
My mama with Alzheimer's.
00:05:56.855 --> 00:06:02.709
She ain't done nothing hard in 12 years Since she got diagnosed.
00:06:02.709 --> 00:06:05.875
I've been doing all the hard work.
00:06:05.875 --> 00:06:18.704
Now, okay, she is living, she is fighting through an awful disease, but I'm just saying, listen, I'm over here busting my ass every day just trying to figure out how to make her swallow a pill.
00:06:18.704 --> 00:06:24.129
All right, dr, talk to us about how.
00:06:24.129 --> 00:06:32.557
Did you even decide that geriatric care was a specialty, that you wanted to be involved in, versus any other kind of medicine.
00:06:32.920 --> 00:06:38.372
Well, you know, when I first started being a doctor, I was in internal medicine in San Francisco.
00:06:38.372 --> 00:06:40.005
That's actually where I grew up.
00:06:40.005 --> 00:06:43.781
I was born in San Francisco, chinatown, and I was a local boy in San Francisco.
00:06:43.781 --> 00:06:48.204
I was born in San Francisco, chinatown, and I was a local boy in San Francisco, and I decided to.
00:06:48.204 --> 00:07:17.103
After I finished my internal medicine training, I decided to go back and serve my community, chinatown, and I worked at a place called Onlock, which in Chinese means peace and happiness, and it takes care of frail older people and the name says it all it's to provide peace and happiness for these people and the medical care was just part of a much bigger team and the day-to-day activities were what was really important.
00:07:17.122 --> 00:07:32.072
Now, the Unlock was the original site of what maybe some of your listeners would know about is the PACE program your listeners would know about is the PACE program, which means that it is a Medicare approved benefit for Medicare beneficiaries who meet the criteria for the program.
00:07:32.072 --> 00:07:37.694
But PACE is available in many places across the country.
00:07:37.694 --> 00:07:41.122
It's not available everywhere, but it is a Medicare benefit.
00:07:41.122 --> 00:07:48.735
But that's how it started and actually I wanted to segue a little bit into like, well, how is a geriatrician different?
00:07:50.261 --> 00:07:54.507
And so Go right ahead, you go right ahead.
00:07:54.507 --> 00:07:57.689
Listen, you got there before I did.
00:07:58.069 --> 00:08:02.110
Okay, I'll tell you a story that I hope, but how come you're, yes, right?
00:08:02.480 --> 00:08:11.939
How are you different from a family practitioner that just happens to stick with you from the time that you're 30 to 40 to 60 to 70?
00:08:12.540 --> 00:08:25.076
So I would kind of actually say that the parallel that I like to use the most is we're kind of the opposite end of the spectrum of a pediatrician.
00:08:25.076 --> 00:08:47.482
So a regular adult doctor might talk about your diabetes, your blood pressure, your heart failure, whereas a pediatrician talks about developmental states, how you know, what are you able to do, Are you able to put your clothes on, and things like that.
00:08:47.482 --> 00:08:52.606
And actually as geriatricians we see it kind of in a mirror image of.
00:08:52.606 --> 00:09:03.255
That is, we look not at the developmental stages but we look at the functional states how's your diabetes, how's your hypertension?
00:09:03.255 --> 00:09:13.802
But we would go into things like well, what can you do now?
00:09:13.802 --> 00:09:14.684
Are you able to manage your own bills?
00:09:14.684 --> 00:09:15.568
That's a certain high-level skill.
00:09:15.568 --> 00:09:19.461
That might be one of the first things to go in a person who's starting to develop some degree of Alzheimer's disease.
00:09:19.883 --> 00:09:27.722
And then we would ask some questions that usually most caregivers know the answers to but most physicians never would ask.
00:09:27.722 --> 00:09:41.952
For instance, I frequently ask the question is this person able to use both a knife and a fork, or does this person just use a fork, or does this person use a spoon?
