The new doctors start today, all over the country newly qualified FY1's will be starting their first jobs on the way to being consultants or whatever. Every department will get new FY2's and maybe ST grades as well, this is going to be fun for the next week or two until they settle down. The jobbing doctor has posted about it here. The big problem that we as an A&E department have is trying to change the doctors priorities, what they learned on the wards is not necessarily what we want them to do and also the nursing staff in A&E have different priorities, we do things differently. Never mind, they will get the idea soon enough.
Today though, I want to mention the doctors who have just left. In a time when there seems to be a lot of them and us and Dr. Crippen repeatedly alienates nurses, I want to take this opportunity to say that the doctors who have left my little part of the NHS were without exception excellent. They were good clinicians, they were nice people and it was a pleasure to work with them. Many seemed to be going into General Practice so despite The Jobbing Doctors misgivings, GP land (at least in Scotland) is going to be well catered for. No names, but I will miss you all and I wish you all success. I hope that your replacements are as good.
The Jobbing Doctor in his post mentioned that this is not a good time to go into hospital as the junior doctors are new and can make mistakes. I have commented that I have read somewhere that in fact the junior doctors are full of enthusiasm and tend to over treat and in fact the death rate goes down in August. Unfortunately I don't know where I found that particular gem and I don't know even if it is true. So if anyone has the real figures I would appreciate the reference.
Wednesday, 6 August 2008
Saturday, 2 August 2008
Trauma
There has been an RTA, a car has veered over the white lines and hit a minibus head, on there are multiple dead and injured. Then the injured start trickling in, the first and most serious arrives by helicopter, unloaded and the helicopter heads back to get more patients. We start to work on this lady, multiple injuries, where do we start? We know we have to work quickly, not only for her but because we know that more are coming. We know this lady needs surgery, but who goes first? Surgeons or Orthopaedics? We let them sort that out between them and get her to scan then theatre. The next one arrives and then more. It becomes a blur of injuries, tubes, wires, recordings, blood, people calling out for equipment and the various bits and bobs that go into a major trauma. As nurses we divorce ourselves from what is happening, we try to listen to everyone and as a doctor will talk over a plan with a colleague we listen so that we can get the next bit of equipment, yes it can sometimes make you feel a bit like their servant but it is what the patient needs at that time and lets be honest, that is our job. We know where everything is kept and how it works.
After a time it calms down a bit, it becomes less frenetic and we can look around and take stock. We have 4 spaces in our resus room, space 1 has an injured male who is going to go to orthopaedic theatre for various fractures, space 2 is going to general surgeons for exploration of her abdomen - she is bleeding somewhere internally plus has broken bones. Spaces 3 and 4 have dead people in them who crunch when you move them, I hate crepitus, we have not had time to take them to the viewing room. We have time before we have to deal with relatives, they are all from the other side of the country and will take time to get here so we can make the dead presentable. There is blood everywhere, the floor is a mess of discarded packages, swabs and the odd bit of equipment that fell off the trays. My colleague and I look at each other and and think "if our families could see what we do".
All this carnage and so many peoples lives ruined because someone tried to overtake on a corner.
After a time it calms down a bit, it becomes less frenetic and we can look around and take stock. We have 4 spaces in our resus room, space 1 has an injured male who is going to go to orthopaedic theatre for various fractures, space 2 is going to general surgeons for exploration of her abdomen - she is bleeding somewhere internally plus has broken bones. Spaces 3 and 4 have dead people in them who crunch when you move them, I hate crepitus, we have not had time to take them to the viewing room. We have time before we have to deal with relatives, they are all from the other side of the country and will take time to get here so we can make the dead presentable. There is blood everywhere, the floor is a mess of discarded packages, swabs and the odd bit of equipment that fell off the trays. My colleague and I look at each other and and think "if our families could see what we do".
All this carnage and so many peoples lives ruined because someone tried to overtake on a corner.
Friday, 25 July 2008
Numpties and Neds
I feel I've got a bit political recently which is not really what I do (it's enough that the writing is on the wall for Gordon Brown), so I've gone back to my first love for this post - the idiots that seem to inhabit my world, or at least my night shift world. In these cases however, I'm sure you will agree that I am not picking on the innocent or the unlucky.
