21 years and it feels like we have gone backward
Please do not see this post as a criticism. It is not about the amazing medics and staff who work on the front line of our incredible NHS. Rather the systems that teach. The executives who manage. The new reliance on tech, that seems to forget the person with the problem. It’s about a broken system on it’s last legs being held together by medics who care.
It was a Sunday morning and I had already missed Luca’s football match. I was sat in the same area I sat in 21 years ago when I received my diagnosis of DVT. I’d tried to cheat the system and hoped I would’ve been out of there at this point. Unfortunately, a very skilled medic saw me. He passed me back to A and E from See and Treat. Apparently after the compartment syndrome it’s just not worth the risk of not scanning me.
The girl as high as a kite on god knows what was looking for where she began. SDUCU, SDEC or See and treat she needed. Her sister had dislocated her shoulder. She kept poking it and laughing whilst the sister screamed with pain. I sat outside MAU and thought back 21 years. The waiting area was smaller then. Somehow though you did get seen quicker.
I always remember laughing at the sign on the wall for Triage codes. Number 1: the patient has stopped breathing and their heart has stopped beating. I used to think great you have to be dead to be seen in here first. The system was good – there was a four hour wait maximum. Ninety percent of the time it was achieved. There were no beds up corridors, patients had dignity in their wait.
Now there is not an empty seat. People wait to be called in to majors/minors or to move round to see and treat. The ones in my waiting room faced a 6 hour wait just to be seen. As I waited to be called I chatted to couple next to me. I had already been there four hours.
Finally my name was called, My Dr was the lovely Vicki Price. She trained with my haematologist Dave so I knew I was in safe hands. We had a chat about next steps. Which was a scan of my leg – just to double check no clot. We then had a conversation about how things have changed and how the patient is very rarely seen these days.
The advances in tech, bring our new resident doctors lists of results. If your results don’t fit the diagnosis then there is nothing wrong. I explained how scary this can be. As I do not and have never had that clear pathway to diagnosis. Fortunately I am a good self advocate. Nonetheless it extremely frustrating. It’s a barrier to care.
40% of patients who died of a VTE were seen by a medic prior to their death. How are we getting this so wrong. what are we missing? what is the data or the tools we use not telling us?
Has the system has improved in 21 years – No. Do I feel seen – No. Do I feel I have to justify why I am there at times – Yes. Do I worry I will be misdiagnosed – All the time. Is there anything I want doctors to know and understand – Yes.
My advice for doctors in A and E –
Think! – where has this patient come from – where I am sending them to.
Think! – will anything I say unintentionally cause this patient anxiety.
Think! – Outside of the box. What is this patient telling me, that the test results are not.
Ultimately I don’t know what the answer is to A and E. I know, I am more scared than ever to go. Even though I am an extremely good advocate for myself.
Tech shouldn’t replace all aspects of medicine. There are just some things a computer cannot compute. Doctors sign up to do no harm. However, to simply complying to this mantra. In my experience causes more harm than good.
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