Harry and Nell

Age at interview: 78

Brief Outline: Harry has atrial fibrillation and high blood pressure. He had a heart operation to have a stent fitted in 2006 and attends regular check-ups for his INR tests. Previously, in 2001, he underwent an angioplasty operation. Many years ago Harry was admitted to hospital twice with painful kidney stones. He has had no problems since and was unaware that his kidney function is being monitored.

Background: Harry is a retired quality manager for British Aerospace. He lives with his wife, Nell, who briefly worked as an auxiliary nurse before her past job as a civil servant. They have 3 children and 6 grandchildren. Ethnic background: White British.

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Harry has atrial fibrillation and high blood pressure. In 2001, he underwent an angioplasty operation following heart problems. In 2006, he had further heart problems whilst on holiday in Spain and had to have a stent fitted. A few months later, he had to have a second operation in the UK to fit another stent. He made a good recovery and has continued a fairly active lifestyle ever since, just taking things a bit more easily than previously. He still plays golf two to three times a week and generally feels in good health. He currently takes amlodipine, bisoprolol, enalapril and atorvastatin to help his heart, cholesterol and blood pressure. More recently, Harry was diagnosed with atrial fibrillation and now also takes warfarin, for which he needs to attend monthly blood tests to adjust the dosage. Taking his medication has become part of his routine and he hardly thinks about it.

A few months ago Harry experienced a TIA (Transient ischaemic attack, or mini-stroke). He was admitted to hospital and had a CT scan but was assured that no permanent damage had occurred. The slight numbness he felt in his right hand at the time has gradually subsided. Most recently, Harry was found to have developed some pre-cancerous cells on top of his head that may have been caused by spending a lot of the time in the sun without wearing a hat when he was younger. He has been prescribed an acidic lotion to try and burn off the cell growth (keratosis) and has been given a check-up appointment in 12 weeks’ time.

The only other health problem that currently affects Harry is his arthritis. He has had two hip replacements and tends to get pain in his ankles. To manage the pain, he takes prescription painkillers (tramadol and co-codamol) preventively on days when he plans to do something active, such as playing golf.

More than 30 years ago, Harry twice had to be admitted to hospital with kidney stones. On both occasions, he passed the stones naturally without need for surgery, but describes the experiences as excruciatingly painful. He has had no kidney problems since and was unaware that his kidney function is being monitored as part of his current annual routine check-ups.

Two years ago Harry experienced a serious urinary tract infection. He became very disoriented and deteriorated so quickly that his wife had to call an ambulance to take him into hospital. He had to stay in hospital for two weeks and was diagnosed with septicaemia. It was explained to him that bacteria from his urinary tract had been washed into his blood stream via his kidneys, but his kidney health was not discussed as part of the hospital discharge letter.

Harry has great confidence in the health professionals he has dealt with and feels confident to ask questions. He describes himself as fairly inquisitive but also believes in ‘trusting the experts to do their job’ rather than trying to become an expert in everything yourself. As an ex-quality control manager he is mindful of the fact that human error can always creep in. While he thinks that if GPs were to give all their ageing patients large amounts of information about their various health conditions this could create unnecessary worry, it might be helpful for patients to receive a written summary of their test results rather than just be told that they’ll be contacted if there is a problem. Harry believes in preventive medicine and finds having regular check-ups beneficial and reassuring. He and his wife Nell would like to see a larger range of preventive tests, such as for dementia, available on the NHS but are also mindful that cost factors may not allow this.

Harry thinks while there is a danger that too much information might cause people to over-worry, it is useful to take an active interest in one’s check-ups to prevent loss of information and miscommunication.

So what are your views on… the information GPs should give to patients like yourself? I mean….

I think as we said earlier, a feedback from this periodic test would not be a bad thing. On the other hand, I think there’s a danger that, if you feed too much information to patients, they end up by thinking they’ve got every problem under the sun. Because… I’m quite clear in my own mind, that as you get older, things don’t function quite as well as they did when you were younger. And it would be quite easy to end up with a whole list of things which are going downhill and you could end up by focusing on this and you end up wondering whether you’ll survive another day. So, you know, I think you can have too much information but I don’t think it would be a bad idea just to send a brief synopsis of you know, the tests that are carried out back to the patient so that they have some idea that everything was okay.

[Laughs] okay. So generally, do you think that patients should be told about the tests that they’re having? So assuming that you’re being for your kidney function, you didn’t know that was one of the things.

Yes, I think.

That was being tested.

I think it would be interesting, well, not just interesting, but it’s it- it certainly helps the patient to realise that he-, whilst they may have some problems they haven’t got other problem, rather than just taking for granted that, “well, there’s nothing wrong”, you know. And, as I said earlier, any human being can make a mistake and a problem might be diagnosed and there is no communication.

I mean that’s, wouldn’t be the first time that’s happened [laughs].
 

In Harry and Nell’s experience, doctors are not as good at taking blood as the staff who do this all day long.

And what do you think about the way in which this is done and the frequency in which it is done?

Harry: Well I don’t have any complaints, I find it’s fine and I’ve- I have high regard for the nurses. I find the nurses sometimes better than the doctor.

