Not long ago I assumed the responsibility of caring for an elderly, demented, bedbound woman who came to me from another facility. She had a deep decubitus over her greater trochanter that was clean but would never heal without a surgical flap. Her family demanded something be done.

I was in a difficult position, not just because of my patient’s poor... »

In a close paraphrase of one British physician, here is what the deliberate rationing of medical care sounded like back in 1972:

When I tell my patient with end- stage renal disease that there is nothing more to be done, I try not to look him in the eye.

This statement, by a nephrologist, appeared in the New England Journal of Medicine and left a big... »

I am an aging geriatrician, three and a half decades in the medical trenches now. As it happens, since almost all of my patients are covered by Medicare, I have worked in what amounts to a single payer health care system all these years.

Despite the fact that my medical specialty – the primary care of the oldest and most vulnerable among us – is the least... »

As a geriatrician, I was recently present at a rare event: the removal of a PEG feeding tube from the stomach of an 87-year-old woman who had suffered a debilitating brain stem infarct 1 year ago.

This woman is my mother. I wrote about her ordeal in this newspaper last October. I spoke about the frustrations I had as a family member trying to negotiate... »

For the past decade, I have volun­teered as an associate faculty mem­ber at the Center for Medical Humanities and Ethics, part of the Uni­versity of Texas Health Science Center at San Antonio.

<[stk 2]>It is our job to meet with groups of students in their first and fourth years of medical school in order to provide them some instruction in medical... »

Long ago, I was trained as a general internist, a diagnostician. I remember that the surgeons referred to us as “fleas” because, by their estimate, all we did was buzz around and suck blood from those in our charge, dithering as we evaluated lists of differential diagnoses, keeping track of our boring trade in annual physicals, flu shots, mammograms,... »

My mother has just had a stroke. She is 86 years old and has survived her share of medical problems, including bilateral breast cancers. She has weathered the emotional trauma of ministering to her husband at home for 7 years as he descended deeper and deeper into dementia. She is tough. She worked in my office until she was 80, retiring only because her... »