The letter

The letter

When thinking about the big issues, such as the aged care crisis, it’s sometimes easy to forget the people at the centre of it. Dr Alison Semmonds shares a recent experience that helped crystallise why it’s important to remember the impact clinicians have on patients’ lives.

As the Federal election looms there are many things that concern me as a geriatrician. Will the needs of the aged care sector be addressed in policy commitments and funding allocation that is more than pork barrelling? Will models of care that result in better out of hospital care for older people be prioritised? Which party will commit to keeping ACATs in state health and not moved to NGOs? 

However, in the midst of the turmoil of the constant tussle in our environment of the cumbrous health sector, I am sending you a little fresh air with a recent story of my own from one of my workplaces.

When I first went to the “mail room” in my renovated hospital, I knocked on the door and nobody answered. I went in and saw a small room with shelves and no people – no one was going to answer my knock at the door. 

On a shelf with my name on it were four letters: a pathology referral to sign; two letters from colleagues about patients I had seen; and one more… it looked official. It had a window with my name and address typed inside and I thought it was another colleague’s letter. It wasn’t.

Inside was a card stating: “Love is Patient, Love is Kind.” 

I saw a glimpse of a copy of a letter I had written to the RMS driver licence review unit and my heart sank. This was looking personal – was it a letter from a disgruntled patient that I had thought unfit to drive?

I read my letter from June last year and remembered the patient. He was an 86-year-old man who had come in for rehab after an acute urological illness. He lived alone, with his family about 100km away. I had thought him somewhat eccentric, and he failed cognitive tests in the first week of his arrival. As the next week passed his mobility and self-care improved and he became increasingly worried about his upcoming driving assessment. He knew that he needed to have a medical examination yearly. A practical driving assessment was due within days as he approached his 87th birthday and he sought an unrestricted driver’s licence. But as he worried, he was also getting better. How would I assess his ability to drive safely with him in a hospital ward? A repeat MoCA1? A Trails A and B test 2? A Maze Task3? A physical examination to check his vision, his ability to turn his head to look over his shoulders, his muscle strength to operate a car, his reaction time, and take him downstairs to see if he could get in and out of a car in the hospital grounds?

Well, with the help of my multidisciplinary team we did most of that. And he did well. Not perfect, but well. Given the impact of losing his licence, he agreed to have driving lessons and an on-road assessment, and I wrote to the RMS. Should he have had an assessment from an occupational therapist? He didn’t have dementia and had significantly improved… However, I have never forgotten a patient of mine with mild dementia who had been thoroughly assessed by me, and an OT, and not long later reversed over her husband who sustained fatal injuries…

Back to the letter. Here it is, reproduced with permission:

Dear Dr, The attached letter was written by a beautiful young lady who gave me confidence to live again. It has taken me a long time to recover but I now walk without a walker or walking stick. I do all my own house cleaning, washing, cooking, and best of all I got my driving licence back and playing lawn bowls. I do my own shopping and one of the carer’s showed me how to do shopping on the internet. All of this was because of the faith you had in me and the hospital staff, particularly the nurses who were very kind and always helpful. Thank you and all your staff and hope you had a happy Christmas and a happy new year. Love from G.

I hope that in writing this I have helped you all remember and cherish the positive feedback we are fortunate to receive at times, to be inspired by the potential our patients have to recover and to remember to think again about the impact our decisions make. Now, back to policy and the election… 

REFERENCES

1. Nasreddine ZS et al (2005). J Am Geriatr Soc 53: 695-699

2. Hunt et al (1993). J Am Geriatr Soc 41: 747-753 

3. Snellgrove CA https://www.infrastructure.gov.au/sites/default/files/migrated/roads/safety/publications/2005/pdf/cog_screen_old.pdf

ABOUT THE AUTHOR

Dr Alison Semmonds is an AMA (NSW) Councillor and a geriatrician, general physician and perioperative medicine specialist who has extensive experience managing complex medical problems in hospitalised patients.