Fillers A memorable patient

Caring for those who refuse help

BMJ 2004; 328 doi: (Published 24 June 2004) Cite this as: BMJ 2004;328:1546
  1. Melvyn Jones, lecturer in general practice
  1. department of primary care and population sciences, Royal Free and University College Medical School, London

    John is 85 years old, and his condition has been getting worse over the past few months. He is forgetful, not taking his drugs, and forgetting to eat his “meals on wheels.” His family are helpful but cannot be with him all day. His prostate specific antigen concentration is sky high, and nobody knows quite what happened when he went to the urology outpatient clinic: he never saw the registrar and somehow found his own way home.

    The deputising GP service saw him last night and said he must be urgently reviewed today, Saturday. He is lying on the floor, crumpled, his pants are soiled, and his food is down his trousers. His mini-mental state score is 13. He has dementia and is prone to falling over. His digoxin box should be half empty, but it is still …

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