Doing the impossible with the insufficient

Comments Off on Doing the impossible with the insufficient

One of the things that comes up, particularly after a few days of triage is that England, or at least the bits of it I’ve encountered, appear to have a problem with entitlement.

Now I was unfortunate, due to the skill mix being a bit less than it could be, and us being extraordinarily* busy I ended up triaging a lot. Really, a lot. To the point where what is termed an ‘inappropriate attendance’** really really tested my abilites with professionalism***. Anyhow. This front-loading of the system meant that those poor souls who should have been there (not that many) and who actually needed treatment (even fewer) were sometimes left waiting quite a while.

The government in the UK stipulates that we must, in the emergency department, see, diagnose, and admit or treat/discharge within four hours of their booking in time. No matter if you’ve stubbed your toe and got a bit of an owie or suffered multiple trauma, 4 hours is all you’ve got****. This, when it takes up to 2 hours for blood results to return is not actually that long. Before this standard was applied, people stayed in the ED overnight, and I’m told by colleagues in other countries that 4 hours is actually really very quick in emergency department standards.

Which is why when people sit around for 2 hours and start to get stroppy I want to tell them a few things. I don’t, because I’m – at the end of the day – fond of my job, and my job is to behave in a professional manner.

But really. 2 hours? I can waste more time than that reading a paper.

People also seem to suffer under the delusion that their problem is more important than everyone elses, and that they should be seen before everyone else, and that 4 hours is just too damn long to wait. I understand that it’s not very interesting being in the ED. Well, frankly it can be quite entertaining, I suspect, as a spectator sport watching the many, many drunk people rocking up on nights.

But shouting at/cursing us and telling us that you pay your taxes does not serve to impress me. Especially when the UK ranks 18th in the world for it’s spending per-capita on healthcare. It’s cheap. It’s really *really* cheap. It’s incredible value for money.

And frankly, it needs more. Lots more.

Less managers.
More money.
More wards.
More beds.
More on the shop-floor staff.

We won’t get that though, because the greater population of the UK are sold lies about the NHS by the tabloid press, and largely, the population seems confused as to how much tax we pay. It turns out we’re not nearly as heavily taxed as even I thought. And I never thought we were *that* heavily taxed…



Yes, Shut your yappin’ is basically the point. That and take some frickin’ responsibility for your own healthcare. Jeeze. Learn something about that body you inhabit and try, at least try and look after it a very little bit.

Anyhow, sorry if that’s a bit incoherant, but I have been up 24 hours.

* a situation which is becoming depressingly ordinary
** true examples: ‘I’ve had this pain, here, for a few months… and it’s been bothering me… so I thought I should get it checked’ (at 4:30 in the *morning* at an *emergency department*?!). “I’ve had this pain in the side of my nose since this morning. Well, it’s more an ache. Or an itch. It’s been bothering me…” and “I’ve had a cold since yesterday, and I’ve taken this [waves X brand cold/flu medication] and I’m not better yet, so I thought I should come in”.
*** And of course, handily there’s always the young-person-with-rare-condition who you read the booking in complaint for, *sigh*, call in and then go ‘Oooh, you really are quite sick I best do something rather rapidly’ which reminds you of *why* you remain professional and do your job properly and don’t just say “Get thee hence! Begone foul abuser of our fine services!” when people appear to be inappropriately attending.
**** There is a clinical exception which I’ve seen applied all of once or twice – when it is actually unsafe to move the patient because the ED is the best place, clinically, for them to be.


Kate's allegedly a human (although increasingly right-wing bigots would say otherwise). She's definitely not a vampire, despite what some other people claim. She's also mostly built out of spite and overcoming oppositional-sexism, racism, and other random bullshit. So she's either a human or a lizard in disguise sent to destroy all of humanity. Either way, she's here to reassure that it's all fine.