When you get to my age, your sphincters can let you down. Which explains the damp patch which occurred as a result of the following conversation between myself and Pulse’s news editor on the phone yesterday.
News Editor: Apparently doctors may have to apply for permission to the local authority or PCT to prescribe antipsychotic drugs to patients with dementia or in elderly care homes.
Me: And if we don’t?
News Editor (without missing a beat): You get sent to jail for five years.
Nice one. Pant-wettingly hilarious. But it’s true.
Blimey, that’s a bit of a leap. One minute, prescribing antipsychotics to the elderly knocks a few points off my local prescribing incentive scheme, the next it’s a custodial sentence. What next? Community service if I overdo the ciprofloxacin? Execution if I start prescribing interferon? (Note, irony: it’s a life-saving treatment).
Look, I really can’t be arsed to once again go over the issue of why GPs prescribe anti-psychotics to these patients. If you’re interested, take a look here.
But I truly resent the implication behind this bonkers threat. Which is that doctors are wilfully indiscriminate and dangerous, and that the only way to change their behaviour is to dream up disproportionate and headline-grabbing punishments.
So I’d would welcome those who come up with this insulting cack to spend a little time on Planet Primary Care, in the orbit of a care home for the elderly.
We will receive a phone call from distressed staff about one of the inmates going bonkers. They will have tried all usual sensible ploys, and also the insensible ones contained in the guidance, like putting on all the lights, giving his feet a nice rub and playing Andrew Lloyd Webber’s greatest hits. The CMHT will make an ‘assessment’, but only in ‘a few days’, the CPN will not be answering his bleep, the staff will be threatening to walk out and SOMETHING WILL NEED TO BE DONE NOW.
If I was that man and I suddenly became sentient enough to make a sensible decision, I’d vote for the antipsychotic. It would make everyone’s life that bit better. If it happened to shorten mine via a cerebrovascular coup-de-grace, so what? And if you want to view that as an advance directive, fine. How much fun am I having clearing up my own puddles?
Just like I’ve got to do now, in fact.
Dr Tony Copperfield is a GP in Essex.