A model patient

BMJ 2007; 334 doi: (Published 25 January 2007) Cite this as: BMJ 2007;334:193
  1. Nicola Thomas, senior house officer, Sheffield Care Trust, Sheffield (scousemouse6{at}

    Mary wasn't feeling very well according to the nurse on the other end of the telephone. The nurse said that Mary “came over a bit funny” at the dinner table and was found to have an irregular pulse with a rate of about 30 beats/minute—enough to make anyone come over a bit funny. I went to see Mary, examined her, and performed electrocardiography, which confirmed slow atrial fibrillation.

    I contacted the cardiology registrar, who listened patiently while I presented my case. At the end of my monologue, she immediately agreed to review Mary with a view to putting her on Friday's list for a pacemaker.

    I have to confess, I was shocked. Why? Because Mary is 89 years old and has Alzheimer's disease. She is otherwise well, apart from well controlled hypertension, but on previous occasions when we have referred our patients with dementia to other specialties we have often met with resistance. The stigma of their condition means that it is often assumed that non-psychiatric wards won't be able to handle their behaviour or that their current quality of life is so poor that prolonging their life isn't a worthwhile use of resources. But today was different; today Mary was treated like any other patient in need of interventional treatment.

    The screening blood tests were done (they were better than mine), and Friday came. I telephoned the cardiology ward to explain how best to handle Mary and to ask them to call me before her procedure if they wanted me to accompany her.

    The telephone didn't ring. The whole ward waited for news. Eventually, by lunchtime, we couldn't bear the suspense any longer, and we phoned the ward to ask how she was. The sister told me how wonderful Mary had been, the only one on the list who didn't need sedation. It seems that Mary had been the model patient—keeping her arm still, not meddling with her cannula, and keeping the department amused with stories of her mischievous youth.

    Mary made an uneventful recovery and now has a new lease of life; in fact she's got more energy than I have on some days.

    We are fighting the stigma of mental illness on a daily basis, not just in public but also within the medical profession itself. I am delighted to see that the tide is turning in favour of improving the management of patients with dementia. Mary is living proof that it is worth judging each patient on a case by case basis and not by diagnosis or age.

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