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Until death do us fall apart

Phil is feeling his age this week, but it has given him a fresh insight into the rise in GP referrals

Phil is feeling his age this week, but it has given him a fresh insight into the rise in GP referrals

I had one of my regular patients in this morning, a lovely old lady of around 80. Her joints were giving her grief. 'I usually walk here you know, doctor' (I do know. I often see her inching around the locale with her stick) 'but I swear I'm slowing down. It usually takes me half an hour' (it's a good mile) 'but this morning it took me nearly 40 minutes. Am I getting old?'

It was a good question. Maybe she is. Her hips certainly are; they barely move at all. Her other organs seem fairly sound. We talked about getting her an appointment with orthopaedics and maybe a couple of new hips. 'Would they operate on me at my age, doctor?' I reminded her that the Queen Mother was 95 when she had hers done, and she still got a good bit of use out of them.

In the end we decided that warmer weather in the spring would probably loosen her up a bit, and we'd leave the referral until next year.

'You know what gets me down?' she said. 'I'm still 18 years old inside. I can't touch my feet and I don't know when I'm going to pee, but I feel the same in my head as when I was a teenager.'

Last month I was 45. I have to admit to myself that I'm now a good third of the way through my life - if all goes according to plan - but my body is getting older while the inside of my head stays the same.

Clicking knee

It's a disconcerting thing. My brain still agonises and loves and worries as if I was in sixth form, yet I've got a skin tag, a patch of varicose eczema on one ankle and when I get out of a chair I go 'oooof'. One knee clicks and bits of my teeth are falling off. What is going on? I didn't sign up for this.

There has been coverage in the press recently of the gradual but marked increase in referrals by GPs. They've gone up by about a quarter in the past couple of years and I am beginning to understand why.

We are the victims of our own success. Life expectancy is rising. Practically nobody now dies in accidents or industrial incidents, and maternal and neonatal mortality has to all intents and purposes disappeared. Young people rarely die any more.

The incidence of COPD, once the scourge of this region, is dropping like a stone.

Most of our hypertensive patients are controlled and most of the HbA1Cs are in the recommended range. Heart attacks and strokes are down - and when they happen they get the treatment they need, so people don't die as often as they used to.

But they do go on having healthcare needs. So what we are left with is a population of young brains in old bodies that are gradually falling to bits - and we can't blame people for wanting medical care in their old age.

So fix my old lady's hips. There may be no economic benefit but she'll walk a bit faster and be able to tie her own shoelaces.

And take my skin tag off and fix my knee and give me some cream for my leg - and let me spend my last 20 years in a nursing home.

We might all bankrupt the country in the process but I see no alternative.

Dr Phil Peverley is a GP in Sunderland

Phil Peverley

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