Leia o texto a seguir e responda à questão.
Dr. John B. Murphy specializes in geriatrics and family medicine. He teaches and practices medicine in Rhode Island.
Q: As a physician who takes care of elderly people, what’s the difference between taking care of someone who’s quite old and someone who’s not?
DR. MURPHY: There’s lots of differences. The one that always comes to mind first is they have more stories and those stories are important to them. And it’s how I remember my patients. I now focus exclusively on taking care of older patients. But I was originally trained as a family physician before I did my geriatric training. And until just four or five years ago, I still had some children in my practice and many adolescent and middle aged people in my practice, although it was mostly older patients. And but the stories that patients tell me are what distinguishes that population the most. They’ve got richer and a longer history to draw on. It’s much more complex, it’s like taking care of the infants and children that I used to take care of because invariably, there are family members involved of the care. You have the 50 year old who comes into my office for hypertension and diabetes, or whatever, it’s the rare situation where I’m talking to family about that. Maybe the spouse coming in and wanting to know about diet or something. But there’s not that involvement of the family. It’s the rare situation that a patient comes into my office nowadays without a family member. Far more often than not, there’s a daughter or daughter- -in-law who comes in the office with the patient. And, in fact, there are some sons who come in, but I think I’m probably more likely to see the ex-daughter-in-law come in with her ex-mother-in-law than I am to see a son. And there are some sons who are doing superb jobs, but it tends to be the daughters and daughters-in-law who are doing the work.
Q: There must be some medical conditions that are much more serious for the elderly. Can you list off a few of those sorts of things?
DR. MURPHY: Oh, yeah. There’s a balance. I mean, feet are really important, for some people diabetes is important. But feet are what we walk on, and one of the major things that you need to be able to do in caring for older people is to make sure that they’re going to maintain their independence, be able to walk and not fall. Falls, hip fractures, are potentially inter-cranial bleeds, subdural hematomas and things that can occur with those falls, are a major issue. And so preventing falls is a key thing as a geriatrician that one’s thinking about, and feet are a part of it. In hospitalized or bed-bound patients, skin is a key issue. I’ll be making rounds in the hospital with some medical residents and they religiously will listen to the heart and lungs every time they go to see a patient, and if I have an older person who’s admitted for an infection in their leg or urinary tract infection, well I don’t think it’s inappropriate to be listening to the heart and the lungs. It’s very inappropriate to not look at the heels as they’re lying in bed, or their back to look for the early signs of pressure sores. And in fact, far more important to be looking at those things than it is, in that case, to be listening to the heart and lungs. So there are those sorts of issues. It takes longer for one of my patients to get from the waiting room to get to my exam room. It takes more to get them from the chair that I’m speaking to them in to the exam table. Hearing deficits create difficulty in communication. The communication issues for people who have cognitive deficits multiply. And so those complexities in gathering data and implementing plans, I think, make it a little bit comparable to the psychiatric situation where you’re dealing with the whole family. Visual problems, again, a lot of sensory deficits make it much more difficult. And our patients have much less reserve. Three days for anybody in a hospital bed recovering from a pneumonia, you’re going to be tired for a little while after. If you’re doing that at 93, it’s going to take a long time to recover from a brief hospitalization even though the illness, the bacteria is dead, the pneumonia is gone, but the de-conditioning that occurs in just a brief period of time with somebody who’s in their late 80s or 90s is pretty dramatic.
(MURPHY, J. B. Dr. Murphy Interview. 20 set. 2007. Entrevista concedida a Michael Kirk. Disponível em: http://www.pbs.org/wgbh/caringforyourparents/interviews/interview1.html. Acesso em: 20 jun. 2016.)
Com relação às opiniões do Dr. Murphy expressas no texto, considere as afirmativas a seguir.
I. O paciente idoso se diferencia dos outros na medida em que dispõe de mais histórias interessantes para contar.
II. A geriatria se mostra similar à pediatria, uma vez que, em ambas as especialidades, o médico lida também com a família do paciente.
III. Geralmente, quem acompanha os idosos nas consultas médicas são as filhas, as noras e até as ex- -noras, raramente um filho.
IV. É comum que as esposas dos idosos participem da consulta e queiram saber sobre restrições alimentares, entre outras coisas.
Assinale a alternativa correta.