00:09:41.952 --> 00:09:54.528
And when you think about it, that's exactly the opposite of what you see, when children, they first learn how to use their hands, then they learn how to use a spoon, then they learn how to use a fork.
00:09:54.528 --> 00:10:02.649
And you can guess, Jay, how old does a child have to be before they know how to use a fork and a knife?
00:10:04.961 --> 00:10:06.123
Okay, I'm going to guess.
00:10:06.123 --> 00:10:13.144
Okay, I don't have kids, but I'm going to guess three.
00:10:13.845 --> 00:10:15.807
No, so you don't have kids.
00:10:15.807 --> 00:10:19.259
Usually using a fork and a knife is about seven or eight years old.
00:10:19.780 --> 00:10:20.783
Yeah, listen.
00:10:20.783 --> 00:10:25.754
So I told you, doc, I don't know what the hell I'm doing, listen, I got my mom.
00:10:25.754 --> 00:10:28.428
My mom is my first baby and I got her at 63.
00:10:29.159 --> 00:10:29.500
You know.
00:10:29.500 --> 00:10:34.928
So think of it this way that if I asked you, can your mom use a knife and a fork?
00:10:34.928 --> 00:10:41.366
You would know the answer right away, or you would know no, and so she cannot anymore.
00:10:41.366 --> 00:10:43.466
And so that tells you something.
00:10:43.466 --> 00:10:49.090
When I say, look at that, aha, she's not at the level where she can use a knife and a fork.
00:10:49.090 --> 00:10:50.764
What is she at level of?
00:10:50.764 --> 00:10:51.749
Can she use a fork?
00:10:51.749 --> 00:10:53.065
Can she use a spoon?
00:10:53.065 --> 00:10:57.171
Those are the kinds of questions that are geriatricians very likely to ask.
00:10:58.061 --> 00:11:16.182
Let me tell you this, dr Warren no doctor has ever asked me that and I've actually been to some geriatricians not not to say I'm not about to decide who is or is not doing it right, but those are some really great questions to think about and think of.
00:11:16.182 --> 00:11:45.051
You know, in terms of the developmental stages, like I absolutely have heard of parents and family members say, oh, my child is not developing according to statistics Because the pediatrician said that he or she is not speaking, or they're not crawling, or they're not rolling the ball right, they're not rolling, they're not throwing the ball back and forth.
00:11:45.051 --> 00:11:54.195
Rolling the ball right, they're not rolling, they're not throwing the ball back and forth, but then to say that in reverse, that's pretty powerful for someone.
00:11:54.195 --> 00:12:00.376
As they age, at what age does a geriatrician get involved with an adult?
00:12:00.836 --> 00:12:14.643
Well, so most of our patients are in their 80s, but I've actually had some patients who are as young as 40 to 50 years old that actually there were.
00:12:14.643 --> 00:12:25.467
Even some neurologists have sent patients to me to do a little bit of neurocognitive status testing and get a second opinion about how a person is developing.
00:12:25.467 --> 00:13:00.352
But most frequently our patients are in their 80s and that's because I like to put it this way is there are certain insights that people can get, is you know, the diseases that people are very likely to get in their 50s and 60s and 70s are the diseases like heart failure, complications of diabetes, kidney failure and people who age beyond that start to get to the age where those are not the issues.
00:13:00.352 --> 00:13:04.778
I think of the 80s as the age, the decade of frailty.
00:13:04.778 --> 00:13:07.523
I think of the 80s as the age, the decade of frailty.
00:13:07.582 --> 00:13:23.844
So I'll give you a very simple example of that, jay how many people do you know, who are 80 years old, who are still driving Okay, driving and those of us who know them are happy about it Zero.
00:13:23.844 --> 00:13:41.621
Well, actually I know one I actually know only of one, and that person they don't drive very far, they don't drive very often, but it's, you know, maybe like to the post office and to church, because church is like two miles away.
00:13:41.763 --> 00:13:49.779
So I'm gonna go with none well, the truth is actually quite a few people at the age of 80 are still driving and have driver's licenses.
