h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Thanks Gnomon as I said to kea in post nine when you get to the front line service it verges on brilliance. It is the obstacles put in the way of getting there that are the problem. Like in the hour that you are anxiously waiting there is a security guard breathing down your neck for illegally parking, uncaring authoritarian and uncooperative receptionists, people who have personal problems of their own that concern them more than the problems of those they are serving.
The last time my wife was taken by an ambulance she bye-passed A&E and finished up directly in the Medical Assessment Unit. You never quite know what to do for the best. Calling an ambulance the patient gets the direct attention of a paramedic and bye passes quite a bit of the red tape with the added advantage that treatment starts when the ambulance gets to the patient.

The problem is, I can see situations in which two non-ambulance parking bays may suddenly be needed outside A&E, late at night. There are emergencies which require attendant police presence with victims or injured suspects, for instance. Moreover, such events may well come up unexpectedly, meaning non-essential vehicles need to be kept out of the way as a matter of urgency at all times. Urgency can often be confused for rudeness if the cause is not immediately apparent.
The whole situation must have been very stressful for you, but I always try to look for the other side in questions such as this and, when I did, it was there for me to find.

Yes I'm failing to see what was so bad about a security guard doing his job - you admit yourself you were illegally parked, and who knows what emergency could have needed those bays at any moment.

But I'm glad your wife got the treatment she needed, and wish her a speedy recovery.

I work in A+E, and am a GP. We are constantly in + out, on visits, etc- Ambulances are forever going in + out- so out o courtesy, don't block us in , or park in my spot--else I may not be able to see my patients (one of whom may be you) + treat you at all!!

The rules are simple I think,- A+E is for accidents and emergencies (thats what it stands for)- so if your case is not an Accident or an Emergency (ie life or limb or sight threatening condition), do not go there -instead go see your emergency GP service (out of hours) - or even make an appointment to see your own GP.

The number of people I see who say they can't get a GPs appointment, (and then I see them for something that could have possibly waited) mystifies me- we have loads of appointments!!!

I suspect they love coming to A+E, or out of hours- you do get the same patients sadly turning up!!- oh well, keep me out of mischief

It was not a question of doing their jobs, it was the way in which they did them. I did what I thought was right at the time following the dismissive attitude of whoever it was that answered the phone on the number we were given to ring in an emergency. All prior 'treatment' to getting the front line service she needed.

Joyika - My wife is an octogenarian and a patient. Please read post 1 and tell me in your wisdom what should have happened in the circumstances.

Why not ring the gp on call service, who will advise you, and either arrange a visit, appointment- or possibly refer you directly to whichever specialty you need to see (usually the medics- i've done that job myself and it was overrun).

You won't be bothered by any security guards (unless you misbehave or are agressive to nhs staff), if you do this- i've been qualified since 1999- and worked in hospitals since then, so i know the system. I also know the security guards have a hard time, especially with people parking all over the place.

Incidentally a lot of the treatment paramedics provide can be done in an acute gp setting (eg nebs, oxygen, im injections, oral administration of steroids, antibiotics, etc)

I trust all your patients are aware of the simplicity of getting the service they need. My wife was 2 weeks out hospital after a total knee replacement and under the care of the district nursing unit with an emergency number to ring day and night given any problem. Her leg that was understandably swollen after the operation had expanded to twice the the size it was when she left the hospital, it was a brilliant red and giving pain that had kept her awake most of the night. Not only that her good leg was also swollen and I should mention that she is on warfrin.
Please stop inventing your own scenario and talking to me as though I am an idiot. Remember bedside manner and all that.

So did she have a DVT, or a post op infection (or both)? My bedside manner is great as it happens according to my patients, and incidentally just because someone is on warfarin, doesn't preclude them from having a DVT- it just makes it unlikely.

I don't think you are an idiot- but I'm just tryng to tell you how to access services for the best. The NHS does work, and all the staff are amazing I think (pity the same can't be said for all the patients).

I'm sorry your experience wasn't great- why don't you tell your local acute Hospital trust what you think?

Come on Dr. Joyika.
Still no answer as to what you would have done in the circumstance.
How should I know what was going on medically. I'm her husband not her consultant that was the nature of the situation. You present clever posts but totally fail to answer the question. Let me put it to you again 'What would have been the correct thing to have done given the circumstances'
PS. Prior to the operation we were told that blood clotting was a problem in knee replacement surgery and that warfarin increased the likelyhood. It was also emphasised that the next most serious consequence could be infection of surgical wound.

