As my regular reader will know, there is a rant coming – but this time there’s a twist in the tale…
One of the stupidest of all the stupid things in our stupid job is the need to do the stupid traditional hoop-jump dementia blood screen before the memory clinic will accept a referral. Never ever in the history of dementia has the correction of any ‘abnormality’ picked up on this screen led to the resolution of memory issues, and that’s not my Alzheimer’s talking, that’s a fact.
Hence some choice expletives when I received a low vitamin B12 result in an obviously dementing lady recently brought in to me by her uncomplaining but ever-so-slightly-despairing husband. This meant B12 replacement and, therefore, the inevitable delay in referral to see if she’d get better, which she wouldn’t. And didn’t. She got worse.
At least now, I thought, I could refer her. So imagine my joy when that referral was bounced back by an admindroid demanding a repeat B12 level to ‘prove’ that her levels were back to normal. Yes. In a woman having regular B12. By injection. Now imagine my reply to that, and yes, it’s fair to say the memory team would have found it hurtful, though not so hurtful as it would have been had they been within arm’s reach.
In the midst of all this bureaucrockofshit, my patient deteriorated to the point of crisis
Problem was, in the midst of all this bureaucrockofshit, my dementing patient was deteriorating to the point of crisis. And that’s when I thought, ‘Aha! Dementia! In crisis! This is a case for the dementia crisis team!’ Followed rapidly by other thoughts such as, ‘But she hasn’t got a formal diagnosis yet, they’ve never seen the patient, I haven’t ruled out a UTI, I’m not sure what form to use, I don’t know the referral criteria, I probably haven’t got an up-to-date phone number’, etc etc. In other words, this would translate into yet more debate, frustration, delays and anguish.
Because that’s what happens, isn’t it? Take your average unstable patient, and whether you’re trying to refer them to CAMHS, the mental health team or the falls clinic, there is no doubt that, respectively, they would not fit the referral criteria, be too severe/not severe enough, or be falling in the wrong direction. You seek help, in desperation, from wherever you can, but because those you seek help from are so stretched, elusive, disillusioned or protocol-bound, all you find is frustration.
But I phoned the dementia crisis team anyway. And the most shocking thing happened. They took the referral. No quibbles. No demand for anything in writing. No passing me from pillar to post. Incredible. They acted like people who knew their job and were actually prepared to do it.
So there’s the twist. Not that, ha ha, two days later they bounced her back because her inside leg measurement did not fall within their referral criteria. No. They took her on and sorted her out. A bit of the NHS worked, in both senses of the word. The effect on me was astonishing. I nearly wept with gratitude and that in itself indicates that there is something seriously deficient in the current system.
And no, it’s not vitamin B12.
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield