{"id":739,"date":"2026-03-07T06:53:47","date_gmt":"2026-03-07T14:53:47","guid":{"rendered":"https:\/\/conniedavis.ca\/home\/?p=739"},"modified":"2026-03-25T12:19:29","modified_gmt":"2026-03-25T19:19:29","slug":"book-review-a-bitter-pill-how-the-medical-system-is-failing-the-elderly-by-john-sloan-md-2009-greystone-press-repost-from-29-march-2010","status":"publish","type":"post","link":"https:\/\/conniedavis.ca\/home\/book-review-a-bitter-pill-how-the-medical-system-is-failing-the-elderly-by-john-sloan-md-2009-greystone-press-repost-from-29-march-2010\/","title":{"rendered":"Book Review: A Bitter Pill: How the medical system is failing the elderly by John Sloan, MD (2009, Greystone Press) repost from 29 March 2010."},"content":{"rendered":"\n


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John Sloan writes, \u201cThe way modern medical care is usually practiced is all wrong for old people near the end of their lives\u201d and he sets out in his book to describe exactly who these people are that are not benefiting (and indeed being harmed) by current medical practice, why that is so, and what can be done about it. He builds his case using anecdotes from practice, references to research, and analysis of the mismatch between what is considered best practice and what makes sense for frail people. The book opens describing exactly who this book is talking about: the fragile elderly.  This state is defined by the person or a caregiver as the time when the emphasis from prevention and rescue changes to different priorities. These priorities are described with other the characteristics of the fragile elderly by Dr. Sloan:<\/p>\n\n\n\n

    \n
  1. They have multiple problems (diseases, poorly functioning organs, etc.)<\/li>\n\n\n\n
  2. They are dependent in doing their activities of daily living (bathing is usually the first to go)<\/li>\n\n\n\n
  3. Daily function is their #1 priority<\/li>\n\n\n\n
  4. A crisis is a crisis of function: you don\u2019t end up in the hospital because of pneumonia, you end up there because it made you confused and unable to manage your day<\/li>\n\n\n\n
  5. Comfort is an overriding priority<\/li>\n\n\n\n
  6. Fragile elderly are different from each other<\/li>\n\n\n\n
  7. Response to medications is unpredictable <\/li>\n\n\n\n
  8. Illnesses don\u2019t look like they do in a textbook.  <\/li>\n\n\n\n
  9. They are near the end of their lives.<\/li>\n<\/ol>\n\n\n\n

    Methodically Dr Sloan builds his case, telling stories and citing studies to describe how we got to a \u201cprevent and rescue\u201d system (well-designed for the average, healthy or 1-diagnosis patient), how hospital care can be downright dangerous for older people (another symptom, another specialist working up something that won\u2019t change function or quality of life and has been known for years), and sadly, what happens when we don\u2019t give fragile elderly what they really need. And what is that? You have to ask and then LISTEN!  I found myself nodding in agreement throughout this book, particularly when Dr Sloan describes how many medications he safely discontinues, performing the geriatric specialist procedure: the drugectomy.  I was often reminded of what the gerontologist Bernice Neugarten suggested: Older people become more like themselves as they age.  <\/p>\n\n\n\n

    When I speak to professionals about guidelines, I remind them that NONE of the science behind the guidelines was conducted on a frail elderly population. As Dr Sloan says, you are in an evidence-free zone when working with fragile elderly.  This makes informed decision-making incredibly important. What are the patient\u2019s goals? Will any treatment, test or procedure help to meet those goals without causing harm?  Another important thing to remember about guidelines is that reliability in regards to guidelines means to reliably consider the guideline, not universally apply it.  Does this guideline fit this situation? Does it fit this patient?  With the frail elderly, the answer is generally no to both.  <\/p>\n\n\n\n

    When Dr Sloan addresses the fixes, he\u2019s in familiar territory for those of us who have been working in system redesign and quality improvement in the last decade: collaboration with patients and caregivers, supporting patient and caregiver decisions, supporting people at home as long as it is desired and possible (with important distinctions about what it means to live at risk), avoiding unnecessary hospitalizations, planning for crises, supporting family caregiving (and he references a favorite children\u2019s book in our family \u201cLove You Forever\u201d by Munsch), focusing care on comfort and function, providing more care at home (including medical care), considering every prescription a drug trial, advance care planning, and a focus on the relationship between professional and patient. For most people, this is the relationship with their primary care provider.<\/p>\n\n\n\n

    I stopped marking pages to remember in this book; it was almost every page.  I heartily recommend \u201cA Bitter Pill\u201d to health care professionals and those who are caring for an elderly relative. <\/p>\n\n\n\n

    2026 Note: Sadly, not much has changed! May you all be strong advocates for yourselves and your loved ones!<\/p>\n","protected":false},"excerpt":{"rendered":"

    John Sloan writes, \u201cThe way modern medical care is usually practiced is all wrong for old people near the end of their lives\u201d and he sets out in his book to describe exactly who these people are that are not benefiting (and indeed being harmed) by current medical practice, why that is so, and what … <\/p>\n

    Continue reading “Book Review: A Bitter Pill: How the medical system is failing the elderly by John Sloan, MD (2009, Greystone Press) repost from 29 March 2010.”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[66],"tags":[67],"class_list":["post-739","post","type-post","status-publish","format-standard","hentry","category-life-and-aging","tag-book-review"],"_links":{"self":[{"href":"https:\/\/conniedavis.ca\/home\/wp-json\/wp\/v2\/posts\/739","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/conniedavis.ca\/home\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/conniedavis.ca\/home\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/conniedavis.ca\/home\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/conniedavis.ca\/home\/wp-json\/wp\/v2\/comments?post=739"}],"version-history":[{"count":1,"href":"https:\/\/conniedavis.ca\/home\/wp-json\/wp\/v2\/posts\/739\/revisions"}],"predecessor-version":[{"id":740,"href":"https:\/\/conniedavis.ca\/home\/wp-json\/wp\/v2\/posts\/739\/revisions\/740"}],"wp:attachment":[{"href":"https:\/\/conniedavis.ca\/home\/wp-json\/wp\/v2\/media?parent=739"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/conniedavis.ca\/home\/wp-json\/wp\/v2\/categories?post=739"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/conniedavis.ca\/home\/wp-json\/wp\/v2\/tags?post=739"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}