Wednesday, July 07, 2004
Random Acts of Reality
I've just stumbled upon this site by accident, and had my breath taken away.
This guy works for the london ambulance service, and he really
writes. He doesn't just write, like for instance, the other guys on lingualnerve.com (no offence)... he really writes. He writes for the layman, and the professional alike.
His pieces are fascinating to me.
And the strange thing is, I actually work on the receiving end. I'm the guy who pulls a (mock, but none of the staff can tell) long face whenever one of the crews pulls up in their ambulances, and groans "go away..." before accepting the handover and getting serious.
None of it is new to me. But I've never had the opportunity to read it, laid out in stark honesty and in so much detail before. Parameds tend not to talk a great deal en route from ambulance to coffee room aside from the perfunctory handover :p
I remember the one day I had in the back of an ambulance as a med student. It was one of the best days of my life, ever.
Sure, there were a lot of things going for it, including the ah young, genuine-blonde ambulance tech taking her assessment who made the greens look GOOD, and err also had her top unbuttoned just a little more than usual. cough. And the major RTA that had me sitting in the car manually immobilising someone's neck while the fire crews cut the car to slivers around me with their jaws of life. (cool!)
But the thing that got me was the... raw in-your-faceness of it all. This was life-or-death medicine. There wasn't a great deal that could be done... but this was the frontline, where patients made it, or broke.
Reading this guy's accounts about his life, and his job, I've just realised that the knights in shining armour aren't the guys with the white coats... but the chaps soldiering on out there on the frontline. Nobody offers them any thanks, and they don't get a great deal of publicity. And they don't brag about it either. I'd imagine they get a lot of flak from irate doctors, including myself, for bringing in patients with "minor" conditions (eg arthritic knees. grrrrrr).
I already knew this, but his blog reminds me that it's not really (always) their faults... and that it must be equally frustrating for these chaps to have to take well patients to hospital, because some GP decided they were too lazy or incompetent to prescribe analgesia.
Their jobs are as difficult, if not more so than ours.
The caveat is that we all make mistakes - all of us. And sometimes, listening to a handover and looking at the crew out the corner of my eye breathlessly handover a rather well patient to us, the mean streak in me starts me muttering under my breath. And as the sisters like to say, "it's always the same crew..." (the sentence is actually left incomplete, and the three dots are almost audible)
The flip side is... how many times have I made crap referrals to specialty teams?
And what must it be like to be that GP, wandering out in the middle of the night, half asleep, to wonder, with your limited drugs and resources what on earth you can actually do for this patient, and what if your diagnosis is wrong?
I think the NHS needs some serious revamping.
I think for one, that everyone needs formal training. Sure, we get a lot of training on the job, and we pick things up as we go. And sure, we get a lot of departmental teaching, motivated by individual consultants and performed by casualty officers, or registrars, or senior nurses.
I think the NHS ought to bring us all together, GPs, parameds, EMTs, nurses and SHOs for symposiums that last a week, to standardise care AND REFERRAL practices.
A lot of the time I find myself talking on the phone to GPs who simply haven't got a clue what happens in A&E, having apparently never done it themselves. No, I do not exist to give you second opinions on a patient's bursitis, which you deal with as your bread and butter, and I deal with infrequently. No, I can't get an MRI for your patient's non-acute back pain, if you're truly concerned, perhaps you might want to refer to orthopedic outpatients yourself, rather than subject your patient to a needless six hour wait in casualty?
Most GPs are sensible. It's the ones who aren't that give the rest a bad name.
And we need to get together to hash things out like whether ambulance control should have the right to refuse sending ambulances out to calls, and whether parameds of sufficient experience should be allowed to vetoe a GP's "bring to A&E" order, in the face of blatant stupidity.
and I honestly think NHS direct needs to be properly audited.
Not just on safety, and on positive patient clinical outcome, but also on criteria like needless visits to hospital, unnecessary ambulance activations, and inadequate communication with patients.
The number of times I've seen patients advised by NHS direct to attend A&E for reasons completely beyond my comprehension is by now legion. Cough? Go straight to A&E. Cold? Go straight to A&E. Chest pain after lifting an elephant? Go straight to A&E.
Child walked into a doorframe, no LOC, no apparent injury? Go straight to A&E.
For that matter, the number of times I've had patients panicking over minor ailments because NHS direct told them they had to go straight to A&E is remarkable as well.
And the number of people coming through the doors for "checkups"... howl.
