How to get best for elderly from GP

What are the types of problems the ageing need to see their GP about?

Life can get more complex as you get older and health issues especially so

If there is one aspect about caring for the elderly that is characteristic, it is the fact that they suffer from complex and interlinked medical conditions

In practice, this means that a ten minute consultation will not only have to deal with a number of health problems, (a blood pressure check, arthritic knees, breathlessness and insomnia might be a typical combination), but often there are serious conditions which are linked in and need careful teasing apart

The drugs used for arthritis can increase blood pressure, or damage the kidneys, breathlessness could just be natural ageing, or represent an incipient heart condition and all of these issues need to be addressed

Added to this are the more profound effects of even simple medical problems.

Scratches and knocks take longer to heal; skin is more fragile and a blow against a table or stool can persist and unless dealt with thoroughly, brings on the anxiety, pain and disability associated with a leg ulcer

Even a urinary infection, a passing irritation easily cured by antibiotics in the young or middle aged, can lead the elderly to be profoundly unwell and lose their mobility, independence and confine them to bed, or even require admission to hospital

Clearly, this greater complexity carries with it greater risk. Indeed, research has shown that the more co-existing conditions that someone has, the greater the risk of ill-health due the interactions between the diseases themselves, or the drugs used to treat them

What this means for the GP and the patient

In practical terms, this interlinking of problems often puts greater demands on GPs’ time and the availability of time is often a barrier to providing the best possible care

Though the answer to this may be to spread problems more thinly over more consultations, for example, dealing with one or two issues at a time this can, ironically, be more difficult for the elderly

Getting to the doctor may mean demands on relatives for a lift, using poorly provided public transport, or expensive taxis, so trying to get everything sorted in ‘one hit’ is tempting

How to get the best out of your conversation with the GP

Perhaps the best advice is to start the consultation with a discussion

When asked “what can I do for you”, perhaps the answer should be direct. “My knees are my biggest problem, but I also have insomnia, breathlessness and need a blood pressure check, but if none of this are a danger I can always come back” would be music to the GP’s ears

It would allow a focus on the potentially dangerous breathlessness to be negotiated and then allow the patients priority problem to be dealt with

Dr Michael Ingram 

Dr Michael Ingram is a full time GP in a large practice in  Hertfordshire and has 25 years experience of General practice

Born in Kingsbury in 1957  and educated at Latymer Upper School in London then Charing Cross Hospital medical School. Reading VTS and joined his present practice in 1986.

Member of Hertfordshire LMC and the National LMC Conference Agenda Committee; Associate Trainer in General Practice. He has special interest in Travel Medicine and Member of Faculty of Travel Medicine RCPS (Gla.) .  Medical legal expertise and works as a medical expert, writes for the General Practice press and has broadcast extensively.

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