Abstract
I have no sense of direction. I never know which way north is, I get left and right mixed up and I can’t translate what I see on a map to the real world.
This is not something I was ever asked about in an aptitude test, but it has caused considerable difficulty in my working life. As a junior doctor, I ran when the arrest bleep went off, but rarely in the right direction. Moving between jobs was traumatic – it took me weeks to learn to navigate large hospital sites and almost as long to learn the way there.
As a GP registrar, house calls became a major source of stress. Once, I got so lost on my way back from a home visit that I was late for my afternoon surgery. I almost wept with frustration as the first patient came through my door 40 minutes after the appointed time.
A satnav solved some of my problems, but house calls started to cause a churning in the depths of my stomach. They made my heart ‘sink’. On another occasion, I had been booked to see one elderly lady in a care home, but the nurses then sprang two further patients on me. As I was walking out, a fourth lady arrested … it felt like a bad sketch at a medical school pantomime only no-one laughed when I was, once again, late for afternoon surgery.
I also felt overwhelmed by elderly patients – a group needing the majority of house calls. I found the combination of frailty and complexity difficult both to understand and manage. I thought patients in residential homes were slightly safer, but I quickly learnt that care varies wildly between institutions and even between staff. My struggles with time management were also affecting my attitude – older people move slower and speak slower. It can take all your allocated time just to get the patient to their room. A huge gap developed between my ideals of altruism and service and my emotions of dread and haste.
A friend pointed out that my attitude was a little concerning. She loves home visits. She relishes catching a glimpse into people’s lives. It is an intimacy few professionals are allowed. She also enjoys elderly care – she sees medical complexity as a challenge and feels privileged to be able to help vulnerable people. Often, some attention and practical help is the best that can be done, and GPs are ideally placed to coordinate this.
I have not yet reached such levels of compassion and enthusiasm. I still struggle to complete my visits in a timely manner and occasionally get that sinking feeling when I have a list of people at a care home. I have made progress though. Simple experience has been a huge factor. Navigating local pathways and discovering which services actually deliver, means that I now have tools that I know might change people’s lives.
Using care-of-the-elderly techniques has been helpful too – problem lists, holistic medicine, patient-directed priorities. The National Institute for Health and Care Excellence (NICE) multimorbidity guidelines, as well as a general move away from polypharmacy and preventative medicine in frail, elderly patients, have given me the confidence to stop treatments that are of questionable value in this group. Stopping medication often rejuvenates people and certainly makes life simpler.
So, while my sense of direction remains non-existent, I am addressing my ageism. Last week I enjoyed visiting an elderly lady (she was into her second century). When I arrived, there was some confusion over why I’d been called – one of the night team mentioned a cough and someone said she hadn’t been seen for ‘ages’. I asked her how she felt (fine), took some observations (perfect) and listened to her chest (clear). She took no regular medication. She seemed a little bewildered that I had been called. I asked what I could do for her. She replied, ‘Please could you scratch my back?’ So I did. I scratched an elderly lady’s back for 5 minutes. She made appreciative noises and I mused that it was probably the best thing I’d done all week.