00:13:49.779 --> 00:14:00.150
I think that among people who have some dementia that's going to be significantly less, but quite a few people at the age of 80 are driving.
00:14:00.150 --> 00:14:01.892
Then the follow-up question is how many of them are driving at 90?
00:14:01.892 --> 00:14:04.974
Then the follow-up question is how many of them are driving at 90?
00:14:04.974 --> 00:14:09.017
And then the number goes quite a bit lower.
00:14:09.017 --> 00:14:35.231
And the point is between 80 and 90, it's a functional status decline that's very common between 80 and 90, is that 80 is the decade where your abilities, regardless of whether a person has Alzheimer's disease or any kind of dementia tend to go downwards.
00:14:35.253 --> 00:14:38.182
In the 80s, people are less likely to travel and, gradually, less and less likely to be able to do things such as driving.
00:14:38.182 --> 00:14:42.937
So getting back to your question, jay, about what age group do most geriatricians take care of?
00:14:42.937 --> 00:14:49.552
We take care of people in their usually in their 80s and beyond, because their functional status is starting to decline.
00:14:49.552 --> 00:15:07.580
And when the functional status starts to decline, we kind of start to look at things differently in terms of not just worrying about the diabetes, the heart failure, we start looking at very basic things how well are they eating, how well are they sleeping, what are their bowel movements, how much are they able to live independently?
00:15:07.580 --> 00:15:14.802
And then we look also at the caregivers and say how well is the patient able to do with this caregiver?
00:15:17.610 --> 00:15:40.854
Dr Warren, in terms of caregiving the caregivers doing caregiving for individuals who are 70 and 80 years old what have you noticed that that type of caregiving requires that may be different than individuals who are caring for significantly younger people?
00:15:41.975 --> 00:15:50.135
yeah, so uh, when they're caring for younger people, it's usually about chronic illness, it's about medication management and things like that.
00:15:50.135 --> 00:15:58.477
Sometimes it's about emotional status, but I think it's important to know I'm caring for this person.
00:15:58.477 --> 00:16:01.082
What is it that I actually need to do?
00:16:01.082 --> 00:16:24.740
To do and it could be anything from just managing bills and grocery shopping, or much more difficult is when a person starts to really become unable to do some very basic things, such as needing assistance to put their clothes on or going to the bathroom or showering and bathing.
00:16:24.740 --> 00:16:31.158
That actually is a different set of tasks that require a different thing from caregivers.
00:16:31.158 --> 00:16:46.679
And then there are people who have emotional problems, feelings of loneliness, and that's a different set of quote tasks, but things that are important to do with an older person.
00:16:46.679 --> 00:16:52.461
Frequently, when people are younger, it's more just about the medication management.
00:16:54.873 --> 00:16:59.402
How do you figure that out, especially the emotional loneliness?
00:16:59.402 --> 00:17:29.913
Let's say, you, someone like myself, you're a family member or a friend and you see that this elder person that you care for, maybe their spouse is deceased or they're living alone, or even if they're living in a assisted living community, but they might not really have friends Every time you go to visit, really have friends every time you go to visit.
00:17:29.913 --> 00:17:37.551
This has happened to me, where I go to visit extended relatives and I'm like, geez, yeah, I see that there's an activity room, but my loved one is never in it.
00:17:37.551 --> 00:17:43.809
They're always in their unit in their apartment, but it's hard to get involved.
00:17:43.809 --> 00:17:45.532
Or when should you get involved?
00:17:45.532 --> 00:17:51.124
How can you tell if they're getting an adequate amount, I guess, of companionship?
00:17:51.124 --> 00:17:52.932
Hey, what's up?
00:17:52.932 --> 00:17:54.278
Parented Up family.
00:17:54.278 --> 00:17:55.099
Guess what.
00:17:55.510 --> 00:17:58.059
Have you ever wanted to connect with other caregivers?
00:17:58.059 --> 00:18:01.219
You want to see more behind the scenes footage?
