Sqad ..

[Elina]

can you tell me what responsibilities of care a doctor or consultant has if an illness is diagnosed in a patient , say a dementia type illness & as a result of that particular illness ... follow up treatment is missed by the patient solely looking after themselves without knowledge to next of kin/ family of that illness?

[Elina]

Thank you.

[bednobs]

practically, the consultant would record it as a "did not attend". where i love, they would get one more letter, and then be discharged back to the care of the GP

[Peter Pedant]

Yes this happened to one of my tenants who was so depressed that he didnt attend the psych OP session and was discharged as a non attended and told to go back to the GP

used to be commonplace - this practice has been stopped in Paed clinics ( oops not likely with dementia ) as carers may not turn up to the kids' OPs it the child is bruised....

[Elina]

Thanks bednobs x

[woofgang]

So are you saying that
The person forgot to go to an appointment because they had an illness affecting their memory?
This same person has chosen not to inform their family of their illness and has chosen to take care of themselves independently?
The doctor has no permission from the patient to discuss the patient's condition with their family?
The patient has been judged to be mentally competent to care for themselves or the issue has never arisen?

In that case the doctor (or clinic admin) has no more responsibility for "chasing up" the patient than they would for any other person who missed an appointment.

I am an ex NHS clinician and know the procedures well. IF the patient had been referred to a community support facility and had accepted their help then it would be usual for the community support to be informed of the missed appointment.

[Elina]

Would the gp receive a letter that states a non attendance? If so in this scenario (dementia) would some other practice be implemented?

[Sqad]

I see......in a nutshell......if a patient doesn't turn up for review it is not the responsibility of the Consultant for any untoward sequelae.

However.........it it was for a post operative review, and the patient didn't turn up, then the Consultant may ask for the nurses or secretary to contact the patient.

It varies from hospital to hospital, some hospitals automatically send one further appt and then if that is ignored, the patient is deemed to be lost to follow up.

[Elina]

Sorry woof, didn't see your reply there.

[Peter Pedant]

// It varies from hospital to hospital, some hospitals automatically send one further appt and //

you're joking Sqad nowadays one strike and you're out ....

[Elina]

So there's no responsibility on gps ect to 'chase' up a patient for a no show even if say the illness is memory loss & a condition further deteriorates.

[woofgang]

If the doctor had made the original referral then its likely that they would be informed of the DNA but not definite. It certainly wouldn't be done as a matter of urgency and the letter might just be filed in the patient's notes and left until the GP did a review. Again if the patient had not given permission for the matter to be raised with family then if the GP was concerned enough to follow up, they might contact the patient or ask one of the community care team to do so. Again, NHS staff can only do what the patient will agree to.
Is the person upset that they forgot their appointment and do they want another one?

[Elina]

Woof, there's absolutely no proof of anything wrong at this time. Just querying if a patients memory was so bad & that patient 'forgot' to attend hospital appointments & that condition further deteriorated what responsibility of follow up care might be expected. Thanks for all replies x

[woofgang]

No, none unless the person is deemed to be very severely impaired and thus "at risk" If that was the case then its very likely that the GP would have involved community services and or social services at the same time that they made the consultant appointment, always assuming that the patient had allowed them to. When i was working in the community I knew quite a few older people with cognitive issues (memory, function, minor stroke damage) who refused assistance and would not have their family involved. They managed in their own way often for quite some time before things collapsed totally.

Baseline is that legally and ethically a person either has mental capacity to make decisions about their lives or they don't. If they have that mental capacity then clinicians are not responsible for ensuring that they attend appointments and so on.

[Elina]

Short term memory loss ( limbic Encephelitis)

[Elina]

Very informative, thanks so much.

[woofgang]

So is the person upset about the missed appointment and do they want another one? Was it their first consultant/clinic appointment?

[Elina]

Thanks everyone x

[Elina]

No not first consultation woof. Will pay for access to copies of his medical records to fill in the gaps. Letters have been found regards previous conditions that may have related & finally led up to this debilitating encephelitis. We just want to fill in some gaps that 'he' can't.

[Elina]

Thanks sqad.

[Elina]

Sorry Peter, thank you too.