Confessions of a GP

It’s a Sunday and I’m working a locum shift in A&E to make a bit of extra money. I used to work in A&E during my hospital training and quite like going back to work the odd shift. It helps keep me up to date with my A&E skills and also makes me happy that I’m not a full-time A&E doctor any more. I pick up the notes for my first patient of the shift, open the curtains and lying on a trolley in front of me is Alf.

‘Oh bloody ’ell. Not you. You’re bleedin’ everywhere, you are.’

Although these were Alf’s words, they also very closely reflected my own thoughts.

I had been visiting Alf at home all week as his GP and then I turn up for a shift in A&E to get a bit of excitement and escape from the daily drudge of general practice…and there is Alf lying in front of me.

Alf is in his late eighties and lives alone in a small run-down house that he can’t really look after. Alf’s notes state that he has had 23 A&E admissions in the last five years, which qualifies him to reach the status of ’frequent flyer’ in A&E talk. If hospital admissions could earn you loyalty points, Alf would be able to cash his in for two weeks of dialysis and a free boob job. Unfortunately, all Alf ’s hospital admissions have actually earned him is a bout of MRSA and a collective groan of disappointment from the A&E staff when they see him being wheeled into the department.

Given the large amount of time Alf spends coming in and out of hospital, you would think that he had a huge list of complex medical problems but, in fact, Alf doesn’t really have much wrong with him physically. His admissions have been almost purely ‘social’. This means that Alf is admitted to hospital costing a large amount in time, resources and money, because he can’t really look after himself at home. When they talk about bed crises and patients on trolleys in corridors, it is because patients like Alf are lying in hospital beds that they don’t really need.

This is what happened to Alf this week. I got a phone call from his worried neighbour on Monday saying she had heard him shouting through the wall. I couldn’t get into the house so I had to call the police to break the door down. Once inside we picked up Alf, who was basically fine but had fallen over as he often does. Sometimes there are specific reasons why elderly people fall over such as blood pressure problems or irregular heart rhythms. Sometimes elderly people just fall over because they are frail and have poor balance. Alf falls because he refuses to use his three-wheeled Zimmer frame (‘it makes him feel old’), because his house is filled with clutter that he refuses to allow to be tidied away and, finally, because he is still rather partial to a large scotch after lunch.

On the Monday I gave Alf a check-over and he was fine. He hadn’t bumped his head or broken his hip and insisted that we all ‘bugger off’ and leave him in peace. Alf looked terrible. He was thin and bony with filthy clothes, long straggly grey hair and quite frankly in need of a good wash.

‘How do you feel you’re getting on at home Alf?’

‘Fine, now piss off and leave me alone. The race starts in 20 minutes.’

‘What about if I got you some help around the house? Perhaps someone to clean up a bit and maybe give you a hand getting washed and dressed in the mornings?’

‘I’ve been looking after myself perfectly well for 70-odd years, I don’t need you lot interfering.’

‘How about just some meals on wheels to get some meat on those bones.’

‘I’m a very good cook, thank you very much.’

Alf had been offered support at home numerous times before, but he had always declined. He was a grown-up and knew his own mind. He sometimes forgot things but he wasn’t demented and was entitled to make his own decisions about his own house, health and hygiene. When I got back to the surgery, I phoned social services and asked them to make an assessment. I was specifically going against the wishes of my patient, but Alf was in desperate need of some support and if some nice friendly social worker came and had a chat over a cuppa, perhaps Alf could be persuaded… Needless to say the next day the social worker phoned to say that after a brief conversation through the letter box, she had been given the same ‘bugger off’ as the rest of us.

I can completely see where Alf is coming from. He has lived a long hard life and has managed independently, making his own decisions and doing his own thing. Why should he suddenly have strangers in his house interfering? He wasn’t harming anyone other than himself, so why didn’t we just leave him alone. I imagine his biggest fear was being carted off to a nursing home and losing his independence completely.