Another article on Hospital care.

Should we bother writing to this woman and explaining how unrealistic her expectations were and how greatly she misunderstood the situation?  She is right about hospital care.  But yet she completely misinterpreted the situation.

Do you think she actually wants to know and understand or do you think she just wants to moan?

http://blogs.telegraph.co.uk/news/judithpotts/100070484/my-mother-in-laws-shocking-experience-at-scarborough-hospital-and-what-it-says-about-the-nhs/

As I work in medicine at a district general hospital I know how long it takes to get new patients sorted.  I know how difficult it is to do the right thing with elderly people and how slow the system is to act.  But I think this woman just has it in for the frontline professionals.  She lacks insight and sense and takes it out on the Nurses and Doctors rather than the shitty system they work in.

The GP had been called to the residential care home in which she lives – Sylvia has severe dementia – because she had not been eating or, more importantly, drinking for 24 hours and was virtually comatose. The GP diagnosed possible pneumonia and asked that Sylvia should be put on a re-hydration and anti-biotic drip within two hours

The GP had to know that there was no way that she could be admitted and started on those orders within two hours. He must have been covering his ass. Tests have to be done in hospital and the hospital consultant has to see the patient in AAU long before anything can be started. A lot of ducks have to be line up in a row for a diagnosis to happen and the right treatment to be initiated.

Unfortunately, no assessing of Sylvia’s condition was carried out for several hours. I understand that recent policy in the NHS requires patients to be held for no longer than 4 hours in Casualty. Clearly, this does not apply to the “assessment” ward.

That is of course why they have assessment wards (AAU). There are not enough beds, staff (the right kind of staff) or facilities to meet the targets and avoid the hospital getting fined.  Management did this.

After waiting three hours, I approached a female nurse and explained about the GP’s wishes. Standing under a poster warning patients and their families not to abuse hospital staff, the nurse sarcastically answered me. “With all due respect, darling, it is for the hospital doctor to decide on diagnosis and treatment not the GP.”

That is 100% true. No hospital Nurse or hospital doctor can act on orders by a GP. The GP did not make a definite diagnosis. He did not have the diagnostic tests at his disposal to do that. It would hurt patients even more if the hospital staff did what this author believed that they should do. Hanging the wrong IV fluids or IV antibiotics could kill a patient very fast and a doctor's rule is "first do no harm". The Nurse of course can NOT hang IV fluids or IV antibiotics until the consultant has seen the patient and one of his doctors has prescribed the darn things. These places are so short of qualified staff (not unqualified staff ....lots of them hanging around) that I think they did well to get it sorted within 24 hours.

Eventually a doctor appeared. He was perfectly polite and, after examining Sylvia, took us to one side, explained that there were “quite a few things going on with Sylvia” and asked for our decision on resuscitation. Not having realised Sylvia’s condition was that serious, we were very shocked – not least because she had been left untreated

That is a bit silly. An elderly woman with severe dementia who has stopped eating and drinking could be at death's door regardless of pneumonia, IV fluids and IV antibiotics. Those treatments might have worked or they might have sent another organ system in her body totally screwy. Doctors are clinicians not psychic mediums. Medicine is not a cut and dried science that always follows a logical planned and steady algorithm. I bet her renal function was also a mess. Anyone (me, you, etc) could drop over dead at any time. An elderly person who is sick enough to get admitted to hospital is very likely to just crash at anytime regardless of anything the doctors and nurses are or are not doing.

He was correct to ask about rescus status. At this point there was no way for the medic to know how things would turn out for Sylvia.  I once worked with a young healthy nurse who fell over and died of a stroke in the middle of the shift.  If that can happen to her it can happen to an elderly lady at anytime, regardless of IV antibiotics and fluids.

The whereabouts of the consultant was a mystery. Neither he nor his team were in attendance, despite the fact that there were two other elderly ladies with chronic dementia on the ward.

Believe me when I tell you that this consultant would have had over a 100 patients with confusion, dementia and multiple other medical problems on many, many, different wards all over the hospital. It takes these guys something like 10 hours in a day to see all of these people just one time. Plus they have clinics and everything else. It is offensive for you to imply that he was bunking off and ignoring his patients.  If you tried to keep pace with his work day just once you would collapse.

Next morning I rang again – quite prepared for Sylvia to have died in the night – to be told that she was absolutely fine and could go home.

