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Practitioner May 2010 - 254 (1729): 38

Read Codes don't tell half the story

30 May 2010

AUTHORS

Professor David Haslam CBE FRCGP
GP, Ramsey, Cambridgeshire;

Past President RCGP; national clinical adviser to the Healthcare Commission; and Visiting Professor at de Montfort University, Leicester

Article

Have you ever noticed just how breathtakingly negative a view of life is expressed by our computerised GP records?

Don't believe me? Well, just try finding the Read Codes that include the word husband. It is quite the most depressing list you can imagine. I quote: ‘Husband alcoholic, husband left home, husband committed adultery, husband in prison, looks after chronically sick husband, husband died, artificial insemination from husband'.

It is strange, and very clear that apparently no-one would ever want to enter into a medical record the fact that a husband was supportive, loving, kind, or caring. And - just in case you were wondering - the negative bias applies equally strongly to wives.

It's not only sad, but it's not even vaguely true or representative of real life. In the real world, husbands and wives can be extraordinary - a word that never would find its way into a Read Code description. And I'm well aware that they can be alcoholic, chronically sick, adulterous, inseminators - but marriage doesn't have to be like that.

I had known this particular couple for about 25 years. They lived in an ordinary house on an ordinary street but had an extraordinary relationship. I had looked after them through one relatively minor health problem after another until the husband suffered a massive stroke that left him almost completely helpless. But when the hospital team discussed discharging him to a nursing home, his wife would have none of it. He was coming home, and she would care for him. By this stage she was in her eighties, but she set to organising the house, rearranging everything to make her husband's last months or years comfortable.

And for just over three years she worked a miracle - washing, feeding, supporting, and loving her husband in the most wonderfully moving of ways.

And then one day he developed bronchopneumonia, they both opted against his going into hospital, and despite all our best efforts, and with a degree of inevitability, he died.

A few days later I called in to see how she was doing. As ever, she was bustling around the house, but she was pleased to see me and made me a cup of tea.

As we sat there, discussing how the last three years had been, she said: ‘Actually doctor, now that he's gone, there's something I need to ask you.'

And then she told me about a breast lump that was worrying her, and asked me to examine it.

She showed me a crater in her chest wall caused by a massive fungating breast cancer - a crater that she had packed with dressings and kept totally hidden from her husband, for fear of upsetting or worrying him.

I don't think I have ever felt so overwhelmed by the power of a relationship between two people. She had almost literally sacrificed her own life to make her husband happy and content.

Indeed she died just five days later, having appeared to all the world to have been perfectly well until that moment she showed me the cancer.

So what Read Code would you use to describe that relationship? We don't have to see everything in the world as a negative.

Good things do happen too - but when did you last read an article on breaking good news?

 

REFERENCES

Professor David Haslam CBE

FRCGP

GP, Ramsey, Cambridgeshire;

Past President RCGP; national clinical adviser to the Healthcare Commission; and Visiting Professor at de Montfort University, Leicester

 

 

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