I think it's high time people abusing the services start paying it money. That would solve the problem immediately.
This guy works for the london ambulance service, and he really
writes. He doesn't just write, like for instance, the other guys on lingualnerve.com (no offence)... he really writes. He writes for the layman, and the professional alike.
His pieces are fascinating to me.
And the strange thing is, I actually work on the receiving end. I'm the guy who pulls a (mock, but none of the staff can tell) long face whenever one of the crews pulls up in their ambulances, and groans "go away..." before accepting the handover and getting serious.
None of it is new to me. But I've never had the opportunity to read it, laid out in stark honesty and in so much detail before. Parameds tend not to talk a great deal en route from ambulance to coffee room aside from the perfunctory handover :p
I remember the one day I had in the back of an ambulance as a med student. It was one of the best days of my life, ever.
Sure, there were a lot of things going for it, including the ah young, genuine-blonde ambulance tech taking her assessment who made the greens look GOOD, and err also had her top unbuttoned just a little more than usual. cough. And the major RTA that had me sitting in the car manually immobilising someone's neck while the fire crews cut the car to slivers around me with their jaws of life. (cool!)
But the thing that got me was the... raw in-your-faceness of it all. This was life-or-death medicine. There wasn't a great deal that could be done... but this was the frontline, where patients made it, or broke.
Reading this guy's accounts about his life, and his job, I've just realised that the knights in shining armour aren't the guys with the white coats... but the chaps soldiering on out there on the frontline. Nobody offers them any thanks, and they don't get a great deal of publicity. And they don't brag about it either. I'd imagine they get a lot of flak from irate doctors, including myself, for bringing in patients with "minor" conditions (eg arthritic knees. grrrrrr).
I already knew this, but his blog reminds me that it's not really (always) their faults... and that it must be equally frustrating for these chaps to have to take well patients to hospital, because some GP decided they were too lazy or incompetent to prescribe analgesia.
Their jobs are as difficult, if not more so than ours.
The caveat is that we all make mistakes - all of us. And sometimes, listening to a handover and looking at the crew out the corner of my eye breathlessly handover a rather well patient to us, the mean streak in me starts me muttering under my breath. And as the sisters like to say, "it's always the same crew..." (the sentence is actually left incomplete, and the three dots are almost audible)
The flip side is... how many times have I made crap referrals to specialty teams?
And what must it be like to be that GP, wandering out in the middle of the night, half asleep, to wonder, with your limited drugs and resources what on earth you can actually do for this patient, and what if your diagnosis is wrong?
I think the NHS needs some serious revamping.
I think for one, that everyone needs formal training. Sure, we get a lot of training on the job, and we pick things up as we go. And sure, we get a lot of departmental teaching, motivated by individual consultants and performed by casualty officers, or registrars, or senior nurses.
I think the NHS ought to bring us all together, GPs, parameds, EMTs, nurses and SHOs for symposiums that last a week, to standardise care AND REFERRAL practices.
A lot of the time I find myself talking on the phone to GPs who simply haven't got a clue what happens in A&E, having apparently never done it themselves. No, I do not exist to give you second opinions on a patient's bursitis, which you deal with as your bread and butter, and I deal with infrequently. No, I can't get an MRI for your patient's non-acute back pain, if you're truly concerned, perhaps you might want to refer to orthopedic outpatients yourself, rather than subject your patient to a needless six hour wait in casualty?
Most GPs are sensible. It's the ones who aren't that give the rest a bad name.
And we need to get together to hash things out like whether ambulance control should have the right to refuse sending ambulances out to calls, and whether parameds of sufficient experience should be allowed to vetoe a GP's "bring to A&E" order, in the face of blatant stupidity.
and I honestly think NHS direct needs to be properly audited.
Not just on safety, and on positive patient clinical outcome, but also on criteria like needless visits to hospital, unnecessary ambulance activations, and inadequate communication with patients.
The number of times I've seen patients advised by NHS direct to attend A&E for reasons completely beyond my comprehension is by now legion. Cough? Go straight to A&E. Cold? Go straight to A&E. Chest pain after lifting an elephant? Go straight to A&E.
Child walked into a doorframe, no LOC, no apparent injury? Go straight to A&E.
For that matter, the number of times I've had patients panicking over minor ailments because NHS direct told them they had to go straight to A&E is remarkable as well.
And the number of people coming through the doors for "checkups"... howl.
I think it's high time people abusing the services start paying it money. That would solve the problem immediately.
