“Failure to thrive” or failure to look?

Geriatrics is a field of investigation. To solve medical puzzles, doctors must become detectives, identifying the effects of overlapping causes that include chronic conditions, acute injuries, social factors, and the normal aging process. It is a challenge that tests the patience of many doctors; the number of board-certified geriatricians in the United States, now just over 7,000, has been decreasing since 2017.

By masquerading as a diagnosis, the term “growth failure” shortens the investigative process, stopping the investigation before doctors can determine the true cause, said Dr. Clara Tsui, a geriatrician at St. Paul's Hospital in Vancouver, British Columbia. Last month, she saw the label in the medical records of an 82-year-old man with Alzheimer's who had fallen and hit his head. Although a brain scan showed internal bleeding, the man was only diagnosed with “failure to thrive” – which, Dr. Tsui noted, “is not a diagnosis at all.”

Dr. Martha Spencer, a geriatrician and Dr. Tsui's colleague at St. Paul, called the phrase vague, demeaning and anti-aging. “It baffles me why he went on so long,” she said.

In 2020, Dr. Spencer and Dr. Tsui conducted a study that found that older patients who were given the label “failed to thrive” waited significantly longer to be admitted to the hospital. Once hospitalized, these patients faced longer hospital stays, which are known to increase the risk of infection and other complications. At the time of release, most of them – 88% – had received specific diagnoses, such as kidney failure or severe dehydration.

In other words, the authors concluded, the label “failure” tended to mask treatable diseases, burdening the patient with unnecessary delays in treatment. A diagnosis of “failure” could become a self-fulfilling prophecy, leading doctors to assume they are just another elderly patient on the inevitable path to decline. (Similarly, researchers have found that “acopia,” a form of medicalese that literally means “not to cope” and is still sometimes used in the United Kingdom and Australia, often leads doctors to overlook acute illnesses.)

Leave a Reply

Your email address will not be published. Required fields are marked *