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Unfortunately, few doctors now practicing have been trained in geriatrics. But good physicians will have intuitively learned to adapt their approach to the special needs of patients who are older or disabled by chronic disease. Before age even enters the equation, your doctor must have the twin essentials for providing good care – technical competence and a good bedside manner.

A good bedside manner is not irrelevant to quality treatment. We are more likely to visit a doctor who is warm and accepting; we are more likely to make an appointment and to follow through on any procedure the doctor suggests. Having a doctor with a congenial personality is even more important as we grow older, because our physicians are almost destined to become much more central in our lives. These 1983 statistics are a grim testament: in that year, Americans aged twenty-five to forty-four saw a doctor an average of 4.8 times; the figure for people over seventy-five was 8.4 times.

Dealing with chronic illnesses involves ongoing collaboration. It behooves you to have a collaborator who seems caring, whom you can talk to honestly, who values what you say, who believes that something can be done for you, whom you can feel free to “bother” with any reasonable question or concern.

On the other hand, a pleasing personality can be seductive. We tend to develop an intense attachment to our doctors-, a combination of respect and adoration very like the bond young children develop with their parents. We are especially likely to develop these “transference” feelings if we have a longstanding relationship with our doctors, are seeing them regularly, and have a potentially fatal disease. But love can blind, and blind loyalty can be dangerous. It can cause us to put up with poor care beyond the time we should. We don’t get a second opinion because we are afraid it will hurt the doctor. We have been with him for thirty years, and he has always treated us so well. We may be afraid if we change doctors we will not get the same attention. “Won’t I lose my special relationship with Dr. Smith if he learns I consulted someone else?”

My husband is assertive in his business, but he is jelly when it comes to saving his own life. He has cancer of the throat. The prognosis is not good. I know oncologists differ in their skill and their ability to cure. He insists on staying with the first doctor we consulted, a man I know is second-rate. I think another doctor might be his life raft, or at least buy him more time. He is clinging like a baby to this sinking ship.

If you suspect you are getting inadequate care, harden your heart. Put aside loyalty, love, and inertia and get a consultation. What you learn may make you more secure, or you may discover your suspicions are right – that you must steel yourself and find a new doctor.

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GENERAL HEALTH