Archive for the ‘MediRants’ Category

Who Should Pay?

So the NHS is in crisis, A&E is fit to burst, there are no beds for those who need them. Plenty of opinion-givers have waded in on how to fix the problem, some qualified, some obviously not, and one of the solutions I keep seeing (from both sides) is, honestly quite disturbing.

Patients who turn up to A&E suffering injury or illness due to alcohol or drugs should pay for their treatment.

I know a few people who agree with this and genuinely believe it to be an acceptable way to deal with NHS overcrowding, and I’ve also seen comments to this effect beneath nearly every article about A&E online. I’ve even had people say to me “as someone who doesn’t drink, doesn’t it really piss you off having to deal with drunks at work?” which is something I find quite astonishing, because you wouldn’t say “as someone who doesn’t drive a car, doesn’t it really piss you off having to deal with injured car drivers?”.

Yes, it’s unpleasant being verbally and physically assaulted by intoxicated patients, but I’ve been punched and spat at by sober patients, and I’ve had drunk patients treat me with respect and decency whilst being incredibly apologetic for their state.

Plus “drunk patients” is an incredibly broad term, some recent examples that I can remember:
The woman who was beaten by her partner, who then spent the entire night drinking vodka to numb the pain as he wouldn’t let her leave the house until he had gone to work;
The hen party who’s taxi collided with a lorry, killing one of the occupants and seriously injuring the others;
The young child who had been bullied and beaten at school, so he snuck into his parent’s drinks cabinet and drank a bottle of liqueur, becoming violently ill;
The teenager who had been out celebrating his birthday and was assaulted by a group of men at the taxi rank putting him into a coma.

So which one would you send an invoice to? Fair enough we get plenty of people who get drunk, fall over and injure themselves as well, that’s pretty standard, but where do you draw the line? Some people say “if it’s self inflicted, they should pay” but again, what counts as self inflicted? The 70 year old lady who falls over her own slippers and breaks her hip- that’s entirely self inflicted, no one else could be blamed for that, but would you charge her for her treatment? How about mentally ill patients who attempt suicide because our woeful mental health services have failed them? Sports injuries- that 17 year old didn’t have to play rugby, he could have stayed indoors playing Xbox, but now he’s broken his leg, should he be paying? Motorbikes are dangerous, should all injured bikers receive a bill at the door?

Ultimately, no one wants to be injured, and it’s horrible when patients repeatedly apologise for taking up our time (that happens a lot on Christmas and New Year shifts), but the entire ethos of the NHS is to provide healthcare to the public, free of charge at the point of use. There is abuse of this system, yes, but it is minute in comparison to the amount of patients in genuine need of help. All this talk of putting patients off coming to A&E hurts even more when a patient (usually elderly, usually with a chronic injury or illness) tells me that they’ve been in pain for a while but “didn’t want to be a bother”.

The recent idea of sending an invoice showing “this is how much your treatment was worth” but without actually asking for payment would only put such patients off even more, and will undoubtably lead to the most vulnerable members of society dying long and unpleasant deaths so as “not to cause a fuss”.

I wonder whether the attitude towards users of the NHS has recently worsened due to the government’s swing towards privatisation; perhaps encouraging these opinions in the media and online will lead to more of an acceptance of the American way of “providing” healthcare, so that when it begins sneaking in subtley, people will welcome it, rather than abhor it.

“Well obviously I shouldn’t have to pay to have my appendix removed, but that alcoholic in bed 6 should be handed a bill on his way out.”

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Accident, Emergency, & Pandemonium

I’m sure you’ve all read the headlines, some of you may have seen the chaos for yourselves, either as a patient suffering from the chaos, or a staff member trying to work amongst it. A&E departments across the country are at breaking point. Or so the media would have you believe. In reality, the problem does not lie solely within A&E, and this is rarely the case when reports such as these hit the news.

Pretty much the only time an A&E department can solely be the point of failure is when a lot of people attend with acute injuries which do not require admission or long term treatment, such as sprains, cuts, etc. The problem that we are actually having is that the whole hospital is unable to cope, not just A&E.

In an ideal situation, where the NHS is properly funded, staffed, and resourced, here’s what would happen:

George has a stroke. His partner notices the signs immediately (due to the well advertised FAST public awareness campaign) and calls 999, and a well stocked ambulance with two paramedics (who have just enjoyed a 1 hour lunchbreak outside of their vehicle) arrives within 15 minutes and they quickly assess George and bring him to the nearest stroke unit. The thrombolysis team are waiting for him, he’s given a head CT scan on arrival, they see it’s ischaemic, and they decide to thrombolyse immediately having discussed the risks with George and his family. He’s moved out of resus and onto the stroke ward where the specialists can administer the clot-busting drugs and monitor him properly. Two days later he’s fully mobile and back to his old self, and goes home with his partner, and has regular visits from the community care team.

