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Patient expectation versus reality

Dr John Grant, outlines his thought process when assessing benefit claims.

Dr John Grant, receives a copy of Dr Phil Hammond’s latest DVD, Dr Phil’s Rude Health Show.

You know the feeling when your eye alights on the name at the top of the blue badge application and you do a double take. OK, in the ‘chancer’ stakes he does not reach the level of some of the more notorious DLA higher mobility claimants who have been outed running the touchline as an assistant referee or displaying virtuoso dancing skills. However, you know he is capable of walking a quarter mile from the local pub and if his speed and manner of walking is impaired then this owes more to the liquid refreshment partaken than to the antalgic gait from his mildly arthritic hip.

Then there is the mistaken impression with some patients that a diagnosis entitles them to awards. Take the patient who has been diagnosed as having COPD. When I phone the patient to forewarn her that the local council will not be sending a blue badge in the post because I really cannot, hand on heart, declare that she meets the criteria for ‘virtually unable to walk,’ there is an extended silence.

‘But,’ she eventually says, ‘I get very breathless whenever I walk and I cannot walk far.’ ‘The practice nurse saw you six weeks ago for your annual review,’ I reply ‘and she has recorded that you are doing very well and grades you as Grade 2 on the MRC Breathlessness scale, which means that you only get breathless if you are hurrying on the level or walking up an incline.’ The silence seems more resentful and is broken by ‘Well, if you cannot help me, doctor’ delivered so pitifully, an appealing last throw of the dice.

If trying to reign in patient expectations to realistic levels is not trying enough, there is the well-meaning but misconceived ‘helpful advice and guidance’ from some healthcare team members regarding benefits that patients may be entitled to. A form on Mr A arrived from the council to claim reduced council tax on the grounds of severe mental impairment. Now, Mr A does have mild memory problems and I referred him to the memory clinic and they made a diagnosis of dementia. However, he goes out by himself, usually manages to keep appointments with me and sometimes even remembers why he made the appointment. I study the criteria on the form: to qualify, one needs to have an incomplete or arrested development of the brain, mental illness or dementia; and have severe impairment of intelligence; and severe impairment of social functioning. I look at his notes and see he was reviewed by the dementia team three weeks before. Coincidental timing? I phone the team member who saw Mr A.

‘When you saw Mr A recently, I was wondering if you mentioned anything to him about making a claim for reduced council tax?’

‘Yes, he has got dementia so he is entitled to it.’

‘Well, I think that’s not quite right. He may be entitled to it if he is severely mentally impaired.’

‘We advise everyone with a diagnosis of dementia to apply.’

‘But,’ says I, ‘your letter says he still drives 30 miles to visit his son.’

‘Oh, we do not tell people they can no longer drive as it can upset them, but we advise they have their driving assessed by the approved DVLA assessment centre locally. ‘Mr A did this and he passed,’ is the reply.

I am absolutely dumbfounded. I state the obvious: ‘Do you think there is a contradiction in recommending a person applies for a benefit on the grounds of severe mental impairment when that person has been assessed fit to drive?’

There is a pause, followed by a laugh, believe it or not, and without any obvious embarrassment: ‘I see what you mean. I will discuss it with the team.’

By Dr John Grant

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