FWIW Joe Lieberman just died … of complications from a fall.
And this in my JAMA issue feed today:
For anyone who wants details about why knowing fall history is a big deal.
And you don’t think that a fall could possibly be connected to that pain in your knee?
Sure it could be connected. Ask if there was a history of injury and I’ll respond. But reading questions from the computer terminal because the medical group requires he do it? Nah.
I’ve never had a doctor read me a list of questions from a computer terminal. I’ve had an aide do it while rooming me, or had forms given with checklists for me to complete, but not that. Different sets of docs I guess.
I get that you want a problem focused visit to limit itself to that problem and not look for anything else. Likely you are bothered by your blood pressure or other vitals being checked too. “Not here for my blood pressure, doc!”
From my side having been in (and happily done with) “leadership” of a large group, we are not only looking at you as the unit of concern but at the health of our entire community of patients. Ethically we want to keep that community healthy and screen those 65 and over for fall risk is a big return there.
Even from a pure greed perspective… we have more and more of our patient populations as “full risk”, meaning our group is essentially paid a fixed amount to take care of them. Screening and intervening for fall risk is low cost big return on prevention of expensive care, as the various anecdotes and the article linked both illustrate. Every future significant fall prevented isn’t only health and years of life gained; its costs avoided too! 
Bitch about it if you want. We are still going to ask you about it and a host of other things.
I saw that report, and popped in here to post but you beat me to it.
Yeah, it’s pretty critical info. My in-laws had sustained a number of falls during their last years; FIL in particular had several (which were, in hindsight, strongly suggestive of his decline). They had to call 911 for help in getting back up at least once.
Neither was ever badly injured, but it was frankly a matter of time. And one injury bad enough to reduce your ability to move, and you’re on a slippery slope as a number of people have mentioned.
Actually, my old doctor (since retired) was bitching about being required to ask and record my replies. I agreed with him.
My point of view is that by having an adversarial relationship with my PCP I’m less likely to seek care.
Again former “leadership” hat on:
Definitely there were individual docs who were not enthusiastic members of team community medicine, who really either did not understand, or did not care about thinking of, the entire population entrusted to us as a unit of analysis. It was our role to think about population wide metrics and to figure out how we could through system approaches (even more than education of our docs) impact changes. Minimally to make it easier to have our docs identify risks and to intervene effectively once identified. And to get the message to even those unenthusiastic docs that as members of our team they have to do it even if they don’t like it.
I’m not too tongue in cheek on the dollars comment. Yes insurers and at risk groups realize that things like preventing falls save money. I don’t recall falls being one of our insurer defined “quality of care” metrics during my time but it would have made great sense for it to have been one. There were lots on a variety of other ounces of prevention.
There are many aspects of how the business of medicine has gone that have frustrated and disappointed me to no end, and many reasons that I am thrilled to be done with my time in leadership dealing with administration folks. But having incentives lined up with prevention and early detection of problems and achieving better care for our communities is one of the good things. And accomplishing that requires systems wide built in approaches and taking advantage of every clinical interaction as an opportunity to achieve those goals.
The impact of a very few curmudgeons who feel that being screened for risks and such is intrusive and adversarial, and who then are less likely to seek care? Pretty sure that is not something that is going to cost us, especially compared to the cost of even one significant fall prevented across the large population.
I think that the doctor asking questions about my general welfare is the exact opposite of adversarial. About 15 years ago, I went in for something, and the NP who saw me said that it was probably nothing to worry about and would probably clear itself up in a day or two, but ordered some routine bloodwork while I was there. Which uncovered a chronic condition that I had no clue that I had, which was completely unrelated to the reason I went in, and which, as a result of that diagnosis, is now completely managed and under control. That, to me, is a medical professional doing their job, and doing it well.
Now, if a doctor or nurse ever told me that they didn’t want to read off the stock questions and were just doing it because they were required to, that I would consider adversarial.
There are other reasons that medical personnel might be asking about guns. Guns and dementia don’t play well together, especially if there’s some paranoia thrown in. But then the question might not go to the patient, but the patient’s care team.
My grandmother used to complain that my dad kept telling her to stay off ladders. Now I get to tell my tell to stay off ladders.
One time a nurse asked me at my annual physical “Is any male in the house preventing you from getting enough sleep?” I asked if my infant son counted. She laughed. That was the last time I heard that question. (I probably did look tired, to be fair.)
What does the question even mean?
I probably should have expanded - the reason I think the question is more useful when kids are involved is because IME parents have a tendency not to predict the future capabilities of their kids very well. I used to have a job that required me to have a handgun. At some point , conversation turned to how we would store them and keep our kids away from them. More than one person said they would keep it in the top dresser drawer as their kids couldn’t reach it. Their kids were either younger than or had different personalities than mine - they were quite surprised when I told them I found out my son could get to the top dresser drawer when I saw him do it and there’s no telling how many times he did it before I saw it. That’s not really an issue with adults - and as you note, for a dementia patient, that’s really a question for the caregiver.
I wonder if that was a clumsy way of asking about a partner’s sleep. If our doctor had ever asked me that, my husband probably would have gotten a sleep study and a CPAP years earlier. Didn’t happen until there was a stretch that caused me to ask for sleeping pills because I could not sleep with the snoring.
At the time, I thought it was a way of asking about possible domestic abuse. In other words, I think she was asking if I was afraid of anybody, although it was a really roundabout way of asking.
It’s cause for celebration when my wife hasn’t fallen recently. I’ve fallen exactly once in the last 50 years or so, and that was because I tripped over a rock in the garden. I’ve slipped; I’ve flailed; I’ve windmilled my arms wildly; but I just don’t fall. At least not yet. Anyway, I answer their silly questions because it’s their jobs to ask them. The only thing I have an issue with at times is repeating all the words.
I think “Is anybody” would be a lot better there than “is any male”. Is it not supposed to matter if the person preventing you from sleeping is female or other?
It might have been a way of asking about forms of abuse that some may be less likely to recognize as abuse. I wouldn’t be afraid, necessarily, of somebody who kept waking me up at three in the morning and again an hour before the alarm went off. – it might even be something that the person itself didn’t think of as abusive; some people need less sleep and/or have different sleep patterns and may genuinely not realize that they’re seriously screwing up the person who they think ought to go to sleep and wake up when they do.
I haven’t actually been asked that one yet, and don’t know how I’d do on it, because I often don’t absorb spoken words well unless I write them down. But I’ve been like that pretty much all of my life.
If I’m specifically told I should remember them, I might be able to do it; but that’s probably going to distract me from everything they say after that.
I suspect that 95% of people seeking a sleep study and then CPAP are doing so because their spouse made them do it. It’s what got my husband in for his study.
And it got Mr. Dendarii Dame into a study too
Coming late to this thread. I’m 70 now and if my doctor ever asked me this I’d truthfully say I fall about 120 times a week since I’m still practising aikido on average 3 evenings a week, and in each class I get thrown about 40 times. On the plus side, I get to throw others to the ground about the same number of times each class.
As it happens, I was asked that question yesterday. I was there for a general checkup and to get my meds renewed. When he asked me that question, I gulped because my wife was there and I hadn’t told her about it. Maybe three months ago, I was putting my right leg up on the toilet seat to dry it and my still wet left foot slipped and I fell. Didn’t hit my head or really hurt anything but I wanted to give an honest answer. I was leaning against the sink, so I hand rail would not have helped. Now I have a small non-slip rug in front of the sink so that cannot repeat. I explained all this to the doctor who didn’t comment. Maybe I should sit on the toilet lid to dry my legs.
I’m happy to hear one of the traits you’ve passed on to your kids is a sense of humor.