In Contrast

I was met by a friend and as I walked into the corridor I saw my patient sitting on the stair-lift. She saw me, turned and smiled at me.

Eighty three years old, Jamaican born and already dressed ready to go to hospital.

“Hello there, what seems to be the problem?”, I asked, kneeling down so I wouldn't be towering over her.

“I fell down the stairs”, she replied.

She'd fallen down all fourteen stairs, tumbling backwards from the top. She's landed at the bottom and had hit herself on the stairlift parked there. She couldn't remember the fall and the only obvious injury was a swelling to her leg. Nothing obviously broken but she'd probably have a few bruises the next day.

I take these sorts of things seriously, it's a long fall and with old bones there is a real chance of serious injury. While she looked fine, I wasn't going to take any chances, so I popped a hard collar around her neck to help protect it if she had injured it.

It was only after we had safely secured her in the ambulance that she told me that the fall had happened more than twenty-four hours ago, and that it was only because she couldn't walk on her painful leg that she had called us there.

She hadn't been able to walk because of the pain, yet had only now considered it serious to call an ambulance. I also suspect that it was only because her friend had visited and 'bullied' her into calling an ambulance that we were there now.

Thankfully, after a load of x-rays at the hospital, it turned out that the pain in her leg was from a large bruise and that she hadn't seriously injured herself.

This is why any suggestion for a charge for an ambulance, or for a charge for an inappropriate call won't work. The people who need us will struggle on because they 'don't want to be a burden', while the people who think they are 'entitled' to our free taxi every time they get a sniffle will continue to use us as such – if only because any 'fine' won't be paid, or the person will be so poor they won't be eligible for being charged.

I can't begin to count the number of elderly who I've picked off the floor where they have spent the whole night because, “I didn't want to bother anyone at that time of the night”.

I fear that the only solution is education, maybe education administered by me and my stick o' pain.

22 thoughts on “In Contrast”

  1. Point taken.That's always the way though, my experience of elderly patients is that they wait patiently for their turn, still believing in the idea of a fair go. Or as you say, they don't want to bother you. Contrast that with the younger patient from the 'it's all about me' school of thought. I have such fond memories of my time working in an NHS hospital in East London with the 'I pay your wages' patients and their relatives. One such occasion still warms the cockles of my heart. A relative of a particularly nasty, rude and ungreatful patient had just delivered the immortal line. I smiled sweetly and said, “Yes, and I pay your dole, your housing and your child support. Now, do you want to sit back down and be quiet?” Fortunately for me I seemed to have shocked him into silence and he walked away like I'd stunned him.

    I love the idea of free health care at the point of delivery but I hate the evil turds who abuse it.

  2. I got run over by a car 2 years ago, and I felt very guilty for asking for an ambulance to come pick me up – I could walk etc, but I didnt think that would have been a smart idea (Only broke wrist and both legs in the end) – just felt really guilty that the crew probably had something better to do, like pick up little old dears and dealing with people who are having heart attacks!

  3. I'm an ex-pat Aussie living in the UK. I can remember there was a voluntary “membership” for the Ambulance in Oz. An annual fee (fairly nominal if I remember correctly), which ensured you wouldn't get a bill for an enormous amount, (couple of hundred A$) after you had been ferried to hospital. While appreciating not every would be in favour of this, I thought it was a good system, as I was financially supporting an essential service, and could call for help if needed. Thankfully never had to. I believe pensioners were exempt from the fee. Let's face it though, the same problems exist for Health Systems, no matter where you live!

  4. Feel free to flame me guys, but why doesn't the NHS fund a TV campaign educating about proper use of the ambulance services? It's surely cheaper than responding to inappropriate calls?While we're on that subject, why not TV adverts advising drivers to turn their fog lights off and use their indicators?!

  5. Many years ago I was visiting my grandmother and woke up to the sound of her passing out. I called an ambulance for her over her objections that she didn't need to bother anyone. Turns out she had a bleeding ulcer (which she knew about) and needed a transfusion and many days in the hospital to recover. I hope I'm as tough at her age as she was.

  6. Brings back memories. My maternal grandmother at the age of 78 fell over whilst cleaning in the morning. She pulled herself over to the phone and sat there all day waiting until she knew my mother would be home from work before calling her and asking for help. When we asked her why she hadnt called an ambulance or called anyone of us on our work numbers she said “I didnt want to be a bother”.She had broken her hip and whilst in hospital she had a reaction to the anesthetic and never woke up. It always angers me when I see people wasting the police,fire and hospital staff time and energy for trivial things, whilst the people who can really do with some help dont want to be a burden and so struggle on.

  7. I imagine the effectiveness of such a campaign would be debatable, people have become accustomed to gory, shock tactic adverts, and there probably isn't another way of getting the message across.Also, can you imagine the cost? People would be up in arms if X million pounds were spent on TV adverts when little Johnny is in hospital with something nasty and hithero incurable.

    That said, i'm for the idea. It worked for drink driving, and it is apparantly working for those who drive with mobiles clamped to their heads. I don't think it should come out of any sort of healthcare budget though, not unless that cost is met with the summary sacking of a few dozen managers πŸ˜€

  8. I've tumbled down the stairs a few times and not called 999. Just curled up on the doormat for a while (had a newspaper delivered on to my head once!) and waited to see if I'd be able to move in a little while. Generally speaking, after half an hour I've been able to crawl to the living room where there's medications and a couple of blankets.I've had some bloody nasty bruises, although bruises is all they've been. (Although on the day I have also got internal bleeding and die horribly, you may stand at my funeral and say “I told you so”.)

    My reason for not calling you has buggerall to do with 'not being a bother'.

