Advanced Care Planning- A message that your future you will be grateful for!

What could be less sexy than filling out an  Advanced Care Directive form to let family and doctors know what medical care to provide or not provide you, if you were so unwell that you were unable to make your own  decisions! Here I explain why I think filling out one of these forms is a great idea.

Medicine has become so advanced, that a sick person can be kept alive even when major organs and bodily systems are failing. We can prop up failing hearts, kidneys and digestive systems way beyond when meaningful quality of life is possible.

Whilst this is marvellous in some ways especially when a good health outcome may be ultimately possible, the reality is that doctors are not very good at letting things take their natural course. Because of their training and culture they often have the sense that they should treat or manage health conditions sometimes even to the point of futility. 

In Australia, on a state-by-state basis, there is now available an Advanced Medical Directive form, that you can fill out with your doctor. In it you can express your preferences for quality of life, what outcomes would be acceptable and what outcomes would be unacceptable to you, and to what extent you would want your life prolonged.

Obviously this is a sensitive and confronting process but in the event that you should have severe illness, an Advanced Medical Directive will provide valuable guidance to your family and your doctors.  So whether you are currently suffering from a serious illness or even if you are well, taking a moment to fill out one of these forms is a most worthwhile activity.

These forms and the process are discussed in details in the latest familydoctor.expert video.  

When is normal forgetfulness of ageing more suggestive of dementia?

I was surprised and slightly perturbed to read that after the age of 40 we are all losing about 10,000 neurones a day- luckily we have billions to start with! But it's true that as we age we all do experience some normal age-related cognitive decline.

This can manifest with less ability to manage tasks that require divided attention.  I'm afraid I'm aware of this catching myself recently asking a cafe to turn down the music while I was working on something important on my laptop! Just becoming a grumpy old man perhaps?

As we get older our cognitive processing can get slower too, though most of the decline seems to be a retrieval issue rather than a storage issue. It's like all the clothes are still in the cupboard but we can't find that jacket we are looking for just when we want it.

And then there's always that concern about dementia, which is when memory problems go beyond normal age-related cognitive decline and in fact affects some 300,000 Australians.  Actually dementia is not one disease ~ there are lots of different types with 70% of cases being what we call Alzheimer's disease and about 10 to 15% being vascular dementia due to poor blood supply to the brain. 

So the question is what are the first cognitive domains affected in dementia which might suggest memory problems beyond normal aging? Short-term memory and orientation to time often are the first affected.  So people with early dementia may well forget what they had for lunch, miss appointments, or might be a bit confused about the time relationship between recent events.

In any case if you would like to read more about this important issue, I highly recommend the chapter in our Future Leaders book Living Life Loving Life, called Brain Health by Professors McFarlane and O'Connor.  They are leading clinicians and researchers in Australia in the area of cognitive decline and dementias  

And of course  If you are worried about your memory, or that of a loved one, go along to your GP who can do some simple tests to see if there may be a more serious reason for memory problems  and refer you if necessary.  

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Read the full echapter on Future Leaders

New Evidence Based Medicine Podcast with Dr Dan - Review

Evidence-Based Medicine Podcast with Dr Dan- Review

A great new podcast on the scene is hosted by Dr Daniel Aronov (AKA Dr Dan) called Evidence Based Medicine and is being subscribed at a rapid rate on itunes. For people who haven't heard of this concept of evidence based medicine before, it’s basically an approach to summarising top-quality research studies to help doctors optimise their clinical decisions.

Dr Daniel Aronov provides listeners with a most entertaining and sometimes humorous, well informed description of the latest randomised controlled studies. He also places these studies in context, and discusses how the studies are impacting on current clinical practice, and the latest professional guidelines.

It's a fantastic resource for busy doctors, especially GPs, who are pretty unlikely to ever dig out the original randomised controlled trials unless they happen to be academics linked in with a university.

I immediately was engaged to hear about the latest studies which impact on the decisions that I make with my patients- for example, the core question for GPs about how low to target blood pressure control in their patients. It's not all whiz bang high tech medicine either. For instance, Daniel looks at some recent evidence around best treatment for warts.

One really insightful aspect of the podcast is that it doesn't just report the upside of treatments, but carefully looks at the side effects and complications. For example, getting blood pressure really low may be great to reduce heart disease but what's it doing to our patients’ kidneys?

Daniel also provides many insights which doctors don't usually get from the professional guidelines. For example, the number needed to treat is a technical term which gives doctors and patients a sense of how effective a treatment really is and how many people would need to be treated to actually achieve a benefit for one patient. It's enlightening to realise that some of the claims of drug companies actually relate to tiny percent improvements for our patients.

There are some moments in the early podcasts where some of the technical terms and numbers get a bit overwhelming for the uninitiated, but it sounds like Daniel is tightening up his complexity budget for listeners as the podcasts evolve! A lot of the nitty gritty numbers are migrating on to the accompanying show pages, so this will only improve listenability.

family doctor.expert wishes Daniel lots of success with these podcasts and will be listening with interest to this great new podcast- a wonderful resource for doctors and for enthusiastic patients who want to go to the original source of evidence regarding their treatments.

Subscribe to Evidence Based Medicine Podcast