A doctor who’s known you for a while, that’s a less obvious occasion to ask, but they might be concerned that things are changing as you are aging.
A few years ago, I took my son to the local ER for something that turned out to be nothing worrisome. While he was there, someone asked that question. I snickered and said I’d leave the room so he could answer honestly. I wasn’t arrested, so I guess he said he was OK. Not long after that, my SIL tripped over an uneven sidewalk, face-planted and broke her nose. In the ER, late on a Saturday night, with facial injuries, with friends and husband, all of whom had been partaking of liquid refreshment, and apparently nobody asked her that question. Which was a bit mind-boggling to me, hearing of it - I mean, the scenario of “husband gets drunk, decks wife” is not all that novel, sadly enough, and you’d think there’d have been some suspicion.
Years ago, I tripped over a piece of farm equipment while walking around in the dark, and banged my face up pretty badly. I remember going into town a day or two afterwards and wondering whether anybody was going to ask me about it. Nobody did, which I actually found kind of disconcerting. That must have been something like thirty years ago, though; and I think people are more aware of the issue now.
These days I carry a flashlight.
I live alone (aside from the dog and the cats) and the last few years I also get asked whether I feel safe at home. I suppose, come to think of it, that if I were afraid of the neighbors I might feel unsafe even though – or possibly because – I live alone; but I have good neighbors. And I’d rather they’d ask me, who doesn’t need the question, than not ask somebody who does need it.
And, come to think of another thing – some people going into dementia get paranoid; and sometimes it’s one of the first symptoms. So probably they ought to be asking me, because if I suddenly started saying yes, it might be indicating a problem of that sort.
This is a good screening question, and a common presentation in emergency rooms. It is important to try to determine the cause, of which there are many: bad balance, poor lighting or vision, alcohol or drug abuse, mobility restrictions, dehydration, heart problems, medication issues, accidents, neurological issues and all sorts of other things.
Of course, all sorts of musculoskeletal and other injuries can be caused by the actual tumble. So this history should lead to a very detailed history taking and physical exam. Probably lots of secondary tests and imaging as well.
Not a doctor of adults but my impression is that falls are a major cause of both morbidity and mortality in older age groups. Lots of reasons for the risks of falls to increase and for the risks of serious harms from falls to increase as well.
Many of the risks of having a fall and of the consequences of fall are preventable. Some by addressing medical issues associated, some by having an awareness of what the person could modify in their environment to reduce the risks.
@kayaker I would consider a doctor who did not ask someone of the age group who was in the office for a “pain in the knee”, which definitely may be a result of fall, and/or of an increased risk of fall, or injury from fall, about their fall history, to have not done their job well.
My mom fell twice. Broke a hip each time. And then a final fall where she was on the floor for maybe 12 hours.
I had purchased an emergency button for her, but she refused to wear it. Drove me crazy.
I work at home alone during the day. My office is in a loft and the stairs are very steep. I do not go anywhere when I’m home alone without my cell phone.
I went down hard about three months ago. Dog made an unexpected move, and I had to sort of skip over him. Skinned my knee and ripped may pants
I hope that when the time comes that I don’t have people around all the time, I have the sense to wear a button. My in-laws were FINALLY persuaded to wear theirs, and used them several times; both had begun to fall with some regularity. MIL is now in assisted living, where there are buttons all around the place; not sure if she still uses a wearable one.
I fall, or otherwise injure myself, with some regularity; most recently I tripped over my own damn feet getting up from the couch. Likely a broken bone in one foot, likely cracked or bruised ribs (as I hit the couch arm on the way down);. Neither showed on X-rays, and the foot really doesn’t hurt, but the bruises there don’t lie,
2 years ago, broken foot (it fell asleep, I stood on it wrong). 3 years ago, broken toe (that one was not my fault). Both took a while to heal, too - low-grade osteopenia diagnosed after the foot. A couple years earlier, broken tailbone (slipped on stairs). A few years before, broken elbow (radial neck), also on stairs, and damn lucky that was the only neck I broke. 10 years before that, stumbled stepping up on a curb, face-planted, and broke the other elbow. We won’t count the number of minor (and several major) ankle sprains I’ve sustained.
So yeah, falls of any sort are frankly terrifying to me.