The first young lad I saw had a sad tale to tell, how he was minding his own business and had been attacked and had had to defend himself and hurt his hand in the process. I am always prepared to give the benefit of the doubt to someone and I try not to judge but I was feeling just a bit sorry for him then one of the other sides friends appeared. Screaming and shouting and swearing at him that he had no business here after hitting his pal with a glass and giving him some very nasty facial lacerations. A fight started in the middle of reception, We did not have security and I was on the other side of the reception desk and unable to intervene but luckily an ambulancewoman was passing and got between them and stopped the fight. Turns out far from being the innocent party, he had started the whole thing by hitting some guy with a pint glass for no real reason. He then asked for a loan of my pen and stuck out his hand which was covered in blood - no way mate, if I gave you that I would have to throw the pen out. He was arrested and taken to the cells for assault.
If you are going to threaten to punch your girlfriend, don't do it when I am passing and can overhear and don't do it where there is CCTV camera coverage. You were really unhappy when I told you that if you did punch her you would be on your way to jail as I always called the police and I always ask for arrest not just removal from premises.
The third patient had a minor injury and had had a wait of about 40 minutes. I went into the waiting room to explain that we were busy and he would probably have to wait another hour at least but he was not happy with this. He asked who I was and when I explained I was one of the nurses his only comment was "poof". He was lucky, I wanted to get him arrested but my colleague had a better idea, we kept moving him to the bottom of the queue so that he would not be seen for hours. We told him we were going to do this hoping he would leave but the numptie kept waiting. After 4 hours of this he was eventually seen, by which time he was a bit more sober and a bit apologetic. Unethical I know but understandable under the circumstances.
The first young lad I saw had a sad tale to tell, how he was minding his own business and had been attacked and had had to defend himself and hurt his hand in the process. I am always prepared to give the benefit of the doubt to someone and I try not to judge but I was feeling just a bit sorry for him then one of the other sides friends appeared. Screaming and shouting and swearing at him that he had no business here after hitting his pal with a glass and giving him some very nasty facial lacerations. A fight started in the middle of reception, We did not have security and I was on the other side of the reception desk and unable to intervene but luckily an ambulancewoman was passing and got between them and stopped the fight. Turns out far from being the innocent party, he had started the whole thing by hitting some guy with a pint glass for no real reason. He then asked for a loan of my pen and stuck out his hand which was covered in blood - no way mate, if I gave you that I would have to throw the pen out. He was arrested and taken to the cells for assault.
If you are going to threaten to punch your girlfriend, don't do it when I am passing and can overhear and don't do it where there is CCTV camera coverage. You were really unhappy when I told you that if you did punch her you would be on your way to jail as I always called the police and I always ask for arrest not just removal from premises.
The third patient had a minor injury and had had a wait of about 40 minutes. I went into the waiting room to explain that we were busy and he would probably have to wait another hour at least but he was not happy with this. He asked who I was and when I explained I was one of the nurses his only comment was "poof". He was lucky, I wanted to get him arrested but my colleague had a better idea, we kept moving him to the bottom of the queue so that he would not be seen for hours. We told him we were going to do this hoping he would leave but the numptie kept waiting. After 4 hours of this he was eventually seen, by which time he was a bit more sober and a bit apologetic. Unethical I know but understandable under the circumstances.
Thursday, 24 July 2008
Nursing Heroes
Who are your hero's?
I was at the gym the other day and while on the jogging machine a trailer came on the TV for the programme Heroes and you know the way your mind wanders? I thought about who my heroes are. It is a question that is asked at the start of courses so that it can be used as an ice breaker and get everyone talking. My usual answer is Homer Simpson! It usually generates a bit of comment and as I am aware of the reason for asking the question in the first place I don't mind taking a bit of ridicule. Actually I can justify it to an extent, he loves his family and does not let anything get in the way of what he wants and it always works out for him in the end - if only real life were like that.
I thought about the use of the term "Hero" and it seems to me that it is way overused. There is not, in my opinion, a sportsman in this world who deserves the title hero. They are training to do what they do and are very well paid to do it so they are out of the hero stakes. Comic book heroes are fine but do not exist. I am going to be controversial - firemen used to be automatic heroes but lost the right to the title when they stated doing risk assessments before going into dangerous situations. Lifeboatmen/women and people like mountain rescue personnel who put themselves in danger for someone else without pay are to me much more deserving of the title.
I then thought about nursing, do you have a nursing, or medical, hero? There have been plenty of doctors who could qualify for the title but not so many nurses. Everyone will tell you about Florence Nightingale although her hospital was several miles to the rear of any fighting during the Crimean war. Black nurses may mention Mary Seacole who was to be found at the front line during the same war treating soldiers from both sides. What about modern times?
