Wednesday, December 31, 2008
Still, on Christmas morning, I found myself waiting in Resus, checking the kit. The call didn't offer much hope. An elderly patient, visiting family for the holiday, had fallen down the stairs. No output with the Paramedics. This sort of call tends to be an 'in-and-out' job. If they haven't got an output back by the time they get to us, they probably aren't going to. And while the NHS isn't ageist, God is, I'm afriad. Your chances of surviving cardiac arrest are not improved by being over 80...
Despite my fears, six minutes later, we were greeted with a bounding pulse. A moment of light relief passed us by, when the charge nurse briefly attempted one handed CPR while cannulating with the other hand. We waited, checking the scene, quiet bar for the slow rhythmic hiss of the ventilatotor; once the adrenaline wears off...
Half an hour later, the patient was warm, well oxygenated and ventilated, and still going. The intensivists duly attended and spirited our patient away.
Will they recover? I honestly doubt it, but maybe hope is all you get at Christmas.
I guess... as a patient and having experienced something say, a yeast infection or a urinary tract infection or a sore throat needing to be looked at, and getting the ol' "you're-wasting-my-time" look from the doc, I'd rather go to a PA while my doc goes and tackles something else much more challenging.
Or, at the very least... make my doc stop rolling his eyes when I haven't been able to swallow for two weeks and my glands are huge and I just want some antibiotics or some relief! :D
My husband is a medic with the canadian army and I'm encouraging him to go for his PA as soon as he is able to. He's too old (36) to start fresh and become a doctor but he's not too old to do the PA and still earn a living in his second career. We're so short of doctors here, anyone who can alleviate the pressure or at least, free up enough time so doctors can provide more care for serious things, would be nice. Something like, 10 million Canadians (out of 30 million in total) do not have a family physician. PAs would
really make an impact, in an area like ours with such shortages!
Personally, I think that, as Doctors, we should be happy looking at yeast infections/sore throats/UTIs. Generally, they don't need to be seen in the ED, that's true, and patients pitching up to the ED may occasion the rolling of eyes... BUT: if the system doesn'tprovide another opportunity for patients to see a Physician, then it's not their fault, and we should keep our eye-rolling to ourselves. That should be part of the deal: you can come to us with anything and not feel ridiculed. We should be allowed to roll our eyes BEHIND CLOSED DOORS. And I'm more than happy for PAs to see this stuff; but if their breadth of experience extends only to simple sore throats are they more likely to miss early meningitis? to mistake glandular fever for tonsillitis?
The point I'm trying to make, and labouring rather, is that Doctors have, or shoukd have, a breadth of experience, born of experience. And what at first glance appears simple and straight-forward may not be. I would argue that that is when we earn our pay - not in the vast bulk of practice, which is routine (and often gets better no matter what we do... sore throats are an excellent example of this, despite the public love of, and faith in, antibiotics), but in the recognition of, and prompt treatment of the more serious cases.
I reckon I could take one of my more dextrous, non-medical friends and teach him how to take an appendix out; but not what to do when things went wrong, or when the diagnosis doesn't match the operative findings. Being an expert in a very small area will mostly be fine. Mostly.
Do we need more practitioners? Yes.
But I'm not convinced that telling ourselves that, as doctors, we don't need to be dealing with certain conditions is the answer. Maybe, economically, it makes more sense to employ PAs, and if practitioners want to perform this sort of extended role - brilliant. But, like most solutions for thorny problems, I'm not convinced it's perfect.
Tuesday, December 30, 2008
It's early, it's dark, and it's cold. For the UK, anyway. My dear colonial readers can feel free to refrain from reminding me what real cold is like.
I've followed, with some interest a debate on the usefulness (or not) of the PA, or Physician's Assistant, over on some of my more erudite colleagues blogs. Check here, here or here.
As ever, it makes for interesting reading; and has fired up my little grey cells. Much has already been said on many UK blogs about extended role nursing practice, often not especially complementary...
I'm old nough to have seen the transition, and it does make me a little uncomfortable. Not because I'm not convinced that 'non-doctors' cannot do the job; they can, although I do occasionally have my concerns about the risks of such narrow fields of practice. But mostly because I increasingly see the 'extended role practitioner' doing the stuff on which I cut my teeth.
In 'farming' some of this work out, because wwe think it frees doctors up to do other (?more important) jobs, are we not mortgaging some of what makes us doctors?
I worry that we are.
Monday, December 29, 2008
Friday, December 12, 2008
Thursday, December 11, 2008
Wednesday, December 10, 2008
Tuesday, December 09, 2008
Monday, December 08, 2008
He'd had a bad run the night before, attending to a young patient, in cardiac arrest. Nothing to be done, but run the numbers, mark time and call it.
I could see it hurt him, hit him hard; the knowledge that it were all for naught.
I know just how he feels; I've been there, run the same code, counted the same numbers, marked the same time.
Somehow, this makes it harder to talk about. We share a look, and go our separate ways into the dark....
Sunday, December 07, 2008
I don't know; hospitals are surely the site of more strong emotions than most, so should be primed for supernatural activity. I worked in a hospital years ago that was reputed to be haunted; talk was of strange occurrances, and odd sitings on the first floor. This was the da case floor, and usually occupied at night only by the Resident Medical Officer.
Which, for a year, was me.
I never quite saw anything, though on one night a few lights and a t.v. may have switched themselves on in a room a few doors down. Or, the other staff may have been yanking my ding-a-ling.
Shroom's jury is still out, but the other night, while decamping from my car in anticipation of another happy night shift, I was sure I saw someone lurking in the car park, just out of the corner of my eye. On glancing round, there was, of course, no-one there. I'm sure it was but a trick of the light, reflecting on my glasses.
But, try as I might, I could not repeat the feat.
Until I stopped trying.
Twice more I 'saw' him, and each time, he seemed a little closer to me.
A trick of the light, I'm sure.
Nonetheless, I walked in a little quicker than usual that night.
Saturday, December 06, 2008
Friday, December 05, 2008
Thursday, December 04, 2008
Wednesday, December 03, 2008
Hospital, and thus department, busy as f...eather boas.
Spent more hours than is seemly trying to organise admission of one consultant's patient under the care of another; consultant 2 didn't wanna do it, and consultant 1 thought this was very unfair, but, curiously, neither would talk to the other, preferring to use me as a go-between.
Ultimately, grown men should be above saying "I won't be calling him, but if he wants to call me, I'd be happy to talk to him"...
I left a patient behind today, handed them over, after failing to get anyone to take them seriously; well, it wasn't so much that they wouldn't take him seriously, it was more that the general opinion was "Sure, he's sick, but it's because of (body system looked after by rival speciality)"
Details to follow, but I'm convinced intra-abdominal mischief was to blame, and failed to convince either the KnifeMen, or the Moths. If I'm right, I'm sure they'll try to lay it at my door; for what it's worth, I still think he'd perfed a diverticulum, but God forbid anyone should take my opinion seriously.
Le Shroom: c'est grumpy.
Tuesday, December 02, 2008
His exact words?
"I'm not being funny, yeah, but I don't even think any of you are real doctors. I mean, you're all wearing trainers, for fuck's sake!"
Monday, December 01, 2008
I undertake to get of my arse, and keep my end of the bargain again.
Starting tonight; promise...
(And, yes, I've back-dated it; I'm cheating, for reasons I will explain. It's sort of my version of the Kobyashi Maru)