Patient Files

I grimaced at the patient’s file in front of me; the great wedge of admission forms (eight pages), global assessments, risk assessments, Care Programme Approach assessments, Health of the Nation Outcome Scales, SCART assessments, bed sore assessments (altogether twelve pages), care plans (four pages), care plan daily record sheets (twenty two pages), multidisciplinary team meeting sheets (eight pages), blood pressure charts, weight charts, pathology test records for possible urinary infection, blood counts, drug levels, and physical examinations (in total ten pages), Care Programme Approach records (Six pages), Correspondence (Seven pages), personal finance receipts (four pages), a pair of broken false teeth in a plastic bag, and the seven cardboard dividers which attempted to structure this ridiculous monster.
I then thought about the patient in question; a fifty year old man who had a long standing inadequate and manipulative personality, no suicidal ideation, went on home leave every weekend, was physically fit, who had been on the unit for almost a decade without significant change, and who would have been transferred to a private sector hostel years ago if there had been the funding available to do it. This man was not acutely ill and he didn’t really belong in hospital at all, and yet we continued to treat him as though he had just arrived as an emergency admission on a stretcher.
He didn’t need the heavyweight ‘everything but the kitchen sink’ nursing care plan, because he didn’t need the hospital environment at all, yet instead of making a common sense adjustment to his care we continued to submerge him under a sea of medics, tests, re-assessments, specialist referrals and weekly multidisciplinary meetings, simply because that was our professional ‘role’ and we were too inflexible to change it. Due to the absurd overkill involved, the man had slowly become conditioned to think of himself as a desperately ill and permanent hospital patient; one who could no longer conceive of a future beyond the unit, even though one day he would no doubt be rocketed into the private sector where no such attention would be given.


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