Having read this week ‘The Book About Getting Older (for those who don’t want to talk about it)’, I have a few problems with its author, Consultant Geriatrician, Dr Lucy Pollock. The first is that, since she is of a similar age to me, should I be fortunate enough to make it to a ripe old age, it is extremely unlikely that she will still be working when I have need of someone to oversee my medical care. However, with luck, whoever it is who will one day have the misfortune of being called upon to advise me in my dotage will have read her book and taken on board all that she has written there, for it sums up what good medicine is, for me, all about. And so the second problem I have with Dr Pollock is that she is liable to cause me to run out of the superlatives necessary for describing what she has said.
For this is a book that, along with considerable humour, oozes wisdom, overflows with compassion and is chock-full with sensible counsel which really does make it a must read for hospital consultants, general practitioners and anybody who cares for an elderly person. And that, of course, includes anybody who is themselves elderly or one day hopes to be so. No wonder she is so highly regarded by those I work with who refer into the hospital where she works and who, on occasions have had the very great pleasure of hearing her speak.
Much of the book is written like a novel with exquisitely drawn descriptions of patients, written by somebody who clearly cares deeply about those she is writing about and who draws the reader into their stories, making us care for them too. Here then is somebody who cares enough to notice the little details of an individual’s character, somebody who listens attentively to what it is they are saying, spoken or otherwise, and somebody who makes every effort to understand those who come to her for help, surely the foundation upon which all good care must rest. Here too are elderly folk, described as they truly are, not as burdensome individuals who drain the healthcare system with their multiple problems, but people who have lived and loved and have much to offer despite the level of their current need for support.
The book takes an honest look at the problems that increasingly longevity brings with it. As more and more of us are living longer, with those added years inevitably being at the end of our lives, greater numbers of us are consequently spending our final years increasingly dependent on others. The book urges a thoughtful consideration of how medicine can be best applied to those individuals for whom yet another medical intervention will not always be in their best interests. But Dr Pollock never suggests that old people are not worthy of being treated. On the contrary, as she helpfully puts it, some treatments are simply not good enough to be used on some elderly folk. It is the treatments, not the patients, that aren’t worthy.
Rather than thoughtless adherence to medical protocols and treatment algorithms, it is for Dr Pollock an understanding of her patients and what it is that is important to them as individuals that should drive the decisions that are made by the clinician, the patient and their families, as to what should and should not be done. Just because something can be done doesn’t mean it should be. The book is full of cases of how this principle is not one that is held merely theoretically. Her sadness and frustration at the case of the elderly patient who, over the course of a previous three month hospital stay, suffered 77 blood tests, undertaken for reasons that were no doubt well meant but were nonetheless almost entirely unnecessary, is a case in point. Rather than yet another investigation being ordered, a discussion of what was important to the patient leads to the individual going back home to enjoy watching football on the TV with his son whilst taking a few sips of cider. That really is good practice, medicine that, rather than vainly seeking to add years to life, aims to add life to the limited time those who of an advanced age inevitably have.
The book also has a useful discussion about advance care plans, a realistic look at the success or otherwise of attempts at cardiopulmonary resuscitation and the challenges of dementia. There are also some practical chapters on assessing capacity, powers of attorney and considerations around driving.
It really is a superb book in which the author clearly cares about the reader every bit as much as she does her patient as evidenced both by the gentle way she softens the delivery of less palatable truths and by the slightly larger font that has no doubt deliberately been employed whilst mindful of the deteriorating eyesight of some of her readers. Please do read it, and then recommended it to your family and friends and, for those of you working in healthcare, recommend it to your patients. It really does deserve a very wide readership.
Which brings me to my final problem with Lucy Pollock. In the unlikely event that I am ever cast away on a desert island, I am now going to have an even more difficult task choosing what book I might like to take with me alongside the Bible and the complete works of Shakespeare. For this is a book, full of delightful characters, that is in turns both moving and inspiring, one that makes me want to live better and practice better. It is also one that, marooned on a desert island far from any medical attention, might just reassure me that perhaps we don’t always need quite as much medicine as we sometimes foolishly think we do. Even so, all alone on an island I would undoubtedly miss doctors like the writer of this excellent book and the wonderful patients I, like her, have had the joy or caring for.
But never mind this review, read the brilliant Lucy Pollock’s, brilliant book. Easily worth six stars.
To read, ‘Vaccinating to remain susceptible’, click here
To read, ‘Shot of Love’, click here
To read, ‘On not remotely caring’, click here
To read, ‘The Did – it’s well worth it’, click here
To read, ‘The Repair Shop’, click here
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