Monday, 14 June 2010

Bad weather, building work and reassessing patients.

It is said that the British apparently talk about nothing else other than the weather. Today in Northernshire the weather has been typical British summer weather. Wet, cold, dull, misty and overcast. Perfect champagne and strawberries weather or if old, miserable and lonely a perfect day for a trip to the doctor.

This barbeque weather has coincided with some recent building work which has led us to make some interesting observations regarding our patients’ true health.

Many years ago a friend from school worked for a small unit of the Government which assessed patients who were claiming industrial illness compensation. As a receptionist they sat in an office which overlooked the local car park.

They would watch the claimants walk unaided up a steep hill from the car park into the office where they arrived by lift. The walk from the car was frequently unaided but the walk from the lift on the flat into the waiting area was different.

Relatives were often there to give assistance, help was always asked for and oxygen frequently deployed in order to ensure that the claimant got their claim.

Unfortunately the doctor’s office also overlooked the car park and they could see the same sights and the claim was not based on acting but on the appearance of an x-ray.

This was a few years ago and recently some building work disabled a lift and rather than using a tannoy we had to call patients ourselves due to a major change in the layout of the building that caused a lot of confusion to patients some of whom had been coming to the same unchanged building for 50 years.

What struck us was how breathless people were after walking up one flight of stairs as there was no upstairs waiting room.

Granted we see a biased population who are allegedly ill and therefore might be presumed to be less than 100% fit but when as a doctor you are struck by the fact that most 50-80 year olds could walk up a flight of stairs without being breathless while those in the 20 –50 year old were struggling, without any other existing disease it was a revelation.

What was more striking was the fact that those who had other disease affecting their breathing, for example heart failure or chronic lung disease, where sometimes less short of breath at the top of the stairs than some of the overweight 20 year olds who sounded like they had run a marathon. Their kids however being thin had no such problem and were frequently on the landing before their parents were even half way up.

Perhaps there is an argument for building all new surgeries 50 yards from the car park on a slope with the doctors’ offices looking out onto the slope from the car park? That way we could assess our patients’ cardiovascular fitness, their fitness to fly and whether they qualified for a Blue Badge just by observation?

Doctor’s time saved, more honest answers by observation and a gradually fitter patient population. Just a thought, inspired by the inconvenience of some building work.

Praise be to the Party for inventing builders and allowing us to observe our patients outside of the chair where we see most of them.

No comments: