It's just been one of those days

Managed to get a short shift today, only 10 hours instead of the usual 12. However, with the sort of day it has been I am glad I didn't have to work the last 2 hours.

It has been one of those days where nothing has gone right. Patients have been shipped in the Clinical Decisions Unit from A&E not because they need further tests which can be arranged by us, or because they need to be observed for a few hours, but simply because A&E has been packed to the rafters and no one has been seen by a doctor until about 3 hours after they booked in. This of course goes against the government's wonderful guidelines that patients should be seen, treated and discharged/admitted within 4 hours of arriving at A&E.

What this ultimately means is that patients who have presented with minor injuries have been told by the triage nurse to make a GP's appointment (for conditions lasting 2+ days), go to a Walk In centre or go to the Minor Injuries Unit. This has weaned out a lot of malingerers but some creep through the net. Usually the ones who claim to be in pain, or insist on having an X-Ray, or have problems that nurse practitioners won't deal with (and don't get me started on the rant there, see Dr. Crippen's blog for some good rants).

I've had some very funny conversations with patients today, including one that went like this. Bearing in mind that the patient had already sat in a cubicle in A&E for 1 1/2 hours whilst nobody treated her. She then got moved to us as she was elderly, dehydrated, had previously collapsed and no one could work out what was wrong with her and no one was prepared to risk discharging her.

Me: Hello, I'm MJ, I'm one of the doctor's here. What seems to be the problem? This being done whilst flicking through her A&E notes.
Patient: I don't know. I felt funny this morning and collapsed. My neighbour found me. I feel much better now, can I go home?
Me: Not yet, we really need to find out what's wrong with you. Are you in any pain? Noticing that in her notes she has been taking dihydrocodeine (a strong painkiller) regularly for 8 months.
Patient: No, no pain.
Me: So why are you taking dihydrocodeine?
Patient: For the pain.

Is there any wonder I want a brick wall to bang my head against at times??