Different types of tests and therapy are touted as being useful for the evaluation and treatment of patients who fall. This too has become a big business. I frequently get requests beseeching me to refer patients for "balance therapy." Companies that would like to appeal to my entrepreneurial spirit keep my office fax machine busy, trying to interest me in equipment to assess the fall risk of my patients. One recent fax demands to know if I am "a Pro-Active Doctor or Simply a Re-Active Doctor." The morning I fell on my face in the parking lot I was probably just a reactive (and embarrassed) doctor. The four-page fax advertisement went on to promise "five thousand four-color deluxe preprinted postcards to mail to patients" telling them of my new-found, proactive, anti-fall assessment equipment. Perhaps there is clinical merit for these high-priced gadgets, but I suspect that a decent history and physical does a pretty good job of identifying which patients are at high risk of fall and injury.
The worst-case scenario is having a patient fall in my office. I frequently help frail patients get down from the exam table. Sometimes they look at me a little bit quizzically or even get downright annoyed, as they tell me that they are capable of getting down without my help. But I always figure "better safe than sorry." Once they are safely down from the exam table, I remind them "Humpty Dumpty doesn’t doctor here."
Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind.