The patient was an eighty-eight year old man who lived at home with his wife, both of whom were surrounded by a perpetual cloud of smoke despite our nurse’s continued requests that they butt it while we visit. He was a man just managing to stay at home by the skin of his teeth – or, more accurately, by a lot of effort from the support services put in place to keep him safe at home, services neither he nor his wife appreciated. They both had a diagnosis of dementia and shared a common lack of insight into their own failing health and poor living circumstances. Neither acknowledged the nicotine-stained walls or ceilings, the carpeting stained with old and fresh dog shit, or their own deteriorating bodies and minds stained with years of neglect and abuse. In their estimate, they were, ‘…doing fine, and we don’t need anyone barging in and taking over!’
But despite his shortcomings, this wasn’t enough to make him one of the bad ones. Once you got past the bluster and opened a window to air out the house, both he and his wife were pleasant in their own confused and belligerent way. The problem was the patient’s GP.
The patient had returned home from a short stay in hospital due to his yo-yoing health, and, as hospitals are prone to do in an effort to prove they did something to help the patient, they had played around with his medications. This slight tweak on their behalf often means a mountainous headache of work for us. Easily one of the most infuriating and frustrating aspects of my job is attempting to get a list of my patient’s medications, complete with the drug’s dose, route, and frequency, and topped off with a signature from the prescribing doctor, so that I may legally administer those medications.
Perhaps you’re reading this, thinking, “Surely, that’s not so hard a thing to obtain. A doctor would have on file the current medications his patient’s are taking.” This world of doctors keeping an up-to-date list of their patient’s medications is one that belongs in a medical utopia, a place where patients are keen to participate in their health and old stoma bags smell like vanilla essence. Unfortunately, I operate outside that sphere, and consider it lucky if the GP I’m corresponding with has a computer on which to type a list of medications. The stereotype of illegible doctor’s handwriting is very real.
The client’s GP was a doctor I was familiar with, and I knew him to be a man resentful of assisting in any way. His choking arrogance always seemed to get in the way. So, knowing this, I rang his office.
‘Hi, this is Jonathan the district nurse, I was just hoping to speak to the doctor regarding Mr X.’
‘Oh, sure,’ his secretary replied, ‘I’ll pop you through.’
*On-hold music* – wait time 30 seconds.
‘Hi, Doctor, this is Jonathan the district nurse. I’m just ringing because Mr X has returned home from hospital. He was diagnosed with GORD while in there and commenced on Nexium, and I was hoping you could add this to his medication authority and fax it through to us.’
He had hung up.
I rang again.
‘Hello, Doctor’s office.’
‘Hi, this is Jonathan again. The Doctor just hung up on me. Could you put me through to him.’
*On-hold music* – wait time 1 minute.
‘Doctor, it’s Jonathan again. We got disconnected. So as I was saying, we just need a new medical authority so we can administer Mr X his new medication.’
‘What is all this?’ he grunted. ‘I’m sick of doing all this work for your company. Why don’t you have your own doctor on staff?’
‘You know how we operate, Doctor, how community health operates. You’ve worked with us for years. You know we don’t have our own doctor on staff.’
‘I’m sick of doing all this over the counter work, it’s ridiculous.’
‘Sorry, I’m not following you. What do you mean “over the counter?”’
‘Well, it’s not face-to-face, is it? I’m not billing for this.’
‘Oh, so you’re worried about your money?’ I chuckled.
In retrospect, laughing may have been the wrong tact to take.
I squeezed my mobile phone, envisioning the pathetic old doctor’s neck, and rang a third time.
‘Hello,’ his secretary said.
‘Yeah, it’s Jonathan again.’
‘ I thought so, it’s why I didn’t answer with the spiel. Is it a connection issues or is he angry?’
‘Oh, he’s angry. Can you put me through again?’
‘I can try.’
*On-hold music* – wait time 3 minutes.
‘Are you still there?’
‘I’m still here,’ I replied.
‘The Doctor’s busy at the moment—’
‘—but tell me what you need and I’ll see what I can do.’
I detailed what was required, explaining that my persistence was only to ensure the patient got his medications and remained out of hospital. I did my best to stay calm and jovial with the secretary, reminding myself that her employer’s childishness was no fault of hers, that she was the only one attempting to help, and that she had to put up with the megalomaniacal wanker for hours at a time. Once I had repeated what I needed and she wrote it down, she assured me that she would have it faxed to me by the end of the day. I thanked her, sincerely, and hung up.
It’s hard to work in an industry full of contradictive people claiming to be there to care for others whilst only caring about themselves. It’s hard to advocate for your patient against the very people who should be helping. It’s hard to remain professional while those you deal with act like children. And it’s too easy to think, ‘Why do I continue to work in this faulted system?’
The secretary was true to her word, and by the end of the day I had a medical authority with the patient’s new drug added to the list. Unfortunately, the previous authority had two medications that, due to the Doctor’s past laziness, had only been scrawled on by hand, and hadn’t come across with the new list. I would have to phone him the next day to have them added.
He was one of the bad ones.