To think giving doctors a quota of ultrasound scans is ridiculous?

[unlucky83]

Don't want to get into NHS cuts/costs etc - it is the mentality behind this that is annoying me...who thought this was a workable/sensible/good idea?
So I have dodgy bloody - had a couple of DVTs years ago now have to err on the side of caution. Have a slightly swollen sore leg but did sleep funny on it...
Left it all day yesterday to see if it got better it didn't...ended up phoning 111 and going to OOH GP - phoned at 9.15 got an appointment with OOH GP at 1am. Agreed looks dodgy - a DVT - gave me fragmin injections and an appointment at the acute medical unit a the local hospital this afternoon.
(Now actually think I should have just gone straight to A&E -but that's another IABU)
Turn up this afternoon staff fantastic - my story is complicated - possible misdiagnosis of a blood disorder etc (my notes were in a mess and incomplete - spread over 4 hospitals - discovered today a fantastic haemotologist I saw once a few years ago has finally (after over 20yrs) managed to get all my notes together and write a synopsis - I love him!).
My blood test for DVT came back negative - but that's not 100% reliable -Doctor really thought I needed a scan...but she can only ask for two scans a day. She has already gone over her allowance so she is really sorry but her next available slot is on Mon. She has booked me in and given me enough fragmin to self inject till Mon...
I feel bad about taking the slot - someone might need it more (I actually asked if I could pay or something to not take it out of her allowance but I can't) ...that she had to apologise ...and also with the fragmin dissolving the 'clot' by Monday the result might be inconclusive (this has happened to me once before - kept on a ward for 5 days because it was the Easter weekend - by the time I got a scan it was inconclusive) - and actually for my record I would like it to be confirmed or not - inconclusive adds to the confusion. Or worse if it is one I might get a PE ... would be ambulance etc - a lot more of time and expense...(if I didn't die - and sure that would be a hassle too) .
Basically the NHS has paid for me to see 2 doctors and a nurse - blood test, fragmin I may not need (and luckily I did the injections when pregnant or they would have either had to fit me in with a nurse to do it for me - or teach me how to do it then ...and it is a hard thing to do at first). And I will be back on Mon taking up more of the doctors time...and it might not even by the same one -so might have to go through everything again...
Alternative a scan that will take tops 10 mins.. if clear - I'm ticked off out of the system ... without another unconfirmed DVT clouding my notes...
AIBU to think it is a stupid system?

Your baby could be in trouble and they're making you wait until Monday??

There must be a misunderstanding. There is no quota AFAIK, only limited scanners and technician time. I hope things work out safely for you.

Yes, that's properly stupid. It can't be supposed to work that way. I wonder how high up the management actually knows about this daft "system"? Write and complain, and if you are not satisfied with the final result, taken it to the ombudsman.

How ridiculous! I think I would be demanding a scan and not leaving until I had one.

It sounds like it will take someone actually going home and tragically dieing before someone realises it isn't a workable system.

I had 2 dvt scares, one when pregnant and one after birth, both times I was scanned quickly.

I know things are bad in England but why doesn't she just send you up to the hospital as an emergency? To be honest you are on the correct treatment but why subject you to it if not needed.
Don't blame the GP though go to your MP and tell them this is happening.

doctors do overscan but reducing that means a change in medical culture & there will always be a clinical need to do scans (like in OP case) which is unpredictable day to day. I would be taking this further.

Sorry typed a reply earlier and lost it...
Squiggly - not pregnant a scan for a clot in my leg..
And in Scotland - not England
Glad it isn't just me that sees this as flawed logic -with the potential of costing the NHS more in the long run...
I think I will put something in writing ...it is madness.
And I should have just gone to A&E - but was hoping that someone would say if its a trapped nerve or something try this stretch etc to get rid of the pain.
If it wasn't sore I wouldn't be worried about the swelling - that leg is the one I had a big clot in years ago and is a bit dodgy -plus it didn't swell at all until my DVT was massive -so unexplained pain is a bigger concern than swelling if that make sense.
(I was going to write a thank you to that haematologist - it must have been a lot of hassle and work to get my notes together - but I think he died suddenly a year or so ago )

I'm not sure I fully follow all of this.

If the sonographer and ultra sound machine were both sitting around doing nothing this afternoon then yes it would be crazy to ask you to come back on Monday for the scan to be carried out.

However, it is more likely that the clinic was already fully booked.

I'm not sure going to a&e would have necessarily helped. At my local hospital dvt scans are booked centrally from the same diary, so you won't necessarily have got a sooner appointment going down that route.

Squiggly if it had been her baby it would likely have been worse. I presented at out of hours with a threatened miscarriage on a Tuesday and was offered a scan to see if the baby was alive - the following Monday lunchtime.

OP sorry you are going through this worry. Will the injections sort you out for now?

There are limited resources in the NHS, in terms of people, time, machines etc, so unfortunately people do sometimes have to wait.

If it is a DVT, then you are on appropriate treatment (although you would need switched to warfarin at some point) but it is safe and appropriate treatment of a DVT, although I can definitely appreciate your concerns about the scan being inconclusive by Monday.

Going to A&E wouldn't have made any difference though, so you did the right thing by calling the OOH GP. You simply would have been started on Fragmin and booked in to this afternoon's clinic.

