The Subtle Ageism and Ableism of "It's Just a Mask" (Or Universal Mask Mandates in Healthcare)

Saying "it's just a mask" is dismissive and condescending to people who have protested the whole affair for the past 2+ years. Saying this 75+ year olds is far worse.

As long as I’ve been practicing, the healthcare specialty of geriatrics has always been “the armpit” of the medical industry. We’re paid less, medical shows on TV are never about the geriatrics field (all the medical shows are set in ERs, almost without fail), and for the youth-obsessed culture of the USA, older people are just not that interesting and we really, still, don’t want to think about them much in my opinion. We prefer thinking about the super doctors on TV:

Tah duh! Super doctor!

That being said - there are a number of reasons why geriatrics as a medical specialty continues to demonstrate increasing shortages of practitioners relative to other specialties - a phenomenon that extends to other, non-physician specialties as well, like clinical geropsychology:

Of course, we have to talk about money - or the issue of medical reimbursements. We also have to talk about the question of what makes for a “sexy” medical specialty, one that people romanticize and get excited by - as well as simply a financially rewarding one.

So - why *would* someone want to become a cardiac surgeon as opposed to a geriatric physician, or a become, say, a pediatric psychologist as opposed to a geriatric psychologist?

There’s a lot of reasons for this - obviously, as I’ve alluded, the geriatrics field is not “sexy.”

Unlike neurosurgery, cardiology, or emergency medicine, it’s not focused around heroic, lifesaving medical activities - you’re not going to see a geriatrician leaping up onto an 90 year old person’s chest giving them chest compressions as they are sent upstairs for emergency exploratory surgery.

But, if you can take a 70 year old and convince them to get cardiac surgery - that cardiac surgeon, the facility, and the team can bill six figures plus - with 80% of that bill covered by Medicare. Not bad.

In geriatrics, you’ll see a lot of rather prosaic activity that sometimes doesn’t look much like medicine at all. While the cardiac surgery team & facility can net a cool six figures by giving grandma a quintuple bypass (open question as to whether grandma, at 72, really will benefit but hey), let’s examine what a geriatric physician might do in their outpatient clinic.

They have an older adult in their clinic. They are seeing them for an office visit. They meet with them for an hour. And they talk about…. shoes.

You see, for us young people, we can wear shoes that may not fit that great, or have other issues. Take me for example - I take at least 1-2 good 10-15 minute walks during my workday (NON NEGOTIABLE) as they are good for clearing my head. I’ve been doing this for about the last 10 years. Well - I recall a couple of years ago as I was taking one of my walks, my right foot started feeling a bit cool on the sole of my foot. Odd - I thought.

I didn’t even notice

Well it turns out I had worn down the heel of my shoe without realizing it.

For someone like me, not an older adult (more healthy middle aged) - shoes are an afterthought. Unless we have a habit of squeezing ourselves into absurdly fashionable stilettos or things of that nature - we, as younger adults, don’t really think about the shoes we wear.

For older adults, it’s a different story. Plantar fascitis, arthritis, hip surgery necessitating orthotics, the list goes on - shoes are a big deal. For geriatricians, therefore, a one hour conversation about shoes is entirely conceivable as a vital medical procedure (unfortunately - this one hour conversation nets a far, far lower reimbursement rate from Medicare than cardiac surgery).

For older adults - it’s not “just shoes.”

Arguably one of the most famous mask-obsessed cardiac surgeons on Twitter

This brings us back full circle to my favorite subject - universal masking in healthcare.

In clinics, it’s absurd and annoying to many / most these days. In long-term care, an overwhelming majority of my patients don’t wear masks anymore. Nursing has long tired of fighting with residents to get them to put them on, and residents clearly don’t want to wear them anyways.

But for us - nurses, doctors, occupational therapy, recreation therapy, psychologists, family members - we are all required to wear them, and because we don’t want to be fired or asked to leave the facility, we all do. So - this is all older adults see:

Older adults aren’t young people. They aren’t the same thing. My long-term care residents are even more different - they wear hearing aids (for those that are compliant / cognitively intact enough to wear them) or they have dementia. They overwhelming need to read lips, or “read faces” in order to understand their families and caregivers. This is aside from the fact that they are 5x vaccinated at this point (we’ve almost completed getting them all the bivalent booster), and at the end of their lives anyways.

For older adults in nursing homes - it’s not “just a mask.” Much like for older adults it’s not “just shoes.”

And for people who say “it’s just a mask” - this is ignorant ableism and ageism at it’s most malignant.

Universal masking in healthcare - specifically aged care facilities - needs to stop, and needs to stop now.