I have recently been asked to show what I do, to demonstrate, I guess, how much value I am for the money spent on me.
It is and has been tricky; counting the cost of my activities, what I do, what I don’t do, is not something I have ever been taught, I guess, it is a form of accounting that I thought I had left behind at school. Silly me, I had considered being a doctor a way-out of adding, subtracting and measuring people.
And just this morning, it struck me. As I was out walking Maisie my dog, we passed the house of a former patient who I had advised against certain treatments, opting for a more ‘conservative’ approach (the only time I like to use that word…), I thought of what I do and what I don’t do and how I can show it, for a geriatrician doesn’t have a nice shiny hip or knee joint to give you, or a scorecard of bypass operations.
How do I reflect the harm I prevent, as that, is much of what I do. Sure, I kid myself that I help get people better, say when they have pneumonia or have fallen; I fiddle with their medicines and ponder over their blood results. As with my previous blog on urine infections, I am sure that much of my patients’ recovery, if not all, is because of the care they receive on my ward – the affection, support, nutrition and hydration provided by the nurses and healthcare assistants I work with.
But, surely, I do do something?
I think the biggest influence I have is avoiding harm, protecting my patients firstly from the diseases or events that threaten them, but secondly, and perhaps more significantly, from the system, the system that is designed for otherwise healthy 50 year olds, but is tottering under the weight of too many 90 year olds.
What is right for someone who is 40, can be right for a person in their 80’s or 90’s – we all feel pain in the same way, we are all susceptible to bacteria and viruses; yet, it is those chronic disease that are far more prevalent as we age that make the difference.
Chronic diseases, combined with frailty, mean, that an individual’s resilience is often reduced as they get older and consequently, the ability to recover, from some interventions, particularly operations and complex investigations is less, with the potential for harm, from the wrong medicines or treatments being greater.
So, I guess, much of what I do is advising, guiding and supporting those older people who would likely not benefit much from the multitude of medicines and investigations available to them, whose chance of living productively, enjoyably into the future is unlikely to be influenced by the sophistication of Western Medicine.
And, how do I show that? How do I show the man who hasn’t fallen-over, or who hasn’t died because of not having an operation, or who has remained out of hospital?
There are lots of complex ways to measure these things that are beyond my ken; I just wish sometimes, I wasn’t the one having to do it!