In the current situation where NHS funding is catastrophically low, George may have died at home, waiting for an ambulance. Or in resus, waiting for a CT scan, because one scanner was broken and the other one has a huge backlog. Or he may live, but the delay between the clot reaching his brain, and him being assessed by the stroke team is too long, and his condition worsens. There are no beds on the stroke ward so he stays in resus for 8 hours waiting to be moved. Eventually one of the stroke team calls in a favour from her friend on ITU who has just had a bed become free. She would prefer not to, as they’re not equipped for neuro patients, and the on-call reg will have to dash from one end of the hospital to the other to see George if his condition changes during the night, rather than being able to monitor him from the neuro unit. The next day a neuro bed has opened up, but three more stroke patients have arrived since George was admitted so there is some competition to get in. George’s partner has so many questions about his recovery, but there’s never a specialist available when she visits, so she has no idea how much longer he’ll be on ITU. A journalist submits an FOI to the trust about hospital admissions, and refers to George as a “bed blocker” in his front page article on how rubbish the hospital is.

“Bed blocker” is a ghastly term which seems to be adored by journalists. It makes you think of some useless lump of a person who refuses to leave the hospital and solely exists to inconvenience others. In reality that could be you, your mum, your dad, your gran… they’re human beings in need of care, but being inappropriately managed by the system. They’re rarely perfectly healthy people who enjoy being in hospital and don’t want to leave. Even in the case of people who are healthy enough to be discharged, it’s a lack of community care which is keeping them on the ward; ethically we can’t just send people out into the wilderness without follow-up care.

Another group which everyone seems to love blaming are so-called timewasters who come to A&E with the sniffles, or a minor rash. While this is a genuine issue which the NHS has to deal with, it’s not the cause of the current chaos. Minor ailments can be dealt with very easily, assuming that the healthcare staff aren’t completely overstretched dealing with not so minor complaints. A patient who comes in to A&E and then goes home rather than being admitted is really easy to see, assuming the resources are available. We investigate their illness/injury, treat it or provide advice, and then send them home, something which is (on paper) completely achievable within the 4 hour target. If they genuinely do not need medical intervention, or can be referred to their GP or a pharmacist, this can be dealt with by triage, and if the waiting room is heaving, they’re unlikely to want to wait hours and hours to get a paracetamol and a plaster.

So what’s causing the problem? Well, quite simplified, it’s an increase in acutely unwell patients and a decrease in facilities to treat them. The money isn’t there to provide the staff, and beds are being closed across the country. Due to fantastic medical and social advances, the population is getting older, and therefore becoming more vulnerable to illness, but unfortunately health and social care funding is barely meeting the rate of inflation.

The government are “dealing” with the situation by selling off any services that can generate profit, and chastising health workers for not being able to keep their heads above water.

We’re constantly getting patronising emails from the health secretary “reminding” us of the 4 hour target and all the other arbitrary benchmarks which do nothing but create further problems.

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Industrial Inaction

It’s been ages since I last blogged, and there’s a reason for that. In the past, something would come to mind while I was at work, and I’d jot down a few points or occasionally even a full post if there wasn’t much going on. However, the days of “not much going on” seem to have passed. Since the opening of the helipad, and the major trauma network policy being that all trauma patients come to us rather than to a DGH, the workload at the hospital has drastically increased.

Other than that, there have been a few other developments; 24 Hours in A&E have been and gone, the cameras have been taken down, the fixings painted over, and the program will be aired sometime before Christmas apparently. All very exciting. We don’t yet know which particular time periods have been covered on the program, but the final weekend of filming was incredibly dramatic so I’d be very surprised if at least some of it doesn’t make the cut.

We’ve also had a load of brand new Band 5 radiographers start in the department so that’s been interesting, it’s a busy London department, so plenty of people come and go, but it’s been a while since so many newbies showed up in one go. One thing that’s quite remarkable about this graduating year group (if our newbies are a representative sample) is how many of them went on elective placements abroad; Sweden, Argentina, Singapore… all over the place. It’s very encouraging to see, because (while I appreciate not everyone is able to) it gives them the opportunity to experience healthcare provision from a very different perspective. Some countries are very similar to the UK in the way they provide radiology services, others are completely different. Radiation protection is a subject which varies greatly, and as I saw in Nepal, in some places the concept does not exist, and from chatting to some of our new staff they also saw that elsewhere in the world. Also, while the UK tends to be very modern generally, because our healthcare is provided through taxation, funding is limited, so we don’t always have the more cutting edge equipment available to us. In countries like Singapore, you get to play with the really fun toys.

