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Monday, 22 October 2012

The perfect team?

So you go to the doctor with a patient you are convinced has some kind of eating disorder.  You sit down and express your concerns.   You mention FAED and ARFID and he look them up on the computer.  The doctor turns to the patient, asks lots of pertinent questions and then looks at you.

"Which specialist would you recommend?"

"Professor Treasure at the Maudsley"

"I will write a referral letter today" (which he does!).

"Anything else you are concerned about?"

"The terrible eczema which responded very well to steroids last time.  It is making her very uncomfortable and is not helping her sleeping."

"A short course of steroids then?  Why not?"

There follows a "discussion" on what long term steroid use problems there are and side effects and warnings.

Forward three week and the appointment at the Maudsley comes through for next Wednesday.  The patient has finished her short course of steroids, which helped her appetite and her eating.  A "bit of a blip" at a bridge session and she returns home.  Within half an hour, the nurse from the surgery has popped round, the doctor has been on the phone and the pharmacist has popped round with a new prescription for steroids filled and ready to go.

You have a bit of a heart-stopping phone call, grind teeth and then gather your thoughts.

You email the doctor suggesting that the blood test he has scheduled for tomorrow incorporate this.  You also suggest that the patient may not need to have yet another round of tests and scans that have so far proved negative over the last six months until we know whether this is physical or psychological.

He agrees and says that he will hold off on any more physical tests (except the blood test) until the patient has seen Professor Treasure, unless it becomes an emergency.

Dr Chris Castle, Cathy (aka Angel Nurse) and Mr Patel, Southwold, saviours to my mother, I salute you.  You are the perfect example of what the NHS can and should  do.  Thank you.

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