AREAS OF CONFLICT: OBTAINING MEDICAL HELP
For most of us our main medical carer is the general practitioner. If the medical problem is serious then the GP should see the person at home, especially if the patient is old and somewhat frail. Obtaining this visit should not be difficult and if the person concerned or the carer feels that they cannot get to the surgery, then a GP should visit. In all other instances, unless the GP routinely sees his/her elderly patients at home, one should try and get to the surgery. Many people complain that they cannot get past the receptionist for either a home visit or a chance to speak to the doctor. The receptionist has a job to do and most manage to find out the problem, fit in appointments, do a host of other things and remain friendly. If however you feel you must speak to the doctor then insist on doing so. Most receptionists only protect the doctor so far, and are then under orders to pass the problem on.
Any difficulties with medication should be reported at once so that it can be stopped if the GP thinks it advisable. Anyone on repeat prescriptions should see their doctor regularly and have the need for the medicine reassessed. Most elderly people can stop taking their medication safely once the acute problem is over; few should be on drugs long term, and then only under supervision. If a hospital appointment changes the medication, be sure to let the GP know. The hospital should automatically let the GP know anyway, but it sometimes takes many weeks for letters to arrive.
Many elderly people and their carers worry about health issues but often keep the worries to themselves. The GP should be told of any concerns so that the person can be listened to, examined and then either reassured or the problem dealt with. No symptom should be taken as a sign of old age, especially if the problem involves confusional episodes, falls, incontinence or decreased mobility. The GP can perform many of the screening tests necessary to rule out treatable causes, but may then want to refer the person to a specialist. There is now an ideal opportunity to regularly have some of these issues discussed. GPs are now obliged to offer a screening/assessment visit to all elderly people over the age of 75. The GP may perform the visit (or invite you to the surgery) or they may delegate the screening to a practice nurse. The areas that have to be asked about are sight, hearing, feet, diet, weight and blood pressure but an elderly person can add any issue that is worrying them. This can prove to be an excellent time to get all one’s questions answered.
Many carers feel that their relative was not referred to a specialist soon enough. This dilemma is often a difficult one for in some cases the specialist cannot offer any more help than is already being given. However in most difficult cases a ‘second opinion’ is no bad thing and at least it can reassure sufferer and carers that no stone is being left unturned to help. Most GPs will not refuse a referral to another doctor unless they really feel that it is not justified.
Hopefully real areas of conflict between patient/carer and doctor will be few, but as a last resort one is entitled to leave one GP’s books and join another. Help is available from the Family Health Services Agency (FHSA) – (the GP’s watchdog) or Citizens Advice Bureaux. GP’s are not only the gatekeepers to further medical tests and advice; they also can hold sway over the local district nurses and health visitors. Changes in these services often have to go through the GP, but it is worth contacting them directly if there are any problems. The fact that a GP practice is a fund-holder should not affect the care given in any way. Should a problem arise that is apparently linked to finance, it is best first to discuss it openly with the GP. If you are still not satisfied then go to the FHSA or local Citizen’s Advice Bureau.