Yesterday, in the hospital, we had a talk about clinical coding. This is the language used by hospitals, care systems, the government, national and international organisations to tally, calculate, cost and analyse what goes-on. That is, how many patients, operations, and treatments a hospital is undertaking, this allows for individual ward or clinician level analysis – how many patients with pneumonia did Rod treat between May 2015 and 2016? How long did those patients remain in hospital? How many recovered, died?
It is unimaginably complicated and results in much feverish activity in the clinical coding department – this is a team of skilled analysers who plough-through medical records and assign codes which are then translated into numbers which are then collected by a cloud-like disease, morbidity and mortality tracker in the sky. From this you can work out the risk of you acquiring C. difficile from hospital A or B. See here for more.
As with all highly complex systems, it exists within a margin of error. Most people don’t know what that margin is, suffice it to say that it doesn’t matter, as when in doubt we endeavour to compare like with like instead.
‘They did 100 varicose vein operations in hospital A, but 150 in hospital B’ – is B better? Is A treating more complex veins? Do B work twice as fast yet have twice the number of complications – infection, pain, dissatisfied patients.
Tabloids love these figures as it allows them to get away with saying… ‘Hospital H – death rate is twice the national average!’ Subtlety is usually lost in these situations.
And from here I go to the title of this blog… Geriatric fall.
I was discussing this diagnosis with my team on Wednesday.
An older woman fell at home and was admitted to hospital; the initial diagnosis was ‘Geriatric fall’ – I guess to those of us who are less uptight than me, this might be OK – something to acknowledge and move-on; for me however, it stuck.
‘Geriatric fall, what is a geriatric fall? How does it differ from a non-geriatric fall? Do ‘geriatrics’ have a special way of falling (aside here – when I was young, in the 70’s I remember my dad talking about the falls my grandma experienced in her Southside tenement – somehow, despite her falls she never managed to harm herself; she had a special way of falling; ‘She would crumple,’ I think was the description.)
Anyway, here is my point –
I, an experienced doctor who has spent many years caring for older people doesn’t know what a geriatric fall is; specifically, how it differs from all the other falls – perhaps, someone reading this can help.
Does it matter?
*I don’t even know whether I should be writing, ‘Geriatric Fall,’ ‘Geriatric fall,’ or ‘geriatric fall,’ which is more correct or appropriate?
Will the system see Geriatric Fall and align this with better statistics? Will it allow those looking-on to understand the true complexity and challenge inherent in supporting a geriatric who has fallen, compared to someone else who is just old.
My preference is usually to say, ‘93-year-old man admitted with a fall,’ I might then explain why I think they have fallen – arthritis, dizziness, too many sedatives, and so on;
(I have just read the British Geriatrics Society Introduction to falls written by renowned geriatrician, Finbarr Martin in 2007 and revised in 2010 – he doesn’t mention ‘geriatric fall’ in that document, so, at least I am amongst good company)
Over and above this is my problem with geriatrics in general; the word translates from the Greek – Geri – old age and Iatros – doctor; Not too far away from ‘Paediatrics’, but that is another matter.
You see, in recent years the age thing has become less relevant to my work – age, in the chronological sense. Physical, physiological and psychological age yes, these are more closely associated with Anno Domini.
We are moving toward Medicine for Older People – Older being a relative term specific to each person; examining and addressing complexity, co-morbidity (what else you have wrong with you), frailty and fragility are all areas in which I have a level of skill.
Geriatric. I don’t know where that fits-in.
In my experience, most older people – and that is whether you are 40, 80 or 100, see the world through a set of ageing eyes. They don’t necessarily see themselves from outside – the wrinkles, liver-spots and greying hair; more often, people see themselves no different to the individual who was once 18. Adulthood. Away from the seven ages of man. There is just one age… Now.
And back to geriatric falls.
I am going to stick with the basic ‘fall’ – I may be doing myself a disservice; I might be losing my organisation millions and sullying its reputation for the quality of care we provide geriatrics.
I, however have my reasons.
In the end, although names are important, it is what you do with them that counts.