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DrHelen
DrHelen, Doctor
Category: Medical
Satisfied Customers: 61
Experience:  UK Family doctor with special interest in Palliative Medicine
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My father in law is 84. He has mild dementia. His pleasures

Customer Question

My father in law is 84. He has mild dementia. His pleasures are gardening and walking. He is in a lot of pain and limping very badly. Pain is attributed to back. He is non compliant with PT regime at home because he can't remember it and resists direction from wife. He is a lamb when I visit. He is on topical ibuprofen and codeine-paracetamol. He is dogged about getting up and moving. Question: home pt available in uk? Physiatry consultation available in uk?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 2 years ago.
Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Hi. Still need help?
Customer: replied 2 years ago.
Are you in UK?
Expert:  Dr. Phil, MD replied 2 years ago.
No I am in the US

He should be able to get home PT or a physiatry consultation
Customer: replied 2 years ago.
I am an American physician. I was looking for input from the uk. The website indicates UK so I thought I was accessing someone there. Additionally you call yourself GP which is not commonly used in the US but is in UK. Can you re-direct to a UK doc please?! What I need help with is NHS specific. I myself had suggested both home PTand physiatrist consultation and my mother in law says not available. She is afraid of getting thrown off the GPs books if she is too aggressive.
Expert:  DrHelen replied 2 years ago.

Hello, I am Dr Helen, a UK doctor and GP.

Your mother-in-law is right in what she says. It is not possible to have a home consultation for anything in the UK with the one exception of terminal care where dying patients are visited at home. Likewise physiatristy is not a recognised speciality in the UK. It is still very much a US speciality. We do have rehabilitation medicine which is probably the closest but is reserved for stroke and injury patients on the whole. UK dementia patients are looked after by the psycho-geriatricians and the GP would do the referral to such a specialist. The general geriatricians would be the best speciality to review his pain and mobility problems.

The UK health system is, as you say, very different to the US. I am UK born and bred but have US doctors in my family and know that the differences are quite astounding! The GP is the gatekeeper for everything here. A person can ask to see a specialist privately, rather than on the NHS, but still has to see the GP first for the referral. You cannot self-refer to a specialist.

A lot of US expressions don't even make sense here....the phrase "certified" for example means you have been detained under the mental health act so for UK patients to see a doctor describing themselves as "certified" can be quite alarming!

I am sure the GP could arrange further referral for your father-in-law and GPs are very reluctant to throw people off their books. That is reserved for aggressive and violent patients who continue to threaten the GP/clinic staff so you can reassure your mother-in-law on this account.

I hope this helps. I'm happy to help with any other questions you have.

Best wishes.

 

I joined JustAnswer in June 2013 and am a UK doctor. I have been qualified for 23 years and have widespread experience in GP and cancer care.

Customer: replied 2 years ago.
Thank you. He is not a typical patient. He has seen several specialists. I believe it was a neuro-geriatrician who worked him up some years ago. He has been described as having had 'small strokes' with stable chronic short term memory loss with really touching residual insight. He has not worsened in years. Suddenly he can barely walk with an acute change in the past two months. Clearly musculoskeletal-skeletal I thought. Assessed by GP as hip arthritis this was rejected by hip ortho who attributes it to spine. He has a history of back problems. To my limited exam pain is focal on SI joint on right and with decreased right hip internal rotation combined with some sort of pelvic girdle muscular process. He had point tenderness on posterior aspect of right greater trochanter which is odd. The GP has refused further referral saying MRI would not be tolerated, and spine injection, helpful in the past, would not 'be tolerated'. I do not agree with either point. A general geriatrician in US would not do injections to alleviate pain. Do they in uk? V
Expert:  DrHelen replied 2 years ago.
Hello, I am surprised too that the GP has said MRI and spinal injection would not be tolerated. I could understand if your father-in-law had severe dementia but not when he has mild dementia. Plenty of people with mild dementia tolerate both procedures very well.
Could your in-laws see another GP in the practice? It varies from practice to practice how easy this is. In some practices you have your own allocated GP (so called personal lists), in others you simply see whoever is available. Even when a practice works with personal lists patients have the right to see another GP within the practice. A different GP may be more sympathetic.
From the further details you have supplied the most appropriate specialist to see would probably be a rheumatologist. Like in the US general geriatricians here don't do pain injections. Rheumatologists do and we also have pain clinics in most NHS hospitals which are staffed by anaesthetists who offer all manner of pain injections.
However it does sound like your father-in-law needs this investigating further given the acute changes and if the hip ortho is not seeing him again, a rheumatologist would certainly be my next suggestion.
Best wishes.
DrHelen, Doctor
Category: Medical
Satisfied Customers: 61
Experience: UK Family doctor with special interest in Palliative Medicine
DrHelen and 2 other Medical Specialists are ready to help you
Customer: replied 2 years ago.
That sounds right. Thank you for your answers and your wonderful tone. Is it possible for me to communicate with you again?
Expert:  DrHelen replied 2 years ago.
Many thanks for your positive rating, it is much appreciated.
You can contact me again...the easiest way is to just put "Question for Dr Helen, UK only" as your question title.
All the best.

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