I met with a GP rather early (because most GPs in my neighbourhood start work at some ungodly hour) to look at the care of a gentleman with dementia. If you're one for diagnostic labels, he's got F00.12 Dementia in Alzheimer's disease, late onset, severe.
On first appearences, he's muddled but manageable. He's not leaving the house, not posing risks to others outside, not wandering in front of traffic, he's fed and watered and cared for by his wife. Speaking with him he says all's fine and can't understand why my nurses and I visit him, or why we dragged his GP there on this occasion.
The truth of it is that the cost of keeping him at home is high. Arguably too high. His wife is going under, big time. He's disoriented so seeks reassaurance. All the time. Really, all the time, such that he follows her everywhere, even to the toilet. She's scared since at night he comes to shout at her, distraught, so she's had to buy a lock for her bedroom door. Her reassaurance doesn't work now, he just gets frustrated and angry and can't understand why things aren't as he recalls/believes they should be.
She's in floods of tears most of the day. She's not clinically depressed, she's just in an untenable situation where she's no longer valued or respected but, despite endless devotion, is shouted at and abused. She gets almost no sleep.
We know this because we visit her and I've been seeing her and her husband for some 4 years now. Their GP knows because I keep in touch with her and she visits them, mostly to support the wife. We're supporting his wife in letting go and choosing a care home for him.
When the government finishes shafting GPs and we've polyclinics in Tescos instead, will the medic or nurse practitioner see this couple at home over time, too? Will they do home visits at all? If they do visit him at home, not having met him or known him before, would they just take at face value what is seen or would they spend an hour unpicking it all then work with me and visit over time to see the system as a whole (physical health, mental health, disturbed behaviour, care for him, cost to the wife) or would they focus just on their patient? Focussing just on their patient, the wife would go under, he'd be placed in emergency respite care (so would be in a care home neither he nor his wife chose) and she'd feel tremendous guilt at having failed.
I've feelings of disquiet . . .