Reminding Folks Of Their Role

As I've mentioned many times in the past us in the ambulance service, and our colleagues working in A&E are often used as a 'safety net' by other medical professionals, whether that is by the nursing home nurse who is concerned by a patient being 'off their food', or the GP who doesn't wish to come out an see a housebound patient.

Obviously there are a lot of people who don't use us as such, but it does seem increasingly common.

Here is an example, we were sent to a severely mentally and physically disabled young woman because she was suffering from thrush. She had been sent home from the day centre and her family had made a sensible decision to phone the GP surgery. This young woman has some complex problems and so she is better served being seen by someone who knows her and her medical history.

The GP had refused to visit, telling the family that 'I'm not examining her' and had told them that they should call an ambulance to have her taken to the local A&E.

We had arrived to find her, not distressed but obviously suffering from the infection, sitting naked on the bedroom floor. Her older sister was playing with her. Both myself and the family were reluctant to take her to A&E, it's an unusual setting full of strange noises, bright lights and strong smells. It's also not the right place to be dealing with a medical condition that is neither an accident or emergency. All in all it would be an immensely distressing experience for her. She'd been there before and had hated it her family told me.

We discussed with the family our best plan of action, they agreed with us that our Control should try the GP and see if they could come out to see the patient, we were aided in this because by this time most of the regular GPs would have changed shifts so we would be talking to a different doctor. The family agreed to this and after our Control spoke to the GP the doctor agreed to come and visit.

It must have been fine as I didn't see her in the A&E department during the duration of the shift.

I don't like leaving people at hospital, it's often the path of least resistance to load up the ambulance and drive them in. But sometimes it really is in the patient's best interest to stay at home and this was a classic example of this and in those cases I'm willing to take that job-threatening risk.

19 thoughts on “Reminding Folks Of Their Role”

  1. While we still have (supposedly) educated health professionals abusing the ambulance service, how are we supposed to educate the general public?????

  2. Nope, I can only give a few drugs, just the emergency stuff really, nothing that would be of any use in this sort of primary healthcare setting.

  3. I'm currently waiting for an ambulance as I type.My Mum is currently bed ridden with sudden and severe back pain and she daren't move.

    We called the GP (being the kind of people who read these blogs and not wanting to bother the overworked people in green unless necessary) and she came out really quickly and gave her a good examination. She went over her medication and prior history (which is quite long, poor Mum) and made an appointment with the hospital.

    The GP has been great, so they do exist somewhere!!

    I've just packed her a bag and we should be off soon.

  4. Sounds like a new way of working to me :-)Seriuosly though we need to find a way of viewing 'acting in the best interests of the patient' as not being a “job threatening risk”. It seems to me that you did the perfect thing for this patient but if I (and my colleagues) can't convice you all that such actions are not job-threatening then we're probably all wasting out time!

    Answers on a postcard.

  5. Oh man. Poor girl. It's stories like this that make me so glad to have finally found a sane and helpful GP that I'm reluctant to ever move. Sending someone into A&E where they'll have to suffer for longer, and only end up being a burden on even more time-critical cases is just negligent, IMO.

  6. Would I be right in the assumption that the call from your control to the GP was a recorded one? And does that make a difference to the response from the GP?

  7. Agreed, unfortunately we all know that this is unlikely to be the case, especially as more and more people sue the NHS, or just go to the press.

  8. We actually have to go round to peoples' houses and take them to the GP. The GP is not allowed to leave his office unless it's a real emergency, in which case we pick him up at his office. This way the patient don't have to go to the a&e, but can be seen by someone they probably know, and quite a few don't go to the hospital at all. But of course, if the doc says they have to, we take them in. It actually works well, in a strange way

  9. Unfortunately this is becoming more of an issue, and it is a concerning one. I know of several patients who when I have suggested the GP route, answer that it would be a waste of time and they wouldn't come out nor care about the condition. Several have apologised to say they tried to get a home visit but the GP told them to call an ambulance. Now these are but a few, and with the fear of an onslaught of angry GPs, this is not always the case, just as Tom talks of good and bad nursing homes, there are good and bad GPs too (as well as good and bad ambulance staff admittedly)I came across a GP on my last set of days who absolutely amazed me…. He was seeing a patient who had struggled down to the surgery (they got told off for that) with a sudden onset of severe DIB (Difficulty in Breathing). The GP went down the route of O2 and a neb straight away, getting the reception to call 999 in the meantime. I hasten to add that the GP had finished surgery and was in fact on his way out the door for the day when he saw this patient arrive. On arrival of the cavalry he gave a very very very clear and concise medical history of the patient (a relevant one at at that too) and then asked if one of us would mind having a listen to the chest as he was concerned that the right side was reduced.

    It was, and one spontaneous tension pneumothorax later, he was dealing with the chest decompression and asking if we would like him to travel. He had a home to go to, he had a family to be with and he had just finished a long day, but he did what everyone expects their GP to do, be there no matter what to help them. Now that GP gets double thumbs up, GP of the month award and boy I wish he was my GP.

  10. Oh how fantastic to read a positive story about a GP! I'm a medical student planning to go into general practice eventually and always on the lookout for tips on how to be a good GP – so you've made my day!

  11. Doctors still make house calls there? Wow, what a concept. You rarely see that here in the States anymore. Still, for something like thrush, it would be the right thing to do. She doesn't need an ER for something like that.

  12. But what about the multitude of other health care professionals working within your average GP surgery in the UK (I can't just think of the correct title for them, but the sort of practice nurse who is in a position to prescribe certain drugs) can they not be called on?It's just seems such a rubbish solution to a simple problem, *sigh*.

  13. I'm also dumbfounded at the thought of a GP actually leaving the comfort and sterile security of their office, surrounded by staff, to come to a patient's home.That sort of thing hasn't happened in my area for over 50 years. (Chicago suburbs). I am going to have to mention that “Doctors still make HOUSE CALLS in the 'socialized medicine hellhole' that is the UK” to my ultra-conservative Neocon family members who are virulently opposed to universal healthcare in the US

  14. ok, that was utterly incomprehensible.I meant that the doctor leaves his staff and comfy offices to go to patients (not dragging his staff with him!!)

    And the quote about the UK socialized medicine isn't my thoughts, but those pathetically regurgitated by my relatives from the spew they are fed by the Neocon media pundits.

    I apologize for being a communications failure today.

  15. I'm wondering if you are a trained prescriber Tom? If so are you not allowed to diagnosed and treat conditions like this?

  16. 1) The problem of thinking that the A&E is a clinic seem worldwide.. With school (I'm studying to become EMT-P), I was visiting a new emergency dept the other day. They actually built another A&E for ambulances and “real” emergency. The nurse doing the visit told us that they kept the name “Emergency” for the old one so people would keep going to it as a walk-in clinic..2) Sadly, I think you've written the answer why the first GP would not examine her: “because by this time most of the regular GPs would have changed shifts”.

  17. I think they should train some of you as prescribers, a lot of minor primary care stuff would be covered by the sort of stuff you could prescribe. Thrush, UTI's, red eye, and a lot of other stuff. But I suppose this would open a can of worms and masses of protocols to be drafted.

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