Morning geriatrics/gerontology thoughts
On #failuretothrive
Last night while researching frailty scores, I vividly remembered being paged at 2am by the paging operator to call a patients family member while I was working in the ICU (back in the day when I did such things 😅)
On #failuretothrive
Last night while researching frailty scores, I vividly remembered being paged at 2am by the paging operator to call a patients family member while I was working in the ICU (back in the day when I did such things 😅)
Things were calm - and I figured a patient family member paging in the middle of the night was probably important - so I called:
“Is this Dr. Weeks?”
“Yes”
“you may not remember me, but I’m ___ you took care of my dad a few months ago and I wanted to talk about his paperwork.”
“Is this Dr. Weeks?”
“Yes”
“you may not remember me, but I’m ___ you took care of my dad a few months ago and I wanted to talk about his paperwork.”
Now this was curious. This patient died but my mind is a Rolodex of patients I’ve pronounced so I remembered this family well.
“How can I help you?”
“Well I noticed in the admission note you wrote and the discharge summary you listed “failure to thrive” as the chief concern.”
“How can I help you?”
“Well I noticed in the admission note you wrote and the discharge summary you listed “failure to thrive” as the chief concern.”
“Yes that’s why the nursing home sent him in”
“But my dad didn’t fail to thrive. He was just old and had cancer. It was just his time”
“But my dad didn’t fail to thrive. He was just old and had cancer. It was just his time”
We discussed the meaning of “failure to thrive”- a term that in adults generally is used to communicate that an elderly patient or patient w/ chronic illness is in a state of decline manifested by poor appetite, lack of weight gain or weight loss & inactivity.
On its own it gives the reader very little information about what’s going on with the patient - one can “fail to thrive” because of metastatic cancer that no longer responds to chemo or infection or depression or dementia or all of the above.
So a former patient’s child was calling me to have the documentation on their dad’s hospital paperwork changed. More specifically:
“I want you to edit out the word fail - he didn’t *fail* anything”
“I want you to edit out the word fail - he didn’t *fail* anything”
I discussed w/ an attending via email & we decided to write a note reflecting the concern about the terminology & clarifying extent of the patient’s physical condition at admission.
Maybe it was the fatigue of grief but somehow this unsatisfactory solution was sufficient.
Maybe it was the fatigue of grief but somehow this unsatisfactory solution was sufficient.
Anyway -we use a lot of formal and informal terminology in medicine that shuffles patients to one side of value binaries:
the failed/the successful;
the victor/the vanquished.
In reality - growing old, getting ill, dying & death are more grey than they are black or white
the failed/the successful;
the victor/the vanquished.
In reality - growing old, getting ill, dying & death are more grey than they are black or white
• • •
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