I have since marvelled at how common a condition DED is, and how often it presents itself in general practice. I shall share my experiences of four consecutive patients in my early morning commuter clinic, which starts at 0 seven-thirty. The O is for ‘Oh my God, it is too early!’
The first patient had a tiny verruca on his toe, for which he had been seeing a private chiropodist for a year but she could not cure it. He was expecting me to refer him urgently to hospital to see a specialist so that a permanent solution could be found, as he had already spent vast amounts of money on it. After I had printed off instructions on self-management, advised the application of duct tape to the offending lesion, and gently explained that we no longer treat warts at the hospital, he left most disgruntled that I had wasted his time!
The second chap could not have been more different. I had recently performed a minor op to remove a discharging sebaceous cyst from his eyebrow, which had been slowly growing over the course of a year. At the time of surgery, it was clear that it was not a cyst but some hard lump, which I tried unsuccessfully to remove in its entirety. The hole in his forehead was already 4 cm big when I knew I could not get it all out. I had to tell him that morning that he had a microcystic adnexal carcinoma (sweat gland tumour, I had to look it up too!). He needed more extensive surgery so I had referred him under the 2-week rule. He could not thank me enough for all I had done: he was grateful that his scar was barely noticeable, and he felt that he was in the best hands.
The third patient was an 84-year-old Italian man with severe dementia (MMSE of 0/30), accompanied by his 82-year-old wife. He kissed my hand in greeting but had no other interaction. His wife was clearly struggling to cope; I had tried to offer her carer’s breaks and social service help at home but she refused everything because it was her place as a wife, in sickness and health, to care for her husband. He would never have wanted to be a burden on anyone else and she was not going to let that happen now. My heart was moved by her devotion and, as if to prove my theories about DED, the next patient brought me crashing back to earth. It was a middle-aged man, claiming that he had been sent by the Job Seekers’ Office to get a sicknote so he didn’t have to sign on any more. He had had the official medical saying that he was fit for work but he had never worked an official day in his life. He had calloused hands and paint under his nails from ‘home DIY’ but could not work, or else he would have all his other benefits stopped. After he had spent 20 minutes shouting at me for declining to sign him off sick (my hands were tied by my social conscience), he stormed out, swearing obscenities and vowing never to see me again.
Delusional Entitlement Disorder—how often are you seeing it?
Joe McGilligan, GP; Chair East Surrey CCG; LGA Health and Wellbeing Champion
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Update your knowledge:
GP curriculum heading 3.12—Cardiovascular health
To learn more about the role of blood pressure testing in the new JBS3 lifetime cardiovascular risk calculator and the calculator’s implications for clinical practice, please read the article here.