What can we do to change this?

A consultation…

How’s this for the GP?

How’s this for the patient?

How could we change this for both?

…….

GP: Good morning. 

(Looks at screen) 

(Waits for patient to start.)

Patient: I saw you a few weeks ago about angina and chest pain and my diabetes. You said to come back if I have concerns or things get worse. And I’ve made a list of things I want to talk to you about.

One condition at a time per appointment please.

I’m worried about my diabetes and blood sugar levels due to increasing foot pain in recent weeks. I think I need a blood test to check HBa1c level. 

Ok let’s take one condition, one issue. This is just one appointment slot.

Your last blood test was only four months ago. You’re not due another yet.

Yes but in the last few weeks I seem to have got worse….my feet ache, and they burn and go cold and hot in the evenings…it’s really uncomfortable.

Have you seen the podiatrist for a check in the last year?

Yes. That seemed to be ok, but he wasn’t interested in my foot pain. He just said I could still feel stimulation so he’d see me next year.

How’s your diet? And exercise?

I’m not eating anything sweet or sugary. So not a bad diet really. 

You do need to do more exercise and make sure you eat sensibly.

I do walk but less than I used to. The thing is, my feet ache, so walking can painful, and I know it’ll be worse afterwards. And I get very very tired. 

Well, exercise will lower your blood sugar levels, so you really need to walk as much as possible.

I used to be able to walk up hills, mountains. But now some days I can only manage half a mile. And working outside at home there are times when I just have to stop for the day. It’s probably my heart not working as well as it used to, I suppose.

You could talk to our diabetic nurse… Make an appointment. 

Last time I met that diabetic nurse she took my blood pressure, weighed me, told me to take exercise, and entered things on the computer. And she said that if I had any concerns about sex and that sort of thing I had to talk to a doctor not her. She didn’t really do anything at all to help me or listen to me.

Hmm

(Looks at screen)

I’m sorry you didn’t like our nurse. You can always choose to see someone else next time.

Her job is not really doing emotional support…that’s more like mental health…I could refer you for counselling. There’s a twelve week wait, but I could put you on the list.

….

Pause. Silence. GP looks at screen then at patient.

….

Another thing…

(Doctor looks at screen…tuts….sighs…)

Can this wait until another appointment…it’s just that there are a lot of patients waiting…

My dementia symptoms are getting worse…more symptoms of memory and perception difficulties…what should I do? Is there anyone I can talk to about it?

You know, your dementia will of course get worse. It can not get better. So you need to accept that. 

There will be good days and bad days, or weeks…

I could do another GP cog test to measure any deterioration, but you’d need to make another appointment.

I don’t think I need another cognitive test. I know I’m getting worse. I always score ok on the test.

And if you are still doing well on the test that would show that actually you are still doing well.

But I don’t feel as if I’m doing well.

I spoke to someone from the alzheimers Society last year and they said I could ask you for some emotional support, or something like that.

I don’t really know about any groups in this area for dementia, and we don’t have any admiral nurses in this county. You could try finding a local branch of Alzheimers society.

Why don’t you have admiral nurses? I’ve heard they are really good working with people with dementia and carers. I just want some advice from someone who understands what I am going through.

Why don’t we have admiral nurses? I don’t know, and I don’t make those decisions. 

Anyway, you can talk to me. I have known you for a few years.

Well I wouldn’t mind talking to you about how I feel. I need to talk to someone. And at the moment I just think about it and worry, and get fed up and wonder what’s going to happen next.

Well I can’t really give you emotional support other than just listening to you. And I’m not sure that would really help much. Would it?

Ok, so go back to reception and make an appointment to see me again. But I’m not sure I can be of much help in your situation. There’s really very little that can be done for people with dementia.

And a new appointment will take how long? Two to three weeks? Like this one did.

Look, I’m sorry, but if you want to see someone urgently it’ll have to be a different doctor.

But a different doctor doesn’t know me like you do.

I’m sorry, I need to get on. Please make another appointment.

……….

Is this fictional?

How do you think the GP felt about this?

And how dos the patient feel?

What can we do to change this?

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