Tuesday, April 1, 2014

A change in perspective...

I’ve spent years in clinic putting patients on medications to lower cholesterol, lower blood pressure, and improve blood sugars in hopes of extending their life.  I’ve pushed for dozens of colonoscopies, mammograms, and stress tests in hopes to prevent disasters. 

Now, I’m in Geriatrics Clinic taking people off medications and forgoing screening because, well, it’ll probably be something else that kills them first.

I’ve spent the other part of my three years on the General Medicine inpatient teams and ICUs trying to cheat death, halt death, or revive persons from near death. 

Now I’m in a Geriatrics Clinic and it feels like I’m actively planning for someone to die.

…But before you think I’m morbid, let me explain

It all started on my first day in Geriatrics Clinic when I was shown a chart of life expectancies for elderly persons in America.  The concept was simple enough, using a person’s age, gender, and overall health to determine how long they were likely to live.  It took more than an instant to digest that even a rather healthy woman  in her 70s may only have less than 10 years to live on average.  It made me afraid to be in my 70s.
With this information, however, came a new sense of purpose and a new outlook on what I was doing in this clinic.  It was easy to feel as if we weren’t “being aggressive” enough or that we were “being passive” but what it really showed was how at all ages in Medicine, the focus always remains on the patient.  With every decision I’ve made for every patient, every day in the past several years, the common focus is doing the best to provide benefit with the lowest possible risk.  While it initially seemed different than what I had been doing on before, it was the exact same.

So as we sat there, taking medications off her list which were unlikely to provide her any further benefit, it felt liberating.  It was not as I felt earlier, a sign of defeat, but rather a celebration of a life lived to its best.  And as we continued to talk, it was just like my usual clinic, continuing with every visit to make sure that everything we are doing is focused on living a longer and better life.  

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