I also remember asking @Cmdr_Hadfield this question!

I quote him in my work as a geriatrician. We get very caught up in doing a full “Comprehensive Geriatric Assessment”, in great detail.

Sometimes we need to revisit:
Why did the crisis arise today?
What needs done now? https://twitter.com/trisha_the_doc/status/822579447509434373

We make long “Problems Lists” for our patients, and set about trying to solve (or ameliorate) each and every one of them.

Very laudable, but easy to lose focus on what actually matters to the patient, today.

There’s also a risk of us overwhelming the patient with all of our offers of investigation and intervention.

If they only presented for a specific purpose, we need to sure that consent is given for the other “and while you’re here...” stuff.

I think GPs are often very good at this. I’m not a GP partly because I couldn’t see myself working in ten minute slots.

But they don’t either. They sort today’s problem, and then invite the person back for a further review another day, if that’s needed.

It’s a balance, of course, because if you can be efficient and do several things at once, that has some advantages.

But it can be overwhelming and also lead to losing sight of the original problem.

When we meet an older person admitted with a fall, & see them in the acute ward, we need to consider the menu on offer:

1. No injury. Known frailty. Return home
2. No injury. Reason for fall unclear. Admit for further investigation & therapy

Or, as above but follow up at HOME!

I learned a lot from my therapy colleagues in the Rapid Response Team back in 2014.

We saw a bloke whose wife had just been admitted to hospital. She was his carer, so it was a crisis.

I offered to make the notes, while Duncan, the physio, did his assessment...

I made a beautiful list. In legible handwriting too.

About the prostatism, the cerebrovascular disease, the polypharmacy & more.

Duncan shook his head:

“Nice list, Trish, but no...”

“Today, his problem is that his wife is ill. We need to work out how he can cope without her!”

I’ve learnt from Commander Hadfield, & Duncan the physio, that sometimes the best thing is to deal with the immediate crisis. Not to look too far ahead, or we’ll become overwhelmed.

Especially at the moment, focussing on small wins can be good. Changing the world can come later.