We have new doctors at work, it being that time of the year. Most of ours, thankfully, so far have not been as soft and gentle as those that I’ve encountered before. And so far whilst they’ve not had the generosity of spirit drilled out of them as slowly becomes the norm for people in the ED, they’ve all seemed to be remarkably pragmatic.
The number of times, over the years, I’ve had to deal with the “oh, we’ll just put them on the observation ward this once” suggestion, which is fine, except it never is that once. It’s that once, then a few days later, then every day, then you’re struggling to change a routine from someone who can cry ‘But you did it before’.
Or my favourite of all – the “I can’t get home” problem. Ambulances bring people to hospital that are sick, and whilst I would love to be able to pop every one of the nearly 60k people who come through our doors into a taxi to run them back home; whilst it would make me feel warm and fuzzy inside to provide some sort of resettlement service for everyone, because frankly, being suddenly ill or injured sucks, we can’t.
Our taxis may be provided via a deal with a taxi company, but they still cost us almost as much as they cost you when you hail them on the street. That £20 journey across town to get home? That’s going to cost us nearly that.
And that would be £1,200,000. Which as you can see is quite a lot of zeros. Even if each taxi only cost us £1, £60,000 is quite a lot of drugs, several replacements for our aging fleet of trolleys, new mattresses, or drugs. So we can’t do that.
Mostly transport home is reserved for those in medical need. Need oxygen? Have to travel by stretcher? Need resettling at home? We’ve got a plan for that.
Beyond that, every department I’ve been in has had a deal with taxi firms for those in extremis. A woman who’d had to drive over a hundred miles to our hospital (where I once worked) to reach her relative only to need to then travel on another 40 or so miles to the specialist hospital where her relative was being transferred? I wasn’t having her drive that. She was in no fit state.
We’ll also look after those who are vulnerable…the 85 year old who wants to go home at 2 in the morning because they don’t want to stay in hospital? Yes, we will sort that. There are lots of reasons, and catch me at the right moment, and I’ll fix most things in your world, so long as you’re not deeply rude to me. Even if you’re rude to me I’ll probably still try and fix things, so long as I can suss what needs fixing. Working in the ED you get used to fixing other people’s problems. It’s good for the soul, and frankly it’s often the last port of call for desperate people. A common refrain is that we fix everyone else’s problems. Don’t know what to do with your patient, just tell them to come to the ED… they’ll sort it ;-/
But as with most things in life, there are limits. And there are very distinct limits to extracurricular things like transport home. And acting like it’s your right is a very quick way to find that we won’t organise it. Demanding transport home because you ‘had it before so I know you can do it’ without trying to sort it yourself is not going to fly. Refusing to ring your friends and relatives because they might be busy? No.
Uh uh.
The number of times I’ve seen this end with a nice doctor or new nurse saying “oh, well, we’ll sort it” is quite high. And it makes the saying ‘no’ bit much harder. But perhaps it’s working in a city ED where people aren’t so cuddly. The repeated explanation ‘we do not routinely provide transport home’ accompanied by the helpful ‘but I can ring anyone you like or provide a phone, and we can look up numbers for you’ and the repeated gentle suggestions of taxi (stopping at bank/cashpoint/etc), bus, or even shanks’ pony whilst maintaining a firm ‘yes, we may have done it in the past but it is for exceptional reasons, not for every trip you make to the department’ almost invariably results in someone suddenly being available to collect the person. In fact, I can only think of a few occasions where it hasn’t, and then suddenly they’ve found enough change to get the bus.
What disappoints me most about it is the selfishness, that you would deny someone else healthcare so you can save a few quid getting home. And I understand that at this point many people are right at the limit of their finances, and I certainly have been more generous with taxis over the past year than I used to be. But sometimes you have just got to say no.
