Tuesday, 6 May 2008

I don't know if I can do this anymore

This DNUK extract is well worth a read, the doctor who wrote the original piece has kindly given me permission to reproduce his words here. It sums up the way in which the front line doctors of the NHS are frustrated beyond belief at a system that continually obstructs the thing that they want to do to the best of their ability, namely care for their patients:

"I love medicine. I think I wanted to be a doctor from about the age of eight. Although I'm sure this sounds like a cliche, it's true; I wanted to be a doctor since I was a kid.

A hospital chaplain once said to me that one person only has so much patience, compassion and energy. I think he is right.

I have just finished a long set of nights in a moderately busy emergency department. It is a relatively good department, in a relatively good hospital.

A lovely gentleman presented with very severe chest pain and back pain. His family were even more lovely. I did a heart scan that showed his aorta, the largest blood vessel in the body was tearing. This is called aortic dissection and is to understate things, a surgical emergency.A CT scan of his chest and abdomen showed that the dissection extended from his heart all the way into his abdomen.

I contacted the local cardiothoracic surgical centre and spoke to the surgeon who would be able to fix this probably fatal condition. In a rather embarrassed tone he told me that there were no available beds on his unit.

Meanwhile the patient sits opposite me. I advised his wife that they should try to get all his available relatives to see him, as he might die suddenly. Each one arrives, and comes to thank me for "all that I am doing".

After two hours I had spoken to four other surgical units. None of them had any beds.

Another family member arrives, walks over to his relatives. They point at me, the relative walks over touches my arm and smiling thanks me for all I am doing.

What am I doing? Am I colluding with a system that is letting this man and so many others like him down. I am trying to tread water in a what sometimes seems a third world system. A system crippled by short sighted targets and budgets. A system where a waiting list is more important than an intensive care bed. A system where the four hour target means that patients are rushed through the hospital, not getting the correct diagnosis, waiting in corridors, in pain and critically ill.

I don't know if I can do this for another 20 years."

I think the nation's professionals all feel this incredible frustration, and the blame lies firmly at the door of an increasingly centralised and controlling state. The state has steadily made it harder for all professionals to do the jobs that they love to the best of their ability, professionals work better when they are treated with respect and trusted to do their jobs by their employers. The current top down micro managed state of affairs is not helping anyone, and certainly not our patients.


the a&e charge nurse said...

Ferret - the UK population has grown by 17% since 1951 while the number of NHS beds has fallen by 40% since 1959 - we have one of the lowest bed per 1000 patients in Western Europe: 3.3 compared to 6 beds in Germany, to cite just one example.

Your item immediately put me in mind of a young man stabbed in the chest after a dispute over drugs (according to the police) - the incident occured late in the evening.

A C/T proved that his aorta had been knicked, but appeared to have tamponaded (at least temporarily)

We do not have cardiothoracics on site so the duty surgeon made nervous phone calls to hospitals that do.

Perhaps, fluids were given too liberally, but at any rate he started to bleed again, in fact he began to rapidly exsanguinate.

A messy resus room thoracotomy ensued after he developed PEA.
One or two of the team actually had their hands inside his chest when the consultant surgeon finally raced into A&E - sadly, it was too little to late.

I think about it like this - the NHS could provide an ideal service if life threatening events become its raison de etre, although we might have to accept that staff will often be idle, or beds will lie empty because in statistical terms this group constitute a minority of cases, and such cases usually require very specialised (and expensive) care.

Or, we can try and do as much as we can for everybody (with all the vageries this entails) because we have no system to ration every new drug, investigation or treatment that comes onto the market.

Yes, NuLab are absolutely dire, we all know this, and as we saw in the London mayoral election they are on their way out - but would the patient (highlighted in your main post) have had a better deal under Cameron & Co............I just don't think he would somehow.

You know, and I know that idealists are likely to crash and burn given all the shit we have to put up with to keep the NHS afloat most days ?

DundeeMedStudent said...

once I've finished my degree and foundation years I will be getting the first plane to anywhere. I'd actually like some proper training and to get on with my job without the micromanagement.