‘She’s been letting strangers in and was found covered in faeces’.
This is the distilled version of the reason the case conference was called, and why I was sitting in the front room of a bemused octogenarian with half a dozen other people from social services and old age care teams.
I do wonder what would have happened if I hadn’t been present
Yes she had dementia, that was indisputable, the question was should she be moved to a care home.
There was a lot of talk as this meeting started and a lot of opinions expressed, I’d sat there quietly wondering what my role in the proceedings was to be, when I was suddenly hit by a novel idea, I’d ask the patient what she wanted to do.
Demented she may be, but her answer was clear and immediate: ‘I want to stay here until I die.’
A silence descended over the room and I used this as my way in.
I quizzed the patient’s daughter, who’d also been sitting quietly and after two minutes of questioning I discovered the ‘strangers’ was actually a new carer and the ‘faeces’ was in fact a bottle of brown sauce she’d spilt down herself.
With the wind in my sails I took the lead and quickly established with some extra carer input and family support, it was perfectly reasonable for this patient to carry on living at home, which was her wish.
Patient happy, relatives happy, GP happy, but I was left wondering if I’d just been an unwitting participant in a social services game of Chinese whispers.
I do wonder what would have happened if I hadn’t been present to catalyse events. Although the standard ten-minute consultation is much criticised, it does focus our minds and has led to most of us becoming experts at sifting through the bullshit pretty quickly.
I reflected afterwards, if social services are as stretched as they claim, how were so many people able to attend a single meeting? A more cynical man might suggest they were cherry picking the ‘easier’ cases to ensure they got away on time on a Friday afternoon, but that would of course be pure speculation.
Much is made of the idea of closer integration of health and social care but for that we would need to be ‘singing from the same sheet’. At the moment it seems we are not even talking in the same language.
Dr David Turner is a GP in west London