One of my nursing heroes is Graham Pink. Mr. Pink was fired from his hospital in 1990 for 'whistle-blowing' after attempting to point out over two years the deficiency of care on the ward he worked on. No one listened, (does this sound familiar?) and he was eventually dismissed for 'breaching patient confidentiality', which he later fought in court and won. He did a tour of the country talking about his experiences and I was lucky enough to be in the audience at my hospital when he spoke. He received a standing ovation at the end of it from all the front line nurses. Sadly one of the nurse managers was overheard stating that she could not believe that this man could get that kind of reception and she would have gotten rid of him much sooner. Read the story here and think that almost 20 years on, nothing has changed - see here. Two parts of Mr. Pinks story has stayed with me since I heard it, the first is the way his supposed colleagues (all female, all senior nurses) failed him by refusing to back him up and in some cases denying there was a problem and the second thing is his account of being behind the screens with an elderly ill patient who he and his HCA could not leave (no other staff) and hearing the padding of footsteps going down the ward and out of the fire exit onto a metal staircase and the helplessness he felt as there was nothing he could do.
We should choose our heroes with care and not because they are popular, well paid or high profile.
I was at the gym the other day and while on the jogging machine a trailer came on the TV for the programme Heroes and you know the way your mind wanders? I thought about who my heroes are. It is a question that is asked at the start of courses so that it can be used as an ice breaker and get everyone talking. My usual answer is Homer Simpson! It usually generates a bit of comment and as I am aware of the reason for asking the question in the first place I don't mind taking a bit of ridicule. Actually I can justify it to an extent, he loves his family and does not let anything get in the way of what he wants and it always works out for him in the end - if only real life were like that.
I thought about the use of the term "Hero" and it seems to me that it is way overused. There is not, in my opinion, a sportsman in this world who deserves the title hero. They are training to do what they do and are very well paid to do it so they are out of the hero stakes. Comic book heroes are fine but do not exist. I am going to be controversial - firemen used to be automatic heroes but lost the right to the title when they stated doing risk assessments before going into dangerous situations. Lifeboatmen/women and people like mountain rescue personnel who put themselves in danger for someone else without pay are to me much more deserving of the title.
I then thought about nursing, do you have a nursing, or medical, hero? There have been plenty of doctors who could qualify for the title but not so many nurses. Everyone will tell you about Florence Nightingale although her hospital was several miles to the rear of any fighting during the Crimean war. Black nurses may mention Mary Seacole who was to be found at the front line during the same war treating soldiers from both sides. What about modern times?
One of my nursing heroes is Graham Pink. Mr. Pink was fired from his hospital in 1990 for 'whistle-blowing' after attempting to point out over two years the deficiency of care on the ward he worked on. No one listened, (does this sound familiar?) and he was eventually dismissed for 'breaching patient confidentiality', which he later fought in court and won. He did a tour of the country talking about his experiences and I was lucky enough to be in the audience at my hospital when he spoke. He received a standing ovation at the end of it from all the front line nurses. Sadly one of the nurse managers was overheard stating that she could not believe that this man could get that kind of reception and she would have gotten rid of him much sooner. Read the story here and think that almost 20 years on, nothing has changed - see here. Two parts of Mr. Pinks story has stayed with me since I heard it, the first is the way his supposed colleagues (all female, all senior nurses) failed him by refusing to back him up and in some cases denying there was a problem and the second thing is his account of being behind the screens with an elderly ill patient who he and his HCA could not leave (no other staff) and hearing the padding of footsteps going down the ward and out of the fire exit onto a metal staircase and the helplessness he felt as there was nothing he could do.
We should choose our heroes with care and not because they are popular, well paid or high profile.
Monday, 21 July 2008
I know my place
This story about surgeons making extra money from successful surgery caught my eye. It's nice to know what the government thinks of us. If the surgeon has a good surgery he gets extra cash, but what about everyone else? Despite what they believe surgeons do not operate in a vacuum. There are a whole host of staff around to make sure that surgery is successful - his medical team, the anaesthetist, the nursing team in the theatre, the nursing team in recovery, the ward nursing staff, the domestics who clean the place, the porters who transport patients, the physios, the laboratory staff, and the sterile supplies people to name but a few. Every one of them vital to a successful operation. So why should only the surgeon be rewarded? In fairness, in all the reports I have seen, there is not one report of a medic who has said this is good and they have actively spoken out against it. So where does the Department of Health get the notion that this is a good idea? This goes along with the idea of rating nurses for compassion. More government interference.
