'It would be foolish to imagine there are no bad eggs in the GP profession.'
Auntie Wilma has been a key focus of my friend Josie's life for many years. Wilma trained and worked in healthcare, never married and remained ﬁt and independent until she was 91. Every morning at 7.30am Josie's phone would ring three rings and then cut off. Auntie Wilma had agreed to this messaging system that would let Josie know she was alive and well.
Josie would take her to the shops, the doctor and generally keep an eye on the old girl who, due to her life of independence, could appear a little cantankerous. Then she had a fall in the night due to low blood pressure. Ever prepared, she had an emergency button and thus when she was able she could get help. An ambulance whisked her off to hospital.
Josie, her next of kin, was given the realistic assessment that Wilma was very old, had been down at a low temperature for a very long time and frankly, it looked a bit touch and go. It wasn't really grim news because Wilma carried around in her bag a living will, and a tape, expressing her wishes not to be resuscitated or have any extraordinary treatment to keep her going in the event of such an occasion. She had been of the view for more than a decade that she had enjoyed all she wanted of life.
Things took a turn for the better. Wilma picked up and while she could not go home, she moved to an aged care facility.
She improved in the ﬁrst few weeks. The effort of looking after herself had been lifted from her shoulders. Having some activities and the occasional attention from a visiting hairdresser and beautician seemed like paradise. But as you might expect, the tedium set in and things pretty much plateaued.
Things, except for the pharmacy bills. Josie has looked after Wilma's accounts for some years. She is very familiar with Wilma's medical needs and her wishes with respect to treatment. For the ﬁrst months the pills were in a familiar pattern. The pharmacy bill was about the same length and price every month. But some time later Josie noticed it had gone up and now ran to a second page.
Being organised Josie decided to go back a few months and do some checking. Wilma was now on a whole new regime of drugs. Josie knows that a little knowledge can be dangerous but also knows that left unchecked people can make mistakes. She hopped on the internet and researched some of Wilma's new drugs.
The two drugs for high blood pressure were a surprise given that it was Wilma's low blood pressure that caused a number of falls. Drugs for a peptic ulcer were equally unsuspected as, to the best of Josie's knowledge, Wilma had never had one. Two drugs for depression were also newly added.
Apparently the food at the facility must be a little turgid. Wilma, who had not complained of irregularity in her 90 years, now needed a large dose of Coloxyl every day. Her diet must have been fairly high in fat because Wilma had apparently developed sufﬁciently high cholesterol to require two different statins.
Armed with the facts of the unexplained rise in the number of drugs and the consequent cost, Josie emailed the facility and asked for a review of Wilma's drugs. Could she be shown when Wilma was diagnosed with an ulcer? What was the explanation for all these drugs appearing? Within a few days the GP had cancelled about five of the new drugs and modiﬁed a few others. Just like that. Today you need them, tomorrow you don't. Josie found the sudden cancellation of these drugs somewhat perplexing. No explanation was given.
On her next visit to Wilma there was a lockdown due to a gastric bug and Josie was unable to go into the wing where Wilma was staying. Never one to waste her time, she asked to see the director of nursing at the facility. Josie has a friend who works at another facility so she had a fair idea what to ask. Did they have a process for an independent audit of the drug intake for patients? Not to second-guess the GP, but checks and balances are a good thing. Had they noticed anything different? No, they did not have such a system.
Wilma is lucky to have someone who bothers to check everything. The new drug regime would have had her on 30 pills a day at 91 years of age and weighing a mere 45 kilograms. Josie's brother was in care in the last few months of his life. In the last few weeks, when he was on fairly high doses of morphine, she had thought it odd that the GP would order multivitamins, but there they were on the bill.
I can't help but wonder how many Wilmas or Williams are out there without someone either suspicious or savvy enough to check what is going on. We all probably judge GPs by the standard we see in our own. My doctor has worked, for the past 25 years at least, in a lower-income area. Clearly she wants to help people more than she wants a brass plaque in a ﬂash suburb.
But it would be foolish to imagine there are no bad eggs in the GP profession. Every chook house has them. Accountants, lawyers, mechanics, stockbrokers and so on. Of course, crooks and cheats prey upon the vulnerable. A facility full of old people with varying degrees of mental acuity and possibly with staff costs down to a minimum would be a goldmine in the hands of a lousy GP. It's a goldmine that you, the public, pay for. Thanks, taxpayers. The worst of it is that unless there is some sort of conspiracy with the facility to siphon off the extra drugs, old people like Wilma are being loaded up with drugs that if they don't need must surely be bad for them.
Everybody can make mistakes but Wilma's story is alarming. If repeated in that facility and in thousands of others around Australia it's a scandal.
Amanda Vanstone is a columnist for The Age and was a minister in the Howard government.