Monday 13 May 2013

Circles

"45 year old female, abdo pain"

In this job you quickly get to know your regulars. People are frequent callers for a number of reasons. Some have complex medical needs that require frequent intentions, some have medical problems they don't control we'll, some are simply lonely, some are alcoholics who fall asleep in the street and others are addicts addicted to Entonox or Morphine and will try anything to get hold of some!

As soon as the address popped up on the screen we groaned! It was an extremely awkward patient who always insisted on going to a hospital a lob way away and always demanded Entonox for her ongoing pain. The fact is, she does get pain but the reason she calls ambulances is because she wants the Entonox. The hospital she insists we take her too, have said they don't want her brought there anymore and her GP insists she should only be taken to the nearest one. After many discussions a protocol was out in place for her which set out what hospital she had to go to and how much Entonox she was allowed. Neither are favourable to her!

When we arrived she was lying on the usual sofa in the usual position.

"I need Entonox, I can't move without it" was the first thing she said as we entered the room.

No 'hello' or 'thank you for coming'! As per recent visits we reminded her of the new rules. She swore a bit, had her 5 minutes of Entonox and then agreed to come to the local hospital. We drove her up there, handed her over to nurse and promptly received a tongue lashing for refusing to give her more Entonox. The duty Dr then entered the cubicle and lectured her about using an ambulance to get a fix of Entonox and told her she wouldn't be getting any whilst in the department. We left to the sound of her F'ing and blinding at the staff! Living the dream.....

We sat there for 20 minutes, did our paperwork, drank some luke warm coffee and then greened up for the next job. 10 minutes later.....

"45 year old female, abdo pain"

Same address, same info, same patient. Really?! I got straight onto control and they confirmed it was indeed the patient. Unbeknown to us, as soon as we'd left, the patient self discharged and had called a taxi and gone home. As soon as she'd got back she dialled 999 and said the previous ambulance crew and hospital had refused to treat her. Due to the symptoms that were described, she was getting another ambulance. And as luck would have it I would get to enjoy seeing the expression on her face when I walked through the door!

10 minutes later we pulled up outside. As usual, the door was open, and in we went to find her lying on the same sofa in the same position.

"I need Enton......is this some kind of joke?!"

"You tell me, we just took you to hospital, why are you wasting resources?"

"Because they wouldn't treat me up there, I'm not going back there, you can take me somewhere else. I'm also allowed 5 minutes of Entonox."

"I'm afraid the only hospital we will take you to is the local one and you've already had your quota of Entonox."

"We'll f**k off then."

With that we left. I know for a fact that later in the evening she had at least one other ambulance. Whether they knew her I don't know, she may have got her own way, she may have had the same as she got from us. One thing is for sure, and that's the going round in circles will continue.

What can be done? Obviously, we can't charge her. We can't refuse an ambulance for someone in pain with a chronic condition. Equally though, it isn't sustainable to keep pandering to people to are simply abusing the system. It's not the call takers fault, nor the dispatcher. It's not our fault, the hospital can't feed her habit and the GP has tried to help. Now what? Where does the madness stop?!

11 comments:

  1. For this sort of caller, does Control let you know that they have a care plan in place? I know that round here they will do that - some callers get put through to the clinical support desk first before getting a crew sent, and I think some can only call one ambulance per day.
    Ann

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    Replies
    1. They do. Very strict protocol now saying exactly what hospital she must go to if she wants to and a specific amount of entonox she can have. Also list drugs shes not to have!

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  2. Surely the GP should be refering for sustance abuse counselling and prescribing a suitable painkiller?
    Unfortunatly, as you continuely highligh, these types of paitents are free to abuse the system by using the correct buzz words to ensure they get what they want. The fact that your service has a protocol for the paitent is just scary and depressing and until someone (GP) offers the support needed to "get off" the entenox, you are correct in that it will continue.
    I am all for paitents getting the correct painkillers but when everyone knows that the patient is abusing it, can you not just deny her use of it and if she kicks off have the address flagged for police back up. If someone just said NO then maybe the cycle would stop.
    Mummycoffee

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    Replies
    1. Pain is subjective, even if you suspect or know abuse of it, its a risky business refusing all pain relief. When we only have entonox and morphine to offer its the lesser of 2 evils. We can restrict the use though!

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  3. What type of pain has she got ....offer her paracetamol or ibuprofen if shes able to take them.

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    Replies
    1. Oh, now there's a surprise. You know what? I have chronic severe abdo pain too, and not once have I pulled that, even though paracetamol makes me puke more than morphine, and NSAIDs give me terrible reflux. I just suck it up and take antiemetics and H2 blockers. People like that give those of us struggling to manage pain all a bad reputation. How on earth do I, should it be necessary, convince medical staff that my pain really is too bad to walk doubled up without my knees buckling, despite paracetamol, naproxen and morphine, when you have to deal with addicts... Especially as when pain is particularly bad, I'm certainly begging for relief.

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  4. Jeremy Andrews13 May 2013 at 15:47

    ''Obviously we can't charge her''

    Maybe then the NHS should look at a system of charging people who waste ambulance crew time and resources? It'd soon stop the people who are ringing up for drug fixes or lifts into the local town when you slam a £300 bill (£300 is just a figure I pulled out of the hat) onto their table!

    ReplyDelete
    Replies
    1. Those sorts of people would never pay up anyway. The people it would put off would be the elderly who would be afraid of the charge, and who already feel like they are being a 'nuisance' when they call.

      Delete
    2. Jeremy Andrews13 May 2013 at 19:45

      Good point! But I'm sure there would be a way of making sure the regular time wasters who on a daily or weekly basis ring 999 for something that they shouldn't (Drug or Taxi services) could be charged. But it'd probably end up too much work for the NHS!

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  5. CBT would proove useful imo. Also there is a duty of care to be excersised with regards to how she is managed. To continue to respond to her needs is placing other patients and road users at risk and potentially exacerbating any Psycho social problems she has. It is a Somatoform disorder and needs to be identified and treated as such. Again imo.

    ReplyDelete

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