Wednesday, 4 June 2008

Dodgy Locums

I'm rather disillusioned with locums at the moment. I'm sure there are some good ones but I've failed to come across any so far.

We have two locums in A&E at the moment who have done nothing to change my opinion and I am actually quite scared for the patients they see. They're both probably in their 40s and Asian and one of the first problems I came across what the fact that I couldn't understand very much of what they were saying. I've had to ask them to review my patients a couple of times and the patients clearly had no idea what they were asking them and I had to translate what I guessed the question was (which I found very embarrassing). One of them kept demanding "any tender here?" while prodding a 3 year old's ankle which created a lot of confusion until I asked her "does it hurt?". I didn't witness the consultations with the patients they saw on their own but I hate to think what happened.

The main problem however is just their lack of clinical judgement. Today was an extreme example when the overnight locum handed over a patient he'd seen about two hours ago who had come in with chest pain. He gave a mostly unintelligable and vague account of the history and when asked what the plan was he said he had referred the patient for admission under the medics but wasn't sure whether he really needed to come in. The day registrar asked what the ECG showed and he muttered something about not having seen it because he was busy with another patient!! Luckily there were no thrombolysable changes but there was some lateral ischaemia which he'd failed to even look at. At that point we gave up trying to get anything useful out of him and the registrar asked me to re-clerk the patient. I found out that he had a very extensive cardiac history including a quadruple bypass and several stents and his angina had been getting progressively worse to the point that he was using GTN more than 10 times every day. I found that the locum hadn't even given the man an aspirin and had basically clerked him (badly) then done nothing whatsoever. His bloods were actually back at this point and he had a raised troponin (only 6 hours after his pain). I called the medical SHO just to let him know the patient would need to go to CCU only to find out the locum had never even referred the patient! AAAGH!

I have heard horror stories of locums in other specialties too including a locum gastroenterology registrar who apparently tried to connect a chest drain to the oxygen on the wall.

I find it really really worrying that the NHS is employing people like this and sometimes wonder whether they actually have a medical qualification at all. The thing that really makes my blood boil is that the reason they even need so many locums is because they didn't create enough training posts and now find they are short staffed (gosh, whoever would have predicted that??).