And on the subject of funding…

The current pressing matter is that of industrial action; several unions have balloted their members, including the Society of Radiographers, and a vote to strike has been made. It wasn’t an easy decision, withdrawing labour is usually a last resort, especially when it is going to have an effect on patients, but since the Tories have been in power, NHS staff have effectively endured continuous pay cuts, and it’s got to a point where something must be done. Personally, I feel hugely uncomfortable- I’ve attended many protests and handed out leaflets to the public, but I have never participated in strike action before, in fact until the two ballot papers arrived at my home last month, I’d never even seen such paperwork before. I was even more conflicted when the ballot result was returned- a turnout of 41% with only 53.3% voting for strike action, and 78.9% voting for action short of a strike. So in reality, a fifth of radiographers voted to strike. Luckily there is currently no minimum turnout to validate a strike, and in my opinion if there was to be one implemented, the same should apply to a general election.

But nevertheless, a strike has been called. so next Monday radiographers across the UK will walk out at 9am and not return to work until 1pm, and I shall be one of them. I’m quite disgusted with the way that the NHS has been treated by the government, with large chunks being sold off to politicians’ friends for a hefty profit, cuts to funding, and disparaging comments being made by those in a position of immense priviledge. Yesterday a significantly larger strike took place, with Unison members on the picket line from 7am. I joined the picket for an hour before work yesterday, and it was lovely to bump into June Hautot again, a local “trouble maker” as she has been described. I doubt we’ll have as much support on the 20th, but I’ll certainly be there regardless of the weather!

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Work Experience

Recently the SoR tabled a motion about whether to make work experience mandatory prior to commencing a radiography degree in the UK. Surprisingly, it failed to pass, even more surprisingly for the reason that apparently some students find it difficult to get work experience as their local hospital may not allow it.

I feel that this raises a few issues which need to be addressed:

1) Radiography degrees in the UK are funded by the NHS for domestic students. This means that upon graduation, you end up with an internationally accepted degree, with good job prospects, and nowhere near the £27k debt that your flatmates were lumped with. It also means that a lot of money is wasted when students drop out of the course, which happens, a lot. Attrition rates are around 40% nationally, which is shocking, and surely must be at least in part due to students not being prepared for what they’re expected to do.

In my year group, 53 started the course in September 2009, but only 39 graduated in 2012, and I know from talking to some prior to their departure that it was because they were not expecting it to be what it was. Our first placement was within 10 weeks of the course starting, and this was the point of the first exodus. Obviously the academic workload was a major factor for some people, but other reasons I’ve heard range from “I didn’t know I’d get vomited on” to “I can’t stand the sight of blood!”. Even a day’s shadowing would give enough insight into our exposure to bodies and their fluids. One student I spoke to recently asked me how long it takes to become a radiologist once you begin radiography training. I explained the difference, and she seemed genuinely surprised that one didn’t lead to the other.

Personally, I find this level of ignorance unacceptable; in the internet age where information is a few clicks away, and emails can be sent with minimal effort, it really isn’t difficult for people to show an interest in the career they’ve decided to pursue. Which brings me to:

2) Apparently some hospitals don’t accept work experience students. This is an issue which needs to be fixed but it can also be avoided; if a hospital isn’t interested in teaching the next generation of healthcare workers then quite frankly, it’s not somewhere a student should be interested in visiting anyway, because that’s a crappy attitude. I’d be interested to hear the reasons a department could give, so please, if you’re aware of any, leave a comment or two below.

So then it’s up to the student- if your local hospital won’t let you visit, go somewhere else! You’ll have to travel to your placement sites once you’re enrolled anyway, so this really can’t be regarded as extraordinary effort. I appreciate that people have jobs and kids and other commitments, but this is your future career we’re talking about. Is it really too much to ask?


As everyone is probably aware, the NHS is under constant pressure to cut costs, and like most huge organisations is quite wasteful in places. Stupid things like paying over the odds for toner cartridges, or allowing boxes of sterilised orthopaedic equipment to expire, unused, in store rooms, spring immediately to mind as things that I’ve personally encountered. On the subject of NHS funded education, one idea I’ve heard thrown around is to make drop-outs to pay the NHS for the tuition that they received, but I fail to see how that’s enforceable. Especially from students who drop out of further education entirely.

Another way of ensuring value for money could be to make it so that NHS funded students must work for the NHS for n years post graduation, something I assumed was already in place prior to fully researching the degree. This wasn’t an issue for me before signing up as I wanted to work within the NHS anyway*, but I was genuinely surprised to discover that the NHS would pay for your education and then you could bugger off to a private practice as soon as you graduate. Interestingly, in my research for this post I discovered from a UoP lecturer (thanks Mark) that of my year group only two graduates went into the private sector immediately, which isn’t terrible. Also, one went into the priesthood, so that’s… different. And apart from another graduate who left healthcare entirely, and one who has successfully avoided the Alumni’s radar, the rest went into the NHS for their first posts.

*There was a short period of time where after meeting Noel Fitzpatrick (the Supervet) at the UK Radiological Congress in 2012 and talking to his chief radiographer when I desperately wanted to work at a veterinary practice, but after composing an email to them with my (not exactly huge) CV attached, I let it sit in my drafts for a while before deciding to get some experience in the human world first.

