I work in between two very insular, economically deprived areas.  Most of my patients are in receipt of government assistance.  A high percentage of my patients don’t drive.  Those with poor mobility are truly limited to services that are within short (and easy) walking distance.  On an average day, I see two or three people who are living with diabetes.  I see a fair number of children where one or both parents struggle with substance abuse.

Recently, I saw a young boy (S) who had a very high plus Rx and a massive RSOT.  He had been referred twice to the orthoptist but, on both occasions, he had failed to attend.  In his file, next to the referrals, was a letter from the hospital informing us that S had been given several appointments and had not shown up to any of them.  They wrote that they would remove S from the list but that we could re-refer at any point.

According to L, S’s parents were both well known in that area and not for good reasons.

I first encountered this family when S’s grandmother came into the practice.  He had lost his specs so the gran was hoping she could arrange a replacement pair for him.  When I looked out the record card, I found out that S was due a test and then, seeing the red referral forms, I asked if S had been discharged from HES yet.  She was confused by this – it was only then I noticed the letter from the hospital about the non-attendence.  So, we arranged a time for S to be tested.

A few days passed and S arrived with his father.  His dad was younger than me but looked very frail.  He’d come out on a cold day with only a thin t shirt and shorts on.  He shuffled from foot to foot and seemed to be in two places at once.

I tested S, which was a struggle because of his densely amblyopic right eye.  I had the sneaking suspicion that, although he was in primary 2 or 3, he was unsure of his letters.  I switched to pictures but he was getting frustrated so we called it a day.

I explained to S’s dad that two of my colleagues had referred S to hospital so he could get treatment for his right eye.  The dad told me that he also had a lazy eye and was keen on his son seeing the orthoptist.  Unfortunately, this man had struggled to get his son to an eye test appointment when they lived across the road and had to walk past us on the way home from school.  Remembering a hospital appointment, organising transport and then getting both him and his son there on time was very difficult for him.

I asked if it would be easier if I used the gran’s address for the referral.  He looked relieved when I suggested this.  I told him I’d call her to check if this was okay and if so, the appointment letter would go to her rather than him.  When they left, I called the gran and she said she would be more than happy to take S for his appointment.  In fact, the other day, she’d been mortified by the missed appointments.

“My son… he isn’t very good with organising things,” she said, sadly. “I try to do as much as I can for the kids but, you know…”

The real problem went unsaid.

While it’s not an ideal scenario, at least I know S will get to see the orthoptist.