Intended for healthcare professionals

Ward Round

Of Struldbruggs, sugar, and gatekeepers: a tale of our times

BMJ 2003; 327 doi: (Published 18 December 2003) Cite this as: BMJ 2003;327:1451

This article has a correction. Please see:

  1. David Kerr, consultant physician (
  1. 1Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth BH7 7DW

    Socially isolated, depressed old patients most often end up on the diabetes wards after someone notices their blood sugar is low and all other specialists have lost interest

    At the beginning of November Gladys noticed a mild ache in the left side of her chest when she got up to go to the toilet in the middle of the night. The nursing home dialled 999 and she was whisked off to hospital. After six hours of processing in the emergency department, she ended up on the acute admission unit where, despite 72 hours of tests, no cause was found for her pain. Gladys was moved to the cardiology ward but again, despite a further battery of tests (including repeating earlier ones) no one could say for sure what caused her pain. Throughout, Gladys remained befuddled, relatively immobile, occasionally incontinent, and “uncooperative.” She didn't like taking the 16 prescribed tablets each morning. The medicine for the elderly team felt that attempting rehabilitation was inappropriate. Due to pressure of beds Gladys was transferred at midnight to an orthopaedic ward, but because of the need to free up the bed for the next day's waiting list initiative patient, she was moved to urology. After three days it was noted that her blood sugar at the time of admission was 15 mmol/l, so the bed manager felt it appropriate that Gladys should be transferred to the diabetic ward, which had two bays closed because of Norwalk virus. At some stage Gladys lost her specs and bottom set of dentures. She will be having turkey on the diabetes ward on Christmas day.

    In the diabetes ward

    “Old age is not so bad when you consider the alternatives,” said Maurice Chevalier. It is difficult to share his optimism after completing a general medical ward round, particularly if you are a …

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