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Differing Opinions

Uh oh,  it’s February and this is my first post of the year… Oops! I have a couple in my drafts but I need to let some time pass before publishing.

I just wanted to throw a quick question out there to my fellow health professionals as it’s an issue I’ve encountered a few times recently. What do you do when a patient says something you really disagree with, expecting a reply, and you know you’re going to be stuck in the examination room with them for an awkward few minutes?

I had to endure a patient’s hateful anti-cyclist diatribe shortly after attending a nasty cycling related trauma call. He even trotted out the ridiculous “they don’t even pay road tax” nonsense. I kept my mouth shut and refrained from providing my opinion because it wouldn’t have been appropriate, but it was a very uncomfortable experience for me.

How do you deal with these situations?


Oh What A Night!

NB: This isn’t meant to be a rant at other healthcare workers in particular, just me venting about some of the issues relating to working in a “multidisciplinary team”. I completely appreciate that every aspect of healthcare presents its own unique challenges, and that the two overriding factors which affect and unite us all are the public’s high expectations of us, and the government’s “bare-minimum” approach to both funding and staffing.

So. Here goes. Last night was easily one of the worst night shifts I’ve had, if not the worst. Nothing especially awful happened, it was just a never ending stream of constant difficulties. Firstly, when I arrived at the department there were already three patients on trolleys lined up in the corridor and two wheelchairs in the waiting area. The day crew handed over and explained the chaos, and then I went to resus to do an urgent chest and pelvis which absolutely had to be done round there as the patient was too unwell to come round to us. Fair enough, it was a trauma call after all. So I get round to resus and my trauma patient wasn’t collared or boarded, and wasn’t even hooked up to any monitors. When I asked why he couldn’t come to the department the nurse replied “He’s too unwell.” When I asked the patient how he was feeling he shrugged his shoulders and said “Not too bad, foot hurts though.” In the end I did the x-rays in resus, as they asked, because yes, it was a trauma call, yes he did have bruises on his pelvis, and we didn’t have room for him in the department anyway.

It’s exceptionally annoying when our colleagues lie to us in order to make life easier for themselves though, and we always find out, so it’s pretty bloody insulting. Most of the times I get a crappy reason for doing a mobile x-ray I take the time to explain to the referrer why we prefer patients to come to the department; it’s not because we’re lazy (although some radiographers are), it’s not because it’s easier (that’s not always the case), it’s because we actually give a shit about the radiation that we’re exposing ourselves and others to. When we trundle up to the ward with our trusty AMX (other models are available) we’re putting ourselves, other staff, and patients at risk. A radiographer’s best friend is the inverse square law (the further you are from the source of radiation, the better) but not all wards are set up to accommodate us. Hospitals are encouraged to squeeze as many beds as possible into every available space (as a side note, one of Trogdor’s board rooms is actually being turned into a patient area and having beds put in it) meaning that there isn’t always the minimum recommended 2 metres between patients. I’ve occasionally refused to perform a mobile x-ray purely because of the logistics of the ward- in one case the wall separating the patients’ bays was so thin that I would have been directing the primary beam at the back of another patient’s head. Nope.

So when I’m told “Mrs Smith is desaturating rapidly and is too unwell to leave the ward”, and I close the department (because I’m the only one there) only to find Mrs Smith sitting up in bed with a cup of tea and no oxygen mask in sight, it’s more than a little frustrating. Add to this the sheer unpleasantness for the other patients being woken up at 3am because mobile x-ray units don’t have a silent mode. This is a point I try to make regardless of whether the request is for a mobile x-ray; I know the medical registrar said that the chest x-ray was urgent, but it’s for a PICC line placement and you don’t plan on using the PICC before 8am so how about letting the patient sleep?

I think that “bullying” might be too strong a word in this context, but I honestly think that sometimes junior doctors aren’t allowed to use common sense as the pressure from their superiors is too high. A while ago I was chatting with a junior doc in resus while waiting to do an x-ray. She’d just had to abandon an attempt to get blood gasses because the patient was squirming in pain, so I asked if there was a reason why no one here tends to use local anaesthetic for the procedure. Apparently a friend of hers had asked the same question a while back and was told that if you can’t do it without local you can’t do it at all, or words to that effect. Apparently the patient’s comfort is irrelevant.

While the Daily Fail loves to scream about “Killing Season” every August, there isn’t a huge amount of truth behind the scare stories about junior doctors causing loads of extra deaths in their first few weeks. Sure there’s a statistically significant rise of about 6% in death rates in early August, but mortality and morbidity figures fluctuate all over the place throughout the year for a variety of reasons, and this is something which requires a lot more research before wildly labelling all F1s as Harold Shipman. Not that the Daily Fail gives a shit about the truth, of course.

