Friday, May 26, 2006

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??


The Locum said...

I hear you. See also:

"It's been really sore for 2 weeks doctor."
"What've you been taking for it?"
"Oh, nothing. I don't like taking painkillers."
[That's fine. I'll just go and get my magic wand]

"Have you got any problems with your health? Any heart problems, chest problems, diabetes etc etc?"
"Oh, no."
[What're you doing with that great big sternotomy scar then? And the insulin?]

MJ said...

Glad it's not just me that gets the idiots then. Actually not idiots, just the one's who choose to forget things like medical history and current meds.

Like today;
guy in CDU with severe infection in hand spreading up entire arm. A&E shipped him into us as he wouldn't be treated within 4 hours. Not a problem, or so I thought. Take medical history, states no allergies. Give him i/v penicillin. Guy goes into anaphylactic shock. Comes round, I ask him if he's ever reacted like that to penicillin before. He says... oh, yes, a while ago but I didn't think it was serious!?!

Anonymous said...

Patient takes Dihydrocodeine for the pain - therefore there is no pain.

Patient does not understand that sometimes pain happens because of an untreatable (other than painkillers.

Patient isn't having any problems because they are taking their meds as due.

I don't think patients give wrong answers - we sometimes ask the wrong questions though. ;-)

Supermouse said...

I think she probably meant is she in pain *now*, or new pain, or unusual pain.

I take cocodamol 'for the pain' nearly every day at the moment because I am getting migraines every day (it's under investigation), but, if I happened to be in A&E because of, say, a fainting fit and was not hurting at the moment the question was asked, I could end up giving a similar answer, especially if stressed, worried, thirsty or hot. I tend to assume questions relate to right now this minute, because it's an A&E situation.

I often end up trying to guess what information I can give might be relevant. Too much and you sound like a hypochondriac, too little and you end up not giving obvious clear information that could get you sent home with a don't worry all the sooner, or admitted to have an obvious problem fixed quickly. The easiest,, at least for me, is to fix on the here and now, the new, the different from usual, and to ignore, in my case, a plethora of chronic but unalarming symptoms. Including pain.

Andy said...

Well in fairness she probably meant that she wasn't in pain at the time. I'd like to pass on some advice from a teacher friend of mine. He says to himself, "They're doing their best" any time a student misbehaves. You could try repeating that until eventually the ARGH! bit of your inner speech vanishes :-)