    It's because I feel bruised and sore and rubbish and the last thing I particularly want to do is trundle off to the A&E, for an uncomfortable few hours in the waiting room surrounded by drunks and screaming kids, followed by the best part of a day in a cubicle, followed by having to try and get my crippled self back home again somehow which is entertaining and/or expensive even when I'm *not* spectacularly bruised.

    I'll call an ambulance if I think something is exceptionally wrong, but a few cuts and bruises doesn't do it.

    If you've been disabled long enough to get a stairlift, then finding it a little bit more painful than usual to shuffle about the house isn't a big thing. You're USED to gritting your teeth and getting on with your life. The alternative – fretting about every twinge, spending all the time in bed, padding the house with bubblewrap – doesn't bear thinking about.

    I'm not trying to singlehandedly save the ambulance service or avoid encroaching on anybody's time. I'm being entirely selfish πŸ™‚

  9. Not too long ago I went to a DIB on a monday morning who was about as blue as a person could get without been dead, they had been like it for a good 2 days. When I asked the old chaps wife why they had not called sooner she replied “well we know you get busy on the weekend and didn't want to add to your problems.”Chap died 3 hours later and the drunks I spent the weekend scraping up all went on there merry way.

  10. I think you should have to administer a large dose of antibiotics using a very, very large needle & syringe for time wasters (to protect their sorry behinds from MRSA obviously). I think you'll find people will change their minds about having to go.

  11. There have been previous publicity campaigns, “one of these is not a taxi” happened about 5 years ago, however the call rate is continuing to rise.The only solution is to ditch the patient's charter pledge that everyone is entitled to an ambulance and properly assess all patients, either over the phone or at their homes and then send them in the direction they need to go. Although Tom's stick may well need to be left back at the station πŸ™‚

  12. I like the idea of an advertising campaign. It wouldn't have to be anything gory. Just pick any of of Toms recent effwits and contrast them with someone who is really sick. I can see it now – spotty git talking to Tom then cut to a pale, clammy, breathless man clutching his chest, sitting next to his wife who is on the 'phone asking where the ambulance is. Git with headache/drunken chav shouting at ambulance crew- cut to child in middle of road with blood coming out of an ear with mother asking where the ambulance is/old lady on floor at the bottom of the stairs. The voiceover says '999 – what is the nature of the emergency' or whatever it is they say when you ring.Either that or bring on the stick o'pain!

  13. Free health care is something to treasure. Better that than the American health care system. Unfortunately we seem to have created a stupid gene in the last one to two generations. Lots of people need our help and advice but there are a lot more people that have the stupid gene and they make up a relatively large percentage of work. I call them oxygen thieves. They're entitled to oxygen but they take to much (for there stupid gene)

  14. Very good idea and follows with the 'raise awareness' and 'highlight the problem' brigade.Anyone who reads Bystander – the magistrate blog will know from a recent post that educating some people will never work. It's in their blood to act like total Richard Craniums and they will never change.

  15. Free health care is great if people don't abuse it. Charging could start with the countless “alcohol related” jobs we all know and love. If these people can afford to go out drinking all day, especially round the west end, they can surely afford a few quid when we get called out to the “collapsed in the street” calls that take up an A+E bed at the weekend.

  16. Maybe not a gory, shock tactic kind of ad, though. Imagine…A living room, faded old sofa, TV playing quietly in the background, grandfather clock ticking steadily in a corner. The fire is out, there's frost on the windows, it looks cold. Noone visible. Pan around the sofa, line of vision about level with the cushions, towards the half-open living room door, the beginning of a staircase appearing. Still no noise except the quiet burble of the TV and the clock ticking.

    Pan a little further around the door, line of vision dipping a little lower, and there's a figure at the foot of the stairs. On the ground, legs underneath, not moving. It's clear they're not well at all. Phone off the hook, receiver hanging down by their hand, and now you can hear a voice on the other side calling out to the figure (Control trying to get a response). Fading up over the voice, the ticking clock, until it drowns out all the other noises, the camera fixed on the unconscious figure.

    Cue slogan, warning about wasting resources and time or somesuch. NHS logo, fin.

    A bit cliched, but you get the idea. As, hopefully, would they.

  17. Good point you raise there, Tom. Even if one were to put a price on “misuse of the system”, misinformation would leak out and people would be hesitant to call, because they couldn't judge between proper and improper use.Use of emergency services should be part of the curriculum of every primary school.

    For most people having missed that opportunity down here, could you give us a visit with your stick o'pain?

    Cheers πŸ™‚

  18. I'm not sure education would get through to half the selfish ***** who misuse the system, they are just too wrapped up in their own little bubble.True story:

    One Sunday afternoon when our department was as always heaving, we had a baby brought in not breathing. A significant number of our team became involved in resuscitating the infant and supporting his parents. The remainder of the team continued caring for the rest of the seriously ill. And thus the sprained ankles and cut fingers in the waiting room got a little left behind. Numerous apologies were made to the assemebled walking wounded, until eventually the nurse sent to make announcements under the hostile glare felt moved to explain just why we were taking so long. Apparently though an infant death just doesn't move some.

    “Well that's not our problem!” was yelled at her from someone who was doubtless left to wait until the waiting room was thoroughly empty before being seen!

  19. Finished blood, sweat and tea, last week I have become addicted to your site. I too belonged to emergencies services for many years. Not one of your favourite people, ASW – But like you, I did care and always did that extra bit to ensure the really sick people got the help they needed. My angers were always with the (want to be ill's) for attention. How i wish we all had the freedom to speak are knowledgeble minds without fear of litigation. thank you for your book, your thoughts and your brillaint insight. By the way your international, I live in Turkey.

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