To Your Good Health: Medical history helps physicians better understand patients
BY KEITH ROACH, M.D.
DEAR DR. ROACH: I am 77 years old. When I go to a new doctor, there is always that past history form to fill out. I know to include current medications, including OTC and allergies, but how far back should I go?
Should I include the tonsillectomy when I was in grade school (I don’t recall how old I was)? Or the surgery to remove a benign tumor from my right femur in 1955? The miscarriage in 1961? Or that the last of my five children was born over 40 years ago?
I would include the surgery because my right leg is about 3/4 inch shorter than my left. After all these years, it causes a back ache after standing too long. — S.B.
ANSWER: In general, doctors want all the information you can give. However, past medical history tends to become less important as people get older. I agree with you that the surgery on your femur is important: Even now, a leg-length discrepancy may still benefit from being addressed. A small (half the discrepancy or less) adjustment to the shoe of your shorter right leg may help reduce your backache.
If I were your new doctor, it would be important to me to know you had a 40-year-old son (and about the rest of your children), but that would be more to know who you are as a person. I also ask my patients to identify someone in their family who can help make decisions if you are unable to. That should be done formally, through a health care proxy designation, which is complementary to the advance directive that all adults should have.
It’s a privilege for me as a primary care doctor to get to know my patients and follow them over years, sometimes many years.
DEAR DR. ROACH: I’ve read about a new drug for depression that is supposed to work quickly. Is it safe? — N.F.
ANSWER: Ketamine, like many biological molecules, has two forms that are mirror images of each other. Esketamine, the more active of the two, has recently been approved by the Food and Drug Administration for treatment of depression, and is the first new class of approved depression medication in years.
It is striking how quickly it works. With the intravenous drug, test subjects found their mood improving within hours, as opposed to the weeks it takes most current drugs to work. With the nasal spray form, the kind just approved by the FDA, benefit began within two hours and persisted throughout eight weeks of follow-up. It is not yet clear how long the effect will last and whether (or more likely, how often) additional doses will be necessary in long-term use. It is approved to be given only in a doctor’s office, and only for people who have been resistant to other medications.
There are significant potential harms. Blood pressure goes up after the dose, and people can have sedation and disorganized thinking after treatment. For now, the drug is given only through a restricted distribution system.
I am cautiously optimistic. Depression is a serious disease with treatments that are not as effective as we would like. Any new type of treatment is a source of hope; however, I have seen potential “miracle drugs” turn out to be only moderately useful.