Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Estimating a patient’s age-clinical implications

Neil Baum, MD
Physician
June 22, 2014
Share
Tweet
Share

As a medical student I was in awe when a professor looked at a patient’s hands or nail beds and described their medical condition without taking a history.  I was also enthralled by a TED talk by the best selling author, Abraham Verghese, where he described a lesson that Arthur Conan Doyle, author of Sherlock Holmes, learned as a medical student at the medical school in Edinburgh, Scotland from the famous physician Dr. Joseph Bell.

Arthur Conan Doyle described the following exchange between Dr. Bell and his students.  A woman comes in with a child, and the woman says, “Good morning.”

Bell says, “What sort of crossing did you have on the ferry from Burntisland?”

She says, “It was good.”

And he says, “What did you do with the other child?”

She says, “I left him with my sister at Leith.”

And he says, “And did you take the shortcut down Inverleith Row to get here to the infirmary?”

She says, “I did.”

And he says, “Would you still be working at the linoleum factory?”

And she says, “I am.”

And Bell then goes on to explain to the students. He says, “You see, when she said, ‘Good morning,’ I picked up her Fife accent. And the nearest ferry crossing from Fife is from Burntisland. And so she must have taken the ferry over. You notice that the coat she’s carrying is too small for the child who is with her, and therefore, she started out the journey with two children, but dropped one off along the way. You notice the clay on the soles of her feet. Such red clay is not found within a hundred miles of Edinburgh, except in the botanical gardens. And therefore, she took a short cut down Inverleith Row to arrive here. And finally, she has a dermatitis on the fingers of her right hand, a dermatitis that is unique to the linoleum factory workers in Burntisland.”   All of this information was obtained within seconds of the patient being in front of the famous Dr. Bell.

I have prided myself in being able to estimate a patient’s weight and geographic origin of birth by a patient’s accent.  I try to estimate a patient’s age.  But I have found that if I overestimate a patient’s age by more than ten years, it is likely that the patient has one or more chronic conditions.  For example, a patient looking older than the stated age often has a higher BMI, might be a smoker or consume multiple alcoholic drinks every day, does not exercise regularly, may have COPD, may have a type A personality, may suffer from excessive anxiety or even depression, may have diabetes\metabolic syndrome, possibly hypertensive, may have diabetes mellitus, may have joint pain\arthritis and the list goes on.

On the other hand if the age estimate is 10 years younger than the actual age, the patient is likely to have a BMI <25, be normotensive, have a normal pO2, exercises a few times a week, a non smoke or drinks alcohol in moderation, normal cardiac and pulmonary reserve, not on multiple medications, and likely to be receiving regular preventive medical care.

ADVERTISEMENT

What does this have to do with our practice of clinical medicine?  The patient younger than their stated age is probably going to be a compliant patient and will look for non-medical solutions for minor healthcare problems.  If the patient is going to be scheduled for a surgical procedure, it is likely the patient’s health will allow him\her to safely undergo the procedure.

Now for my observation on the patient appearing older than the stated age.  He will be looking for a pill or procedure as a solution to their medical compliant.  This patient may be less compliant than the younger looking patient. If this patient is considering elective surgery he will likely need more preoperative medical attention from his PCP, cardiologists and other specialists.  These patients may have more difficulty in the post-operative period and require more rehab if they are considering orthopedic or cardiac surgery.

I have not put this observation to an evidence-based test but I have found this simple estimating technique may be helpful in my assessment of the patient and my discussion with the patient about treatments including surgery.

Neil Baum is a urologist at Touro Infirmary, New Orleans, LA, and author of Marketing Your Clinical Practices: Ethically, Effectively, Economically. He can be reached at his self-titled site, Neil Baum, MD, or on Facebook and Twitter.

Prev

Patient profiling is part of the medical school curriculum

June 22, 2014 Kevin 11
…
Next

Ethical physicians, now and then

June 22, 2014 Kevin 4
…

Tagged as: Primary Care

Post navigation

< Previous Post
Patient profiling is part of the medical school curriculum
Next Post >
Ethical physicians, now and then

ADVERTISEMENT

More by Neil Baum, MD

  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How the 10th Apple Effect is stealing your joy in medicine

    Neil Baum, MD
  • The hidden chains holding doctors back

    Neil Baum, MD

More in Physician

  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • How regulatory overreach is destroying innovation in U.S. health care

    Kayvan Haddadan, MD
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Estimating a patient’s age-clinical implications
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...