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*

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?!