Monday 10 March 2008


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 . . .


Anonymous said...

"When the government finishes shafting GPs"

By which time there will be no such thing as a GP.

Fiona Marcella said...

Make no mistake the government WANTS to shaft GPs - but then again it wanted to control them in 1948. Their failure to do so is probably psychologically why a Labour Government can countenance using such tactics as working with Tesco's instead of working with the doctors in order to try to undermine them. They didn't succeed in 1948 and I have a hunch that, bloody though the fight might be, they're not going to now either. Drs Finlay and Cameron are alive and well and boy can they put up a good fight when they have to.

Elaine said...

Thank you for an excellent and thoughtful post about the government/GP issues from the, relatively, neutral standpoint of someone in a different part of the medical profession.

Dr Andrew Brown said...

I'm sure you are right to be worried. A large amount of what GPs do could be done by nurses with protocols and sessional doctors who fly in and out. But GPs do a lot of extra stuff to fill the gaps between what seems sensible provision and what an infinitely variety of patients actually need.

It's not just GPs of course. Throughout the NHS, staff have traditionally gone beyond the call of duty, out of goodwill and a shared sense of responsibility.

Let's hope the Government don't foul things up completely.

Made by Mandy said...


I saw something about carers on tv the other day. They are the forgotten ones.

And the news was not good. Many people seem to be caring for others with very little or inappropriate care support for them. They had the spokesperson for the national carers' association and a 'agony aunt' trying to offer support but it appears that social services aren't very pro-active at providing care. If people aren't on their cases all the time, they just leave them to 'go under' as you put it.

I don't know the logistics of all this but a more integrated care approach would seem the most useful one. The holistic model as I have heard it called seems appropriate. Where you look at the individual (with the illness/disability) and all that impacts on them. That would highlight the role of carers, or it should.

I think the GPs, specialists and social services et al...should be working in a more inclusive/ integrated way..rather than shunting people off here,there and everywhere to basically do it for themselves.

Maybe some of this is down to 'preciousness' of professionals. Some of it 'jobsworth' but whatever is stopping or slowing down the care support process needs to be reviewed and sorted.

If only it were that simple but it should be.

Made by Mandy said...

P.S. I have very little time for Rethink as a support organisation for the mentally ill but can say that a carer I know gets alot of support from the local Rethink carers group.

Perhaps, the lady you write about could be given details of a local carers support group. If there is one.

If nothing else she might find some empathy and understanding from other members.

Just a thought.

Calavera said...

That's so sad, and a really valid point. Who will look after people like the wife and the husband, and what sort of continuity of care will they get, the way things are going?


The future does not look too bright...

Calavera said...

Where have you disappeared to, then?


The Shrink said...

"Where have you disappeared to, then?"

Just not had anything exciting to share :-)