Could Do Better

Although I try my best for my patients, I am not infallible. Sometimes I make mistakes, and writing this blog has taught me to examine those mistakes.
The first job of the day was to an elderly day care centre, the sort of place where the elderly go to listen to music, paint some pictures, talk about the good old days and get fed and watered by the staff. Our patient was a 96 year old man, who was apparently 'confused, falling over with an irregular pulse' – a category A response. We got there as quickly as we could and were met at the door by one of the staff, who didn't know why we were there – however she soon found someone who knew what was going on – and we were led to the patient. On the way to the patient the staff was telling us how unwell the patient was, and how worried they were for him.

We entered the large dining hall to find a group of old folks who were quite happily sitting around finishing off their breakfast. Our patient was pointed out to us, so I went to examine him.

All I can say is that, should I reach my 90's, I'm as well as this gentleman. He was alert and orientated, had no pain, had no dizziness, was not confused and had last fallen over two weeks ago (and he showed me the bruising to prove it). He told me that the staff in the centre had seen a muscle in his hand twitching (he showed me, it was) and they had thought it was his pulse. They hadn't actually taken his pulse at any point, and when asked why just replied 'I can see his pulse, why would I need to feel it'… I ran a complete set of observations, blood pressure, e.c.g., blood sugar, pupil and motor response, mini mental state – the whole shebang.

Everything was normal, actually some results were better than mine, something I'm getting more and more used to.

So I asked him if he wanted to go to hospital – he didn't see the point, as he was feeling no different than normal, and I agreed with him.

But, the staff in the centre really wanted him to go to hospital – they had phoned the GP who had told them that he wouldn't be visiting the patient, but that they should get an ambulance because the doctor wanted the patient looked at by someone in the medical sphere.

And people still ask me why I dislike GPs so much…

I told the staff that, because the patient wasn't confused, and he was refusing an ambulance, I couldn't 'kidnap' him to hospital. So the member of staff who had been with us ran off to tell her boss. The boss soon turned up and basically bullied the patient into agreeing to go to hospital. I started to argue with her, but she just walked off saying that the patient was to go to hospital and that was that. Honestly – if it wasn't in a public area I might well have had a blazing row about her arrogance, and how she thought that she could know what was best for the patient if her staff couldn't be bothered to take a patients pulse. As my crewmate told me later, he saw me bite my tongue rather than start arguing at people.

So…I caved in, and took the patient into A&E. I had a chat with one of my favourite nurses and she looked after him for me until they discharged him later that day.

The thing is, it left me feeling angry. I was angry that the staff in this centre were so useless. I was angry that I let the boss of the centre bully me because I didn't want to cause a scene in front of 30 elderly people. I'm angry that the GP didn't visit the patient, and instead fobbed the patient off onto the A&E department. And I'm angry that I didn't do more to protect the best interests of my patient by not dragging a 96 year old man into an A&E department full of diseased, infectious people.

Now I have a tiny knot of hate in my stomach that I can feel now, just thinking about that job is making me angry as I type this up on my sofa. Perhaps next time I'll take the boss aside and make my position clear, in some scathingly sarcastic fashion.

Our next patient was a GP referral, who had arranged the ambulance without actually seeing the patient. The GP had then faxed a referral letter to the A&E department claiming that the patients blood pressure was 130/90, her pulse was 100, so on and so forth, and that he suspected a collapsed lung. I was very impressed by this GP who could check a patients vital signs over the phone, just by talking to the patient's daughter.

Grrrrr…

And in both cases, the patients and their families were very nice people.

22 thoughts on “Could Do Better”

  1. Remember only 50% of the worlds population are like all those nasty people you mentioned, so that leaves a lot of nice people like you to keep me happy.We only need to convert a few more to being kind and as a majority we can vote the nasties out into the cold, then lock the doors and throw away the keys.

  2. Be angry by all means but please don't let some arsehole change the way you work.Some of us sick folk rely on you a lot.

  3. Hi, the scene you painted reminded me much of my great grandfather (who lived to 108, and was doing his own shopping by bus until about 106 when unfortunately his sight went. His mind was there to the end).Is there any way you can make a complaint? I understand your position at the time, it was a tricky decision, but you have every right to write a letter expressing your views. Send one to the manager, and one to the GP, and possibly one to their superiors. Send one to the man himself too.

