Monday, 1 March 2010

A one-legged man in a three-legged race

As part of my role and remit,I am able,-in theory anyway-, to refer directly to the various medical and surgical specialities and sub-specialties,to get patients' seen and admitted to the main hospitals within our catchment area.

There are seldom problems making referrals because I personally have a good reputation (he said modestly) ...and so generally too do the rest of the ENP's working in our Unit.

Its always a pleasure to talk to the maxillo-facial surgeons....they are always polite and helpful and will pretty much take anything you need to send them;the Paeds team are a little more precious with their beds;the shrinks are all mad anyway;and of course the surgeons simply can't wait to have someone new to cut up...(apologies Bongi).

The Medical team are a little more difficult....the local hospitals are besieged by hordes of demented elder patients who would have been put out on the ice and left for the polar bears so that they might die with dignity in a more reasonable society...but who in the UK steadfastly cling to life even when they have 3 or 4 co-dependent morbidity's....and of course are not aware that they are now...or indeed...ever were...actually alive in any meaningful sense....and whose family,-always so quick to shout about their human rights-,have actually abandoned them to the vagaries of the NHS.

Typically though we simply phone and ask to speak to the Medical Nurse Practitioner;attempt to "sell" her the patient....("Buff and Turf" still works);and then she typically accepts the patient to be seen on the medical Assessment Unit (MAU).Its a good little system allowing the medics to triage sick patients without clogging up the always-overworked A&E .

Imagine my surprise when I got hold of an actual doctor a few weeks ago....

"Hello....Its Lucian down at the Walk In Centre...I've got a patient I would like to refer to you please"

Are you a doctor?

"Ahh...No...I'm one of the ENP's...we usually speak to the bleep holder about admissions...?"

Well that's all changed...
We're really very busy here you know...

This is Dr Smallpenis speaking...
And I'm the Consultant...

And I don't take phone calls from nurses!!

"Uh huh...well...if you don't want to discuss my case I'll simply send the patient to A&E and get him admitted through them..."

You can't do that!

"Ahh...actually....not only can I do that...but in about 10 seconds that's exactly what I'm going to be doing..."

Well...I'm stationed in A& there!

"Well congratulations...that just means you'll get to see the patient quicker..."

Let me talk to your doctor!!

"I'll try this again in English shall I ? We do not have doctors working here...never have had...probably never will ..."


Well....whats wrong with the patient?

"He's a 48 year old gentleman who is an insulin dependent diabetic;is hypertensive;has angina;is also epileptic and lives alone...he's also morbidly obese..."

And you think that that deserves an admission???

"No...the reason I think he needs to be admitted is because he has bilateral cellulitis in his legs...his temperature is 39,5C...his sugar is off the chart...and he's confused..."

Rubbish....I've never heard of someone getting bilateral're making it up!!

"Suit yourself bud....the ambo has just arrived and he'll be coming through your doors in about 20 minutes..."

You can't do that...I forbid you to send the patient!!

"I really really dont care what you think ....doccie...."

I know who you are!!

"Well then probably really really know that I don't care about you or what you think...don't you?"

Last weekend by chance I saw the patient's son....he told me that his dad had been admitted for one dose of IV antibiotics that afternoon and then discharged home...alone...where he got worse and has subsequently had his right leg amputated...

And he told me this as I was waiting to talk to another consultant about another patient who also had bilateral cellulitis....and who also didn't believe me!!

1 comment:

  1. What a pity.
    Do you have a chance to refer patients to more than one hospital? Do you (or does the patient) have a choice where they go for hospital care? I am not so familiar with the NHS. Here in Germany it would be a punishment that the hospital-especially the smaller hospitals- no longer got referrals from you...or worse yet, they only got the highly unprofitable patients that you couldn't place anywhere else. (I know that last thought is ethically highly questionable, but it does reflect the reality of hospital economics.)
    It might improve the consultant's attitude if he were made aware of that fact the next time he refuses to speak with a nurse. Plus your patients will thank you for pointing them in the direction of the better hospital.
    I would think that the referrer has an awful lot of power. I guess that is naive; if there are no beds in town, there are no beds.