Goldilocks Care—Medical Care that’s Just Right

Enlightened aging and living with intention involve learning about aging and then paying attention to what happens as we age. Proactive people look ahead, acting in anticipation of future events including problems, needs and changes. Enlightened agers know that change will come with age and can accept that. But part of being proactive is that we work to influence the changes that will occur, we act with intention when they occur, and understand the setting in which they occur.

We can anticipate that most of us will seek and need more medical care as we get older. One challenge a proactive ager will likely face is taking an activist role in trying for Goldilocks care, (not too much, not too little) at a time when overdiagnosis and overtreatment are common in most U.S. communities. This is not as easy as it sounds, and also applies to the self-care efforts we make.

As a physician, I’ve seen people who are skeptical of “modern” medicine and end up avoiding seeking care they need. And others, who for complex reasons, overconsume, running from test to test to yet another test—often seeking more treatment than what is good for them. Activist patients seek out information from reliable sources, such as U.S. Preventive Services Task Force recommendations, regional health departments, and reliable public sites such as the Mayo Clinic. They are not afraid of asking penetrating questions when advised to go for testing such as, “How exactly is this test going to help me?” “Could the test discover things of no significance due to false positive findings or incidentalomas?” and “What are the benefits and, importantly, downsides of a treatment or test?”

Consider two recent events that have been in the news: COVID vaccines and the opioid epidemic. The vaccine is “right care”—for individuals and for the public’s health. The opioid epidemic grew from the false claims that newer synthetic opioid drugs such as Vicodin and Oxycontin were safe, or at least safer and non-addictive. An enlightened proactive and activist, who worried about taking a new vaccine would seek reliable sources for more information. They would share any worry or skepticism with their doctor or other professionals. Even asking, “Did you take the vaccine? Did your family?”

On the other hand, I wish more people, including doctors, dentists, hospitals, and their emergency rooms had resisted the convenience of giving their patients large numbers of these synthetic opioids—often primarily for convenience’s sake. Some activist, proactive patients did ask questions and express concern, albeit not often or soon enough. Unfortunately, many patients liked the “high” that accompanied the pain relief. The important lesson may be what have we learned. Doctors must avoid overprescribing and seeking magic bullet solutions to complex problems of aging, including common, sometimes chronic aches and pain.

To find that “just right” Goldilocks place—in self-care or the medical care we are receiving—requires being proactive and an activist. It’s an attitude and the actions that go with it!

Eric B. Larson, MD, MPH, is the author, with Joan DeClaire, of Enlightened Aging. He is the founding principal investigator of the Adult Changes in Thought (ACT) study, ongoing for about 30 years. ACT recently was awarded a $55.6 million expansion grant from the National Institutes of Health.

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