Working with doctors Working for patients

 

Introduction

Lesley is a 73 year old woman who has osteoarthritis in her hip. Her condition affects her mobility, though she can manage most of the time on her own. She has had a fall at home and has come to the accident and emergency department of her local hospital with bruises and a fractured left wrist.

Dr Martinez has been treating Lesley in A&E. He finds out that Lesley tripped whilst walking down the stairs, checks that Lesley hasn't banged her head and gives her a cast for her wrist. Dr Martinez can see that her bruises are quite minor and thinks that her wrist will heal fully given time. However when speaking to her about aftercare he discovers that Lesley lives alone in a remote location and has no one close to her living nearby. He becomes concerned about how Lesley will manage at home on her own while her wrist heals.

Dr Martinez

Dr Martinez

Lesley, I'm a bit concerned about how you are going to get along at home without help.

Lesley

Lesley

I'm sure I'll be fine, Doctor. I won't be doing too much over the next few weeks anyway!

Dr Martinez

Dr Martinez

No, but you'll need to do things like wash and get dressed. And what about cooking? Is there anyone that could help you with that?

Lesley

Lesley

Well no doctor, but it's really not necessary. I won't need anything fancy...

Dr Martinez

Dr Martinez

But Lesley, I'm worried that you may end up struggling with the basics - getting showered and dressed, and opening tins or packets of food. You need to keep active and mobile - but not put yourself at risk of another fall. I think we should arrange some help for you so that...

Lesley

Lesley

Really Doctor, I can get along fine on my own - I'm perfectly used to getting by without help. I'd like to just get home as soon as possible, please.

What should the doctor do...? (Select A,B or C)

A

Ensure that communication with the GP happens promptly. And persist with the discussion with Lesley to get her agreement to involving social services so that they can ensure that she has all the necessary support while she is recovering?

B

Do nothing straight away but advise Lesley to arrange a home visit from her GP - Lesley's injuries have been treated and her aftercare should be managed by her GP who will be informed of her discharge and will be better placed to judge her level of need?

C

Ring Lesley's GP, outlining the concerns for Lesley and ask him or her to visit her as soon as possible?

Dr Martinez

See what the doctor did

Dr Martinez continued to speak to Lesley about how she would manage at home and in the end he managed to convince her that he understood how important her independence was to her and that he would suggest the least intrusive care option available. Lesley agreed that Dr Martinez could contact her local social care provider who would assess what support she may need at home to make sure she could look after herself.

References

You must contribute to the safe transfer of patients between healthcare providers and between health and social care providers. This means you must:
b. check, where practical, that a named clinician or team has taken over responsibility when your role in providing a patient's care has ended. This may be particularly important for patients with impaired capacity or who are vulnerable for other reasons.
(Good medical practice paragraph 44b)

You must work in partnership with patients, sharing with them the information they will need to make decisions about their care, including:
a. their condition, its likely progression and the options for treatment, including associated risks and uncertainties
b. the progress of their care, and your role and responsibilities in the team
c. who is responsible for each aspect of patient care, and how information is shared within teams and among those who will be providing their care
d. any other information patients need if they are asked to agree to be involved in teaching or research.
(Good medical practice paragraph 49)