Thursday, January 4, 2024

Cradle to grave: Through the generations

One of the fundamental concepts of being a family doctor is the idea of looking after families "From the cradle, to the grave."

I remember using this oversold phrase to buttress my passion for the career choice when I interviewed for my training post some 15 years ago.

Fast forward all these years later, to my reality of managing multi-generational mind sets. 

Patient 1: The Baby boomer

He's a 72 year old man who has recently had a routine health check. His blood tests have shown that his cholesterol levels are a bit raised and he has been advised that he would benefit from medication to lower his cholesterol to reduce his risk of heart attacks and/or strokes.

All other checks and tests are perfectly fine. In fact, he is in significantly better health than most people of his age. He has booked an early morning appointment to discuss this further. He is very well dressed in a smart shirt, jumper and chinos, and I notice that he is wearing smart, polished shoes. This is something I admire about the Babyboomer  generation. They're up early and smartly dressed, born out of habits from many years in one career in the same job.

"I have lived a good life" He tells me. "I have had a good career and good family, all my children are grown and independent. I have tried to live as healthy as I can but obviously my body is failing" He pauses for me to appreciate the seriousness of the situation.  

"I wouldn't exactly put it like that." I start saying. 

"Yes, I know what you're saying but what I would like is for you to sign me a "Do Not Resuscitate" form since I might have a heart attack or stroke soon. I want to go peacefully. I am not ready to end up on many medicines,  I am ready to face the worst."

Very confused, I spend the rest of the consultation reassuring him that he is not dying and indeed, in better shape than most of his mates. 

He walks away even more upright, with a spring in his step.

Patient 2: Generation X.

She is going through the menopause and everything is falling down. 

She cannot entertain the effects of the menopause in this very busy period in her life. She has a high profile managerial job and feels her team will obviously crumble without her, so she can not drop the ball now. The hot sweats and irritability are not helping. 

Her daughter has just returned from university saying she no longer enjoys the course she is studying and is lying in bed all day trying to figure out what to do with her life. Her father has had another fall in the care home and ended up in hospital. 

Her husband's construction business is not doing well and their mortgage is not fully paid. And her hair is falling out.

I empathise with this sister and sort her some HRT sharpish. It has worked wonders for others. I think she really needs breathing space. 

Patient 3: The Millenial.

Guy is 32 and has just been released from a stint in prison for accessory to murder and for causing grevious bodily harm. He needs a referral to be assessed for ADHD (Attention deficit hyperactivity disorder).

He has done some internet researching and thinks this might explain his history of violence. 

He has found some wholistic care centre offering specialist natural remedies and would like to apply for funding to be referred to this service.

I am on my most agreeable behaviour and promise to look into all of this for him, whilst mentally composing the letter to follow: 

"Unfortunately, the bosses at the top have refused to pay for this exotic service but you are on the 18 month long waiting NHS version for adult ADHD assessment and here's the number for the people holding you back. Contact them every month to check your position in the queue. "

I was not prepared to get in his bad books and I have learnt not to argue with Millenials. They know everything. 

Patient 4: Gen Z.

Next up is a young man looking all fresh and tight in a crispy new shirt and tie with his skinny trousers, heralded by the scent of his perfume. He's got his phone in his hand and tells me about his new important job in Tech, by way of explanation for the very important call that he may need to take mid- consultation. 

He looks so young! I am impressed. I still have to remind myself that people born in 2001 are bona-fide adults. 

"So what it is, is.. my girlfriend sent me this Snapchat message saying she needs some space."

I wait for the punchline. He sits tapping his feet.

"The thing is, I'm not sure what she means by that and it's causing me a lot of anxiety. "

I ask  "Have you spoken to her about it. "

"Well we've chatted about general stuff.  But we've not hung out for a couple of weeks cos she's like busy with work and stuff. My mum said to see if she's okay but she's done this Tiktok video with her mates last weekend so I know she's alright. Must be her new job. She's just got a new job and it's been a bit stressful, I think."

Followed by more details about how they were both stressed with working long hours 9-5 through the week, and how his mum identified symptoms of anxiety in him as she suffers the same. 

He lets it all out and finally comes to a resolution that he will go and see her. All by himself! I was so proud of him, I almost gave him a sticker!

Bring on Generation Alpha