Nell: [shhh] I knew you were going to say that! [Laughs]. Don’t say that ever to a doctor [laughs].

Harry: No, well.

You’re not alone but I’m interested to hear why.

Harry: I think sometimes the doctors don’t have that hands on that the nurses have because they’re doing it all day long, aren’t they. They, to them, it’s part of their routine and, therefore, they seem to be more… at ease with that particular part of the diagnosis [laughs].

So do you mean the actual taking of bloods?

Harry: Yeah, I mean they all seem very confident in what they’re doing. I must admit, I’ve had the odd occasion when the doctor has had great difficulty in extracting blood from me and I’ve thought, “if only I had a nurse so that she would do it just like that!” [Laughs].

But, to be fair, the doctors probably don’t get the same level of practice that the nurses do with some the routine things.

Nell: We’re quite confident that if the nurse picked anything up that she was worried about, she would-

Harry:  Oh.

Nell: Refer to a doctor.

Harry:  Yes, on more than one occasion, the nurse has referred something to the doctor and the doctor has given her feedback so it seems to work pretty well.

Harry believes that looking up health information can sometimes result in unnecessary anxiety; he prefers to talk to a doctor about health problems.

Have you ever looked for additional information about health from other sources or like using the internet or using books or something?

Harry: No and I’m a bit anti I know too many people who spend all their time trying to diagnose their own problems. They end up with totally the wrong information because they’re not …I could mention names in this but I won’t [laughs].

Nell: You’re thinking of your sister, [sister’s name], who was told by the doctor she.

Harry: I have a I have a sister who spends all her time.

Nell: Needed a hip replacement.

Harry: And she’s had every illness, every condition under the sun because she spends far too much time looking at the internet. So no, I don’t think, I think it’s much better to go and talk to the doctor than to worry about trying to diagnose it yourself.
 

Harry thinks there is no need for patients to know the fine details of their test results.

I think in life you have to rely on the professional people that are trained and I don’t think it’s appropriate that we all become experts on every part of our body. I mean you can find out, if you’re really interested, there’s plenty of information around, one can read or go on the internet or what. But I think I know enough about what kidneys are there for and what the liver is there for and so on without going into medical terms and knowing all the sort of finite details.

Harry describes the various medicines he takes for his heart problems, high blood pressure and arthritis. He doesn’t mind taking his tablets and it has become part of his routine.

What you’re taking when and what’s it’s actually for.

Right, in the morning, I take a ten milligram amlodipine tablet, a twenty milligram atorvastatin. Oh sorry, I take that one at night so it’s, I also in the morning I take a bisoprolol, I think that’s how you pronounce it.

Bisoprolol [laughs].

Five milligrams and enalapril maleate I take twenty milligrams of that once a day in the morning.

What’s that for?

To be honest, I don’t know without reading the paperwork. It’s something to do with controlling blood pressure, I think. In addition, in the evening, I take the… atorvastatin, which is obviously a statin, and I also take, five, at the present time, five milligrams of warfarin daily. The only other thing I- I take either co-codomol or tramadol as a painkiller just before I play golf or I do anything fairly active because that otherwise I get, I tend to get very painful ankles. from arthritis and so I use that just to, you know, help me, and I don’t- I obviously, whilst I have a golf handicap, I don’t want to, I want to stay at a certain level. [laughs] And that helps me.

How easy is it to take your medication as prescribed?

No problem. It’s very routine. I don’t even think about it. They say take it with food, so I have the three tablets with my breakfast, and then in the evening I have the other, and it’s just so routine now I hardly think about it.

And have you ever experienced any problematic side effects from any of your medications?

Not at all. I thought that my aching ankles might have been a bi-product of one of the tablets but the GP thought not and he thought it was just arthritis and my age [laughs].

And did the GP prescribe you the co-codomol and tramadol for that?

He did indeed, yes, and I’m careful not to take it unless I need it because I, these things I know can be addictive, so you know, I usually take two tablets probably an hour before I play golf or I do something active, which is likely to cause me a problem.

And how do you feel about taking all these different medications?

No problem. It’s so routine, I wouldn’t give it a thought really. And I assume they do what they are supposed to do. I don’t know, if I didn’t take them, what the effect would be [laughs], but I’m being advised and, you know, I trust in the GP. And… most of the tablets I take were prescribed to me when I had my last heart problem, when I was abroad, and I virtually kept on the same tablets since I came back. They thought they were as good as anything that I would be given here so I’ve been prescribed the same tablets.
 

Harry doesn’t know what will happen to his kidney health in the future but would not hesitate to see his GP if he became concerned. He expects things to go wrong at his age.

Now looking towards the future, how do you think your kidney health will be in the future?

Well, I haven’t, to be honest, I have no way of knowing. But if I feel that I might have a problem, I would have no hesitation. I would go and see the GP, explain the symptoms and… expect the GP to give me advice and…

But I, it’s certainly something, I think as you get towards the end of your time on this earth because, you know, none of us are finite [means infinite] and we certainly aren’t [laughs] you are conscious of the fact that things start going wrong. So, you know, one has got to react to that when it’s obvious that something is going wrong and…. in a way, you just can’t spend all your time trying to prevent everything because you can’t do that, you know. Something will catch you in the end.