When the doc asks "Did you fall?" - what do they want to know?

Being of a certain age (70) when I go in for my semi-annual poke-n-prod, my doc will ask if I’ve fallen. I assume she’s asking if I’ve taken a tumble for no apparent reason as opposed to tripping over the dog toys in the middle of the living room. Then again, if I’ve tripped and crashed to the ground, I may well have done some damage, even if I feel OK at the time.

I know we have folks here with medical backgrounds, so I’m asking. Part of what prompted this is my 92-y/o widowed MIL who is now living with us. She has fallen a number of times in the past few months, and we’re pretty sure it’s because of her bad heart and resulting low blood pressure. But there have been times when we see she’s about to fall, and we get her to a seat before she’s on the floor - is that a near-fall? We asked one of the visiting nurses and got a non-answer.

I hate to dump unnecessary information on a doctor, but maybe too much info is better than too little? So, Teeming Millions, I solicit opinions and experiences. I’m not a doctor nor to I play one on TV…

IANAD, but I am getting up there (69), and I get this question at my annual check up too. I believe it’s a standard question for older patients because they want to know if falling is becoming a problem for you. It might not be something you would mention because it only happens rarely. It could be a balance issue, or blood pressure related, or something completely different. If you are falling because you get light-headed getting off the couch, that’s different than tripping and falling while hiking a rocky trail, which I sometimes do when I am not paying attention…

Sorry, doc, I’m not here to chat. “Do you feel safe at home?” “Any guns in the house?” “Fallen recently?”

I just explain that I’m there to explore the pain in my knee and have no desire to chat.

Yeah. I fell from the recoil of my shotgun that I emptied in the general direction of a shadow that scared me. Other then that I’m fine.

I generally say ‘sometimes I slip and fall while getting up and down when I’m doing farmwork on rough ground, but not otherwise, and I haven’t significantly hurt myself.’ That does seem to answer the question; and no, they don’t seem to mean that.

Since I’m a klutz they just assume it about me.

It’s more like “What have you hurt on yourself this time?”

I think they want to know if you are a risk to yourself that might could be remedied.

It’s good practice to screen for fall risk, but on top of that it’s part of the CMS guidelines for screenings that are required for those age 65 and older with a previous history of falls. Here’s the CMS guideline from 2020, but the current version is very similar.

In summary, doctors can get penalized if they don’t perform the screening, and eventually have their reimbursement cut.

I did EMS for a buncha years. Whenever we got a fall call, we’d ask questions to get to why they fell as it would help us to get to the cause of the fall & therefore, how to treat them.

  • Did you fall because you couldn’t see whatever you tripped over? Referral to eye dr to look for cataracts, macular degeneration or maybe just a reminder to turn the lights on at night.
  • Did you fall because you couldn’t lift your leg over the step? Referral to PT/OT to strengthen your leg muscles; if that doesn’t work, talk to patient about possibly moving to a single story place.
  • Did you fall because you got lightheaded when you stood up? That could indicate low BP / cardiac issue; maybe that new drug is not a good fit/right dosage for you.
  • Did you fall & have another symptom, like a droop? Now we’re thinking stroke.
  • Did you fall & don’t remember it? Possibly a seizure?
  • Did you fall because you were walking on a trail with the grands & tripped over an uneven root or rock? Well good on ya for still getting exercise, but maybe only do paved trails from now on.

The fall in & of itself isn’t necessarily a concern, though older women tend to break bones more frequently due to lower bone density but what caused it is the real concern & what needs to be addressed.

My former doctor asked me, when I came in for a sore arm if I “was drunk” when I hurt it.
No way I’m going to admit that.

They want to know if you may have possibly hit your head.

A simple little bump on the head at an older age may result in a brain bleed, which can be easily ignored by you until it its too late, because there may not be any symptoms. “Just a bump, hell I have hit my head harder when I was young.” Well, you are no longer young.

Particularly if you are on any sort of blood thinner, as many older and elderly people are, to reduce the risk of stroke.

If you are on blood thinners and bump your head, get it checked.

