Friday, 17 December 2010

A Battle too Great.

It's nearly half past two on Friday.

My GP is off today and his colleague refuses to do any of my scripts til Monday. Thinks I'm just a junkie. Hasn't read my discharge papers or my imminent surgical admission notes.

I rang the ward.

Nurse told me none of the Gastro doctors knew me, they'd all changed rota and it "wasn't their job to tell GPs what to prescribe."

Unless someone sees sense in the next 3 hours, I'll spend the weekend writhing in pain, delirious and crying.

They're just cruel, cruel bastards that's what they are. I knew this would happen and it is. What is the point of me fighting all of this.

You never, never win.

Update :

An hour later, I spoke to my specialist nurse who had to call the surgery. She spoke to a locum and explained that I would be having major bowel surgery on Wednesday (all in the discharge letter) and this regime had all been agreed with my gastro team and my GP (all in the discharge letter). She confirmed the doses and frequencies (all in the discharge letter.) My mother-in-law is at the surgery now, so fingers crossed all will be well.

I knew when they discharged me that this would happen at some point. It always does. It's humiliating, upsetting and frightening. I have a solution to STOP it happening - yet another post for my "White Paper".


  1. That is shocking but it doesn't surprise me. Some time ago my chest went into spasm, it extremelly painful (it does this sometimes). My wife phoned the surgery and it was a duty doctor. he asked if i'd taken anything for the pain. I told him that i'd had dihydrocodeine. He then said he thought I must be addicted to this and it wasn't really for him to sort out. The next day I told my own GP. She said he's have seen my postcode. The village I lived then is one of Fife most deprived areas, probably the most and has a high level of drug abuse. The doctor would have seen that and just assumed I was another junkie looking for painkillers.

    I really hope you get the painkillers you need Sue, you shouldn't have to suffer like this.

  2. I'm in the same position trying to get a prescription for my daughter... but then she isn't facing surgery on Wednesday.

    Do you think anyone gets their illness/pain addressed without having to always 'fight'?

    I just don't understand why... all they have to do is write/authorise the prescription on behalf of another doctor/consultant. Are they all so terrified that they will be found to have wrongly prescribed ... and if so why aren't they equally terrified of having ignored a patient's needs/pain?

  3. Hope you get the pain killers OK. It is madness that this keeps happening.
    many years ago , in 1982 as it happejs my father in law came out of hospital where they had not been giving him his heart tablets for his angina which he routinely had.
    He died. It was the day before his 64th birthday, hence the Beatle's somg always reminds me of him. Ii have always wondered whether his death was a direct result of the problems about drugs and communication between hospitals and GPs.

    Following childbirth the GP did not give me the additional iron tablets the hospital recommended, I was passing out with anaemia. It was several days before the GP realised hey had not read the letter and the doctor raced round with an apology.

    Fingers crossed now for your op Sue.

    Why can't they just talk to each other, or am I just stupid.

  4. Good post Sue, you have my sympathies....

    Big = Innefficient.

    Tories might even say

    Guarenteed income/market share = takes the customer for granted....

    Is the NHS inefficient>?
    Does the NHS take us for granted?

    are the Tories like Michael Howard correct?

  5. Just a general comment
    Controlled drugs are a nightmare for doctors and nurses alike. As a nurse you are accountable for every ml or tablet and woe betide you if they don't add up. All CD cupboards are monitored by pharmacy on a weekly basis and any discrepancies result in IR1s being fired off. As a doctor, if you write out too many prescriptions you may also expect a visit from the pharmacy police. Having worked in ED I treated a fair number of patients who were drug seekers and no, they did not all look like vagrants...most looked respectable enough and the most common "fake" was abdominal you can see where this is going....we had a "turkey" file with info on drug seekers, many of whom would be known to several hospitals within a 100 or so mile radius. Now I'm not for one minute suggesting that you are not in pain, just pointing out that when you have seen hundreds of people who are faking it, you tend to be a bit more cynical....nothing is more of a kick in the teeth than to see the writhing body given pethidine or ketamine get off the gurney and do a runner.

  6. I feel for you Sue. My mother has a lot of problems that cause her to end up in the local ED screaming for pain killers. Every hospital within a 100 mile radius has her labelled as a drug seeker.

    But the fact is, that we are overwhelmed with drug seekers and getting a hold of CD's is a nightmare as well as dispensing them. When I worked overseas I once went home accidently with the CD cupboard keys in my pocket.

    The police were at my house before I was. It wasn't until I saw the police cars outside of my house that I realised that the CD keys were still in my pocket.

    The ward Nurse was correct when she said that there is no way that the gastro team there would prescribe anything for an outpatient that they did not know personally. That is a good way to get fired and lose your license to practice. They would have gone apeshit on her for even asking.

