He's Not Likely To Be Around Much Longer...
Posted by Jeremy Windsor on Mar 22, 2024
There are many reasons why I enjoy reading my weekly copy of the British Medical Journal. But perhaps what I like most of all are GP John Launer's fascinating columns. In this extract, John highlights the need to take a wider look at the patient and not just focus upon their medical history. For those of us who give advice to folks heading into the mountains this couldn't be more important...
Seven years ago, a consultant cardiologist stood at the end of my hospital bed with five or six people he never introduced, and told me I had severe heart failure. Seven years on I've just finished circumnavigating the whole of Wales on foot. I did it in around 80 stages, a total of around 1000 miles across some of the most rugged coastal and hill terrain in Britain.
I tell my story in this way for several reasons. First, I want to remind everyone that doctors still break bad news to patients in the crassest ways, without either privacy or hope, as if they're making an educational video about all the mistakes you can make. Second, I want to emphasise what a stigmatising and outdated term "heart failure" is: it covers everything from an unexpected finding on an echocardiogram to acute pulmonary oedema. I'm not the first to suggest completely abandoning the name in favour of other terms such as cardiac impairment. Patients with the diagnosis can now live almost without symptoms for well over a decade with the appropriate medicines and implantable devices.
My main purpose in telling the story, however, is to draw attention to how we put people in pathological boxes many years before we bury them in wooden ones. By doing so we may risk condemning them to unwarranted despair and possibly a faster decline.
There's a teaching exercise I've done a few times with medical trainees, based on my own story. I first present a slide showing the medical history of Mr A in bullet points. He had a heart attack at 39, had a series of pulmonary emboli in his 40s, was fitted with a pacemaker for complete heart block in his 60s, has several other recorded conditions including arthritis in his knees, prostatism, and tinnitus, and is taking five medicines. I ask them what image they have of this man. "Frail," they reply, or occasionally "heartsink." The general opinion is that "he's not likely to be around much longer."
The next slide gives a narrative account of Mr B, a man of the same age, married with two adult children, who still works almost full time professionally, quite often travels internationally to do so, and is a keen long distance walker. I ask them to explain how the two men have come to be so different. The reasons the trainees offer include lifestyle factors such as smoking and obesity. Occasionally someone speculates that the slides may relate to the same person, but even then they don't anticipate the punchline. The slides are, of course, different ways of describing myself.
When I completed my walk around Wales I raised several thousand pounds for the wonderful "heart failure" charity Pumping Marvellous . Like that charity, we need to help patients and doctors look beyond the medical labels people carry, to see the person and their potential.
Thanks to John and the BMJ for allowing the publication of this extract.
Thanks to you for reading this post. If this is your sort of thing why don't you take a look at other posts on the blog? Better still, why not join the British Mountain Medicine Society? More information can be found here.
For more information about the University of Central Lancashire's Diploma in Mountain Medicine (DiMM) take a look at this.
Find out more about mountain medicine research at the UCLan Centre for Mountain Medicine.
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22/03/2024 @ 09:20:15 David Hillebrandt
I am 70 years old and for the last 20 years have got my money's worth out of the NHS with times on ICU, surgical interentions and I must be responsible for a large percentage of my GP's drug budget. I still work (a bit), I am off skiing next week and hope to travel to make a presentation to a congress in the USA in the summer.
If I was an insurer reading my medical history I would expect imminent death but with my medical knowledge I am confident that I am on the best medication and I would not go abroad if I felt it was irresponsible.
When we put labels on patients we may be condeming them to a situation where they are unable to get Travel insurance. Of course I should pay a higher premium but most insurance companies simply say "No".
Solution??????????
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25/03/2024 @ 17:38:25 Ross Hofmeyr
I can't help think that AI is swiftly going to blast the actuarial models upon which the insurance business is based right out of the water (and, for want of a better expression, to Kingdom come). I've got a few years on you, David, but was told after a bad fall in the Dolomites a decade ago that I would be lucky if I walked unassisted and without pain again. A few years later I was completing ultratrail events of up to 100 km and leading alpine expeditions. Modelling is good at population level, but as George Box said: "Some models are useful; all models are wrong."
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