Shit! That came out wrong, very wrong! Stuttering, I tried to explain myself – but I don’t think that I managed to dig myself out of the hole very well. I stabilised her medical problem and referred her to the medical doctors for investigation and an echocardiogram. I wrote down the name of my chaperone very carefully. A year later I haven’t heard anything, so I think my faux pas has been excused.
Where have all the dentists gone?
If you needed a plumber urgently, would you call out an electrician because there was a lack of plumbers in the neighbourhood, just in case they could sort you out? No, it is madness. So then why, oh why, do patients with toothache go to A&E. GO TO A BLOODY DENTIST. I know very little about teeth. Very few doctors do. Don’t come to me with teeth problems, go to a dentist.
I got so annoyed with a man this morning – luckily I didn’t show it, as it turned out he was blameless. We were very busy and I felt he was wasting our time. Instead of letting a steam rush come upon me, I tried to have a chat with him (more to calm me down). I asked him why had he come here. The answer surprised me. It wasn’t NHS Direct, it wasn’t even his GP, it was his dentist, or whoever used to be his dentist, who had sent him. You see he had not had a check-up for over two years, so he had been automatically taken off the dentist’s list. The other dentists in the area were not taking new NHS patients and there was no available emergency dentist, so they had advised him of my expertise if he was in need of painkillers, which he was.
He was pissed off. He didn’t want to come to A&E, he wanted his tooth sorted. Luckily, we have an emergency dentist in the area, which our receptionists managed to book him into for the next day.
I felt annoyed with myself for being annoyed with him. It is the system that is at fault and not the patient, but thanks to useless negotiating on behalf of the NHS, the dentistry cover isn’t as good as it could be considering the amount of money put into it. People’s teeth are getting damaged and because people want an instant fix they come to A&E. It is like so much in society. When the normal health services that a society needs to function are not working too well, then people come to A&E, regardless of whether or not they have an accident or emergency.
Should he have called an ambulance?
Some patients really do try your patience. They abuse the system and it is very hard not be judgmental. I had one tonight – I’ll let you decide whether you are happy that your taxes were spent on him.
He was complaining of chest pain, but was well known to us – 14 visits for chest pain in the last year and all on a Saturday or Friday night. Chest pains get seen straight away – and rightly so – so I asked some questions. He said his pain had gone and then he went. I tried to stop him. I tried to explain that he would benefit from an ECG and that I would like to at least examine him before he left.
‘Nah, I have got better things to do,’ he said and walked off.
The ambulance men apologised for bringing him. They had to as he had called them complaining of pains in his chest. It is one of those conditions where it is always better to be safe than sorry and come to A&E. However, this man lives just around the corner from the hospital and whenever he is out and gets pissed he calls for a free taxi and lies about chest pain.
What a selfish and thoughtless act, putting other people’s lives at risk. One day he will have real chest pain and his past action will have put him at risk as the ambulance crew may not believe him or be tied up with other people like him.
I later found out from another ambulance crew that he had done it again. This time they took him to another hospital 35 miles away from this one and 35.1 miles away from his house. He went berserk when he found out that he was nowhere near home. He demanded a lift home after self-discharging. The ambulance men kindly told him where to go.
I understand that it was an expensive taxi ride home, especially on a Saturday night … we haven’t seen him in A&E since. Sometimes you have just got to love your ambulance colleagues. For anyone interested there is a fantastic blog (and book – Blood, Sweat and Tea) by an ambulance man – who describes his joys of working in the NHS (http://randomreality.blogware.com).
A different type of health visitor
I knew I was going to enjoy this consultation from the outset. He was 92, looked 72, and had been flirting with the nurses from the moment the ambulance brought him.
‘Hello sir. How are you?’ I asked.
‘You’ll have to speak up, I am very deaf,’ he responded.
I reassured him that he didn’t need to worry as I was very loud. Now that we knew that this wasn’t going to be a private conversation, despite closing the curtains around the cubicle (which I used to think made the room soundproof), we started the consultation.
I soon found out that he had chest pain. It sounded like angina – a condition he is known to suffer from. Normally it settles with a spray of a drug called GTN. However, he had first got the pain an hour ago and was still in pain. While my colleague did an ECG, I put in an intravenous line and started some medications to ease the discomfort.
‘So what were you doing when the pain came on?’ I asked.
‘It happened when my health visitor was with me. She was the one who called the ambulance.’
I enquired why he had a health visitor and how often she came round to see him.
‘She comes round once every three weeks, just to see how I am and help me … you know.’
I wasn’t too sure what he was talking about, but I thought he must have been describing a new government scheme, whereby community matrons visit patients with chronic conditions at home every couple of weeks to check that they are OK. They then liaise with their GP and try and implement plans to keep them out of hospital. I asked him if that was what he meant by a health visitor.
‘She isn’t organised by the GP. I organised her myself about three years ago. She has been very good to me,’ he responded.
Now I was confused. Naive as well, as it turned out! I continued in my questioning.
‘So does she help round the house then?’
‘No my friend.’ He leaned forward and in a theatrical whisper said, ‘She comes round to help me ejaculate as I can’t really do it myself. It was when she was playing with me that I got the chest pain. It was so bad that she had to stop and call the ambulance.’
‘What a bloke’, I thought, ‘Honest and still enjoying life, and very friendly’. I smiled and in the notes wrote pain started on ‘mild exertion’. It is encounters like this that make my job pleasurable.
How targets can hurt patients and staff
In principle, a target to see and sort out patients within 4 hours is a fantastic aspiration. Unfortunately, it is like a lot of targets and reforms – they comply with the law of unintended consequences by creating an unintentional distortion in clinical priority, which