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Who has lost their marbles?

I've knocked twice now and I begin to wonder if anyone is in — or if some significant event has occurred since this visit was requested, necessitating calls to relatives or possibly even forced entry.

But no, I hear the key in the lock and then Mr Richardson, aged 92, looks benignly out. I introduce myself and we proceed into the sitting room; I can see why he took a while to answer the door — he is almost bent double with the arthritis which has deformed his hands and slowed his gait. With old-world courtesy he offers me a chair and sits back down in his own seat from which my arrival had so rudely dragged him.

I make that elementary mistake of not asking the patient what is concerning him. The visit request had mentioned a skin problem on his hands so I launch into an assessment of this, noting some slightly dry skin and heartily reassuring him that this should settle with moisturiser, although he might possibly need some hydrocortisone from time to time if his skin gets scaly.

He accepts this amiably but then the momentum of the visit stalls and I am sorry to say that I move into quality and outcomes framework mode, taking his blood pressure and asking about his flu jab.

He lets me chat on for a bit then says, nicely, that the Chinese doctor gave him some cream last week and it certainly has helped his hands. I scan the print-out. There is no record of any GP visiting over the last weeks and none of any out-of-hours contact for years, so I stupidly assume — what? confusion? cognitive failure? effects of a urinary tract infection? I’ll need to review the situation, perhaps, and return.

As I leave, however, Mr Richardson’s expression is not one of confusion. He seems, indeed, to be in full possession of all his marbles and not a few of other people’s. I might describe his look, rather, as quizzical.

When I get back to the surgery I find that the visit had been wrongly put in for today instead of a week ago and that my colleague, whose dad was Thai, did indeed visit last week, did note a touch of mild eczema on Mr Richardson’s hands and did give him some E45, but was unable to enter the visit on the records as his login to the system was somehow snarled up.

I wish a medical student were here to absorb the lessons of this episode, namely ask the patient and don’t assume things and that many people in their nineties are sharper than you are. Mr Richardson was quite right to be puzzled.

Flora Tristan is an inner-city GP