00:18:01.219 --> 00:18:03.699
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00:18:06.854 --> 00:18:12.876
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00:18:12.876 --> 00:18:18.420
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00:18:33.374 --> 00:18:34.856
Yeah, so I think that's.
00:18:34.856 --> 00:18:45.182
The first question is to find out what the actual needs are, and there's a whole list and categories of what kinds of assistance people need.
00:18:45.182 --> 00:18:57.141
List and categories of what kinds of assistance people need everything from just organizing their lives to companionship, and I think people have a general understanding of what is important to people and what brings light to those people.
00:18:57.141 --> 00:19:00.570
And then the flip side of it is what are you able to deliver?
00:19:00.570 --> 00:19:05.661
And I think that's a really important question and, as a geriatrician.
00:19:05.681 --> 00:19:06.583
Dr Wong, I got it.
00:19:06.583 --> 00:19:08.013
I just got to pause you right there.
00:19:08.013 --> 00:19:10.039
What are you able to deliver?
00:19:10.039 --> 00:19:17.563
I want everyone listening and watching the Parenting Up community to take that deep to your heart and soul.
00:19:17.563 --> 00:19:20.150
What are you able to deliver?
00:19:20.150 --> 00:19:53.839
And I want to add, in a sustained fashion don't't promise to the person who's elderly or suffering or anybody else in the family, something that you can't deliver and or consistently bring about, because that could cause a lot of chaos in the system that is trying to create some bit of stability for this person who is now elderly and trying to just figure out how to live in this new normal.
00:19:53.839 --> 00:19:55.323
Thanks for saying that.
00:19:55.363 --> 00:20:12.022
Doc, and you know, it's about getting enough oxygen for yourself, and I actually think that a significant amount of time this causes family discord because some family member basically saying I can't do this, and that's so common.
00:20:12.022 --> 00:20:22.776
And of course it creates resentment because the other, the person who's doing more, is kind of thinking, well, I can't do this either, but they are doing it.
00:20:22.895 --> 00:20:24.159
You must know my family.
00:20:27.325 --> 00:20:33.441
But I think part of the role of the dietician partly is to go into these issues and say you know, I see something that's not quite right here.
00:20:33.441 --> 00:20:48.544
And you know some families a sibling might say I'm out of here, I don't even want to be involved, and that requires some degree of family reconciliation.
00:20:48.544 --> 00:20:54.016
Well, let's break it down into what you actually can and cannot do, and then you have to kind of take it for what it is.
00:20:54.016 --> 00:21:04.602
And getting back to your question about the perfect answer to that question of how do you make sure all your loved one's needs are met, well, you know I don't have an answer for that.
00:21:04.602 --> 00:21:06.044
Do you know why?
00:21:06.525 --> 00:21:16.480
Because I've been at this business long enough, jay, to when I make suggestions, people frequently say well, say I don't think that will work.
00:21:16.480 --> 00:21:21.477
And the reason is because they know their own stories.
00:21:21.477 --> 00:21:24.282
So what I tell them is okay.
00:21:24.282 --> 00:21:26.557
I'm just telling you what the problem is.
00:21:26.557 --> 00:21:28.111
This is not working.
00:21:28.111 --> 00:21:29.835
You need to figure it out.
00:21:29.835 --> 00:21:42.834
And a lot of times when they acknowledge that there's a problem, they can figure it out, but when they don't acknowledge there's a problem, it just stays a problem.
00:21:44.596 --> 00:21:55.161
Right, what are, what are the some of the more um, unique stories that, uh, of your clients or your patients that led them to come to you?
00:21:55.161 --> 00:22:09.953
Right, because many people just stick with their family practitioner from the time that they're an adult to the time that they find a casket, but obviously something makes them shift and come to you.
00:22:09.953 --> 00:22:22.796
So has it been like you know, hey, that family practitioner just got to the point where he or she really was just dropping the ball, so they ended up coming to you.
