I expect Dr Crippen will not countenance such activity, but I found myself doing tea and cake this week.
I saw a lady in her mid 60's with a diagnosis of F20.0 Paranoid schizophrenia who's not been seen for years by General Adult psychiatry, by her choice. She'd become unwell, believing people were peering through her window and watching her at night. Her window was 9 feet up with no way this could easily happen, her partner said she'd often seen people when he was there and he couldn't, she'd called police and said the person was at her door right then, when the police answered it, but they couldn't see anyone.
So, it seemed most likely she was experiencing more illness, having elected to stop her medication a few months prior to this. We looked at coping and reality orientation but the answer, in part, was to start medication again.
She started medication enthusiastically, 2 months later she was completely well.
I reviewed her last year and found she'd remained well, her partner thought she was totally well, all was good. She was very happy with her medication, adamant she didn't want it changed and it kept her well. Her diagnosis was clear. Her treatment was clear. She was happy and asymptomatic (with no symptoms either of illness or of side effects from medication). She was again stable and remained so over 6 months. My work done, I had no more to fiddle with.
Not wishing to leave her high and dry, but equally not wishing to drag her back in x months for no purpose, I made an open appointment for her. If she, her partner, her GP, whoever, thought it would be a good idea for me to see her in clinic again they could just 'phone up and book in, without a need for referral. Excellent service, no? Get seen when you need to be seen, not at some arbitary time for no real reason.
She booked herself in to my out-patient clinic. I spoke with her GP before seeing her, in case there were any issues I needed to be aware of or that I could support the GP with, but he thought all was well. She came in to see me with her partner, I asked her what I could help her with. "Oh, just a check up, doctor."
I went through her mood, her thoughts, her general health, her medication, her functional level.
We discussed her medication, the role, benefits, consequences, dose regimen. She's perfectly happy, please don't change it, it's perfect.
So, why did she book in and spend almost 2 hours travelling to see me for half an hour with her partner, then almost 2 hours travelling back? "I just like you to keep an eye on things, doctor." I ask her if I should arrange another open appointment so she can book in if or when she wishes to. She looks crestfallen. She wants another appointment now. I offer to see her in 6 months time. She is very happy. Between now and then, she may become ill. When I see her in 6 months, she may be well. I shall see her any way.
For now, at least, I have very very few patients like this. Thus, for half an hour of my time twice a year, I capitulate and I do tea and cake. A misuse of precious Consultant time, or patient centred care?