How about developing a scheme that will allow medical and nursing staff to do their jobs with enough staff and resources?
How about developing a scheme that will allow medical and nursing staff to do their jobs with enough staff and resources?
Monday, 14 July 2008
Google Analytics
I was put on to google analytics by some fellow bloggers and thought I would give it a try, it has given me a couple of strange results already. Someone asked google "what happened to Lakelandcam?" and I am the top result - weird. Sorry Tony Richardson who owns Lakelandcam I did not mean to steal your thunder and I have credited the photo I took from your site. As I have said in an answer to a comment I love the English lake district and have put one of most favourite hills at the bottom of this blog. I find Catbells such a nice place, peaceful and invigorating. The only thing wrong is that it is too popular and there can be a lot of people about but I have a fix for that. In the lakes people seem to get off the hills very early and I find that come 4:00pm it can be quiet whereas I am used to the Scottish hills where you can still be at the top of a hill at 6:00pm so I have no problem staying out that little bit later to get the peace and tranquility I want.
For some beautiful pictures go to www.lakelandcam.co.uk updated (almost) daily.
For some beautiful pictures go to www.lakelandcam.co.uk updated (almost) daily.
Ratings
The doctor blogs have been commenting on a new site that has been built for rating doctors called iWantGreatCare. Now I am normally for anything which makes people aware of any difficulties with health care but in this case I feel the need to agree with Dr. Crippen, The Jobbing Doctor and the Ferret Fancier ( I must be sickening for something when I agree with Dr. Crippen) and any other doctor who who has written about this. A member of my family is a teacher and they have a site called Rate my Teacher but as they point out, it is only ever written in by children who they have had a run in with. So no one takes it seriously and in fact no teachers even bother to read it as any sensible comments are buried under the childish, the vitriolic and the puerile comments. And this is the problem with this site, there may be some good constructive criticism written but no one will look at that. It is much easier to believe that Dr. X is an arrogant, unfeeling, uncaring martinet written by someone with a grudge than to believe that perhaps Dr. X had a bad day. Dr. X may be all these things and there has to be some method of complaint about doctors (and nurses) and they must have the right of reply but a public, unsecured, anonymous website is not the way.
Nurses have always known the value of popularity contests (otherwise known as patient satisfaction scores) and we consistently score higher than anyone else. Does this mean that we are better than everyone else? Course not, it means that we deal with patients on a day to day basis and are the visible presence of the hospital for patients - we are the ones who get them the cups of tea or the blankets or the pain medicines. For interest, Dr. Shipman was loved by his patients and many did not believe that such a nice man could do what he was accused of despite evidence to the contrary that he was, possibly, the biggest mass murderer in this country.
Out of curiosity I looked up a random department from my hospital, only 3 doctors are listed; 1 moved on a year ago, 1 only works one session a week and the other is a staff grade. That is it, no consultants, no middle grades, no juniors. So who are they going to rate?
I believe that in America they have introduced a system where the hospital payments are linked to receiving good patient satisfaction scores. So what is your priority? Good care or popular care? Sometimes they can be synonymous but only sometimes and very rarely in Emergency Medicine where you have long waiting times.
Sometimes consultations between doctors and patients/relatives do not go smoothly, sometimes it's the doctors fault, sometimes it's the patients/relatives fault and sometimes communications just fail. Doctors have recognised this and a greater amount of time is being spent in medical schools on communication using video technology so perhaps in future consultations can go smoothly and popularity contests will not be required.
Nurses have always known the value of popularity contests (otherwise known as patient satisfaction scores) and we consistently score higher than anyone else. Does this mean that we are better than everyone else? Course not, it means that we deal with patients on a day to day basis and are the visible presence of the hospital for patients - we are the ones who get them the cups of tea or the blankets or the pain medicines. For interest, Dr. Shipman was loved by his patients and many did not believe that such a nice man could do what he was accused of despite evidence to the contrary that he was, possibly, the biggest mass murderer in this country.
Out of curiosity I looked up a random department from my hospital, only 3 doctors are listed; 1 moved on a year ago, 1 only works one session a week and the other is a staff grade. That is it, no consultants, no middle grades, no juniors. So who are they going to rate?