In the first instance read post 28, which I wrote, and gave my answer then

Obviously I'd need to see the patient (your wife) before making a management plan. It would be foolish to just triage this. The differential diagnosis though includes

1) DVT
2) post op infection
3) post op bleed (secondary to be over anti-coagulated)

the treatment dependss on which of those I thought it was, -she may have required admission to await results, or for iv antibiotics if it was in infection for example.

I don't expect you to know the answer- but all I'm saying (repeatedly now) is if you rang the GP on call service (if it was after 18.30) - I suspect they would have visited you initially, and then referred you to the orthopaedic department. Therefore no A+_E wait, quick efficient medical care. Its all acaedemic now anyway, as your wife has been treated.

The UK has one of the best (if not the best) GP out of hours service in the world- you pay for it, so use it (else this government will probably take it away)

I have already said that when you get to the front line the service verges on brilliant. The problem is with the barriers that you have to mount in order to get the service that you require. Read post 21.
The post operative system was already in place, following my wifes from discharge from hospital after the operation. Your Post 28 implies that I should have ignored that and contacted the GP on call system, I can't believe that you meant that.
What I had hoped to get from you was your 'professional' view on what should have happened when my wife rang the emergency number that she had been given by the Community District Nursing Service.

My understanding of your experience is:

1. You called the emergency number you were given and they told you to take your wife to A&E.

2. You parked your car as close to the hospital as possible and took your wife in to get her booked in.

3. A security guard asked you to move your car as it was blocking a potentiallly vital parking spot which could be needed at any time and was marked as such.

4. You asked the receptionist if your wife should take her scheduled medication. The receptionist told you to wait to see the doctor.

5. You were seen within an hour of arriving.

Does that sum it up? If so, my comments on each part of it:

1. I understand your wife ended up being kept in hospital. In that case I would imagine that had you been referred to the out of hours GP (either for a home visit or to wherever they operate from in your local area) your wife would still have had to go to hospital via A&E.

2. Quite right, I would have done the same. And as soon as the patient was seated in A&E I would have gone back and moved it somewhere more suitable.

3. Quite right, he was just doing his job.

4. I would imagine she did this because she has encountered this question numerous times before and on asking has been given the reply that the patient should wait until they see the doctor.

5. Amazing! I've been a few times with different people and it's never been that quick. My husband had to go by ambulance a couple of times and when we got to the hospital I was sent to check him in at the A&E reception and then left to twiddle my thumbs for ½-1 hour wondering what the hell was going on before I finally got taken through to be with him.

What aspects of the experience do you think should have been different?

Deb

Almost as it happened or would have happened if the security officer had given me the time to move the car in my own time instead of pouncing and the receptionist had been civil in her reply without the totally unnecessary and stupid comment that there were ill people needing attention. After all we were in the A&E section of a hospital.
The point to be made is that an almost perfect NHS service was ruined by the behavior of back up staff.
My own view is that the response to my first call could have been more helpful but I will take this up as appropriate.

The varied reactions to the post are also of interest.

I'm unsure what the district nursing tem would have said- other than call the GP out of hours service. They rarely send people to A+E, and tend to refer directly to a specialty. - which is much faster.

Gp out of hours services are now working in conjunction wityh A+E departments throughout the country to provide unscheduled care in the most efficient way, and cost-effective way. So in the future, you may well be triaged to the GP out of hours service.

I'm currently working in the GP out of hr service locally + we have had quite a few calls from the A+E dept across the way to see some patients, who quite clearly don't need emergency treatment (most can wait to be fair- but we don't mind)

The way you dribbled out the information over a number of posts make it seem like you weren't just posting to get a worrying experience off your chest: you were trying to make some point. I don't know what that point was, because you're still being vague about it. In the circumstances, I don't blame SWL for teasing you a little.

TRiG.

I agree with Trig, there.

If parking bays are marked as emergency vehicles only, that's not the same as disabled spaces, so I'm not sure where your badges come into it

A bit of each Trigg. Why did you bother to post.
The same goes for you Malabarista.
We have Malabarista > Trigg > SWL just like to keep my records straight there are one or two little cliques around.
Sorry chaps I am not coming out to play.
My wife is home and well and the point was made in post 35 and your hand holding reaction presents another interesting twist.
Ever wondered why some people don't like h2g2 ?
Happy hunting.