Nice post! I find that the cataloguing of symptoms and their severity are not as important as understanding how the symptoms are limiting their achieving goals. If we understand that, then we are better able to meet the patient's needs. Maybe it's not the pain so much as it prevents a patient from going on walks with friends. Most patients as they age are less interested in longevity than they are in having and achieving goals.
All so true and so wonderfully written. Patients are always teaching me lessons. I had an 82 yo patient who I knew well, start complaining to me that he could not lift weights like he used over the last few years. He was an amateur boxer in his younger years. I tried to explain that this was to be expected with aging, but he was convinced something was wrong. So we did some tests, and I saw him back a couple of times with the same complaint and concern. Then on his fourth visit for the same problem, he reported, "Doc, I figured out what was wrong." "What is that? " I asked. His response was a wonderful lesson for us all. "I am not Superman!" he replied.
In retirement and with aging, I realize I too, have lost my "superpowers". Grieving that loss is one of my biggest challenges and one I am fairly certain one that I share with many of my retired colleagues.
Great advice. Having just celebrated my 80th birthday, I can relate to the problems with memory and sleep patterns. Struggling to come up with certain words or names was a problem for many of my elderly patients. I finally figured out that most of their anxiety was due to a fear that they were experiencing the early onset of dementia. It helped when I could reassure them that forgetting names and words that describe abstract thought were normal in aging because they don't correspond with specific material objects. If they couldn't identify a chair as a chair, then we had something to discuss.
"The doctor must avoid excessive evaluations while not missing the occasional needle in the haystack." That is so much of the challenge of medicine . . .
"Although longevity folks try to convince us otherwise, human bodies age, and as we get older, more things hurt, we sleep less well, and our cognitive abilities decline" - Amen thank you for reminding all of us that aging is not a disease/diagnosis. Embrace the moments you have and be grateful for every year around the globe
Alas, aging is inevitably accompanied by a steady decline in cardiofitness. A decline in cardiofitness can also be a marker for significant cardiac problems like aortic stenosis and heart failure. Sorting this out requires all the wisdom and skill of the experienced physician.
I marvel at my own adventuresome aging process at 77. It is a gift and a privilege to be alive and upright. Humility, patience and stay in the moment! Ultreia
Fun read and my favorite population to care for. Usually the most calibrated people with the least angst about the unknown. When less time is spent investigating and more time is spent discussing how to make it to a graduation or wedding, all that matters seems to come into focus.
I believe many times these sort of symptoms are just manifestations of a patient mourning the loss of their youth. Or as you said, struggling to face their own mortality.
Perhaps there is a market for an “anti-longevity” clinic where the focus is not on extending life but enriching the present. Books would be read and art appreciated….
Nice post! I find that the cataloguing of symptoms and their severity are not as important as understanding how the symptoms are limiting their achieving goals. If we understand that, then we are better able to meet the patient's needs. Maybe it's not the pain so much as it prevents a patient from going on walks with friends. Most patients as they age are less interested in longevity than they are in having and achieving goals.
All so true and so wonderfully written. Patients are always teaching me lessons. I had an 82 yo patient who I knew well, start complaining to me that he could not lift weights like he used over the last few years. He was an amateur boxer in his younger years. I tried to explain that this was to be expected with aging, but he was convinced something was wrong. So we did some tests, and I saw him back a couple of times with the same complaint and concern. Then on his fourth visit for the same problem, he reported, "Doc, I figured out what was wrong." "What is that? " I asked. His response was a wonderful lesson for us all. "I am not Superman!" he replied.
In retirement and with aging, I realize I too, have lost my "superpowers". Grieving that loss is one of my biggest challenges and one I am fairly certain one that I share with many of my retired colleagues.
Great advice. Having just celebrated my 80th birthday, I can relate to the problems with memory and sleep patterns. Struggling to come up with certain words or names was a problem for many of my elderly patients. I finally figured out that most of their anxiety was due to a fear that they were experiencing the early onset of dementia. It helped when I could reassure them that forgetting names and words that describe abstract thought were normal in aging because they don't correspond with specific material objects. If they couldn't identify a chair as a chair, then we had something to discuss.
Here to say two things:
1. Fantastic piece.
2. The Costco episode of acquired is incredible.
Another gem from Dr. Cifu.
"The doctor must avoid excessive evaluations while not missing the occasional needle in the haystack." That is so much of the challenge of medicine . . .
"Although longevity folks try to convince us otherwise, human bodies age, and as we get older, more things hurt, we sleep less well, and our cognitive abilities decline" - Amen thank you for reminding all of us that aging is not a disease/diagnosis. Embrace the moments you have and be grateful for every year around the globe
Alas, aging is inevitably accompanied by a steady decline in cardiofitness. A decline in cardiofitness can also be a marker for significant cardiac problems like aortic stenosis and heart failure. Sorting this out requires all the wisdom and skill of the experienced physician.
I marvel at my own adventuresome aging process at 77. It is a gift and a privilege to be alive and upright. Humility, patience and stay in the moment! Ultreia
Fun read and my favorite population to care for. Usually the most calibrated people with the least angst about the unknown. When less time is spent investigating and more time is spent discussing how to make it to a graduation or wedding, all that matters seems to come into focus.
I wish more Dr's had your acumen and patience while dealing with their patients.
I believe many times these sort of symptoms are just manifestations of a patient mourning the loss of their youth. Or as you said, struggling to face their own mortality.
Perhaps there is a market for an “anti-longevity” clinic where the focus is not on extending life but enriching the present. Books would be read and art appreciated….