Being independent the services offered by GPs will vary. There is great debate at the moment on whether or not GPs should be allowed to advertise. I think advertising could improve the standards of many practices and give some people an element of choice, depending on the services offered. The elderly as a client group and carers looking after the old should ask a GP some fundamental questions.

Does the practice use an age/sex register?

This allows the GP to be aware of the elderly population in the practice and develop schemes for their benefit.

Does the practice do its own house calls out of hours?

The elderly especially need continuation of care. The use of deputizing services often means inappropriate measures being taken and poor communication.

How does the practice arrange the special services for elderly people?

Who does the screening?

Is it available if you are under the age of 75?

What does it cover and include?

Does the practice follow up if you miss the first request?

Some GPs offer well woman clinics which may welcome elderly women. I do outpatient clinics in GPs surgeries enabling specialist opinions to be obtained without the necessity of a trip to hospital.

Does the practice offer regular (once every six months or year) visits to the elderly house-bound?

Does the practice regularly review medication and give cards or printouts of drugs being taken?

Many practices by using the age-sex register are able to identify the elderly in their practice and make arrangements for them to be seen regularly.

District nurses are fully qualified nurses who have undergone specialist community nurse training. Their job is a particularly hard yet rewarding one. A group of nurses usually work out of a GP practice, allowing good communication between the two groups of professionals. Their work is extremely varied, from tending to ulcers and wounds, supervising medication, giving injections, helping the frail and sick in and out of bed and generally giving them rehabilitative care and nursing attention. They are also one of the main contact groups giving a kind word, making a quick cup of tea and just being there.

In many areas nurses are being less generalist and more specialists. Thus, there are some nurses who specialize in the advice on and treatment of diabetes. Terminal/palliative care and incontinence are other areas where nurses have become highly skilled specialists involved in all aspects of that particular problem. Some of the less skilled parts of nursing have been given over to other groups such as bathing attendants. This service should be available at least weekly, and more often if there are special problems such as incontinence. Bathing someone involves skills of its own, however, and these attendants perform a very special job.

Access to the nursing services is usually via the GP but direct access can be made through the district nursing headquarters, the telephone number being in the book under Health Authority.

Whatever services visit an elderly person, they and the carer should keep a note of the person’s name and a telephone number where they can be contacted. The services concerned are usually very conscientious and aware of the need that is placed upon them. However, sometimes things go wrong (especially in these times of financial constraint), and then there can be nothing worse than not knowing if a service is going to appear or not. A phone call may solve the problem or at least it should afford a means of communication. If a complaint is justified, never be afraid to contact the manager concerned.

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Why RK Becomes Necessary in Some Situations

Some critics of the radial keratotomy procedure maintain that it is cosmetic surgery, thus relegating it to a lesser role as a method of treatment for the eye. Dr. Michael R. Deitz of Kansas City argues that the benefits RK are first, functional improvement and second (though less important), cosmetic improvement. “Function appears to be far more important to the patients I have treated,” he told the August 1980 Kerato-Refractive Society Symposium on RK. “They’re far more interested in how well they see the world than how well the world sees them.”

Dr. Deitz stressed the importance of unaided good vision in times of emergency. Automobile drivers with high myopia cannot afford to lose their corrective glasses while driving in high-risk situations. Or, in the event of fire while asleep at a hotel, a guest who was nearsighted might he hard pressed to make his way to the exit, Dr. Deitz pointed out.

A Necessary and Beneficial RK

Nickolas Totora of Springfield, Massachusetts lay on the operating table at the Massachusetts General Hospital, the sixty-seventh Boston metropolitan area person to undergo RK through the first quarter of 1984. Within fifteen minutes of the beginning of surgery, 20-year-old Nickolas was up and out of the operating room. He was anxious to “have a look at my new vision.” His left eye had   been   cured   of nearsightedness   only a month   before, and the right eye was the one done now.

“I had begun wearing eyeglasses at the age of two,” the patient said, “and they didn’t do more than act as a crutch. My vision was getting worse. After entering college, my lenses were so thick, I had to put them on before getting out of bed in the morning to see my way clearly to the bathroom. I couldn’t read any of my textbooks without them. Once I was giving a speech to the student body and one of the lenses fell out of its frame. I had to abort the speech. Was I ever embarrassed? That’s when I prevailed on my parents to pay for this double session of operations. I don’t want to wear eyeglasses anymore.”

As he spoke, Nickolas reached for a pair of eyeglass frames in which the left lens had been poked out. He had been using just the right lens for his eyes and seeing normally without the lens for his left. Nickolas pushed against the right lens and popped it out of its frame. “I won’t need these at all anymore,” the young man said.

Looking at the eye first operated on, through a slit lamp, we saw the right radial cuts that had been made in Nickolas’ cornea. They were peripheral to that part of it covering the iris, showing only as faint lines which were minute scars of healing.

After the operation, an antibiotic eye drop is used and the patient is ordinarily patched for twenty-four hours, as mentioned earlier. But this patient declined so much as a bandage for the newly operated eye. The bandage was not put on so as to permit Nickolas the self-testing of his vision after surgery.

His first comment as he covered his corrected left eye and looked at a wall chart out of his newly cured right was, “Oh boy, I can read even the small letters on line 8, D E F. . .”

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