One thing which does increase in August though, is crappy x-ray requests, and while it’s frustrating and annoying, it’s our job as radiographers to vet these requests rather than blindly performing them. I know it must be hugely difficult to be an A&E doctor, especially early on in one’s career, but it’s almost comical how the requests pile in. So far I have seen two perforated bowels (colloquially called a perf) but I have probably done a few hundred x-rays with “?perf” on the form. This is basically like a cheat code for a chest x-ray, write “?perf” on the form, get  a chest x-ray. Write “?obstruction ?perf” and you’ll have an abdomen thrown in as well. And you can tell when the new doctors learn about this, because the requests come flooding in shortly after. Instead of properly examining the patient to give us a real reason for doing the chest x-ray (and there is usually a real reason) we get loads of these cheat-codes. A tip for spotting when this has happened: a genuine perforated bowel does not present with the patient strolling in to the x-ray room and making small talk. A real perf is generally accompanied by a patient curled into the foetal position, screaming in agony. Not always, but most times.

So as well as crappy requests we also had loads of patients turning up without wristbands, who we were unable to positively identify. Patients suffering from stroke, dementia, acute confusion (due to LRTI etc), and narcotic or alcohol abuse need to have wristbands on so that we can categorically confirm that we are about to x-ray the correct person for the correct body part. This is beyond essential, yet some of the nurses on shift last night didn’t seem to think so, and the worrying thing was that a few of these patients had clearly been administered drugs before coming to x-ray, something which really shouldn’t be done unless you can be 100% certain of their identity.

Then there was the abuse, a constant factor in this job, but it was particularly noteworthy last night. The first was from a group of “lads” who came along at about midnight with their friend who had banged his wrist earlier that evening: I was processing the x-rays of the patient I had just examined, and standing at the computer annotating the images. One of the “lads” loudly exclaimed that “she needs to get off Facebook and sort your wrist out cos I’m sick of waiting here”, a comment I had no choice but to ignore for the sake of professionalism. I helped my current patient put his shoe back on, and pushed his wheelchair out of the room, and was met with another “hilarious” quip from the group, which I won’t repeat. Then when I called in the injured boy for his x-ray, all of his mates tried to come into the examination room and didn’t like it when I told them that they couldn’t, so I said that he could have one companion to hold his hand if he was really that scared and that seemed to shut them up. The patient was actually alright when the door was closed, but then reverted to making obscene comments about me when he left the room. What a gent.

Not long after there was a middle aged man with a laceration to his arm, he wasn’t drunk (a usual factor in abusive patients) but he was really grumpy. I only had one image to do as we were just looking for broken glass in the wound rather than a fracture, but he was determined to make it a difficult one. First off he refused to let me remove the bandage, but his wife talked him round. Then he wouldn’t put his arm where it needed to be because he didn’t want me to touch it, and when his wife came to the rescue again, he got really arsey with me. I demonstrated with my own arm what I wanted him to do, but he wasn’t getting it, so I lightly tapped his (uninjured) elbow to show where it needed to be and he said “touch me again and you’ll regret it”. No swearing, no bravado, just a plain threat. At this point I figured that his position was good enough for what I needed so I set up the x-ray tube, ushered his wife behind the screen and took the image. Walking back towards him I gestured for him to lift his arm off the x-ray cassette so I could remove it for processing, he did so, but when I reached to pick it up he grabbed my wrist very tightly and said “put the bandage back on now”. I stood my ground and said that I’d like to make sure that the x-ray was ok before doing that, and he hissed something derogatory as I wriggled out of his grip and walked to the processor. His wife looked so embarrassed, I really felt for her. I only had to spend a few minutes with him, she was married to the guy.

Then at about 3am I had a patient growl at me when I asked his name. I phoned majors to ask if there was anything I should be aware of: “Yeah, he spits and will try to bite if you go anywhere near his head”. Thanks for putting that on the form, guys. I nearly found that out the hard way.

I also had a lady call me a stupid cow when I told her I couldn’t confirm whether her ankle was broken or not (it wasn’t), but she actually came back to apologise on her way out, which surprised me. Apparently the nurses in minors explained why I wasn’t able to tell her and she felt shitty about it so she wanted to make it right. That was nice.

So that was my night. Busy, but not the busiest. Just generally unpleasant even though I was working with fantastic colleagues (one with me, and one in CT), I dread to think how it would have been with others!

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Anything and Everything

I’ve spent quite a lot of time working in A&E recently as I’ve had a few night shifts and even a whole week of regular days there.  It’s one of my favourite places (along with theatre) and I really enjoy the challenges it throws at me. I’m also constantly amazed by what some people class as an “emergency” though (and yes, A&E stands for Accident and Emergency not Anything and Everything) and this can be incredibly frustrating.

The other weekend we had a paediatric trauma call; when a paeds trauma bleep goes out you can see the dread on the team’s faces while we wait nervously in resus for their arrival. Apparently a young girl had fallen quite a height from a tree and landed face down, where she remained unresponsive for a while. These were the only details we had at this point so it was hard not to worry about the state she might be in. The ambulance crew wheeled her in, neck brace, head blocks, parents alongside, and we were all quite relieved to see her conscious; at first glance it was obvious that she had broken at least one wrist so I knew that she’d definitely be coming round to x-ray very soon, and upon further investigation it turned out that she had not been unresponsive or unconscious for any amount of time. Due to this and the lack of any head injury she ended up coming round to x-ray for a full trauma series as well as some extremities.

Our A&E x-ray department has two examination rooms, and therefore we are only able to see two patients at a time; normally this is fine, and people only have to wait a short while, but this particular day was quite busy. Several patients were waiting to be seen when the trauma patient arrived and I heard a few tuts as we whisked her straight in to the examination room. I was honestly quite shocked, as one of the men who tutted was there for an x-ray of his ankle which he injured two weeks ago and had been walking around on ever since; how he got through triage I’ll never understand. Luckily the girl’s parents were too worried about consoling their child to hear such an inconsiderate man making his feelings known, but myself and my colleagues definitely heard him. One of them decided to make things clear by announcing that: “A paediatric trauma patient has arrived so there may be a delay in getting to you- I’m sure you all understand the urgency of the situation, thanks for your patience.” Hurty-ankle man tutted some more and looked at his watch dramatically, and then rolled his eyes when the patient in front of him was called in. I wasn’t there when he was eventually seen, but I do now know that he hadn’t broken anything (what a surprise!) and he was very rude to the radiographer who saw him. Meanwhile I was next door attempting to get some decent radiographs of a terrified child; we had to take x-rays of her neck, chest, pelvis, and both forearms, one of which was visibly deformed. She had never had an x-ray before so was understandably terrified to be strapped down flat to a stretcher and wheeled into a dark room while I shone a bright light at her and made her move her badly bruised arms.

In the end she “only” had a couple of fractures to one arm which was fixed in theatre that afternoon, so all in all a fairly good outcome.

So back to Hurty-ankle man. Someone in the triage stage should have explained to him that better care options are available (it’s possible that they did but he insisted on being seen- that happens too) but for whatever reason he ended up being seen through A&E. Apparently he had twisted his ankle two weeks before but hadn’t been to see his GP because apparently A&E is more convenient to get to.

You may think I’m being overly judgemental (and it’s likely that I am) but the NHS, and emergency departments in particular, are currently experiencing workloads which are simply unmanageable. The government’s answer to this is to add more targets and blame GPs and junior doctors for failing to meet them. The real solution isn’t that simple, but patients can help by choosing their care provider wisely; A&E is for acute illness and injury- things which cannot wait. Unfortunately it’s difficult to get this message across without risking scaring those away who genuinely need help. The elderly are especially at risk- “oh I didn’t want to be a bother” they say, having revealed that yes, they have been walking on a broken hip for a week, while the woman with cystitis calls an ambulance to rush herself to hospital.

NHS Choices is a good starting point for finding out who is best suited to look after you in your hour of need, but you should also familiarise yourself with which services are available in your area before you desperately need them. Some cities and towns have urgent care centres which are essentially diet A&E departments. These are a touchy subject politically, as they have sprung up in recent years, replacing real A&Es. They’re perfect for when you sprain your wrist, or cut your knee, but if you’re having chest pain, call an ambulance or go straight to a proper A&E. Some A&E departments are even able to book same day GP appointments for patients that are deemed suitable, so if your sprained ankle isn’t improving and you can’t get an appointment for a week, there might be other options available to you.

All I’m asking, as a healthcare worker and supporter of the NHS, is that you consider your options before going to (or not going to) A&E.


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What a PAIN!

I haven’t written a lot recently, although I’ve had more than enough material for a book already. The problem is, after a particularly heavy day at work (and those are the ones I’d be more inclined to write about) I usually just want to zone out when I get home so I usually do.

Anyway, so I’m now about 6 months into my first job and already my eyes have been opened more than I expected. I always knew that “how things should be” and “how things are” rarely follow the exact same tracks, but it’s disappointing, and I try to keep my standards as high as practically possible.

Nowadays some patients expect to be treated like customers (they’re even referred to as “clients” in some NHS literature) and therefore if they don’t get what they want, regardless of what they need, they get upset. This is something of a common theme; when a patient goes to see a GP they expect an intervention, whether it’s anti-biotics, an x-ray, blood tests, whatever. What they don’t want to be told is that their low back pain can be helped with exercise and posture improvement, or that their cold is not swine flu and doesn’t require medication. What this means for the radiology department is that we’re constantly getting x-ray requests for things that are just completely unjustified, and our job as radiographers is to weed these crappy requests out. Unfortunately a lot of people find it easier to just do it. I’m not one of those people; radiology referrals have fairly clear guidelines and they’re not difficult to find. I’d rather take the time to get the full story from the patient and determine whether the x-ray is needed instead of exposing a patient to unnecessary radiation. A lot of the time these crappy requests are actually fine, they’re just missing information- not surprising when GPs are only given 10 minutes per patient.

This is a difficult problem to tackle, as when you hand the request form back to the patient they are completely within their rights to take it to another hospital where they may not be questioned, and thus the fee for that examination goes onto someone else’s books. I have absolutely no doubt that this has happened to patients that I have refused to irradiate, even after explaining my reasons to them. But what can I do?

Recently I picked up a form for a 29 year old female patient which had only three letters in the Clinical Information section: LBP. This section is meant to contain relevant information so that we can justify the examination- things like fell onto outstretched hand or ?osteoarthritis are enough for the radiographer to understand why the examination can go ahead and which images they need to produce.

LBP means low back pain, an affliction suffered by many due to things like poor posture or years of manual labour. It’s unfortunately a sad fact of life, and the guidelines clearly state that there’s no need for x-rays except in certain very particular circumstances, none of which were applicable to this patient. She was young, otherwise fit and well, had no family history of osteoporosis or spine pathologies, and had suffered no trauma. Her only problem was that she was unable to sit in her office chair for more than a couple of hours at a time without feeling pain in her lower back. And this had been going on for two weeks. I explained why I wasn’t going to do the x-ray, and that even if I did it would have absolutely no effect on her future treatment; the GP would give her exercises to strengthen her back muscles and probably recommend a better office chair. She seemed annoyed and didn’t like my quick explanation of the ALARA principle, instead choosing to assume that I was being lazy because I couldn’t be bothered to do her x-ray. Sure, my laziness lead me to speak to her to find out more information about her pain, then phone the GP (7 minutes on hold after navigating their hideous phone menu) to ask if he was looking for anything in particular in this patient’s spine (I also took the opportunity to direct him to the Royal College of Radiologists’ guidelines which are freely available online), and then to explain the concept of risk vs benefit to a woman who just wanted to know why her back hurts.

I can’t say I made any friends in that particular encounter, and I’m pretty certain I was branded a jobsworth by all parties involved… I can see why the just do it attitude is so popular! Can’t say I’ll be adhering to it any time soon though.


10 Week Update

I haven’t blogged in a while, partly because I’ve been busy / exhausted, but also because I worry that if I blog about specific events, even with details removed, patients and colleagues may potentially be able to identify themselves if I write about it straight away, and that would be unfair and unprofessional. But mostly, I’m lazy and can’t motivate myself to write after a day at work.

So I’ve been working for 2 and a half months now, and honestly, I’ve really been enjoying it. There are some stark differences between working in Hampshire and London; most noticeably, budget. I’d mentioned before that the imaging equipment was different to what I’m used to, but it extends beyond that. The rooms in general could do with a refurb; the paediatric room is quite an intimidating place for an adult, let alone a 5 year old with a broken leg. There’s also a dearth of basic accessories such as positioning pads and cassette holders; this doesn’t necessarily affect patient safety or the diagnostic quality of the resulting radiograph (assuming that the radiographer is determined and caring enough) but it can affect patient comfort, and it can also make the task for the radiographer much more laborious and require some significant creativity.

That said though, having the newest fanciest kit doesn’t solve everything; our fancy DR system in Resus decided to stop working on the morning of the Vauxhall helicopter crash, when we were on standby for some of the casualties. It turned out to be a very quiet morning in the end, but nerves were certainly frayed when one of the A&E rooms packed in at the same time! This all happened during my fortnight’s “training” in A&E (I’m still rotating through the various modalities so I can get a basic understanding of equipment, protocols, and working practices). Unsurprisingly, this was my favourite time period so far, and I can’t wait to get back round there.

So far, my shifts have been nice and easy; 9-5 every day, no weekends, but that all changes this month. Luckily I’ve only got one evening shift, one weekend long day, and two weekday long days in February, but it steps up further in March with night shifts thrown into the mix too.

So… what other news? Well I received a dose badge, but then that expired and I wasn’t on the list for a replacement so now I’ve got a temporary one; my markers finally arrived from the USA but apart from my A&E fortnight I’ve hardly used them; and I’ve received half of my uniform (the trousers) and when I collected them my colleague, who accompanied me to find out about hers, demanded that they give me a plain white tunic to tide me over til my proper ones arrive. Hopefully this will mean fewer incidences of being called “The Student” by consultants.

After all this behind-the-scenes waffle you may be surprised to hear that I have actually encountered some patients in my 10 weeks of employment, so here are some anonymised excerpts of the ones who have, for various reasons, stuck in my memory:

The 6 year old who barely even winced when I moved his obviously fractured arm to a more lateral position- brave kids like this just make me even more annoyed at perfectly well yet uncooperative adults who scream the place down over a slight sprain or bruise.

