when a patient slips through the cracks

While on my rural prac I went out with a staff member to perform an ACAT Ax on an illiterate patient who was exercising his power of attorney and in doing so required a review of the current services he was receiving. All that was known about his PMH was that he had long suffered from COPD and HTN. When queried about his current health status he stated that he was due for a consultation with a specialist in the city for reasons unknown to him. He also stated that his bowel weren't working properly and that he had lost a lot of weight in recent months. His exercise tolerance was extremely poor and as such he had barely moves from his chair not even to go to bed. The only meds he was on to assist with chest function was ventolin.

I questioned the pt over whether he gets any pain, numbness or tingling due to prolonged sitting and rapid wt loss, however this had gone unoticed by all the carers and medical reviews that he had had. The patient's memory was intact and while asking the patient these questions it seemed that the rapid wt loss, poor bowel function, lack of mobility and conflict in medications was pointing to something more sinister.

It apeared that with all the services this patient was receiving and all the appointments with varying Dr's it appeared that each health professional had diagnosed this patient with something different yet no one ha bothered to Ax this pt as a whole & look at his health in the global sense.

Ideally the pt needed to be Ax by a geriatrician who can accumulate all of the findings and tailor the patients medications and services so that he receives the best care. I felt like common logic had failed in this instance not so much from an allied health perspective but from a medical one who failed to notice the change in symptoms and medications. I learned that just by being patient and asking the right questions you can gain far more important information rather than just relying on medical records.