I am going through a whole thing at the moment, trying to find support for my new role as a geriatrician working in primary care.
At times it feels as if I am doing something really radical like challenging the status quo or empowering patients –
You see, there appears to be a question about whether it is OK for someone like me – that is, a doctor with 20 years’ experience and a specialist to boot, to work outside the hospital.
I am, as per the rulebook a ‘general physician and geriatrician’ – I have a licence to treat any adult with any medical condition and in particular older people.
I will not go into more detail about this but suffice it to say, this is congruent with my values and probably my purpose.
It is what I do best, where I am confident, competent and appreciated (mostly).
Four months ago, I determined that this skillset was transferable; that it could be transported out of the ivory towers of an acute hospital into the community.
My idea was to take myself – the doctor, to the patients, rather than forcing them to come to me, in a hospital in a clinic or ward.
It doesn’t seem that radical an idea when expressed this way although it is still far from certain as to whether I will be able to continue.
This is a little away from the title.
Q: A nurse’s job?
I won’t try to find an answer to that as I suspect the answer is as broad as the certainty of my future. Yet, something I did today that I loved was tootling around town administering flu jab/jags to our housebound patients.
Housebound is a funny term.
Unlike ‘bedbound’ (sometimes called bed-fast) – we don’t insist in the surgery that a person can never leave their house to meet these criteria; it is enough that it isn’t straightforward or easy for the person to get out the house because of frailty or mobility issues.
This possibly means that we have more ‘housebound’ patients than might be anticipated, it does however seem right.
I am pleased when one of my patients who is housebound tells me that she managed to get to the hairdresser or the bingo. Getting to the doctor is far less straightforward.
This was something I had never before done; knocking on doors, ‘Hello, it is the doctor, I am here to give you your flu…’
Everyone was welcoming and grateful, even the odd person who refused; and, my favourite, a 98-year-old who never has the flu jab, who, despite my entreaties and the offer of a chocolate from her sister adamantly said no.
How fortunate am I to experience this aspect of humanity?
I know I would never have witnessed it on a hospital ward or clinic; I wouldn’t have seen the tattered carpets, the narrow stair and hallways, the darkening banana skin. My perception of myself as a doctor, a carer, supporter, healer would have been different, more abstract.
The trust that patients place in their doctors and nurses is truly humbling. It is enough to stop you in your tracks and question the validity of your actions. This level of vulnerability is never encountered in hospital; yes, people allow you to do all sorts to their conscious or otherwise bodies, but welcoming you into their home is something special, something separate from the everyday.
I imagine that old colleagues might look down on my visits as not appropriate to my paygrade or expertise. It is a pity that they haven’t the opportunity to experience this element of the doctor-patient relationship that runs deeper that waiting times, referral pathways, complications and prognosis.
There is more to medicine than we are sometimes allowed and it deserves to be shared!