Wednesday 21 January 2009


I've a patient who's not asking for anything.

I see her every so often, at her home, usually with the CPN who's doing her depot. I've known her for a number of years and find her utterly delightful. Because she's on a depot and now in her late 60's I'm obliged to review her depot medication and consider the risks, benefits, necessity and rationale for it with her, which is a pleasure to do since she's such good company.

She's never had any side effects on her current depot antipsychotic. She sees it as keeping her exceptionally well for a goodly while, now. She absolutely wishes to continue and is, "Very happy indeed, thank you, doctor."
She's had no recent changes to her drug regimen, no new over the counter medication, no substantial change to her physical health (although her osteoarthritis is worse), so all's stable and she continues on her depot antipsychotic unchanged.

A local lass visits. Helps her with shopping, helps her into and out of the bath. Put in about half an hour a day, at most, usually less. My patient gives her money for her help. It amounts to about £6000 a year. £34 an hour. My patient isn't wealthy and resides in a hellishly deprived area.

She has learning difficulties (LD) and bipolar mood disorder. Dunno if she's dementing or not, tricky to tease out the cognitive deficits that are through LD and through just getting older (Primary Ageing) and changes superimposed on this which could suggest a neurodegenerative process too. If she is dementing, it's early, with no compelling clinical evidence yet. But how ever you frame it, she's not sharp at working out details. And she's nice to people, she likes to be helpful.

She worries about money and won't accept elements of social care offered because she reckons that they cost too much (averaging just a few pounds a day).

She doesn't appreciate what the minimum wage is and what a typical wage for home care would be. The carer won't meet with anyone professional to talk about it.

I can't help but think this young carer is taking my patient for a ride.


XE said...

Wow, that's quite a salary. I do think that your patient is taken advantage of, it's quite unfortunate. Perhaps eventually you'll be able to gently nudge her towards a better care set-up; I do hope so.

Azulinebloo said...

This lady could be another one for an advocacy worker perhaps?

Anonymous said...

Does this not come under POVA?