Is retirement the ultimate goal?

I am often asked when am I going to retire? Since I have achieved the age denoted as "senior citizen" it is a fairly legitimate question. Yesterday as I was pondering what I would like to write about in this month's Health Points, I came upon a lead article in the "Wall Street Journal" entitled "The Case Against Early Retirement". To delve into the philosophical -  I have often thought there are two phases to later life; and I define them as, "living or waiting to die". As Richard W Johnson states in the opening of the article, "Most people look forward to retirement, a reward for decades of hard work. But like many other pleasures, it may be bad for your health. It may even kill you."

"How can that be? How can working longer be good for your health? After all, many people dream of-- and plan for-- retiring early. Strenuous, stressful work can wear people down and damage their health. On the other hand retirees can relax and reinvigorate themselves. They have time to follow their passions and pursue activities that enrich their lives."  -Richard W. Johnson


Boston collge mortality statisticsThe reality is many retirees lose a sense of life purpose that they derived from their chosen employment. They lose the social interactions that occur in most workplaces and they become sedentary and inactive. Our jobs subtly force us to maintain a high level of mental agility that defers and delays those signs of aging such as forgetfulness and memory loss. From a societal perspective there is a transformation from being a provider to being a consumer. As we alter our self perception as a valued contributor we increase our sense of mortality. This increases our sense of vulnerability both physically and financially. In many instances we have too much time to think and each minor change in how we feel becomes exaggerated as an impending health event. This sends us increasingly to doctor’s appointments for both real and perceived health events.


For those who have retired and moved to retirement communities in Florida, Arizona, California their visits to physicians become an important activity. The critical issue becomes does the physician hear them or does he/she become more insensitive as a result of the volume of aging patients they consistently examine. I recall very early in my career as a lawyer I tried criminal cases, as appointed counsel, in what was known as Recorders Court that only handled criminal matters. I, being a young lawyer, pursued those cases with all the enthusiasm and a sense of justice that had been inculcated in law school. Soon I realized that the judges had become cynical and jaded. The concept of “innocent until proven guilty” was not the premise upon which the cases were heard. More often than not it was "guilty until proven innocent".


 Closeup portrait, overwhelmed, busy unhappy stressed female health care professional, funny looking doctor holding big clock running out of time exhausted, isolated red background. Healthcare reformThe physicians who treat aging patients face the same challenge as they listen to aging patients, many of whom are lonely, explaining their aches and pains. The doctors face the dilemma of trying to determine if these are actual or perceived health issues. That is why we see so many cases of overmedication in senior citizens.

The physicians who are pressed for time seek the path of least resistance and will write a prescription for the perceived illness. The patient who is visiting various doctors is then uncertain as to whether the problem is resolved or exacerbated by the medication.


Senior woman at home figuring out income tax-1One could then argue, as we work longer we extend our lives because we have less time to be consumed with the aging process and its maladies. We have the benefit of responsibilities to others to focus our attention. Our state of mind has such an incredible impact on our physical health. As we continue to feel productive and useful we preserve our health and defer our decline. A Study published in the Lancet concluded that a a longer lifespan could be linked to a sense of meaning and purpose in life. 


Too often, at Curus,  we have seen that less would be better than more in the prescribed medications being taken. Too much medication has a tendency to lead to both cognitive and physical decline. It is entirely possible that too much time on our hands can indirectly lead to too much medication being prescribed.  We at Curus pay particular attention to the list of medications our older members have been prescribed. Our clinical pharmacist plays a particularly pivotal role in the evaluation of the health status of our senior citizens.


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If the prescription for healthier aging is a sense of self, contributing to others and meaningful social interactions; working longer should be an important part of this prescription.



Filed Under: mental status affects health, Mental Health, elder care, retirement, retirement health

Conspicuous Caring

In an interesting article on, “Have We Missed the Hidden Cause of Medical Overuse,” the author raises a provocative issue about medical overuse. He cites the story of when a mother kisses the scrape of a toddler, "No healing takes place, yet both parties appreciate the ritual." Continuing, he states, "The ritual shows how we might be programmed to both seek and offer healthcare even when it isn't medically useful.” He believes this is "Conspicuous Caring".


The provocative conclusion is that healthcare isn't just about health; it's also a grand signaling exercise called conspicuous caring. If healthcare was only a transaction about getting well, you would expect patients to pay for (and doctors to prescribe) only treatments in which benefits exceed costs. Conspicuous caring provides an alternative explanation for demand that leads to consumption that exceeds the point of value. And in modern medicine, demand resulting from conspicuous caring can be masked by the real healing that often occurs.

 - John Mandrola M.D.


The thesis of the article is when providers appeared to be doing something that will be perceived as helping the patient, this conspicuous caring provides the public with a tangible signal of medical quality. The article’s primary focus is the evaluation of a book The Elephant in the Brain: Hidden Motives in Everyday Life by Kevin Simler and Robin Hanson and how our thought processes impact on healthcare delivery.


The question that arises from this discussion of Conspicuous Caring is - If this is written into our DNA, how do we make it a constructive force in healthcare delivery? When doctors prescribe tests, procedures and prescriptions to simply satisfy our need to perceive them as caring, the articles author argues this is what leads to medical overuse and the high cost of care in the United States. On the other hand, it may well indicate that our providers are losing the ability to communicate with us in a meaningful way that expresses a caring professional.


I spoke to a retired healthcare professional recently who indicated he had seen his cardiologist and he felt the doctor had focused totally on the data available on his computer and never had an empathetic interaction with him as a patient. This lack of conspicuous caring motivated this knowledgeable retired healthcare professional in his 80s to seek out a second opinion. What this real life interaction teaches us is there is much more to the healing process then the technology driven data points that are available to professionals.

Doctor working with a tablet computer in his office


Today, the need to exhibit empathy, concern and understanding is very important to the recipient of care.  


In another instance I watched the interaction between a hospitalist and patient. The hospitalist never took his eyes off of the computer as if it were the one requiring treatment. If we define Conspicuous Caring as our professionals providing empathy, compassion, and concern, we might achieve the ultimate by reducing the cost of healthcare and creating real patient satisfaction.


The patients in our healthcare system are beginning to feel like a commodity in a highly mechanized, technology driven system. Their primary care physician no longer makes rounds at the hospital to check on their progress; the patients are visited by the hospitalist who is employed to accelerate the patients’ discharges from the facility and are strangers to the patients. It is no wonder, in this process, why people seeking out healthcare feel estranged.


New call-to-actionThe physicians, in their defense, are under increasing pressure to see more patients and have reduced amounts of time to really engage in the process of caring. As a result, they turn to Conspicuous Caring through the writing of prescriptions for lab tests and diagnostic tests to give their patients the appearance of being engaged in their care. There have been studies made that indicate as physician’s face increasingly fatigues as the day goes on, the physician is more inclined to order additional diagnostics because the coping and decision-making processes for them have broken down.



The driving force for the creation of Curus was an increased understanding that the discerning healthcare consumer needs the expertise, sensitivity and a caring voice to help navigate through the healthcare process. The idea that we receive more attention and empathy from our wealth managers than from our healthcare providers became a compelling reason to create Curus to be that advisor, and empathetic voice -  providing both direction and comfort for our members. Our tagline, "Because health is the greatest wealth there is," reflects our commitment to protect your most invaluable asset, your well-being. 


Click Here to schedule time to talk with someone from Curus We need to place caring as one of the highest priorities in the delivery of healthcare. If we achieve this we will substantially reduce Conspicuous Caring.


Filed Under: Insider, Health Management, healthcare quality, patient satisfaction, changes in healthcare, mental status affects health, unnecessary testing