Dr Nadia Farhat, MBBS, MRCP

There are usually two people in the room and I am only asked to see one of them. The patient sits in the first chair, and in the second chair, holding the bag with the tablets in it, is the person who knows what has actually been happening: who noticed the confusion started on the Thursday, who has watched the walking get worse over six weeks, who knows which tablet gets refused every evening. In a twenty minute clinic that person is very often asked nothing at all. Most of what goes wrong at home afterwards was sitting in the second chair, unasked.

I am a consultant in geriatric medicine. My working week is frailty, falls, delirium, dementia, medication that has quietly accumulated over fifteen years, planning discharges that hold, and care at the end of life. Almost none of that happens in a hospital. It happens in somebody’s front room, carried out by a relative with no training and no rota, and the quality of it depends on whether anyone ever explained the reasoning to them.

I put my name to the clinical half of The Care We Need. That means the pages on medication, spotting deterioration, falls, delirium and dementia, pressure damage, continence, eating and drinking, moving someone safely, and the pages on dying at home. On those pages I check that the explanation matches current guidance, that the warning signs are the right warning signs, and that the page tells you plainly when something is a call today rather than a question for next week. No page here gives a dose, and I would not sign one that did.

The scope line matters, so here it is drawn twice. The pages about assessments, benefits, attorney paperwork, siblings, work and money do not carry my name, because they are not medicine and it would be misleading to imply a geriatrician had validated them. And on the pages that do carry my name, what I have checked is whether the information is accurate in general. I have not met the person you are looking after, examined them, or seen their notes. Only the clinician who has can tell you what any of it means for them.