Friday, 14 June 2013

I Didn't Think


Welcome to Facepalm Friday! I've decided that each week I will share with you a patient, or a conversation or an encounter that has simply left my head in my hands. Far too often I'm left questioning how some people manage to exist being so moronic! If anyone has their own tails to share, of people they've met or contenders for the Darwin award, I'm happy to have guests posts! Enjoy!

So......

"47 year old female, dizziness, pain in jaw, headache"

10:15am: Patient phones NHS 111 and lists her symptoms. She told them she had chest tightness radiating to her jaw. She said she had severe ear pain. She said she was dizzy. She also had a headache. Despite it's faults, NHS 111 correctly requested an ambulance to be dispatched because of the priority symptoms. 

10:26: Because the patient has told the call taker she has chest tightness it is categorised as a high priority of call. An FRU (Fast Response Unit) and an ambulance were dispatched.

10:32: FRU arrives on scene (me!)

10:33: Ambulance arrives on scene

10:51: After much knocking and shouting and several attempts by control to phone the patient back the door is answered by the patient. 

"Sorry, didn't think you'd be so quick, I normally have to wait ages for my ambulances. I thought I'd have a shower before you arrived."

In my humble opinion, if you are well enough to jump in the shower whilst you are waiting for your emergency response you are a) not that ill and b) not an emergency. Also, the phrase 'my ambulances' grated on me. It means she has us out a lot, probably for similar symptoms. 

"What's the problem today?"

"I already told them on the phone!"

"But that wasn't us was it?!"

"OK, I've got this awful headache and dizziness and this pain in my jaw."

"Do you have any chest pain?"

"Nope."

"Oh, you told the call taker you did! What pain killers have you taken?"

"I haven't taken anything."

"Why not?"

"I didn't think they would work"

*Facepalm*

Seriously! Why do people not take pain killers! The clue is in the name! Time and time and time again it's the same futile conversations! "Are you in pain?", "Yes", "Taken pain killers?", "No". Why?! Why?! Why?! Can someone please suggest an answer to this age old question!

"So what time did the symptoms start?"

"About 2 weeks ago."

*Facepalm*

"Has you seen your GP?!" I asked, fully expecting her to say 'No'!

"Yes."

"And did he diagnose anything or give you any medication?"

"Yeah, these." she said as she passed 2 packets of drugs.

Ah, clarithromycin and prochlorperazine! The former, an antibiotic which she was given to treat an ear infection and the latter is a medication used to treat dizziness caused by inner ear problems. Both should be alleviating her symptoms.

"How long have you been taking these?"

"He gave them to me a week ago but I haven't taken them."

*Facepalm*

"Why not?!"

"Because I thought they'd make me feel sick ."

*Facepalm*

Notice she said 'thought'. She hadn't felt sick because of them. Her, an expert in general practice and pharmacology (not) had opted against the medication given to treat her symptoms. Instead, she called for us! The conversation continued in much the same way whilst we were checking her over. We did her ECG and the full battery of tests we do on most people and found nothing untoward. 

"How about we leave you at home, you take your course of medication and if that doesn't work make another appointment with your GP?"

"Nah, I think I should go to hospital. I know my body, something's not right."

*Facepalm*

Yeah, you have an ear infection and needed clarithromycin and prochlorperazine to cure your symptoms! It's not rocket science! Why do people go to their GP, call 111 or 999 and then ignore all the advice they are given?! Why?! Why?! Why?!

I gave it my best shot at convincing her she didn't need to go to hospital but she was dead set! We walked her out to the ambulance. On board I continued to ask her questions about her symptoms, specifically the jaw pain. 

"So how long have you had this pain in your jaw?"

"About a month, I've seen my dentist about it and he says I have a tooth infection."

"And did he give you anything for it?!"

"Yeah, these." 

She produced a box of Amoxicillin from her hand bag. I don't know why I had to ask, I knew what the answer would be but I was curious!

"And have you been taking them?!"

"No, I don't agree with antibiotics."

*Facepalm*

11:17: I got out of the ambulance to let them get on their way.

11:37: (ish) Patient arrives at A & E and her 4-6 hour journey of waiting, triage, waiting, being told off, waiting and discharge begins. 

There are times when I write my blog and I really really wish that what I was writing about isn't true. Frustratingly, it is painfully true and not uncommon or an isolated incident. It happens every day!

