Wednesday, 3 October 2007

Dangerous Incompetence

When I first started working I asked the nurses for advice about a lot of things and trusted their judgement about whether a patient was sick and needed to be seen etc. I figured they had been doing the job for years and had seen lots of junior doctors come and go and probably were pretty clued up about most of the day to day patient care. A few things have happened recently that have made me seriously question that assumption.

Yesterday was a good example of this. A patient had come back from ITU on IV amiodarone which had been started to treat a (life-threatening) cardiac arrhythmia. The nurses left a note on the drug chart asking us to change the amiodarone to oral because they couldn't give it IV. I was a bit concerned about this so phoned the ITU doctors to ask their advice. They told me in no uncertain terms that the amiodarone must be continued IV (the patient had just had bowel surgery and was unlikely to be absorbing oral medication) and informed me that the nurses always claimed they weren't allowed to give it but in fact they were. Giving it IV means they have to do frequent obs on the patient and creates more work so they say they are not allowed to give it on the ward. The ITU doctors suggested I speak to the nurse in charge and explain that it had to be given.

I found the nurse in charge and explained the reasons that the medication had to be given IV very clearly. She conceded that it could be given but told me that she would have to ask the other nurses "really nicely" to get them to give it. I thought that had sorted the situation out but two days later on the ward round we looked at the drug chart and noticed that the medication hadn't been given at all since the patient had come back from ITU. The nurses had taken it upon themselves to stop giving it without telling anyone.

Luckily no harm came to the patient. We did an ECG and thankfully he was in sinus rhythm. It could easily have turned out differently though. I was really scared by the fact that nurses can go ahead and make stupid decisions like that and nobody really knows about it. Unless something goes wrong of course. They didn't go to medical school. They really don't understand what arrhythmias are or what amiodarone does, yet they are in a position where they can decide whether the patient is treated or not.

I wonder what would have happened if the patient had suffered another arrhythmia and died. Would anyone have admitted that the nurses were at fault or is everything the responsibility of the doctor? Do I really have to go around and look at the drug charts of every patient on the ward to make sure the nurses are actually giving the medication I have prescribed?


Monday, 1 October 2007

Private Patients

I don't understand what the deal is with private patients in NHS hospitals.

I always thought that if you paid for private healthcare you'd be put in a nicer hospital with more staff etc but this doesn't seem to be the case. In the hospital where I work the private patients are all go to a ward which is half private patients and half gynae patients. This ward is well known among doctors as the home of the stupidest, laziest and most irritating nurses in the whole hospital. I have to say that the majority of them are foreign and only seem to have a limited grasp of the English language but this isn't the main problem (of course there are plenty of good foreign nurses on other wards). They call you about the most stupid things and don't seem to be able to cope at all without constant input from the doctors.

During the ward round in the morning I am almost guaranteed to recieve at least one bleep from the ward asking if we will be coming to see the patients (ummm... yes... we see them every morning, it's called a ward round. We've seen them every other day so why would today be different?) They don't seem to have caught on to the fact that the more times they bleep me the longer it'll take us to get there! They are pretty incompetent at basic practical tasks compared to the nurses on other wards and will call us to do NG tubes, catheters etc if they have any suspician that they might be slightly difficult. They are supposed to be able to cannulate people and take blood but over the weekend I was called constantly to put cannulas in patients who had 'no veins' only to find I could practically have done the cannula with my eyes closed.

Having private patients in NHS hospitals seems a bit morally dodgy. I'm still not quite sure whether we're supposed to look after them or not but if we don't do the stuff like bloods and writing up fluids then who will? I suppose they've paid their taxes too so are just as entitled to care but instead of actually paying for separate private care it's like they've just slipped the consultant a few grand and been bumped up the list they would have been on anyway if they had been an NHS patient. It's all very confusing and different people keep telling me different things about whether or not we are supposed to be looking after them.

Surely there should be a completely separate hospital for private patients with a separate team of doctors to look after them. I barely have enough time to look after the NHS patients properly so I feel really annoyed when I'm constantly being called to do things for the private ones. You can't really refuse to look after them if your consultant tells you too (I'm pretty sure that would be career suicide) but it doen't seem fair. The most annoying thing is that the stupid nurses seem to be under the impression that their patients should take priority over the NHS ones and get very arsey if you take more than an hour to come up after they've bleeped you to write up fluids or something.

I don't think I would like to go privately if I ever got ill after seeing the reality of private healthcare - crap nurses and intermittant care from doctors who are not sure if they are supposed to be looking after you or not. The only other difference I can see between the private ward and the normal wards is that you are guaranteed a side room on the private ward and the little cupboard things by the beds are fake-wood coloured instead of white. I think I'll take my chances with the NHS thanks.