Yeah. We live in snow and ice country. This is not a good combination. I have twice fallen in the last 5 years in our drive. We get ice on a slope. Get a little topping of snow, and you are screwed. I once crawled to my shed because there was no way to stand on this stuff. I had salt in the shed and made it back to the house. I now use Yaktracs pretty much all the time. My neighbors that are younger use Crampons Ice Cleats.
He bumped his head on a Friday, and didn’t think much of it. He had a rather busy weekend, not aware that anything was amiss. On Monday, he and my mother went to Los Angeles. That evening, he suddenly fell very ill; and shortly, was in a coma.
Apparently, when he bumped his head, a blood vessel in his brain had ruptured, and had been leaking into his brain, all weekend, slowly crushing it. By the time they got him to the hospital, he was effectively brain-dead.
That was just a few weeks before Christmas, 2008, and about a month before his 75th birthday.
A few months after I broke my leg in September of 2019, I started having violent muscle spasms in the other leg, the one that wasn’t broken. When @Seanette took me to the Emergency Room, they made a point of right away separating me from her, and interrogating me, with a line of questioning that was very obviously aimed at trying to determine if @Seanette had been physically abusing me in some way.
If the patient seems in pain and is depressed maybe easy access to a gun is a risk of suicide.
Granted the doctor may have no reason to suspect depression or someone considering suicide but it is a question on a form. It is not about “you”…it is general data gathering which can be used later.
It’s one thing to ask about any contributing factors for the knee pain. It makes sense to ask if you have fallen and had issues with it, or asking if you’ve fallen since.
But it sounds like these general questions aren’t about that. And I can see why they would frustrate people to be asked every time they go in. It seems to me that it would just become something you just say “no” to without even really listening.
It definitely definitely annoying if you are in for a particular ailment and it feels like the doctor is asking about everything else first. With perfunctory questions, it can feel like that’s always the case–that these questions are always unrelated.
The way my doctor handles it, the nurse asks these types of questions, clearly on a checklist. But then if he actually thinks it is relevant, he brings it up himself. Though, I could see that approach not working for people annoyed because they already answered the question. But I’m used to having to repeat myself to the doctor a little bit anyways.
Is there a chance the questions are repeated as we get to the older stages of life to see that the answers are consistent and, if not, might hint at dementia or abuse?
Or is it just a bureaucracy and every functionary has to tick their boxes on a form?
They ask new Mothers about the hot water heater temperature, whether anyone smokes in the house, are guns locked up and just recently DIL said they ask her if any large breed dogs lived with them. She told 'em, “yeah the twins Dad”. She said the pediatrician laughed and said he meant of the canine variety.
Falls can be a death sentence for the elderly. My MIL (84) fell and broke her wrist last December (she lived alone) Within a few weeks she started going downhill. She ended up in the ICU after Christmas because of low sodium. She then went to a rehab for close to a month to help her get ready to go back home. She didn’t want to go home. She was afraid of falling again and was afraid of being alone. She went into assisted living at the beginning of February. From there things really snowballed downhill. She started having dementia symptoms, she wasn’t eating properly, she just had a really hard time. She died 3 weeks ago. It was all so fast and unexpected. And it started with a broken wrist.
Yeah but the irony of being upset over being asked the questions when the questions were actually very relevant to the chief complaint was too great to not point out.
The reality is that most of these questions would be best addressed in a regular well care visit. Problem is of course that many of the people most at risk of the issues the questions are aimed at addressing are the least likely to be having regular well care visits. The system needs to get to them where and when it can. Making it automatic across the board is the systems approach to getting it done.
On my side of the fence it is the same attitude that gets me talking about flu shots or catching up on some delayed vaccines while the kids are brought in for a minor illness visit. We need to use the opportunities we have when we don’t get the opportunities we want.
Yes mandates and incentives of various sorts play a role.
When I’m actually in the room with a doctor, the last thing I want to do is rush the process, or waste his time. He asks a question and the answer is a single syllable word, I’m saying the single syllable word and moving on. I’m not debating it and complaining about it.
I also much prefer a doctor who is attentive to the little details, not skipping over things because he figures it’s OK.
Last pro-question comment, these questions might not be for me, but they might save another person’s life, so ask away!