‘I need a report stating exactly what’s wrong with me,’ is her opening statement. It is the beginning of my afternoon surgery and I have seen her plenty of times, but never had the opportunity for a thorough and meaningful encounter. I am aware of the long back story including various mental health diagnoses and encounters with all sorts of state organisations. I am also aware of the various interlinked conditions, ranging from obesity to high blood pressure to interactions between the side-effects of antipsychotic medication, their effects on weight and the risk of developing diabetes. And the aching knees. And the poor sleep. And the precarious financial situation.
I could press a special button and the printer would deliver a piece of paper with the main disease codes including a fairly recent statement about her frailty. But she is only 45! The code has been applied by the invisible hand on the basis of her unscheduled care encounters. Read More