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Holding court at a case conference

Jobbing Doctor has to endure a case conference for a patient with Down's syndrome, but quite enjoys himself

The case conference is generally a process that I avoid. Case conferences are always called for by people in social work or managerial roles (sometimes in education), and over the last many years I must have been invited to hundreds.

I have attended three.

Fortunately they are fairly easy to avoid. The reason is that I have to attend case conferences in my non-clinical, educational or administrative time in the week. This is what many people call their lunch hour. Many other workers like to preserve their lunch hours to have, well, lunch; I don't blame them. My lunch is often parked up between house calls listening to BBC Radio 4 or Radio 3.

For years people called for case conferences at 10 am on a Monday morning. Unsurprisingly, I am rather busy at this time. Saving lives. Making the blind to see and the lame to walk (or is it making the blind to walk, and the lame to see?) So I politely decline and say ‘I'd love to come, but....' That has worked for many years, and fuels the suspicion in parts of the social work profession that doctors are uninterested, don't want to take part etc. To use the common argot - ‘whatever'.

They have got wise to that, and now call for case conferences at 2 pm - still reasonably avoidable, and more recently at 1 pm. More difficult to avoid.

I went to one of these this week. I arrived fashionably late (8 minutes) although that was accidental, as the traffic was backed up because of road works.

There were 20 people packed in to room to talk about one patient. Community nurses, speech therapists, social workers, the learning difficulties team, managers, carers, workers, students, the family

After introductions, we had an introduction to say why the conference had been called. It was about an elderly lady with Down's syndrome who has developed epilepsy and dementia (two frequent effects of Down's syndrome over 50).

The reason was that the privately-run home is very twitchy about how to deal with her decline. They started to talk about protocols, and pathways, and ‘journeys'. They were concerned as to what was expected from them, and how they could adhere to best practice and make sure that they were protecting themselves from criticism. Therein lay the rub: this was as much to do with process as it was to do with my patient.

I was surprisingly coherent and eloquent. I pointed out that I had know the patient for 30 years, and she always used to greet me with a hug and a kiss when she was non-demented. I had looked after all her health needs throughout that time, had managed her decline, and the family had complete faith in me. That complete faith is a scary thing, of course, but I will leave that thought for another time.

I said that if there was any deterioration, then they were to contact me. I would make decisions on whether she was to be managed palliatively, or whether I needed the help of other professionals. The buck stopped with me.

There was an audible sigh of relief from all that they could park that problem, as they see it, with me. It is something that the family doctor has always done. I'm not exceptional. I am a doctor for the family and now everyone knows it.

I mean it, of course. I trust the family to contact me if I am needed. they know my home number (which is not ex-directory).

They also have my mobile number.

Jobbing Doctor has to endure a case conference for a patient with Down's syndrome, but quite enjoys himself