  4. I sit here smiling because I must…My BSN and Master's, PA, and 38 years of nursing means little to the facility manager or any idiot without a caring bone in their body. I feel for you, I come home some days and want to chew the lock off the door.

    AuntieWu

  5. For most of us OAP's without the do rae me, very few listen to us, for what do we know. 'nutin'. So to find one like you, Diogenes would have done a dance. Leads to a corny joke, old man goes to the psychologist,[at 300$/hr] who proceeds to ask what is the problem, and the old man says “no body listens” so the Doc promply says ' Nurse Next patient'. dung beetle.

  6. I agree – I think you did well to 'hold your tongue' – as it was happening – but I think the only way to combat such ignorance (or paranoia on the part of the head/director of the facility [not following through on GP's orders, problem with patient, retirement facility held liable for his further illness or death]) is to lodge a formal complaint about the situation. You have the knowledge and the experience to liaise with the patient and to discern whether or not he needs to be treated by A&E – clearly there is some serious mismanagement and a worrying lack of education/information within the training of the staff…If this were my grandfather/father/otherwise, I would be relieved to know that someone like you was more concerned with his health and well-being than following the orders of an absent GP!

    I probably would've wanted to give her an earful too – very difficult to maintain one's composure in situations like that! Good on you!

  7. Same thing happens all over the world I'm afraid – when you qork in A&E you get the same crap referrals from disinterested GP's. I once had a patient referred on a busy Saturday afternoon with a trigger finger of all things. I examined the patient, confirmed the diagnosis and sent the patient back to the GP with a note saying basically “yes it's a trigger finger. Why not refer to the orthopaedic surgeons who can fix it?”As for the one that make up vital signs – don't get me started.

  8. I'm a paramedic in the US and we often go to Doctor's offices for patients who should have gone to the emergency room instead of going to see their GP. When we get there we usually find the patient in a room by themself, clearly in distress and without the GP anywhere to be found. When you ask to see the Doctor, they get upset and tell you they don't have time to talk to you, becauuse they are with other patients. Excuse me, but I thought the person you are sending out by ambulance is also a “patient.” And obviously one that needs your attention more than the sore throat in the next room.The other one that really gets me are the Docs that prescribe medicine over the phone without a patient exam. When you get to the patient's house they have that new prescription sitting on the table for the antacid that they have been using to treat their CHEST PAIN!

  9. The BP was out by only 40mmHG Systolic and instead of resps of 20, she had a resp rate of 30…So, no. Not really.

  10. The nurse who I handed the patient over too was, in her words “going to dob him in”. Unfortunately there is no official way that we in the ambulance service can formally complain about a GP/Nursing home – except in serious cases when someone is at risk of abuse.

  11. Oh yes, I also can be “just an ambulance driver” when someone thinks they know more than me. This of course ignores my nurse training and experience. What is worst is when that attitude is being given by a nurse towards me, especially when I am appauled by the state of some nurses education.

  12. That is so infuriating. I worked in one of those daycares for a while in college and I really never understood why some people think that just because a person is old they need to be bullied around. True, some elderly have dementia and need extra help, but many are still autonomous. It is so sad that many people don't see our elderly as people. I was just reading an article the other day about sex in nursing homes and how it was totally discouraged and could lead to major trouble for the patient. I was so mad when I read that because what right does any adult have to tell other adults what to do?

  13. No wonder Many Organisations DON'T want anyone to blog. It be like a man that does want to raise his hat, It may expose his enlarged tonsure.

  14. Why do people who are supposed to be professionals do this? Is it poor training? Apathy? A flaming case of “Not My Problem – Pass It On”? As a first responder, my level of training is somewhere between basic first aid and EMT, but I certainly know better than to mistake a twitching muscle for a pulse. And if they were concerned enough to call an ambulance, why then did they not bother to alert the front desk?!I would have been furious myself, and think you handled the situation well. I do wish, though, that there were some way you could make some formal complaint. Abuse of the ambulance system is dangerous!

  15. Brilliant. Compelling, touching, fair – and so accurate. As a student I used to work as a care assistant in an OAPs home and was so used to seeing the buck passing happen. That said, get a nice crisis like a 25 stone 78-year-old having a grand mal and everyone rallies round brilliantly.

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