It might be helpful speaking to PALS. Part of the problem with understaffing/funding in the NHS is that often patients grumble about it to other people or to their doctors, but don't complain, so when we as doctors say, "Patients are waiting inappropriately", the managers say, "But they are not complaining about it." Mention that you saw a nice doctor and that your complaint isn't about her, but about the systems that she is forced to work with.

Squigglysquid did you even read the OP?

Dino - I have had lots of scans for DVTS in the past - but not for a good few years (I'm more laid back now - hopefully not a false sense of security?) Gone to A&E, quick scan and off (apart from that Easter)
First DVT I got diagnosed (20yrs ago) went to A&E and scanned straight away . My leg hardly swelled but clot was from my calf well into my inferior vena cava - I nearly died anyway. It was still growing at first on a standard dose heparin drip ...they were giving me daily scans - once twice daily. I think if I had waited 3 days for that scan I'd definitely have died...
But basically you are saying that even though we should have more trained staff, the machines should be cheaper etc as technology ahs improved - patients have less access now?
Anyway I think it is a false economy - if that scan is inconclusive they will have to treat me as if I had a clot...Warfarin for 6 months at least (actually with my history it will be for life), with all the resulting blood tests, nurses time etc etc - a whole range of blood clotting tests , consultants time etc etc - and all maybe not needed!

As to no space left that day - this hospital doctor (GP OOH had sent me one to acute Medical Unit at hospital) was already at least 5 slots behind ... days worth - maybe they need to increase capacity - short term expense that may result in longer term savings ?

An update - it is a small clot ...
Not fully blocking the vein and might even be scarring from my previous one ..and of course it should have dissolved quite a bit since last thurs ....
And it was different doctor -unit was very very busy everyone had to wait a long time ...I watched him reading the mess of my notes for at least 5 mins, speaking to me, reading my notes again, conferring with another doctor, speaking to me again ....all repeating what happened last week - a waste of everyone's time..
Now I'm back again tomorrow whilst they get a haemotologist and the anticoagulation nurses to speak to me (both had gone home by then... ) - and of course it will yet another doctor I see...

Sorry to hear that another clot is confirmed. Hope things go well tomorrow.

Its fairly common.

Working in a hospital I'd say it normally takes about 5 days for people to get a scan slot. Not due to slot quotas as such. But just that the slots are booked up.

As the anti coagulation injections are the correct treatment for if you did have a clot its argued that it doesn't matter how long you wait for the scan as you're having the treatment. Though I get you're point about how the treatment might have dissolved the clot and then you don't get an accurate picture of what happened.

charley a long story but I didn't handle being told I had a life long condition very well - desperate to get away from the consultant, off warfarin etc...(I was early 20s).
When I relocated my notes were 'lost' (took 4-5 phone calls to find my GP notes - and one lot of hospital notes were found - after repeated requests from this hospital over 8 yrs were ignored - after I paid £50 to get them) - Before it was really only what I said -and I test negative for APS now...but I always knew at some point with risk of DVT increasing with age it was likely I would have problems.
(And my original consultant made it really clear that even though the big one was after multiple risk factors it was very likely in the 6 months before I'd had several that I'd ignored or had been misdiagnosed... including a PE)
I insisted on setting up an appointment with a haemotologist today - rather than wait for my GP to refer me etc...just in case this is the start of something (APS has 'come back' )... and cos someone needs to take the time and look back over my scans and see if this is a new thing or not... and I doubt the overworked doctors in the Acute medical unit would have time.
I'm on aspirin as well anyway - so fighting clots from two angles...fingers crossed this is just old damage ...
And for you - know living in the shadow of something potentially suddenly fatal is really bloody hard...

I am a doctor and have never heard of this in any hospital. If someone needs a scan, especially for a dvt, they get one.

You've never heard of running out of scanning slots on a Friday afternoon and having to wait until the next working day to get a scan?!

I'd love to work where you work!

A work colleague of DM has liver cancer and is 22 weeks pregnant, she's only ever had 2 scans and no antenatal appointments.

Someone is cutting something somewhere.

I'd wonder if you are getting the whole story there.

Even in low risk mothers, you get antenatal appointments at booking (around 8-10 weeks), then at 16 weeks, with scans at 12 and 20 weeks.

I would have thought that her oncologists would be very closely involved as well.

I think the issue is the negative d dimer.

Yes I have heard of slots running out, but not of each doctor having a quota of two scans each, as the op puts it.

If it wasn't for all those people faking 'abdo pain' and lining up for scans so they get a week off work , the resources would be there for those who need them urgently.

Stone that is definitely what I was told.
And as a doctor - please don't trust a negative d-dimer!
(I'm glad this doctor didn't - she said with my history it wasn't reliable - and I already kind of knew that...)
I haven't been feeling 'well' for a few months and this leg (my dodgy one) has definitely been playing up - been limping a bit and I haven't for a few years. I thought it was longer ago -but checked it was only the beginning of June I went to GP cos it was achy -not really sore or swollen though and I thought I was over reacting. She did a D-dimer to put my mind at rest - negative - now I'm wondering if it was the same thing...and the sleeping funny just caused it to be sore ...

Also I had a look at the APS forum - someone else with a clot and a negative d-dimer - first 4 replies were people who had the same problem...way above what you'd expect statistically - something to be aware of ...