In a drive to be ever more organised when it comes to completing our QOF tasks by April, this week has been a 'Vulnerable Elderly' review week. These reviews involve long consultations with endless questions about hearing problems, mobility, hygiene problems (I never quite know how to ask about this one?) and to finish, the dreaded mini mental state examination.
As a quick aside, can I just say how much I loathe the mini mental test. If the patient is completely coherent, asking what year it is, what country we're in and to follow ridiculous commands involving fingers, ears and nose is just embarrassing. Many are offended, many just think you're wasting their time. If on the other hand the patient suffers from a degree of dementia and can't answer the questions, watching their embarrassment is even worse. All in all a hideous experience.
There is however, one question that I dread asking even more than I dread the mini mental test. It's this:
"During the last month, have you often been bothered by feeling down, depressed, or hopeless"
It's part of the depression screening, and the tragically high number of positive responses provides the basis of many a disheartening conversation. For some, these feelings stem from financial problems, family disagreements or the loss of a loved one. For the majority they are simply due to loneliness. Those without local friends or family, too frail now to make the journeys they once used to.
One patient told me that he insisted on going to the supermarket every single day, because so often the brief conversations with checkout staff provided his only human interaction. Another mused that she had simply lived too long, her husband and all of her friends having died before her. She could only give me her cleaner's name as her next of kin.
So they score a positive on my depression screening, but what of that? Should I give them antidepressants? I can't see how that would help. Psychological therapy? Somehow I don't think so. I've tried to get patients such as these involved in day centres or community activities, but I find that many are simply unable and some too proud.
It's hard to know how I can help and now I too am feeling down, depressed and hopeless...
My mother is a GP and I know a lot of the time elderly patients come to visit her it is more for having someone to chat to then for any medical problems... Is your 10 minute designated appointed enough though?
ReplyDeleteThat's exactly the problem - but how to work out what is the right length of time is difficult. If the appointments are longer you end up wasting time on the shorter consultations. If you have wonderful receptionists (which I do) they can book double appointments for those who you know will need it, but that's not always easy to predict.
ReplyDeleteDon't worry - for those on pension credit relying on housing benefit, they're just about to have a whopping big cut in their housing benefit from the 50th percentile of local rents to the 30th percentile (tucked away behind other cuts in the budget) so they'll be cuddling together for warmth. Another problem you, as a hard-pressed GP, wish you could help with but probably can't.
ReplyDeleteMy GP can do very little for me, but he cares, and that goes an awfully long way.