I believe that in America they have introduced a system where the hospital payments are linked to receiving good patient satisfaction scores. So what is your priority? Good care or popular care? Sometimes they can be synonymous but only sometimes and very rarely in Emergency Medicine where you have long waiting times.
Sometimes consultations between doctors and patients/relatives do not go smoothly, sometimes it's the doctors fault, sometimes it's the patients/relatives fault and sometimes communications just fail. Doctors have recognised this and a greater amount of time is being spent in medical schools on communication using video technology so perhaps in future consultations can go smoothly and popularity contests will not be required.
Wednesday, 9 July 2008
Summertime
Summertime, and the living is........... painful!
It has started, we are seeing kids coming in with nasty fractures to wrists, elbows and even clavicles. Has there been a mass outbreak of child abuse? Well yes, in a way. Their parents have bought them trampolines for the garden.
Trampolines are great fun, bouncing away, getting rid of all that energy, playing with pals and annoying the neighbours. What more could a red blooded child want? Well, a bit of supervision would be nice.
Trampolines are great, trampolines are fun, trampolines are good exercise, trampolines are DANGEROUS!
If you give your kids a trampoline, supervise them, one child at a time on the thing, use the safety nets, they are higher than they look.
I have seen more injuries where the patient had a good chance of losing their limb from trampoline accidents than from motorbike accidents.
It has started, we are seeing kids coming in with nasty fractures to wrists, elbows and even clavicles. Has there been a mass outbreak of child abuse? Well yes, in a way. Their parents have bought them trampolines for the garden.
Trampolines are great fun, bouncing away, getting rid of all that energy, playing with pals and annoying the neighbours. What more could a red blooded child want? Well, a bit of supervision would be nice.
Trampolines are great, trampolines are fun, trampolines are good exercise, trampolines are DANGEROUS!
If you give your kids a trampoline, supervise them, one child at a time on the thing, use the safety nets, they are higher than they look.
I have seen more injuries where the patient had a good chance of losing their limb from trampoline accidents than from motorbike accidents.
Wednesday, 2 July 2008
Fathers Day (The Answers)
I was going back over some of the things I have written and I realised I have forgotten to tell you what I got from my kids.
I received a book I wanted, a new rugby shirt and a model boat tool from one and a model 18th Century boat to build from the other - they know I love 18th Century sailing ships and they are expensive to buy. Wife gave me a (expensive) DVD collection that I wanted for my birthday. All in all, very nice of them and I will make sure that they are remembered in my will
I received a book I wanted, a new rugby shirt and a model boat tool from one and a model 18th Century boat to build from the other - they know I love 18th Century sailing ships and they are expensive to buy. Wife gave me a (expensive) DVD collection that I wanted for my birthday. All in all, very nice of them and I will make sure that they are remembered in my will
Pudding
A story over at Space to Rant reminded me of something that happened a few years ago. I was working a nightshift on an observation ward, just me and an HCA with about 4 male patients and 8 female ones in an old fashioned Nightingale ward, but we knew we would get more patients in later. One gentleman of the street was admitted, known alcoholic and lived in the local down and out centre when he remembered to go there. It was near Christmas and he had been admitted as he was drunk and had fallen and hit his head (PAFO - pished and fell over) no great worry and he only needed observed overnight. However he had Christmas puddings in his bag, I don't know if they were stolen or a present or if he was in a Christmassy mood but each one weighed about a pound, and I had placed them in the ward kitchen to keep them safe (there was no way any of us were going to eat his stuff so it WAS safe). After a couple of hours sleep he woke up and demanded his Christmas puddings, I explained it was very late, that he would get them back in the morning, that he should get his head down and go back to sleep. I even told him that he was barred from eating in the ward outwith mealtimes. No effect, he demanded his puddings and was actually singing "I want my puddings, give me my puddings I'm hungry give me my puddings" He was annoying the other patients as well as me so I made the decision to give him his puddings for a bit of piece and quiet. I did NOT say the words "I hope they choke you" as I gave him the pudding (honest), but perhaps it crossed my mind. So I had quiet for a few minutes as he ate his pudding, suddenly I realised that perhaps that was not snoring but a choking sound coming from his bed. I rushed over to find his mouth full of pudding and he was choking on the rest - the stupid bug**r had pushed the whole pudding in in one go. I scooped out what I could and performed the Heimlich maneuver a whole gob came out and he started breathing again, I called for medical help and he was fine in a very short time after we made sure that he had not aspirated a pudding into his lungs. He still had the cheek to demand his other pudding after everything had settled down.
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