So… here I am, planning a presentation to the hospital tomorrow on dementia; I have added ‘delirium’ to the title as for me the two conditions are synonymous – people living with dementia have a ten-fold greater risk of experiencing delirium than others…
Where to I begin? I start with Wendy Mitchell – she has the only blog that I regularly read; the last excerpt of her experiences related to her visit as a patient to hospital. This got me thinking, thinking to how my day began…
I was on call last night. This means that this morning I started my day with a ward round of our Medical Assessment Unit, which a few months ago changed its name to the Acute Medical Unit – I have found this acronymic manipulation funny, as I think do many people – but there you go…
My first patient was an old lady who had fallen at home and fractured her humerus. (Which my Mac wants to call humorous, but that is another matter…) the patient was in a state, she was from city X and moved to town B then transferred to my hospital, as there was a concern that she had a complication. The clinical matters aren’t really important – what captured my imagination, and that of the other doctors and students accompanying me this morning was the fate of her husband.
The documentation recorded that he had ‘dementia’ – as we know, a loose term that in our current health-service, can pretty much mean anything outside ‘fully orientated, conversant in the Queen’s English, with good hearing and intonation.’ My patient was in tears worrying about her husband; she didn’t know how he would cope, how her family would manage – she didn’t have the phone numbers of her children, nor did she have any other contact details. She was effectively, lost in my care.
It took nearly two hours of phone calls between various providers of health and social care (the current shorthand for ‘care’) before we managed to reach her daughter who informed the nurse that her dad had been admitted to the hospital that my patient had been transferred from. This was after several, ‘I can’t share that information’ and ‘you need to contact the patient’s GP’ and ‘phone back when you have more information.’
We are caught-up in a confusion, a confusion of systems within systems and good intentions that become smothered by process and organisation. Here is to anarchy!
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