    Our hospital pharmacy occasionally opens on a weekend for two hours and will refuse to fill scripts for CDs at that time. They say "it should have been ordered during the week". They won't let us ever have extra just in case we get an admission when they are closed.

    Big help that is when you had an admission first thing on a saturday morning that is prescribed zomorph and there is none on the ward.

    I hate the whole system. And I hate pharmacy with a passion that burns like a thousand suns.

  7. Sue,

    I am alerting you to an article on Health Matters in Left Foot Forward... Take a wee look

  8. Dino Nurse and nurse Anne

    That is really helpful to know ... How would you organise a better system?

    It does seem as if the priorities are skewed at the moment. IMO most people would feel that it was much more important to deal with the patient's pain, even if that resulted in some 'gurney-runners'.

  9. Nurse Ann - I don't think you understood my post. I wasn't asking an in-patient doctor to prescribe anything for me as an out-patient! That's would be ridiculous.
    I was sent home with an assurance that if there were any problems at all, I should ring the gastro-team which is what I tried to do.
    My gastro team had spoken extensively with my GP to arrange my three weeks at home, everything was detailed on my discharge letter - the on call doctor should have had no reason to refuse my treatment. That he DID refuse meant that the Addenbrookes team needed to fill him in on my situation as I wait for major bowel surgery.
    That was exactly the arrangement we'd agreed before I left hospital.

  10. First of all I would have 24 hour pharmacies in all NHS hospitals..........

    To be honest I am surprised that they made that arrangement considering how often these teams change doctors. It is like musical doctors. And no one keeps that Nurses updated or aware of which doctor is covering for which team. The list we have is 6 weeks out of date. Ward clerk is no help. Switchboard cannot be bothered to know. Consultants secretaries just snap your head off when you ring them to find out which doctor is covering for that consultant's ward work.

    The other day I went to ring Dr. Simon from the respiratory team about a patient known very well known to the resp team. Simon is now with cardiology and the resp doctor I got never heard of the patient. Patient needed her TTO's rewritten and the current resp doc wouldn't do it because "she didn't know the patient". So she gave me the bleep of another doc to call. He said he was no longer with respiratory. He gave me yet another bleep to call and that doctor had a fit because he was covering aau and couldn't possibly come to the ward and write tto's. So he gave me yet another bleep. It was the bleep number of the new resp doctor who sent me on the wild goose chase in the first place. She said she couldn't do it and gave me the bleep number of yet another doctor. It was the aau doctor. I told her I already knew that he would not do it.

    I then tried Simon who was now up to his eyeballs in cardiology. He apologised and said that I really needed to get one of the resp team doctors.

    By the time I found a doctor to do it pharmacy was closed. Discharge delayed another day. I neglected my other patients for an hour or so to ring trying to get a doctor to sort these TTO's and all I got was a bollocking from the patient and her husband because discharged got delayed.

    For anyone who wants to know what nurses do all day......we are at war with the system.

  11. God Ann, that is all so very, very familiar.
    As far as I can see, that's all nurses ever get to do. All day, every day, wading through treacle, trying to do everything but rarely able to achieve their goals.
    I remember being on a ward with a cancer patient once. She was trialling a new combination approach to cancer : chemo tablets, thalidomide, and something else I've forgotten now (may have been an anti-biotic?). Neither the chemo tablets nor the thalidamide were commonly available, and one of the tablets had to be taken in the presence of two specialist oncology nurses.
    My friend entered a nightmare cycle of never, ever managing to get the right drugs at the right time all at once. The thalidamide would come, but the chemo wouldn't or vice versa. Sometimes none came at all or there were further problems at the supply end. I literally couldn't list here all the ways things went wrong, and one particular nurse spent hours on end, day after day after day trying to sort the cock-ups when they happened, chasing oncology, chasing supply, chasing pharmacy etc etc.
    She was a really sweet nurse, and very good at her job, but one day she just flipped at my friend. It wasn't the patient's fault, but the nurse had just heard "what are you going to do??" one time too many.
    We were gutted for a while, til we realised something had to give, somewhere - the nurse just happened to be standing in front of my friend at the time.
    We have to change this Ann

  12. "I hate the whole system. And I hate pharmacy with a passion that burns like a thousand suns."

    Lol, me too.

  13. Reading through all these comments there is something familiar in just about all of them. Locum doctors not having received full information about ongoing situations. Doctors not talking to the nursing staff. Nursing staff unable to do what they absololutely know needs to be done because of fear of disciplinary action... it goes on and on and for me, the real tragedy is that absolutely nothing seems to have changed in decades!

    Forty years ago my (then) baby son was desperately ill and it transpires in need of urgent surgery. He finally got it after my father (one of your hated pharmacists!) finally lost his rag and drove us to the hospital. As it happens he was mistaken at A&E for an eminent consultant of the same name - so we got first-class priority treatment and never even hinted that we had been mis-recognised. In 2006 I contracted Legionnaire's Disease and went to a London A&E Department. Initially diagnosed with a broken rib (!) and only eight hours later did a doctor examine an X-ray and realise I had pneumonia. Another couple of days on inappropriate antibiotics which caused liver failure and then when my wife (not medically qualified in any field) queried the colour of my urine and politely asked had it been tested... a diagnosis of Legionnaire's Disease. Thank goodness I am still alive to tell the tale!

