A council of elders

Creating a multi-voiced dialogue in a community of care

Arlene M. Katz, Loring Conant, Thomas Inui, David Baron, David Bor

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

In an era of 'medical care delivery systems', there is an increasing need for the patient's voice to be heard, for it to be invited, listened to, and taken seriously. This challenge is particularly evident in geriatrics education, a domain of clinical training in which educators and clinicians alike must struggle to overcome adverse attitudes towards the elderly ('ageism'). In this paper we introduce a 'Council of Elders' as an educational innovation in which we invited community elders to function as our 'Senior Faculty', to whom medical residents present their challenging and heartfelt dilemmas in caring for elder patients. In the conversations that ensue, the elders come to function not simply as teachers, but collaborators in a process in which doctors, researchers, and elders together create a community of resources, capable of identifying novel ways to overcome health-related difficulties which might not have been apparent to either group separately. Using the first meeting of the Council as an exemplar, we describe and discuss the special nature of such meetings and also the special preparations required to build a dialogic relationship between participants from very different worlds - different generations, different cultures (including the professional culture and the world of lived experience). Meetings with the council have become a required part of the primary care residency program - a very different kind of 'challenging case conference' in which moral dilemmas can be presented, discussed and reflected upon. It is not so much that elders give good advice in their responses - although they often do - as that they provide life world and value orientation as young residents gain a better sense of the elder's experience and what matters most to them. This project has been particularly worthwhile in addressing the problem of ageism - a way to render visible stereotypes and adverse physician values, with implications for decision-making with the patient, not for the patient. Copyright (C) 2000 Elsevier Science Ltd.

Original languageEnglish (US)
Pages (from-to)851-860
Number of pages10
JournalSocial Science and Medicine
Volume50
Issue number6
DOIs
StatePublished - Mar 2000
Externally publishedYes

Fingerprint

ageism
dialogue
Ageism
community
innovation
decision making
education
resident
Social Values
value-orientation
geriatrics
resource
Internship and Residency
Geriatrics
medical care
stereotype
Primary Health Care
Decision Making
experience
conversation

Keywords

  • Ageism
  • Answerability
  • Community
  • Culture
  • Dialogue
  • Doctor-patient communication
  • Geriatrics
  • Primary care residency
  • Relationship-centered care

ASJC Scopus subject areas

  • Economics and Econometrics
  • Public Health, Environmental and Occupational Health
  • Social Psychology
  • Development
  • Health(social science)

Cite this

A council of elders : Creating a multi-voiced dialogue in a community of care. / Katz, Arlene M.; Conant, Loring; Inui, Thomas; Baron, David; Bor, David.

In: Social Science and Medicine, Vol. 50, No. 6, 03.2000, p. 851-860.

Research output: Contribution to journalArticle

Katz, Arlene M. ; Conant, Loring ; Inui, Thomas ; Baron, David ; Bor, David. / A council of elders : Creating a multi-voiced dialogue in a community of care. In: Social Science and Medicine. 2000 ; Vol. 50, No. 6. pp. 851-860.
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