Absolutely nothing of interest last night, the most interesting job being someone with a two month history of muscular back pain that had been getting worse that day.

“So”, I asked all innocently, knowing full well the answer I would get, “Have you taken any painkillers as the pain got worse?”

I wasn’t surprised by the answer she gave.

Then two calls to two regulars, one of which had only been discharged from hospital three hours previously.  Then finally to a patient who was actually sick, but that would only be because he earlier discharged himself from hospital against medical advice.

There is nothing more disheartening than to attend to a patient, and to see them clutching a little pink slip of paper.  “Why so?”, I hear you ask.

When you visit the local hospital, and the doctors and nurses are finished poking and prodding you they decide if you need to be admitted to hospital, or if you can safely be sent home with treatment.  If you are to be sent home they give you one or two bottles of pills, explain how the pills work, and then write a letter to give to your GP (family doctor).  The letter tells your GP exactly what tests they have done, and the treatment that they have prescribed.

This letter is on a pink bit of paper.

All too often I get called to a patient who has been seen with a minor condition earlier in the day, but after one dose the medicine hasn’t cured them, this is most common in the case of antibiotics, but you will also find people who tell me that the pain has gotten worse, and that they don’t like to take the painkillers the doctor has prescribed.

Inevitably they still have the discharge letter with them.

In these cases all we can do is take them back to the hospital they were seen in just hours ago, so that the doctors and nurses can repeat all the tests they ran the first time.

Sometimes this happens three of four times.  And each time they call an ambulance.

Don’t get me wrong, sometimes things do indeed get worse, and in that case a return trip to hospital is warranted.  But in most cases I come across it is simply the inability of a single dose of a tablet to make your symptoms disappear instantly and permanently.  Still on the up side, it makes diagnosis really easy, all you have to do is determine if the symptoms are the same as the last time they were in hospital, or if they have gotten worse or changed in any way.  If the symptoms are the same, then they are unlikely to drop dead in the back of the ambulance (thus causing a lot of unnecessary paperwork).

I have two or three days off now (don’t ask me how many, I need sleep before doing any serious thinking), so I may raid my ‘Ideas File’.

9 thoughts on “Boomerang”

  1. An interesting article I read recently suggested that in some cases such as this it was a matter of the patient being illiterate. Although I'm sure the hospital will try and explain the medication at the time there is only so much the patient can 'take in.' Thus when they get home and realise they don't understand their medication then they're not sure what to do, I guess some people simply don't take it and then phone for an ambulance.

  2. Why do people have to abuse the system? If you've been treated and refered to your GP, why don't you at least try what you've been given?I know there have been cases where people have been discharged from the hospital and later fallen very sick or died, but a lot of times people just abuse the system! Un-fortunately they are not likely to read this blog are they.

    The driving Instructor

  3. The thing is that most of these patients call for the ambulance during unsociable hours and so cannot be taken to a health center or sent to a GP. Thus, back to hospital.

  4. Good points there. The stigma attached to not being able to read is very strong and this problem is almost always concealed very effectively. Likewise, being unable to take in any more information when scared and still unwell is a very real problem. I work in healthcare and yet when my turn came for a scary procedure I stopped the doc and asked him to tell me *afterwards* what he was doing / had done as my anxiety level meant my ears were not connected to my brain!All the same, if neither of the above apply, it must be bloody annoying to be called out to these types of problems.

  5. Very frustrating but surely this is a case where we need to explain/coach the patient that a trip back to hospital is not in their best interests and that they need to given their medications time to work (provided of course nothing “new” has popped up). This is certainly the approach we would take in MAS. At the end of the day we are bound to take the patient back to hospital if they are insistent- what are the LAS protocols here?

  6. Protocol is basically – take to hospital. If we leave them at home and they drop dead of something completely unrelated we may still be liable.Also may be liable if they go to hospital, get seen by hospital staff there, and die in the waiting room.

    May be liable for anything as shit rolls downhill, and we on the bottom get well and truly covered in shite.

    I *love* my job…

  7. *smiles*I've found working with more experienced ambos that they tend to be able to steer people toward the “right” decision. My natural inclination based on less clinical experience is when in doubt transport but with ER's bulging at the seams…..

  8. I worked on reception at A&E and so often we'd get patients saying “These pills the Dr gave me this morning haven't worked”. It's not a Dr these people want it's Jesus! Also remember one day when a man was in for the second time with back pain. he was trying to inflate his insurance claim after the original very minor RTA. Unfortuatly for him he got the same SHO who let him sit and wait and wait and wait. He got most upset and threatened to go home and call an ambulance, to which the Dr replied “Well you'll still have to wait 4 hours to be seen”. Too many people equate ambulance with immediate treatment.

  9. In Malta, patients coming into E&A by ambulance usually take priority over those in the waiting rooms, usually priorities 2s and 3s. They just skip the queue

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