Thursday, April 29, 2010

The Judgment Call

This post comes with a spoiler. There follows a replay a scenario I encounter five or six times a year. It's one of the very few (I hope) red rags that I can't help but charge when they are waved in front of me. I'm disappointed that after twenty years behind this desk I'm no better at handling them, and I know that what follows might well provoke an "equal and opposite" reaction in some readers. Please just take this as a glimpse into the darker workings of the Jesterly mind and not as implied criticism of anyone else.

If having read it you then have insights to share I'll happily receive them, and if you feel moved to "flame" then vent away by all means-- just don't expect a very sympathetic hearing if you do. On the other hand I promise I'll sit on my hands and not bite back.

So, now that's out of the way;

Monday 10.00 Request received to visit to Mrs Grundy.

Monday 13.00 Visit to Mrs Grundy, a lady well past retirement age. She requests visits roughly once, sometimes twice, every month or so. I find her, as I always now find her, seated in her living room, watching TV and with her lunch, three parts eaten, on a tray on top of her trolley / walking aid. Today she's feeling a bit chesty, and as is also often the case, her chest is essentially clear, but she has a nagging catarrhal cough that's been hanging on since New Year. We agree that it's a nuisance, but that she's not unwell, and there's nothing in her presentation that would indicate antibiotics are likely to help at all, and that the linctus she swears by is still possibly her best choice for symptom control. As is now her norm she sits barefoot with slightly puffy ankles and with an arcade of tiny thread veins and capillaries running the length of the outside edges of both feet. She frequently comments on them, but does not do so today. I decide to let this particular sleeping dog lie.

Tuesday 09.35 Request for visit to Mrs Grundy. Carers noted "Swollen legs and blue feet".

Tuesday 12.25 Telephone call to Mrs Grundy. She's aware of the carer's request, but agrees her feet are no different than they have been for the past year or two, and that she would not welcome compression (the only sensible "treatment" option here) even if I were to offer it to her, which she's sure I won't because she's made it very plain how she feels about this before. We talk about her trying to elevate her legs a bit more (something we both know she's unlikely to do-- but feel we have to discuss for form's sake). She thanks me for the call and agrees there's no need for a home visit.

Tuesday 14.40 Telephone call from Mr Grundy Jr complaining that "the Doc refused to visit my mum".

Tuesday 14.47 Mr Grundy unavailable on mobile number given to staff when I try to call back.

Tuesday 15.50 Mr Grundy finally answers mobile and staff put him through. We discuss the fact that his mum's feet have been as they are now for years and were fine in that context as recently as yesterday, and that she herself says they are no different today. "But the carer says she thinks mum's got a thrombosis so you've got to see her". "You know. For peace of mind." I remind Mr Grundy that if he or his mother are unhappy with the service we offer they are at liberty to register her elsewhere. He tells me he thinks he will.

Tuesday 19.00 Visit to Mrs Grundy. Her feet are as they always are and ever are likely to be. There is no evidence of thrombosis, but at least now Mr Grundy can sleep easy in his bed.

The main thought that occurs as I drive away is that I'm being used as a form of surrogate, by a son who is unwilling to engage directly in his mother's care. This would be fair enough were Mr Grundy living and working in Kent or Aberdeen, or Spain, or Florida-- as has been the case with others I look after. But Mr Grundy lives three streets away from his mother, and yet, for all his willingness to complain about the surgery and my approach to his mother's care, she sees me far more often than ever she sees him. I'm left with the disappointing impression that she might almost be better off if he did live somewhere far far away if this is his idea of "caring".


Anonymous said...

I live close to my elderly father. I think he'd hit the roof if I phoned his GP.

Have you tried telling Grundy junior that you cannot discuss his mother's health for confidentiality reasons?

nickynockynoonoo said...

Perhaps you need to record your phone calls "For training purposes", just to CYA

Z said...

But if you didn't visit and anything happened, you'd be blamed and he'd be the loving and concerned son. It's a bugger, isn't it, dear Dr J?

Anonymous said...

Dear Dr Jest,

Sorry to leave a message here, but I couldn't find an email address in which to contact you.
We are about to publish a book called Sick Notes, by Pulse writer and GP Dr Tony Copperfield, which I thought you might be interested in reading.
I wondered if there was an address where I could send you a copy for possible review on your blog
Please get in touch if you are interested:

best wishes

Sam Collins

BenefitScroungingScum said...

Hi Dr J! It's a while since your last post so hope all's well?
I seem to remember you wanted to see Australian Pink Floyd last year? Not sure if you know but the tickets for Roger Water's The Wall tour are on sale today. Hope you get the chance to go, BG x

Nostrumdammit said...

I'd like to care for a little filly like that. What price the info Doc?
Oooh those thready veins! Stirs the old juices I'm telling you.