00:22:22.796 --> 00:22:36.666
Or do you feel that people are just becoming we are becoming a more intelligent, I guess community and saying, oh OK, as I get older, I need to find a geriatrician.
00:22:36.666 --> 00:22:39.479
How are people getting to your office?
00:22:40.050 --> 00:22:41.375
Yeah, so I.
00:22:41.375 --> 00:22:43.681
So this is a prior life for me.
00:22:43.681 --> 00:22:48.890
Mostly now I'm I'm writing books and things like that and doing podcasts.
00:22:48.890 --> 00:22:55.923
But you know, in my career a lot of it was word of mouth from families.
00:22:55.923 --> 00:23:00.401
I was getting a fair number of referrals from the Alzheimer's Association.
00:23:00.401 --> 00:23:19.076
But the other thing is I really respect primary care doctors and a lot of the primary care doctors would say this is a little bit beyond me Because you do this all the time.
00:23:19.076 --> 00:23:28.896
I want you involved and you know it's one thing to go to a primary care doctor says well, you need the help of a social worker.
00:23:28.896 --> 00:23:39.098
It's another thing to go to someone who actually knows the social workers and says I think this social worker would be really good for you, for your needs.
00:23:39.098 --> 00:23:44.775
Or here I know somebody at the Alzheimer's Association and it's kind of like you.
00:23:44.775 --> 00:23:54.954
The thing is a family practitioner has a million different things to be concerned about Older people, frail, older people.
00:23:54.954 --> 00:24:01.440
That's my main course of every single day and I get to know the nuts and bolts of what's going on.
00:24:01.440 --> 00:24:10.435
And so many physicians actually referred patients to me and says I don't know this area the way you know this area and it's really interesting.
00:24:11.509 --> 00:24:16.261
Sometimes I would get referrals and I would look at the chart and I said I don't know why I'm getting the referral.
00:24:16.261 --> 00:24:20.356
And then it was always a correct referral.
00:24:20.356 --> 00:24:21.839
Do you know why?
00:24:21.839 --> 00:24:27.961
Why, because the physician knew it was a correct referral, but they never wrote down the reason.
00:24:27.961 --> 00:24:33.041
All they would write about was diabetes, hypertension, heart failure.
00:24:33.041 --> 00:24:40.104
They wouldn't say things like person can't walk or the person's having family problems.
00:24:40.104 --> 00:24:46.512
They knew those things, but do you know how many dollars people get for documenting those kinds of things?
00:24:46.512 --> 00:24:47.212
Zero.
00:24:47.212 --> 00:24:57.278
So they document the things that the insurers look for to document and it's a very traditional way of looking at things.
00:24:57.278 --> 00:25:09.384
I really admired physicians because when I would talk to them about their patients, they would know a lot more than they ever wrote in the chart.
00:25:09.384 --> 00:25:12.445
They said, oh yeah, this family's a real problem.
00:25:12.445 --> 00:25:16.367
They would say things like that and the patient needs help.
00:25:23.529 --> 00:25:24.231
That is very comforting, Doc.
00:25:24.231 --> 00:25:24.874
That is very comforting.
00:25:24.874 --> 00:25:28.222
I know you are a major, major advocate and supporter of caregivers.
00:25:28.222 --> 00:25:37.484
How did you come to know and feel such passion for the community of caregivers?
00:25:38.049 --> 00:25:41.375
Well, everybody says the physician is important, right, important, right.
00:25:41.375 --> 00:26:10.657
But in the daily life of a person who has become frail and older, you know, the care really is the difference between a good day and not a good day, right, and this could even be true for home health aides, who are not paid a lot of money but they can make all the difference in a person's well-being on any average day.
00:26:10.657 --> 00:26:16.155
And then, on top of that, you know the amount of sacrifice that's involved in that.
00:26:16.155 --> 00:26:23.778
I've talked with family caregivers that I would say, you know, I really think this is a little bit beyond the call of duty.
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