NHS 111 has its faults, the GPs have their faults, hospitals faults are well documented as are those of the ambulance service. As for dentists, again, it isn't perfect, but we know we have to a) wait and b) pay. People have a got over the 1996 semi-privatisation of dentistry so don't moan as much! My point is though, all areas of the NHS have faults, but people like this are not the fault of anyone. The GP and the dentist saw the patient and offered treatment. She didn't take the medication. NHS 111 had to call an ambulance because she lied about her symptoms and we had to take her to hospital because she insisted. The hospital then had to see her, triage her and waste the valuable time of the doctors and nurses; for what?! To give her another prescription that the tax payers are funding and she isn't taking. She can't be charged the £1000s she cost the NHS. She is unemployed. She can go home, not take her medication and then call us back in a few days because she's still ill and the cycle continues until her body heals itself....until the next time anyway. Unfortunately you can't medicate stupid.

*Facepalm*





15 comments:

  1. Hit the nail on the head, can't medicate stupid! Don't forget the time she wasted at pharmacy too. We had whole black bags of drugs that were unused brought back to chemist, that had been reordered every month!

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  2. I feel your pain! Been in a similar situation many times! Unfortunately for all parties involved, we know that if we insist on leaving these people at home, they will only call back later and waste yet more public money and nhs time. No point charging them for time wasting either, as it will only be more money for the tax payer to pay. We need proper telephone triage by experienced medical personnel using proper questioning, common sense and no computer flowchart!

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  3. Have found your blog recently and now catching up on all the antics of your patients. Fabulous reading and very funny (although not from your point of view I would imagine). As my dad used to say "there's nowt so queer as folk" LOL

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  4. Shame there isn't a pill for stupid people, hey.

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  5. The triple facepalm picture is really doing it for me ... the scale of fail.

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  6. This could be inspiring ... my facepalm moment of the last year was having to deal with a man who wanted to complain that the police had NOT detained him under the Mental Health Act. He'd asked officers for help so they called him and ambulance and he was both willing to go to hospital with them and not causing a disturbance that would indicate he needed arresting. He then goes to hospital and gets whatever he needed before then attending the station to complain they hadn't arrested him MHA and gone with him. Oh, then he made a complaint that on a seperate occasion, officers had arrested him under the Mental Health Act when it wasn't necessary ...

    Triple facepalm.

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  7. IMHO... the reason is the social model of healthcare and implicit with that is Patients that expect treatment without any ramifications. I.E If it wasn't free the patient would be paying for it and that might mitigate her actions. This is the flipside of the social model.

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  8. You can medicate stupid, but smashing someone's brains in with an O2 bottle is generally frowned upon by the HCPC...

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  9. Brilliant post. Ella, I have a reason for not taking painkillers. I was advised by a doctor to avoid ibuprofen as possible bad reaction to my other medicines. Paracetamol doesn't work so well since ODs when younger. But I do take them before asking for help. Well except for the time I had similar symptoms to the patient you're blogging this time, except I really did have chest pain. I was home alone passed out, dizzy, in pain, came round shaking, confused and weak. Phoned for advice but got the fru car and an ambulance instead.

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  10. I do agree, if your pt had to pay the bill, they wouldn't be so quick to call "their ambulances"...the US is quickly trying to model after your NHS, but I doubt we've figured out how to treat stupidity either.

    P.S. just found your blog...now I have another that I "need" to read. EMS from the other side of the ocean is interesting.

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  11. That's not necessarily true. Some call for an ambulance all the time even if it costs them. They get a headache and call 911...I don't get that! And on top of it all they are paying for it! I think it's just certain people. Maybe it's the attention or something, I just don't know. Personally I think there should be some sort of legal penalty and fine for wasting the services of EMS/Fire. It can take them away from actual emergencies... Love your blog btw!

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  12. Should have called the local horse vet to come out with their humane "device". That would have sorted it. If this stupid person had gone to the GP with a cough, that turned out to be bronchitis, given antibiotics then didn't take them because they "might make me feel sick", where would they be now? Dead most likely as the bronchitis turned into pneumonia... It nearly got me once - not because I didn't take the tablets, but because I didn't bother my GP - it was just "man flu" take paracetamol, plenty of fluids, it'll be OK... or not in my case. And do you know what? I didn't call an ambulance. Though while I was off work, a number of new ambulances didn't get their communications kit fitted ;) People in green - I salute you!

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  13. Ha ha ha ha as a new ECA in the North East I've seen this type of scenario so many times now that I practically need to walk away (unless I'm attending) and shake my head. The frustrating thing is that once you're in the patients home you can almost just about tell if the patient is in need of transferring or is what I term a 'time waster' (or words to that effect). Agree with sentiments about 111, etc and better education on that side would be a great help to sort the wheat from the chaff. Great blog btw, like I said I'm new into position after having worked 10 years in both mental health and general hospitals in the North East and I'm praying that I've not made the wrong decision to join up but so far I'm loving the role.

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