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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Physician Warnings for Persons with Impairments

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As a physician, I sometimes identify persons with conditions that make them vulnerable to accidents and injuries. Physical or emotional disabilities, a pattern of substance abuse, forgetfulness, dementia, poor physical condition, and many other predisposing factors can render a person more likely to suffer a mishap.

When I feel that it’s appropriate, I will tell patients to be particularly careful or to avoid certain activities altogether. But apparently, it’s not always good for a relationship to tell it like it is. 

In an article entitled “Physicians’ Warnings for Unfit Drivers and the Risk of Trauma from Road Crashes” (New England Journal of Medicine 2012;267:1228-36), Dr. Donald Redelmeier and colleagues informed us that physicians’ warnings to patients who are potentially unfit to drive had a number of intended and unintended effects. While these warnings were associated with a 45% decrease in the annual rate of automobile crashes, they were also associated with an increase in subsequent emergency department visits for emotional depression and a decrease in return visits to the responsible physician.

So, while some persons act responsibly after they receive admonitions to change their behaviors, being told that they are "unfit" for a certain activity may cause their mood to lower and for them to avoid the bearer of ill tidings (even though they are well-intentioned). 

I wouldn’t be surprised if this is the case when we tell an elder that it is no longer safe for them to climb, or a severe asthmatic that he or she should not scuba dive. Perhaps it’s not enough just to issue warnings. We should probably take the time to discuss the ramifications of the advice we offer in terms of lifestyle impact and mood. If someone has been really looking forward to something, or is beginning to face the realities of their limitations, it has implications beyond, “You should just stop doing this.” I know that I can’t exercise as often or as hard as I used to. In some ways that’s discouraging, even though it’s because I’m getting older.

Transitions can be difficult, so when we impose them by words or deeds, we should consider alternative activities, be there for the fallout, and accentuate the positive.

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Tags: General Interest

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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