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The embroider’d cloths of hell

‘Had I the heaven’s embroider’d cloths,’ I think, as he shuffles painfully into the room. But even Yeats can’t help me as the consultation starts, like so many, with utter confusion.

‘I thought I was seeing the physiotherapist about my back,’ he begins. He being a stoical, elderly man with crumbling joints but intact mind – I know, because of his impeccable score on the obligatory dementia screening. ‘But she said she couldn’t deal with my back because I’d been referred about my hip.

‘If I want my back treated I need to be re-referred. Back to her.’ He says this with a barely perceptible raise of his eyebrow, betraying a dissatisfaction he’d never articulate.

I’m lost already. Back treatment? We need to back-track. So I click through the hospital communications until I find the key letter.

The pain clinic specialist has referred him to physio, yes, for his hip. And his back? Aha. The plan is some injections to his spine. Just as soon as he comes off that pesky warfarin he’s taking for the DVT caused by the immobility resulting from the pain in his back and hip, etc etc. He has an open appointment for when he won’t bleed all over the pain clinic carpet.

Hang on, though. His DVT was nine months ago. And the anticoagulation clinic letter states clearly: ‘Duration of treatment, six months.’ 

I quiz him on this. Yes, he has his blood tests regularly. Yes the anticoag lab advises on his warfarin dose and no, they haven’t told him to stop it.

Looks like he’s received three months’ unnecessary anticoagulant, which is novel, even if the drug isn’t. This, in turn, has delayed his back injections, prolonged his pain and resulted in a confusing appointment with a physio. And one with me, of course, to sort it all out.

Which I do. I tactfully inform the anticoagulation clinic that they’ve f***ed up, and ask them to a) stop rat-poisoning my patient and b) tell him they’re very sorry and won’t do it again. Then I give him the all-clear to ring the pain clinic. Job done.

So why’s he now back about his back? Because the pain clinic have told him it’s more than six months since he was last seen, so he’ll need a new referral from me. He says this apologetically. What this means is, his treatment has been delayed because of an error made by another department of the same hospital, which I spotted, and the result is that he has to suffer and I have more work to do.

Ah, patient pathways. Supposed to smooth the journey when all they do is spread shards of glass.

This I can cope with, sort of. It’s the utter inability to direct my anger in any constructive way that really gets me. Because when you’re dealing with huge, faceless, bureaucratic organisations in which responsibility is diluted and lost within the cogs of the system, there’s nowhere to focus your ire and the only alternative is to scream, which is what I do. Why does it have to be like this?

He looks at me quizzically. ‘Tread softly because you tread on my dreams,’ I explain.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield.