to wish people would use services appropriately?

[mree]

I've been reading a topic on another forum about ongoing health worries someone's having. She doesn't seem to be being taken seriously by her GP and is becoming increasingly frustrated, quite understandably. Her condition isn't immediately life-threatening (ie., she's not bleeding, she's not burnt, her ability to breathe is not restricted, her circulation is not affected, there's no suggestion of an abnormal pulse, etc.), and is not acutely painful. Several posters on this forum have advised her to dump herself in A&E and refuse to move until they perform a diagnostic test usually done as an outpatient. This test is, in fact, not usually available in an emergency department and, when it is, is used to diagnose such conditions as a leaking aneurysm.

AIBU to jump up and down in frustration at the total lack of understanding from large portions of the general public as to what constitutes an emergency?!! These people are the reason those who attend A&E with appropriate problems have to wait so bloody long!!!

DD's asthma mainly, sometimes DH's

YANBU although I think you could have argued your case on the thread inquestion rather than starting a new one to drum up support and gossip about someone elses medical condition!

Out of hours won't even discuss them; they send us to A&E

Thanks KatyMac, I meant why couldn't you see the normal GP about those things?

thegruffalosma, I haven't gossiped about anyone's medical condition at all, nor am I drumming up support for anything, I honestly wondered if I was being unreasonable and figured that's what this bit was for! In fact, I haven't even mentioned which board the other topic was on, or what the condition or test in question was, as that's irrelevant and was simply the catalyst for setting me off on this train of thought. It wasn't a MN board, and not one I visit often, as the level of conversation on the board in question certainly wouldn't support a debate on the matter, which is what I hoped would happen as I wanted people's views. Did you even read my original post? Please let me know exactly what part of anything I've said is gossip about someone's medical conditon.

Sorry - it always seems to flair on Bank holiday weekends; I think asthma must be psychic

I saw a GP faster on holiday in Wales than I can get to see my own GP

Part of the issue for GP's generally is, I think, that half the time a nurse would be a better option but you can't see one unless the GP tells you you can

I think people just forget that A&E stands for Accident and Emergency - not anyone and everyone....

I would never take myself or anyone else I know to A&E unless it was urgent, we've got a good walk-in and out-of-hours service, and NHS Direct have been brilliant. That being said, NHS Direct ordered an ambulance for me despite me trying to tell them it was just reflux and the only reason I'd called was to find out where I could get Maalox at midnight on a Saturday in a town I didn't know >>sigh

I hate how there are so many different services in different areas, all with different rules on what they will and won't see, and at what times. I truly sympathise with those who go to A&E unneccessarily because they are so baffled by the different options, which also seem to change regularly. That's why I think NHS Direct is under utilised, as people really do need help to decide which service to use for which need. Maybe if the system was simpler there wouldn't be so many people going to A&E for things A&E can't help with. KatyMac, I would never call worsening asthma symptoms inappropriate for A&E, for what it's worth, especially in a child!

Trinaluce, that's what I meant about NHS Direct erring on the side of caution!

I apologise OP I missed the 'another forum, bit and thought it was another thread currently running on here that people would be aware of. I did say YANBU though

NHS direct always say go to A&E with DD & DH; When the out of hours was open it was so much easier

I think the nearest is about 50 miles away now

I got questioned about why I went to A&E when DS split his chin open and bruised his jaw badly. There is a minor injuries in my area one of which is only slightly further away but was rush hour in the direction we were heading - and when faced with a screaming and bleeding DS with a hole in his chin I didn't stop and think tbh.

To me it was an accident and needing medical attention. Yes I agree minor accident. But thats where the confusion lies. Is it emergency accidents or accidents & emergency. And which accidents are for A&E and which not?

Minor injuries apparently deal with minor fractures aswell. But HTF do you tell from looking if its minor or major fracture needing cast or surgery.

OP from your OP though I think YANBU but agree with others that sometimes people feel pushed into this situation.

Apology accepted gruffalosma, and I apologise for biting you, gossiping about someone's medical problems is a serious accusation to me!

KatyMac, I can understand why they do that, asthma's one of those medical conditions that can (as I'm sure you already know) deteriorate very quickly and it would be dangerous for someone on the phone to try to assess how serious an attack is. The kind of condition I'm talking about is someone who attends A&E because they had an ear infection a month ago and their hearing hasn't returned to normal yet; they have a mouth ulcer and the cream the GP gave them yesterday hasn't fixed it yet; they've had a shoulder condition for 10 years and are sick of their GP not being able to magic it away; they have a headache and haven't got any paracetamol at home......

youarekidding I agree completely, there are so many different services it can be impossible to work out which you should go to without a guidebook of some description! It wasn't this kind of situation that triggered the OP though, it was more the kind of thing listed in my last post that had me a bit frustrated!