  14. Problem with pharmacy is the lack of qualified pharmacists. Vast majority of staff are technicians (much like behind the counter at Boots) and have to be checked for nearly everything. I have a pharmacist friend that used to work for the NHS and it drove her mad. We use a drug called APC in severly septic patients..its dead expensive and a nightmare to make up, according to pharmacy. Means that you get one syringe at a time....only an RN can collect it (and CDs) so if we are shortstaffed...idea is that its supposed to be a continuous
    The problem of drug seekers and CDs is not going to go away. ICU is often full of patients who are IVDUs, so not only is it next to impossible to control their pain/ventilator compliance with opiods as their receptors are shot, they are also on megadoses of methadone...many days you feel like a dealer, to be honest. Methadone programmes have been an unadulterated failure and yet we continue to waste money in this way. Its not that we don't believe that you are in pain, we just have too many other things on our backs at the same time ....straw and camel anyone?

  15. Hmmmm. It's quite an eye opener to read all these medical staff telling stories of hoards of drug seekers.
    I suppose it explains a lot.
    How does is explain the treatment of someone with a 27 year history including 7 lots of major surgery for obstruction though? how on earth can you confuse the two?

  16. I don't hate pharmacists. I hate pharmacy. Big difference.

    Glad to know that when they think you are a consultant that you get special treatment. My 8 year old has permanent hearing loss and associated articulation problems thanks to my own hospital (where I work as a staff nurse) not listening to me. For 7 years. They poo pooed me for 7 years. It took me that long to get her referred to a hospital 3 hours a way to get her surgery that she needed.

    The doctor at the second hospital told me straight out that if they would have sorted her out when I first took her to ENT she would be fine.

    But no. It took 7 years. And now her ears are fucked.

    Her school refused to do speech therapy until ENT sorted out her hearing and ENT refused to sort out her hearing and claimed that her speech problems were a "separate issue". Dickheads.

    Anyway she is a bright girl and a superb reader and writer. She refuses to speak because she is so conscious of her pronounciation problems and I think that is what has spurned on her ability to write.

    Maybe she will be a blogger some day!

    Sue, my A&E friends both in the US and the UK tell me that they are overwhelmed with people making stuff up to get a hold of narcs. They could tell some stories.

  17. IVDU= intravenous drug user. We love our' Drug seeking in the ED is a very real problem.
    You would not believe the lengths that people will go to to get drugs. Nothing matters apart from where your next fix is coming from. I've had patients who drank ipecac to induce vomiting, injected insulin to make themselves pale and sweaty, broke small bones or stabbed themselves in non lethal places. Vast majority will fake abdominal pain and are very good at it. They know signs and symptoms and can reel off a very convincing past medical history. Many will have scars from when they ended up with surgery when they realised that a warm bed for the night and morphine on tap via a PCA would actually be rather pleasant. They are very manipulative and know just what to say and also who to target. I apologise if this sounds a bit harsh but its a snapshot of life in the ED. When in the US, I had my ribs broken by an addict who was broght in by his junkie mates having stopped breathing (too much heroin- so he had OD-ed) we gave him narcan, saved his life and got beaten up for our trouble. I get smashed against the gurney and the attending got beaten to a pulp. Last time I allowed myself to get stuck between the gurney and the wall.
    Sorry to here about your daughter Anne. Its a big problem when you get labelled with a specific problem to then get anyone to think outside the box. Thats the problem with a target driven culture. Years ago if you were seen by doc X who then thought you actually needed to be seen by doc Y he could simply refer you, consultant to consultant. Nowadays he has to discharge you back to your GP who then has to have another go at diagnosing you.

  18. This really is fascinating. I'm so glad you two nurses are commenting like this on my blog. It puts a whole different side to what I'm trying to get across.
    I always knew that it wasn't until nurses, doctors AND patients came together with the same story that anything could change.
    Please keep this incredible source of info coming - I'm learning so much about WHY things happen as they do.

  19. Oh and I meant to ask, do you think that some kind of "certificate" from a consultant or pain specialist, updated regularly might help to differentiate the addicts from the genuinely ill?
    Obviously I realise it too would be open to abuse, but is it possible do you think?

  20. How not to look like a drug seeker:

    Drug seeker stories from American emergency department Nurses:

    I think they would just learn to fake certificates.

  21. The list is
    I had thought that having some sort of electronic register might work-would have to be consultant access only to add someone to it but open access for viewing. Then I thought, how easy would it be to hack?
    Seems there is no real solution....