A council of elders: creating a multi-voiced dialogue in a community of care

In an era of 'medical care delivery systems', there is an increasing need f or the patient's voice to be heard, for it to be invited, listened to, and taken seriously. This challenge is particularly evident in geriatrics educa tion, 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 innova tion in which we invited community elders to function as our 'Senior Facult y', to whom medical residents present their challenging and heartfelt dilem mas in caring for elder patients. In the conversations that ensue, the elde rs come to function not simply as teachers, but collaborators in a process in which doctors, researchers, and elders together create a community of re sources, capable of identifying novel ways to overcome health-related diffi culties which might not have been apparent to either group separately. Usin g the first meeting of the Council as an exemplar, we describe and discuss the special nature of such meetings and also the special preparations requi red to build a dialogic relationship between participants from very differe nt worlds - different generations, different cultures (including the profes sional culture and the world of lived experience). Meetings with the counci l have become a required part of the primary care residency program - a Ver y different kind of 'challenging case conference' in which moral dilemmas c an be presented, discussed and reflected upon. It is not so much that elder s give good advice in their responses - although they often do - as that th ey provide life world and value orientation as young residents gain a bette r sense of the elder's experience and what matters most to them. This proje ct has been particularly worthwhile in addressing the problem of ageism - a way to render visible stereotypes and adverse physician values, with impli cations for decision-making with the patient, not for the patient. (C) 2000 Elsevier Science Ltd. All rights reserved.