I think some of the issue is when asking for an appointment to see a GP I get asked 'is it an emergency' so we get indoctrinated into the idea that you can see a GP for an emergency from that it is a small step to accident & emergency

mree In fairness to them, my reflux always presented as severe chest pains and on that particular occasion the paramedics read something on the ECG that gave them reason to want to take me in. I apologised to the A&E staff when I got there and they got me sorted inside of half an hour. The next time it happened in a strange town I wouldn't give them any symptoms, just kept asking for the address of the nearest chemist

I agree that people shouldn't use a&E for other than an emergency but bear in mind not everyone has access to walk in clinics. Our local one also closed down because there was too high demand for it and they couldn't cope. There isn't another within 5 miles (which is a long way when you haven't got transport) and we're in a major city. The closest, is funnily enough situated next to the local A&E so no excuse really.

Our local GPs is fab luckily and run a nurse treatment room service daily who will deal with things like nasty cuts that need stitches and most things I would use a walk in for. They are also really good at giving emergency appts providing you aren't fussy about which gp you see.

The out of hours doctors service is based at a different hospital and much more difficult to access unfortunately. Luckily we've never had to use it.

I would always call the gp surgery or out of hours for advice first providing it wasn't a blue light emergency.

I have always (apart from once) used 999 for asthma attacks though - but it was always either me or dh going downhill very rapidly (unable to speak/beginning to lose conciousness etc) and needing nebulising. Never been told off for it so presumed it was ok.

YANBU but a doctor friend of mine seems to go to A&E with stuff that I think would be more appropriate for a GP and encourages friends to go to A&E if they ever ask her opinion on whether they should see a doctor about a medical issue.

I once attended A&E about something I'd seen an OOH GP for 2 days previously. (yes because no GP available and I was crying in agony) I had an abcess behind my ear which was bloody painful and actually meant moving my head was near on impossible. OOH GP said if he had the facilities he would drain it but gave me AB with instructions to attend A&E if it didn't shrink/ got worse in 48 hours - and it really did grow.

Waited 4 hours in A&E which was fine and then got the why are you here though when explained. Then sent up to ENT where 20ml of pus was drained. Culture proved it to be a highly infected cyst. I was then referred from this ENT ward for ENT apt. When I got there he had no idea why I was there - looked up results when I told him and said then about cyst with a real look at why I was referred.

I think tbh mree is making a very valid point. That often these visits are either lack of GP referral or GP advising A&E for non urgent issues. We are getting confused as patients as to which service to use - as the service which is meant to be providing more options if only we knew the right answer.

YANBU.

It's Accident and Emergency, not a drop-in centre.

The walk in is 60.8 miles away

IME when people claim they can't get an appointment with their GP, they tend to mean they can't get one at the exact and only time that they want one.

I appreciate people are busy and have other commitments but to stipulate that you can only come to the surgery a week on Thursday at quarter past four does tend to limit your options slightly.

I've worked in A&E - we had a man bringing his daughter in with a fractured collarbone at two in the morning (after she had broken it at school that morning) because "he knew it would be a bit quieter and he wouldn't have to wait so long".

I now work in primary care and we get patients saying they can't be bothered to come and wait at the end of evening surgery for an urgent appointment (because they didn't/couldn't call until five o'clock on the Friday afternoon) so they'll just wait until after seven and call Out Of Hours.

Errr. Yes, actually. YABU.

I would rather see 10 inappropriate presentations to ED (it's not A&E any more - now the Emergency Dept) than have one person not attend for fear they would be told they were wrong to be there, wasting time, whatever.

I can remember scores of cases where people presented with something seemingly inappropriate but proper history taking and examination revealed a serious problem which required admission and treatment.

I can remember one in particular - ongoing acute coronary syndrome which initially presented as gastroenteritis. Symptoms for over a week, finally cane to ED (Casualty as it was then!) and had his 4v bypass the next day.

But then I trained in an era when we were there for the patients. Not some tick box culture as is developing.

I find your post extremely sad.

Yes, that kind of thing does of course happen. At times.

However, the 'I called 999 at 3am for the thumb I sprained 3 weeks ago cause it is still sore and I thought you'd be quiet' scenario is so much more common IME.

Of course, the people one remembers most are those who use the service inappropriately: that may be frivolously OR so concerned about 'wasting time' that they don't come even though a limb is hanging off. There seems to be a noticable Generation Gap there though....

I find your attitude extremely sad. Resources are so stretched nowadays we simply can't see everyone who turns up, it's not possible. So, some attendances are inappropriate, the attendees are advised which service would meet their needs, and sent on their way. My post was about people seeing A&E as a cover-all for things they know damn well can be dealt with elsewhere, not such things as the ACS example you give, and the knock-on effect this has on those who really do need emergency care. Including those who think they'll just wait until tomorrow for their GP as A&E will be so busy and they're feeling too unwell to sit in the waiting room for hours, when it turns out they have something that really WAS an emergency. If people who know they should be seeing their GP/pharmacist could be bothered to do so instead of going straight to A&E, there wouldn't be such long waiting times.

I also find your implication that I tick boxes rather than being there for my patients disgusting. You have never met me, you have never seen me at work, you don't know how good I am at my job. The same goes for the whole team I work with. Oh, and the sign above our door still reads Accident & Emergency, not ED.