Wednesday 6 June 2012

There it is

"22 year old female, shortness of breath, ? Pulmonary Embolism, in GP surgery"

I will tell you now that the time this call came in was 17:47 on a Friday evening. We were sat at hospital, I was scribbling paperwork while my crew mate was cleaning the back of the ambulance. It is a routine we go through about 9 or 10 times a day. Hand patient over, book patient in whilst driver makes tea, do paperwork wile driver cleans ambulance, drink tea quickly, go  and do another job. It occurs like a broken record! Having gone through the routine, we came up available for the next one. Within seconds we got it. We headed off through the busy rush hour traffic and within 8 minutes were on scene. The job was now a success regardless of what happened to the patient! We walked in to the surgery at 17:55. A cursory glance at the sign on the front door showed the opening hours:

Mon-Thur: 8am - 7pm
Friday: 8am - 6pm
Saturday: CLOSED
Sunday: CLOSED

Call me a cynic but I do not see these times a coincidence! Then again, a pulmonary embolism (PE) is a serious, life threatening condition, hence the Category A response time and an immediate ambulance. I mean...the GP wouldn't lie to get an ambulance quickly would she?! Surely she wouldn't do that just because the surgery is about to close?! I tried to keep my mind open and treat as I found. For those not in the know a PE is a small blood clot that travels through the bloodstream and gets stuck in the pulmonary artery, which carries blood from the heart to the lungs. There are various risk factors that cause it, such as a recent operation or injury, long journeys such as plane travel and overweight smokers over 40 to name but a few. Seeing as the GP had called us for a PE, I assumed the patient would have at least some of the risk factors associated with the condition.

Sat in the GP's consultation room was our patient, stood next to her was a frustrated looking GP. I have had a variety of handovers from GPs. Some are very detailed, some are vague, some give me the letter, some give the patient the letter to give to me, it doesn't really matter. What made today amusing was the amount of bizarre and irrelevant information she gave me.

"This 22 year old lady has a 45 minute history of shortness of breath, there is no spinal tenderness, her reflexes are fine and she is able to weight bare, she has no calf swelling and both calves are 38cm in circumference. I have referred her to the medics to rule out a PE. Could you give her some oxygen please"

While she was talking, I was looking at the patient and wasn't at all convinced.

"What is her oxygen saturation?"

"I don't know"

"OK, I'll check before with give her the's fine, her oxygen levels are at 100%, have you listened to her chest?"

"No not yet"

"Why do you think it is a PE?"

"She has shortness of breath and chest tightness"

"Any risk factors? Recent travel, operations, smoker, pregnant etc?"

"No, none"

"You do know she is having a panic attack?!"

I turned back to the patient and tried talking to her. She was unable to string a sentence together due to her hyperventilation. I started coaching her breathing while asking her to nod to any questions I asked her. I manged to ascertain that she had some chest tightness, dizziness, pins and needles in her hands and legs, palpitations and was nauseous. It was a classic panic attack, as text book as they come. I turned to my crew mate:

"Can you grab the 'lifepack', we'll do an ECG in here"

At this point the GP interrupted.....

"Can't you do that on the ambulance, we are closing now?"

And THERE it is! That is why we were here. That is why she said it was a PE and not a panic attack. On a Friday evening, she knew all too well that she would have to wait a while for an ambulance if she said 'panic attack'. She wanted to go home! This was not lost on me for one second and in a rare stance of defiance, I dug my heels in. If the GP wanted to play games, so would I. No GP in their right mind could actually think this was a PE. There were no real symptoms or any risk factors whatsoever. She simply didn't want to waste her time, talking a panic attack down and waiting for the symptoms to resolve. Call the stretcher monkeys, we'll deal with it!

"As you think it is a PE and she has chest pain, I think it best we do an ECG before moving her, don't you?"

"Well maybe it is just a panic attack"

"Well if it is just a panic attack, shall we NOT take her to the medics and leave her in your care?"

.........."Probably best to rule out a PE, OK, do your ECG here"

I laughed inside! We did the ECG, I took my time and eventually took her (now fully recovered) to the ambulance. She didn't need or want to go to hospital so signed my paperwork and went on her merry way. What a complete waste of time! What a complete abuse of the system. PE my arse!


  1. As usual, GPs demonstrating why they should be left in charge of the NHS budget...

  2. Have to admit , I still liked the " : LOB " part of the title . ;-)

    1. I do to! You're not alone, but Load Of Bollocks was a bit abrasive for a title! Trying to come up with a regular LOB feature!

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