What Matters in the End

Q&A with Dr. Bob Urata / Juneau, Alaska

Q: What are the trends you’ve seen in family medicine over the 38 years you’ve been practicing, in regard to senior patients? 

A: I’ve delivered babies who have grown up; now I’m caring for their children. Some of my early patients who were in their 60s are now in their 90s. And they’re not dying—it’s actually fascinating! I’m a family-medicine doctor, but as my patients have aged, by default I’ve become more attuned to the unique health needs of seniors. So I eventually obtained qualifications in geriatrics and hospice and palliative medicine.

Q: What are your observations about how providers care for seniors?

A: Coming out of medical school, we’re geared to save lives. We want to take action that solves problems and makes patients healthier. However, not all our elderly patients are up for the rigor we were trained to apply. It’s hard for us to slow down, hold back, and not offer every possible treatment. Those of us caring for the elderly are increasingly thinking about balancing quality of life with medical care.

Working with cultural differences is somewhat common, and having interpretation is key. Usually a family member interprets, but that is not recommended, though often preferred by the patient. We can use phone interpreters, but some are not good, so it can be tricky. Also, here in Juneau, doctors do home visits to elderly and hospice patients and one can get a better idea of their culture.

Q: What do you do differently with your more senior patients?

A: I’ve found it’s important not to just rush in with all kinds of tests right away. On the one hand, if you find something concerning, you do want to treat it like it’s urgent. But if you find something—like a possible tumor—you have to consider, “What should we do?” Not all patients want to know the test results. If something requires treatment, is the treatment worth it for the patient in the long run? I try to work with the patient to weigh the risks and benefits, understanding all the potential side effects.

Q: What do you make of the wave of Baby Boomers hitting their elderly years? 

A: They’ve always liked having a lot of control…and now they want to control how they die, too! In all seriousness, we’re now living in an era in which assisted suicide has been legalized in several states, for patients who have a terminal illness but want to have some control over the situation. That generation has had a hand in some of the shifts that we are only just starting to see. While the older Boomers often want me to decide on the best treatment, I see more of them desire shared decision-making. My typical younger Boomer patients search the Internet and ask many detailed questions, including treatment side effects and effectiveness. There is an increasing interest in natural, over-the-counter products—so it’s important to be aware of their use and drug interactions.

Q: Do you have any guidance on caring for seniors?

A: From their youth through their senior years, our goal is to help our patients have a nice long life. But once the end is in sight, it’s important to support them in having a nice death, too. As you consider every possible treatment, also consider whether such treatment would just make the patient miserable at the end of life. It’s important for the patient, as well as for their loved ones, to feel dignity at the close of a life. As care providers, we play a critical role in helping to preserve the quality of our patients’ final days. 

Dr. Urata received his undergraduate degree in Biology from Northwestern University and his medical degree from the University of Washington. He is board certified in Family Medicine with added qualification in Geriatrics and Hospice and Palliative Medicine. He currently practices at Valley Medical Care in Juneau, Alaska, and is the volunteer director at Hospice and Homecare of Juneau.