Confessions of a GP

Granny dumping is a very harsh expression and the actual individual cases are more complex. Being a full-time carer for a family member is an immensely difficult and often thankless task, but crises always seem to occur at Christmas and all too often lead to an unnecessary hospital admission. This is exactly what happened to one of my elderly patients one Christmas Eve. I was covering the afternoon session at a small surgery where I didn’t know the patients. It was nearly 6 p.m. and I was looking forward to getting home to start celebrating Christmas with my family.

The phone rang as I was just seeing my last patient of the day. A distraught daughter was crying down the phone: ‘It’s my father. We can’t cope any more. He’s got Alzheimer’s and he’s getting frailer. My mother had a stroke two years ago and can barely look after herself. We need some help.’

‘It’s 6 p.m. on Christmas Eve,’ I unhelpfully pointed out.

‘I know!’ wailed the daughter. ‘I’ve got my own family to look after and my sister is away skiing. Dad gets confused during the night and wanders around the house. He just needs someone to sit with him overnight. Someone to make sure he doesn’t fall. My mother can’t be expected to do it, she’s too frail. I’ve got my daughter and her young family staying at ours so I can’t do it myself. If you can’t arrange something, he’ll have to go into hospital.’

I hate these situations. I was being made to feel responsible for this person’s difficult situation. It wasn’t fair to admit him to hospital when he wasn’t actually unwell; however, I could see the daughter’s viewpoint. She had her own family to look after and didn’t want to spend Christmas Eve chasing her confused father around his house. What I couldn’t understand is why this always seems to happen just before the holidays start. Couldn’t something have been organised weeks ago?

This was a social problem rather than a medical one. Other than take him back to my house and have him spend Christmas with me, I didn’t really know what I could do. I ‘Googled’ the telephone number for the local emergency social services and gave it to the daughter. I told her that they might be able to organise some sort of emergency care overnight. Her dad didn’t need a qualified nurse, just a caring person to sit with him and guide him back to bed when he got up and started wandering. There were enough carers in this town who would probably appreciate the money and plenty who weren’t Christian and would happily work on Christmas Eve.

Half an hour later I phoned the daughter back to see how she had got on. She told me that she had dialled the number I had given her but no one had answered. After ten minutes she called 999. The ambulance had just taken her dad to A&E. Another Christmas granny dump delivered to the NHS. Once in A&E on Christmas Eve, there was no way that he would get home. The cost of the ambulance, A&E treatment and ward admission would be thousands of pounds and I just hoped he didn’t get a bout of MRSA with his hospital mince pies. Someone sitting with him overnight would have not cost more than £100. What a waste.

Some areas have wonderful emergency social services with a team of physios, carers and social workers on call to provide urgent assessments and vital care to people who desperately need it. They keep people out of hospital, saving money and preventing people from catching MRSA and other hospital bugs. Unfortunately, most emergency social services teams are terribly underfunded, understaffed and suffer from low morale. They might not have a flashing blue light on their cars but they are desperately needed and would pay for themselves many times over by preventing unnecessary hospital admissions, especially at Christmas.

Aggressive conduct disorder

This is an ethical dilemma that I faced and I have no idea if I did the right thing or not. I wonder what you will think. A mother came in to see me with her 12-year-old daughter and asked for her to be put on the pill. I said no and Mum was furious.