Liam Farrell: Admission letters can be harmless fibs

In a recent blog, a hospital geriatrician decried the term 'social admission' as inaccurate and misleading - there was always something else wrong, he implied, something medical the hospital staff could get stuck into, there's no such thing as somebody who is healthy, just someone who hasn't been investigated enough.

'Such people,' he said, 'should not be admitted from the front door of the hospital as we can add no value to their care.' Now there's something I didn't know; all these years I've actually been adding value to my patients' care (or maybe not).

Well, buddy, you're completely wrong. In the real world, inhabited by real doctors and real people, in the dark hours of the night, there's no immediate access to social workers and so on.

Hospitals might like to think they are there for the big stuff, heroic surgery and mindbogglingly expensive machines and managing thyrotoxic crises and treating diabetic ketoacidoses, but they aren't. They are there to look after patients who need care and if that care is uncomplicated, it doesn't mean it is any less valuable for that.

A hospital should be a haven, a sanctuary, a place of refuge. Sometimes what a patient needs most is a bath, a meal, a bed, some company and a few kind words, which in more innocent times, we used to call nursing care.

We send them to hospital because there is simply nowhere else to go. But, of course, the NHS has no overt facility for providing for this need, and part of the ritual is that the GP has to construct a flimsy Trojan horse of plausible medical grounds to access this care.

And the lies rise blithely to our lips; our moral compromise is slow but implacable. Invention and dissimulation become easy with practice, and so many illnesses accompany neglect that it is only a matter of choosing the handiest one.

So our admission letters are not downright lies, they are only half-truths, harmless little fibs in pursuit of the greater good. Which, as Pierre said in War and Peace, is the only kind of good there is.

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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