This is how it is with elderly people who have dementia. It is never cut and dried and you don't know what will happen. If they sent her home the next day it is highly unlikely that she had pneumonia, as the GP led you to believe. Older people with dementia often stop eating and drinking and have alterations in levels of consciousness. It may be an acute medical problem that needs IVs and other treatments or it may just be the kind of quick deterioration that happens to all older people as their bodies start to shut down. They often seem to rally, then get worse, then rally again. Not eating and drinking etc is normal for people when they get to end stage of life. And all elderly people are at the end stage of life and their bodies are going haywire and shutting down.  Fixing one problem causes another to start. If some IV fluids helped her come around  this time then that is great. But it doesn't mean that she is "cured". 

Pleased though we were, we wanted an explanation. Nothing tallied.

She is elderly. And elderly patients are complicated. There is no cure for old age. She was admitted to hospital. They did some tests. She came around and they determined that she was medically stable and they sent her home.

There is nothing else to tell. You are wanting instant answers and diagnostics and a cut and dried plan of care instantly. This is impossible in general medicine especially with elderly patients.  In other words, nothing tallies because you have no experience or education in health care.  If the hospital doctor and nurses explained this to you as I am  explaining it to you would not have liked it.

However, Sylvia was not sent home that day because she became unwell again.

Yep. Elderly patients go up and down like this because they are at the end of their lives. Doctors are brilliant but there are two things that they cannot do. They cannot cure old age or stop us from being mortals with bodies that give out.

I would imagine that she will deteriorate, rally, deteriorate, rally, deteriorate, rally many more times before she passes. All without a concrete diagnosis. That is normal. It is no different for elderly people in the United States, Canada, Australia etc.

I have numerous questions including – was Sylvia apparently ignored? Why is there no communication between the GP and the ward staff – and is this nurse’s opinion, of the GP’s ability to diagnose, commonly found in NHS wards?

It wasn't the Nurse's opinion.  The Nurse was telling you a fact.  A fact that should be obvious.  Even if the GP had wrote out orders (which he did not) and faxed them the Hospital nurse still would NOT have been able to act on them. The hospital doctor has to write the orders. The GP did not have the information to give safe orders.   A doctor cannot prescribe IVs etc without blood tests and xrays. The hospital doctor will prescribe what needs to be prescribed when he has all of his ducks in a row. If Nurses are to give IV fluids or IV antbiotics the order has to be written on a hospital drug chart by hospital doctors. Otherwise it is an illegal order and  cannot be given. Sylvia was not ignored. She was under the care of Nurses and Doctors who were already 4-5 hours behind on doing what needed to be done for the patients that they already had when Sylvia came through the door.

Why was there no polite, informed communication between the ward staff and me – I was not the only person sitting beside an elderly relative’s bed, not knowing what to do?

Did it very occur to you that:

 A. An RN cannot delay treatment for the 15 people she is responsible for to chat with relatives
 B.  The five unqualifed staff sitting at the Nurse's station cannot help me implement doctors orders or communicate with relatives.  A Nurse has to handle that all by herself all at the same time.  And there is only one Nurse for a large team of patients despite how many techs you see hanging around.
 C..That there was nothing to tell? It gets very frustrating when relatives sit around with nothing to do obsessing over every little detail and inventing these paranoid scenarios where everyone is trying to neglect and kill grandma and hide information from them.  Open your eyes a little.

there was no evidence of shortness of staff; indeed a lot of eating and chatting was going on at the nurses’ station.

From what I hear, Shitborough has some of the worst direct RN to patient ratios in the galaxy. It is lack of RN's that are the problem, not lack of techs and unqualified staff. 
You know not what you see. I know how wards are staffed in these places. Many of the staff you see at the station are not Nurses and Doctors. They are care assistants and techs. And even if I had a hundred of them working with me I would still be too short of nurses and doctors to get things done in a timely fashion. I once had a bag of IV fluids run out on a patient and it took me 5 hours to chase down a doctor to get him to prescribe more so that I could hang a new bag A few techs sat at the nurse's station drinking tea and chatting does not change how long it takes the doctor to get results of diagnostic tests so that he can order the correct treatment. I could have a thousand techs working with me on a shift. But whether they look busy or are sitting around at the station does not change how long it takes to get orders written by the doctor and implemented by the Nurse.



I think you are either very unrealistic or are simply shit stirring.  And please keep in mind that no hospital Nurse can act on orders or start any kind of IV therapy unless it has been prescribed onto the hospital system by the hospital doctors. Not under any circumstances ever.

I am also surprised that a medic told her that someone would ring from the ward with an update!  As a ward Nurse I am almost never in  a position when I can abandon those IV fluids and meds that I am hours and hours behind on starting on all those people to call relatives.  The only help I have are techs and assistants and they cannot make calls to relatives NOR can they  continue with my workload as I am sat around ringing the relatives of 15 different people to give an "update". 

And that's probably all there is to tell Mrs. Potts.  Hope that helps.

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