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The consultation process with our geriatrician begins with a period of getting acquainted with the concerns of the patient and his family members. Health concerns in each and everyone of us should never be considered in isolation – each health complaint carries with it ramifications that impact on other aspects of our lives e.g. a person with problems walking is likely also to be concerned about his ability to move around the house, his ability to go to the toilet and his ability to meet his own basic needs. A holistic solution will then involve not just the identification of the causes of his difficulty in walking, but also seek to offer solutions to his other concerns e.g. the teaching of specific exercises to promote balance and strength, the use of walking aids and suggestions regarding possible modifications to the home environment.
Having identified the primary concerns of the patient, our doctor will then seek to understand the patient’s past medical history. It is not uncommon for the older person to come with multiple chronic problems such as diabetes mellitus, high cholesterol levels and high blood pressure, and to be taking multiple medications from multiple doctors. All of these conditions and the different medications may all have bearing on the problems that the patient presents with, and it is important that our doctor helps that patient to identify potential problems (e.g. possible drug interactions) and to help the patient to understand his health status. It is also not uncommon for patients to have seen multiple doctors because of the “vague” nature of their complaints. Our doctor will then try to help the patient understand his problems and “rationalize” his concerns.
The process of history taking is followed by a thorough physical examination that takes into consideration the patient’s individual circumstances and needs. On occasion, our doctor may recommend further investigations to help in the diagnostic process or to help plan therapeutic strategies.
Subsequent to this process of comprehensive history taking and examination (referred to as Comprehensive Geriatric Assessment), our doctor will then help the patient and his family members arrive at an understanding of the concerns at hand. We will then seek to explore various therapeutic options and make suggestions as to further management. In this regard, we may offer to manage the issues at hand or suggest a coordinating role by working with other doctors that patient is already seeing. Alternatively, we may also suggest recommending the patient to other doctors who may be better able to manage the patient’s conditions.
All in all, the process of geriatric assessment is a thorough and lengthy process that may take up to an hour or more, and may involve a multi-disciplinary approach to tackling the problems at hand. The patient may rest assured that every attempt will be made to look into the complaints that are of concern to him.
