A 72-year-old man comes to your surgery and says that he wants to run a half-marathon in six months’ time. The last time he was seen was the previous year for his routine flu jab, and he is not on medication. How would you advise him?
Dr Manish Bhasin’s view
This elderly man is a refreshing change: most people in his age group are on multiple drugs and spend most of the time struggling to manage their long lists of medication.
I would first look at the patient’s notes and obtain a clear picture about his past history and familiarise myself with his social circumstances.
I would ask him why he wants to participate in the event. For example, is he doing it to raise money for charity, has he participated in a similar event in the past, is this a way to get to know more people, or is he having any underlying feelings of loneliness or depression? I would also find out if he has taken any steps to prepare himself for this marathon.
Respecting his autonomy and trying to balance with the actual observations clinically after a thorough cardiovascular, respiratory, and locomotor exam, I would be supportive of this decision, with appropriate advice if necessary.
I would, however, ask him to meet one of the event organisers, and encourage him to seek advice from a professional trainer in order to build up his stamina.
- Dr Bhasin is a GP registrar in Warrington, Cheshire
Dr Fola Olaleye’s view
I would want to explore this patient’s reasons for wanting to participate in the event. He might see it as a way of keeping fit and healthy, or he might have been running marathons on a regular basis.
I would also want to know if he has any concerns regarding the likely risks of unaccustomed exercise, and also what he expects from this consultation. He might want to have a physical examination or tests to reassure him that he is fit and healthy.
I would look at his records to check that there is no past history of serious cardiovascular conditions. Also, a thorough cardiovascular examination would be very useful.
Even if the results of these investigations show that he is fit and healthy, I would still feel obliged to seek the opinion of a geriatrician to be on the safe side.
Providing that the patient is capable, he retains the autonomy to do whatever he wants. However, I would guide him towards what is in his best interest by advising him of any reasonable concerns I may have regarding his physical fitness. I would certainly make an adequate documentation of the consultation.
- Dr Fola Olaleye is a GP in Medway, Kent. She qualified as a GP in February 2006
Dr Tillmann Jacobi’s view
First I would congratulate this patient on keeping himself in good health and for continuing to set himself new goals. I would then explore and try to understand his motivation and consider treating any underlying anxiety, denial or mental health issues. I would also ask him about his previous experience of this type of event.
A basic check of his BP, BMI, heart-rate and sounds and his respiratory capacity is probably adequate, but I would be cautious about requesting detailed tests, such as ECG and blood tests. These tests cost time and money and may give false assurance.
I would explain to him in a clear but friendly way that I might be, personally, happy or not so happy for him to go ahead with the half-marathon but that professionally I am having problems approving his decision. He has to be aware of the dimension and impact of such a distance and needs to act sensibly and responsibly.
I would need to record this consultation clearly in the notes in case of complications or complaints.
It would also be worthwhile to consider follow-up. I could suggest that he joins a local running club. Some clubs have very well-organised local and regional teams which are happy to advise runners and provide training information and links to experts.
- Dr Jacobi is a salaried GP in York. He qualified as a GP in February 2005
- How you can advise an elderly patient
- Look at the patient’s notes and obtain a clear picture about his past medical history.
- Try to gain further information as to why he wants to participate in the event.
- Enquire about past running and competing experience.
- Carry out a basic check on his health and a cardiovascular examination.
- Suggest he meets one of the event organisers and encourage him to seek advice from a professional trainer, or encourage him to join a local running club.
- Make an adequate documentation of the consultation.