At the end of a recent appointment at Ichilov, after an EMG for a lumbar issue at L4–L5, I asked a straightforward question: What can be done?

The answer I received was equally direct: “Well, in two years you’ll be 80.”

The recommendation that followed was physical therapy.

This was not my first such encounter at Ichilov. It was the second time I found myself facing a clinical conclusion in which age did not simply inform the discussion—it appeared to decide it.

In an earlier case involving my wrist, I was told outright that because of my age—at the time, 76—surgical intervention would not be performed. Not after deliberation. Not after weighing options. Simply stated as fact.

The outcome was not stability, but decline. My hand is now significantly compromised.

There is another detail that is difficult to ignore. In both instances, the emphasis on age came from relatively young male physicians—likely under 30 in the first case, and, in the second, a physician who told me he was 37.

To be clear, I am not inactive. I am not noncompliant. I do private physical therapy. I swim—up to 1,000 meters when I can. These are not symbolic efforts. They are sustained attempts to maintain function and mobility.

And yet, despite this, the treatment pathway presented to me did not move beyond what I am already doing. No criteria for reassessment were offered. No alternative interventions were meaningfully discussed. The conversation closed before it opened.

I write this fully aware of the context in which Israeli medicine is operating. We are at war. The system is under enormous strain. Young soldiers are tragically dying; many more return with severe and life-altering injuries. As someone whose professional work has long engaged with trauma and PTSD, I do not minimize this reality at all.

But even under such conditions, something essential must not be lost: the obligation to engage the patient in front of you.

Age does matter. Of course it does. Risk changes. Recovery changes.

But there is a difference between factoring age into clinical judgment and allowing it to replace judgment.

What I encountered in both instances was not simply a conservative recommendation. It was the absence of reasoning. Decisions appeared as conclusions. Instead, time itself—you will soon be 80—was allowed to stand in for explanation.

For the patient, the experience is unmistakable: one is being managed, not treated.

At moments like this, I had a disturbing image: of being an Alaskan Eskimo put out on a drifting piece of ice to die.

There is also another dimension to the statement “you will soon be 80.” It does not only describe the patient. It reflects something in the physician. Those who say it will, if they are fortunate, arrive there themselves. To confront age in another is also to confront one’s own aging—and it may be easier to distance from that reality than to engage it.

At some point, “you will soon be 80” stops being information and starts becoming a decision.

When that happens—without explanation, without discussion, without regard for the patient in front of the physician—it is not simply caution. It is a closing of the clinical mind.

And if this is not an isolated experience, then a harder question follows: whether age has become, in practice, a shorthand within the system itself.

Would this conversation unfold differently in another medical culture—one where patient autonomy and shared decision-making are more explicitly foregrounded?

If so, then the issue is not only clinical. It is cultural.

© The Times of Israel (Blogs)