A LOUD, (NOT WHISPERING) CONVERSATION WITH MY CHILDREN

The golden egg icon means I’m talking to my children. Sometimes I get ratty with them.

You have a baby who is on the verge of crawling and who wants to eat everything.

Why, why, why then do you leave coins lying about the floor and on low tables.

Don’t you know the diameter of a baby’s intestine in relation to that of a coin?

Don’t you know that coins don’t dissolve when they are swallowed?????

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A CONVERSATION WITH MY CHILDREN

As you all know, recently within our family, an emergency situation arose.

Since it happened on a Saturday night, when A and E departments are busy and ambulances are in full swing, it was thought it might be best to transport the patient to the nearest A and E department by car since there may have been a delay before an ambulance arrived. Although some emergency treatment for what turned out to be an accurate diagnosis was given at home it was clear the patient would need hospital admission for stabilisation and further investigation. However, it was found to be impossible to get the patient out of the house into the car without help and so a decision was made to contact the 24 hour NHS UK telephone service. This was an error, the intention was really to dial 999 in spite of possible Saturday night ambulance delay.

Firstly someone who seemed to be a lay person answered the phone and asked several questions very politely and calmly – all of them were relevant.

There was no doubt she was following a protocol on a computer screen in front of her and this clearly informed her that she would need to pass on the problem and in due course a nurse would phone back.

The nurse phoned back quickly. Very politely, reassuringly, and calmly she asked another battery of questions that delved deeper into the problem. These questions again were clearly protocol driven. The nurse concluded that a visit from a paramedic was required. To be fair, the nurse said if the patient’s condition deteriorated, to dial 999, but gave no indication how long a response would take.

The patient was reasonably stable. It was expected an ambulance would arrive soon. The paramedic arrived soon in a car with a bag full of equipment, not in an ambulance.

He asked lots of questions and did a few blood tests, ECG etc. He decided that the patient had to be transported to hospital and phoned for an ambulance.

The ambulance arrived quickly and with flashing lights transported the patient to A and E where she was seen immediately. Further investigations were performed, she was kept in the acute medical receiving ward overnight and transferred to another medical ward the next day to be discharged stabilised a few days later.

Everyone worked as they should have done. There were no obvious delays. Nevertheless the clock ticked on and the procedures involving 4 separate levels of NHS staff,  took 4 hours before the patient reached an A and E  department. That is, it took four hours to see a doctor. It didn’t seem as long as that, but that’s what the clock said.

The problem with all of this, is that although the various team members involved all worked as the system decreed they should in an emergency, not one of them was trained in diagnostic skills. And so it took four hours for a patient who had collapsed semi-comatose with multiple serious  pathologies and therefore various possible diagnostic problems to see a doctor. Proper treatment cannot begin without proper diagnosis.

So, my children, should things have been done differently? With hindsight what should have been done? What would you do in future? Dial 999? If possible bundle the patient into the car and speed to A and E and hope there are no traffic lights obstructing the journey?

In an emergency, it is often difficult to know what to do for the best.

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A CONVERSATION WITH MY CHILDREN:

Is there something you need to know about?

Then make a start by searching Wiki for information.

Right now.

If you do, you won’t find what you are looking for.

Instead you will find this:

IMAGINE A WORLD WITHOUT FREE KNOWLEDGE

And then click on “read more” and you will find this:

SOPA AND PIPA – LEARN MORE

Read.

Then think.

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January  2012

Since this blog was first started, my family circumstances have changed a lot and with that the blog itself is changing. It no longer has hidden information relating to my own continuing personal development as a doctor.  Rather, it seems to be becoming a resource of reliable information for my own children, none of whom are medically qualified.

I am rather uneasy about the way the NHS in the UK is going. It is becoming increasingly reliant on protocols guiding members of staff who are no more qualified than my own children to make a medical diagnosis.  Furthermore, many “pathways’ are being developed. Some of these seem sensible, but others appear to be a deliberate obstruction between  GP and consultant i.e. the GP is, in certain circumstances, not permitted to refer a patient to the consultant of his/her choice, or indeed to any consultant. Instead patients are being diverted to other health care workers who have never been trained in diagnostic skills, and worse still, they don’t recognise they do not have these skills. Indeed a close family member recently was “fobbed off” by the system because it was “necessary” to enter one of these pathways that obstructed direct access from either GP to a consultant or from GP to the appropriate investigation. The Health Care Workers involved (there were several) made a wrong diagnosis. The patient was an outlier whose symptoms did not fit the tick boxes provided. These members of staff did not have the knowledge to interpret these symptoms and signs outwith the protocols they had been given. They should never have been given the responsibility of triaging patients by making their protocol driven diagnosis.   The patient suffered several months of severe pain before a final diagnosis was made – out of necessity – in the private sector.

The diagnosis that was missed was a serious one.

Cancer.

I could tell of other similar stories but won’t because they do not involve my family directly.

If this patient from a doctor’s family fell through the system, how do patients fare who do not have a doctor in the family, and perhaps cannot afford £1000 to see a consultant who organised the appropriate investigations in order to make an accurate diagnosis?

This cannot be allowed to go on.

I want  this blog to help my own children understand these deficiencies in the NHS and how to recognise them, work their way round them and challenge them if they ever need to.

I want them to understand the great care that the NHS can give too, and hope that care does not slip away with repeated reorganisations as the patient becomes regarded more and more as a commodity that can be bought and sold.

So, from now on, a new icon, a golden egg will be introduced from time to time.  This will indicate a conversation with my children to help guide them through a healthcare system that has already failed some of them and other members of the family in various ways on several occasions.

However, I still believe with a few adjustments and much common sense, the NHS could become the best healthcare system in the world.

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