The elderly lady with multiple myeloma who had been booked in for a skeletal survey (a long list of x-rays covering basically the whole body, to assess the formation of any lesions in the bones) who not only repeatedly apologised for taking so much time (!) but also told me about the horrible experience she’d had at another hospital. Apparently the radiographer there shouted at her when she misunderstood his instructions and she cried on the bus home. I hope I’ve managed to show her that those types of radiographers are in the minority.

The young teenager who came into Resus following a collision with a vehicle; she sustained several injuries (luckily none were life threatening) including losing all of her front teeth only a day after having her braces removed. She was understandably devastated and kept apologising to the trauma team for crying. I think she made a lasting impression on all of us.

The gentleman who refused to take his necklace off for his chest x-ray and got very aggressive at the mere suggestion of doing so, telling me that if he takes it off “and something bad happens, it’ll be your fault” whilst standing 6 inches away from my face. More on this in a future post.

The father of the tiny baby on NICU who was born so premature that her lungs had barely formed. I felt awful asking him to step out of the room while I x-rayed his daughter, especially as he cleared his throat and tried to hide the fact that he’d been crying when he returned.

I’ll try to be more regular with my updates in future; I’ve got a few radiology related posts to write on a number of different subjects which have been on my mind recently.


Missing, Presumed Dead: Revolution

Photo courtesy of the Society of Radiographers

I’m pretty pissed off. So pissed off that on Saturday I marched through London with 150,000 other folk who are angry at the way this country is being treated by the government. And now I’m even more pissed off that we were completely ignored by both the media and those in charge. Is because we didn’t smash shit up? Because there was a football match that day? Or is it because 150,000 people closing roads in central London and marching past Downing Street just isn’t a big deal? After all, back in 2003 approximately one million people marched through London to protest the Iraq war, and that still happened.

The facts are fairly clear: the NHS is being privatised, but apparently, not that many people care. In 2007 the American Filmmaker, Michael Moore, made a documentary investigating the state of insurance-led healthcare in the USA, and comparing it to the socialised medicine available in France, Canada, Cuba, and the UK. While the film isn’t exactly unbiased, as a Briton I find the concepts covered in it as alien as Alien. Concepts such as: people with unrelated pre-existing conditions (such as thrush) being denied health insurance cover for cancer; patients being bundled into taxis mid treatment and abandoned outside charitable hospitals miles away, confused, disorientated, and still wearing gowns and ID wristbands; patients with severe respiratory illnesses contracted whilst volunteering in the clear-up post-911 having to pay hundreds of dollars for an inhaler; insured patients having to pay for ambulance expenses because the emergency response hadn’t been pre-approved by their insurer.

Nah, scratch all that, those examples are disgusting, but they’re also quite extreme. Personally, I find it abhorrent that in a developed country, with such national pride and a history of incredible achievements its citizens are treated with such contempt. Michael Moore seemed shocked that our prescription costs were so cheap and could cover so much. He was surprised to find that the only thing stopping a patient from leaving the hospital was the state of their health, rather than their bank balance. He was confounded by the idea that the cashier’s desk in an NHS hospital serves to reimburse travel costs to poorer patients rather than to collect payment. I am shocked that this is not the case over the pond, and I am even more disturbed that we’re starting to copy them.

Leaflet announcing the launch of the NHS

Moore spoke to Tony Benn to ask about the history of the NHS, talking about the motivation behind it, and the love that the British people have for it. There was, however, one part which was especially poignant today, where he compared the NHS with democracy, saying that taking away our healthcare would be as ridiculous and incomprehensible as removing the vote:

Benn: “They wouldn’t accept the deterioration or destruction of the NHS.”
Moore: “If Thatcher or Blair had said ‘I’m going to dismantle National Healthcare’-“
Benn: “There’d have been a revolution.”

(See the full interview here)

Well where’s our bloody revolution? Seriously? The public reaction to the current dismantling of the NHS by the Conservatives has been, quite frankly, pathetic. Some people blame the media for the lack of coverage, but honestly I don’t buy that anymore. If there was a media blackout on the FA Cup, people would still find out the football results if they were interested; how can football be more interesting than your own health? There are even people working for the NHS who either don’t know or don’t care about the current threat to their employer; I know because I’ve spoken to them. I’ve had plenty of people ask me why I get so upset about this, and why I bother reading and writing about it. Well, I don’t know about you, but if I broke my arm tomorrow I couldn’t afford the bus fare to hospital, let alone the treatment.

People came up to us on Saturday’s march and (genuinely) asked what it was all in aid of (maybe they were illiterate, I dunno, we had plenty of banners). Back in March there were nationwide vigils and I went to one in Southampton and was disgusted with how few people turned up; I even grabbed the megaphone to express my disbelief.

Photo courtesy of Laur Evans


But honestly, what can we do? It seems that the only way to get media coverage is to destroy property, and that would be a wholly inappropriate response. I’ve tried telling people myself; I’ve blogged, tweeted, facebooked, accosted people in the street, written to my MP, attended events and rallies… what else can we do?

Answers on a postcard…

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