Knowing What You Don’t Know

There are things that I know, and things that I don't know. Of the things that I don't know I know what I have to do.
Take them to hospital.

Take for example the patient with an unusual underlying illness that I attended to. She was having some strange symptoms that weren't specifically connected to her normal condition. Whatever ailed her I wasn't able to do anything about, so I knew I had to take her to hospital.

But which hospital?

You see, if the symptoms were caused by her bleeding into her brain then I'd bypass the nearest hospital and take her to one with a neurological unit. If not, then the nearest hospital would be the best place for her.

So you do a neurological assessment and make your decision.

But that's not all. Back when I was an A&E nurse, sitting in triage and making decisions on what priority a patient is I would often see a 'syndrome kid', a child with a strange collection of sypmtoms and underlying health problems that are often named after the Doctor who discovered it.

Now, paediatrics isn't my speciality and there was no way I'd be able to remember all the differently named syndromes, so I'd ask the parents – after all, in living with their child's illness, they would often be the experts.

So, with my current patient I asked her about her disease process, 'Was this normal for her?', 'Had she had this sort of thing previously and what did the hospital do?' and 'How concerned was she about her current symptoms?'

The decision I made was to 'Blue light' her into the nearest hospital, at her insistance I pre-warned the hospital and gave them the number of her specialist team at her own hospital.

By 'blue lighting' her in I was getting her to the experts as quickly as I could.

7 thoughts on “Knowing What You Don’t Know”

  1. I'm a student paediatric nurse and we are taught to always ask the parents and the child (if they are old enough) about their condition. As you said they are the experts and know far more than us and often the doctors too!! They usually appreciate this aswell!In the medical profession I think it's SO important to be aware of what you don't know and ask for help when you don't, ef you are a student or a consultant you can't be expected to know everything. THe good professionals out there realise that. The cocky ones who think they know everything are the ones who get into trouble.

  2. Parents are generally brilliant when helping you treat their child. Unfortunately, occasionally we get an 'I don't really know, he only stays with me for the weekend,' or such, which doesn't help especially.I agree that asking for help is an important ability to learn; none of us know it all, despite how much some of us might like to pretend otherwise.

  3. Never hide from not knowing, there is always someone that has the answer, The smartest people that I know or have known always asking pertinent question to fill in the knowledge gap.That be why Ass u me is such a wonderful word.

  4. Is there any reason why you didn't take her to the hospital she was under? Surely this would be the best thing for her. Was she too unstable or did you not want to get shafted out of area before the end of your shift??

  5. In reply to the above: TR did exactly the right thing.In London, we have a wide variety of “casualty” hospitals, many of which specialize in different types of thing – ie, specialists in burns, plastics, cardio-pulmonary, neuro etc, all the while still being casualty receiving hosps.

    LAS crews will frequently be aware/made aware that a particular patient is under a particular hosp for their condition. In certain circs, we will convey to their recognized treatment centre if we deem it appropriate (ie for sickle cell pats). In other cases, it may not be necessary if – as TR intimated – the patients CURRENT problem has little or nothing to do with their CHRONIC condition.

    It's really a case of “decide on scene, when you have all the facts to hand”.

  6. Saint, I totally agree and understand about the A&E departments in London, and that some are more appropriate that others – I also work for the LAS. I was simply enquiring as to why the patient wasn't taken to her dedicated unit. TR hasn't said that the symptoms arn't related to her condition, and he has already said that he was not familiar with her condition. Just wondering why she wasn't taken to her dedicated unti, and put forward the suggestion that she was possibly too unstable, as there was nothing mentioned in the post about that.

  7. Ok, I need to try and keep the patient's confidentiality, I wrote this post fairly ambiguously because if I mention the condition then there is the risk of breaching that confidentiality…The patient's 'own' hospital was across the other side of London and it was during rush hour that this call happened.

    The condition doesn't really need specialised equipment, the ability to deal with it is available in all hospitals.

    The condition isn't *that* rare, in that the Consultant at the A&E we took the patient to understood the condition and the possible effects that the condition can have and has the treatment to hand there.

    I took the patient to the nearest hospital under blue lights because, while I wasn't *sure* I suspected that the reason why we were called had little to o with the condition, but as I wasn't *sure* I made the decision to take the patient to the nearest A&E.

    If the patient had been suffering from something that would have benefited from treatment at a specialist centre I would have taken them there (e.g. the Neuro centre)

    So in this case of a patient calling us for something probably not serious, but with a complicated underlying condition and not needing specialist treatment (except perhaps from one doctor calling another on the phone) I think that the right thing was to take the patient to the nearest hospital.

    (And it was the start of our shift, so a 'jolly' to another hospital outside our area would have been quite fun actually…)

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