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Introduction to Part 4
Introduction to Part 4
Thus, ever drawn toward far shores uncharted, Into eternal darkness borne away, May we not ever on Time’s sea, unthwarted, Cast anchor for a day? Alphonse De Lamartine The passing of time, though elusive, leaves a tangible mark on living matter. Aging characterizes an inevitable evolution of the body whose quantification is determined by chronological age. However, this mark of time is highly variable and multifactorial. The chronological age criterion only imperfectly reflects the actual aging of the body, and strong variations can be observed between individuals who are of the same chronological age, which makes the management of aging difficult to achieve. In Western societies, however, aging continues to occupy an increasing place, disrupting established conceptions in the social, economic and health fields, thus becoming a significant political subject. Health, and therefore medical practice, has been greatly disrupted in the past 50 years (especially due to the appearance of antibiotics) by this change in the age pyramid. From targeted care in a young population, the physician has shifted to multidimensional care in an older population. The bronchitis in the young dynamic frame has nothing to do with the bronchitis of the suffering octogenarian. Where doctors will take action within 15 minutes for a young patient with all their bookish knowledge, they should have patience and experience to understand the potential morbid cataclysm of the elderly person’s bronchitis.
122
Health Efficiency
In negotiating care modalities with the elderly patient, physicians must integrate the physical, psychological, social, cultural and existential dimensions, taking advantage of the knowledge and trust generated by repeated contacts. Indeed, they often know their patient well, and like a cancer specialist, as has already been said before, they live this long devastating agony with a forced fatalism. The older the patient gets, the more they must have a synthetic mind where the part related to the context of their thinking, aging with the changes that accompany it in the patient, increases the complexity of this approach. They can no longer consider the reason for their visit in a single clinical dimension but rather according to all the dimensions provided by the associated co-morbidities whose prevalence increases with age. They must then include this management in a public health approach aimed at anticipating these co-morbidities in a clinical and economic ethical concern. In this perspective and in view of the increasing aging of the population, the daily organization of the doctor becomes increasingly difficult. With an estimated average consultation time of 16 minutes, quality management assurance forces physicians to use effective related tools to help them maintain their role. These tools can have two vocations: a diagnostic or prognostic role in a pathological state already advanced and a preventive anticipatory role in a healthy state. This last vocation has been explored many times but still opens up many possibilities for reflection.
Thus, ever drawn toward far shores uncharted, Into eternal darkness borne away, May we not ever on Time’s sea, unthwarted, Cast anchor for a day? Alphonse De Lamartine The passing of time, though elusive, leaves a tangible mark on living matter. Aging characterizes an inevitable evolution of the body whose quantification is determined by chronological age. However, this mark of time is highly variable and multifactorial. The chronological age criterion only imperfectly reflects the actual aging of the body, and strong variations can be observed between individuals who are of the same chronological age, which makes the management of aging difficult to achieve. In Western societies, however, aging continues to occupy an increasing place, disrupting established conceptions in the social, economic and health fields, thus becoming a significant political subject. Health, and therefore medical practice, has been greatly disrupted in the past 50 years (especially due to the appearance of antibiotics) by this change in the age pyramid. From targeted care in a young population, the physician has shifted to multidimensional care in an older population. The bronchitis in the young dynamic frame has nothing to do with the bronchitis of the suffering octogenarian. Where doctors will take action within 15 minutes for a young patient with all their bookish knowledge, they should have patience and experience to understand the potential morbid cataclysm of the elderly person’s bronchitis.
122
Health Efficiency
In negotiating care modalities with the elderly patient, physicians must integrate the physical, psychological, social, cultural and existential dimensions, taking advantage of the knowledge and trust generated by repeated contacts. Indeed, they often know their patient well, and like a cancer specialist, as has already been said before, they live this long devastating agony with a forced fatalism. The older the patient gets, the more they must have a synthetic mind where the part related to the context of their thinking, aging with the changes that accompany it in the patient, increases the complexity of this approach. They can no longer consider the reason for their visit in a single clinical dimension but rather according to all the dimensions provided by the associated co-morbidities whose prevalence increases with age. They must then include this management in a public health approach aimed at anticipating these co-morbidities in a clinical and economic ethical concern. In this perspective and in view of the increasing aging of the population, the daily organization of the doctor becomes increasingly difficult. With an estimated average consultation time of 16 minutes, quality management assurance forces physicians to use effective related tools to help them maintain their role. These tools can have two vocations: a diagnostic or prognostic role in a pathological state already advanced and a preventive anticipatory role in a healthy state. This last vocation has been explored many times but still opens up many possibilities for reflection.