If you fall and possibly hit your head you need to go get checked out. It may not be serious but you want to get that confirmed. Otherwise it can be the begining of YOU checking out.

If you get drunk, your doctors need to know that. It can affect anything they prescribe for you; as well as how often they ought to check your kidney function; as well as probably a batch of other things I don’t know about.

The doctor’s office is no place to be embarrassed about anything that affects your body. They’ve heard it before. If they give you a hard time and you don’t want to hear it, tell them that.

They also want to know why you fell; in order to try to figure out whether your having fallen indicates a medical condition.

They’re not chatting. They’re trying to find out whether there’s anything affecting your overall medical condition; which might indeed affect what they should try to address the pain in your knee.

How long does it take to say “Yes; properly secured (or whatever); no?” I’d guess less time than to explain to them about not chatting. Also takes less time to lie about the guns if you want to than to go on about not chatting; or even to say ‘not answering that’.

I was sort of joking. I wasn’t drunk when I hurt my arm, and I thought it a little strange that this was her first question. But yes, she needs to check my liver function yearly.

Yeah, I’d think it odd that that was the first question; especially if getting drunk wasn’t already in your medical records for some reason.

I’m baffled by people who refuse to disclose things to their doctor because of embarrassment or because they think it’s “personal” information that the doctors doesn’t need to know. Do you also refuse to tell your car mechanic everything that you’ve noticed about your car’s condition? If you don’t tell your mechanic that your brakes sometimes feel mushy, and then you get in an accident because the brakes fail, whose fault is that? If you don’t tell your doctor that you drink alcohol and they prescribe you a medication that interacts badly with alcohol … ok never mind, I’m just ranting.

Back to the OP, I would just tell the doctor everything. If you fell once in the last month because you tripped over the dog, tell them that. If you’ve seen your MIL about to fall but caught her in time, explain that. The doctor can filter out any information that isn’t what they were really looking for.

When I fell down the stairs my Doctor said “Hmmm. Dancing down the stairs again. Lemme note that on your chart”
They were being comical.

I acted like I was typing on my phone, “Hmmm, doctor needs to keep their day job. The comedy club has enough bad acts”

It’s not that it is personal or that I’m embarrassed. It’s that it’s none of his business if I own guns (I don’t) or if I “feel safe” in my home. That’s not why I’m there. I want his analysis of my knee pain. Diagnostics and therapeutics.

Incidentally, my PCP agrees. He’s asking questions that his group practice requires he ask.

I can understand why the questions annoy you and maybe your PCP should know you well enough not to bother asking - but you’re looking at the questions from your perspective, not from the perspective of a person who doesn’t feel safe because their caretaker child is abusive and the only chance they have to tell someone is during a visit to the doctor or one who falls fairly often but never thought to mention it to the doctor . I think the gun one is pretty pointless unless there are kids in the household , and even then it should be a more general question about how dangerous items are kept away from the kids and so on but PCPs , especially those that treat kids have always been concerned about issues that aren’t strictly medical.

This is what eventually led to FIL’s death. He fell off a dining room chair and hit his head on the floor. That led to the ER and a hospital stay, then to hospice at home and his eventual death. It was at least the 4th time he’d fallen and hit his head within a year - because he refused to use his walker.

I’ve been told that question is to determine if the patient is in an abusive situation.

I’m 64. I haven’t been asked this question yet, but I would expect they want to know EITHER of those things.

Tripping over the dog might mean your vision is declining, or your household is not safe. Or your balance isn’t what it used to be and you don’t recover from normal things that a younger person would do easily, so a bump / stumble turns into a splat.

A fall for no apparent reason would indicate a whole different list of possible issues.

Any doctor who’s gotten to know me will expect the answer to be a resounding YES sooner rather than later, as I’ve been known to trip over my own feet (including a week ago, resulting in a likely broken bone in my foot and what seems to be a bruised rib).

My endocrinologist was interested to learn that I had fallen on some ice while shoveling - because the fact that I had fallen and not broken anything was an indication of my bone status.