As budgets tighten, it seems to me we’re ever more involved with social care. Our local community trust seems resource-stricken: the district nurses work flat out, but their numbers are down, and they aren’t being replaced. The population is ageing, and families aren’t always keen to step in. So when the octogenarian’s legs start blistering, who’ll be there to dress the wounds?
A pertinent home visit yesterday cost me an item of clothing.
A quick patient profile for you: 87, female, BMI of 42, diabetic, declining mobility, an undiagnosed haematological disorder, recent hospital admission with UTI, discharged two weeks ago with ‘a package of care’.
She lives in a roomy detached house in a local village. Her nearest relative lives half an hour away and is busy with his career in the police. No-one visits. That said, the occupational therapist and physio dropped in last week, and suggested she was ‘too good’ for any further input. Discharged. Her mobility has plumped over the last fortnight, and now her sacrum’s sore. She was independent and cooking for herself, now she’s off food and her weight’s starting to drop.
I fought my way in, solved the keysafe and squeezed past the stairflift. A forlorn wailing resonated through house, and I finally located her in the upstairs bedroom. A full commode sat within reach of a huge but dirty bed. There she was, perched on the edge of the mattress, breathless and helpless.
I started where we tend to in these situations: BP, chest, heart sounds, pulse, sats. Not bad. She had bloods pending, and follow-up arranged by a colleague.
What was the main problem today?, I asked.
My backside, she said. She couldn’t apply the conotrane herself, and when she’d asked her son to do it, he said he’d rather she was in a nursing home. The district nurse said they were too busy to ‘put on creams’. We stood her up, and I examined her sore, red and ulcerated buttocks. I had a quick look round. The full commode, half-eaten porridge, build-up drinks by the bedside: it reeked of neglect.
I squeezed back past the stairlift to the kitchen, where her medications hadn’t been touched for two days. I grabbed the conotrane and bounced back upstairs. I’d forgotten to take gloves, and she had none. So, with an improvised plastic bag, I dipped my hand into the huge tub, scooped it up, and pasted it on her bottom.
‘That’s so much better,’ she volunteered.
Distracted by her commentary, I’d not noticed that my tie had disappeared into the mass of cream and crevasse. I pulled it out, gently, removed it from my collar and tucked it into my bag. At her request, I then opened her curtains and turned on her heating.
Some GPs complain that our pastoral role is diminished, and we’ve become box-ticking automatons or DH lackies. Do I agree?
Yes and no.
Patients are getting older and their care needs are growing. Their children are busy, and our district nurses are like gold dust.
We’ll carry on with our roles but, slowly and inevitably, we’re being sucked into a social care vacuum.
Dr Tom Gillham is a GP in Hertfordshire and specialty doctor in A&E. You can follow him @tjgillham.
