AIBU to think this is a crazy reason to go to A&E?

[JemimaPyjamas]

Bit of background; I am a (well controlled, no history of complications) Type 1 diabetic. I have had it for 40+ years and the medical assistance I have ever needed is minimal, and I have been at the same GP practice for 14 years.

I am not sure how, but I got a splinter in the end of my big toe. Not a massive splinter, or anything remotely dramatic, but it was hard to see the area where it was. I think I removed it, pretty sure, but the area was sore - probably as it's a very sensitive place - so I called the GP, apologetically, to ask if there was any chance someone could have a quick check to make sure it was okay. (I didn't have anyone else to ask, hence me pestering the GP which did seem like semi overkill in itself.)

I was told they'd call back and then got told that 'nobody at the surgery is prepared to check a wound of that nature in a diabetic and we have been told to tell you you need to go to A&E.' I reiterated that it was a double check, for something the size of a very small papercut, and it was purely precautionary rather than necessary.

I got the same reply.

Needless to say, I have not gone to A&E during a pandemic so someone could double check a splinter had gone from my toe. I have instead soaked it, felt it and double checked it and it seems fine.

AIBU to think the (quite large) surgery was bonkers...? Or

I'm a podiatrist working in the NHS and I've seen sepsis, bone infections and amputations occur because of a splinter in long term diabetics. I cannot understand why your GP didn't refer you to NHS podiatry as a 24 hour emergency.
That's what they do here.

The thing that most people don't realise is that injuries that cause most people no harm at all, in diabetics can develop into quite serious infections very quickly, especially in the feet. I had a dirty old fractured wood splinter go right down into my fingernail edge. I went to a pharmacy who advised a 'drawing' paste, and suggested long hot soaks

@marmaladehound many years ago when I worked in A&E we’d often get people attending hoping for prescription medication, hoping they’d get it for free as it was hospital rather than a pharmacy. They got a shock when asked to pony up for their prescription charges!

@marmaladehound

I used to be an ED middle grade (admittedly a decade and a half ago) and we didn't used to charge for medication back then.

We had a big cupboard that had some antibiotics in it but most of the space was taken by box after box of Kapake (co-codamol 30/500) and it really felt like we handed them out like sweets.

Thankfully things have tightened up hugely since then!

Sorry I don't have any experience of diabetes but just as a side - magnesium sulphate paste is amazing for drawing them out.

I'm a dog groomer and get little hairs stuck in like splinters all the time and I pop some of that paste on with a plaster over the top and it draws it out on to the plaster

I called 111 on a weekend couple years ago as my autistic son had a temp of 38.9. I figured he needed to see an out of hours doctor as he will not take any medicine. His brother used to be prescribed paracetamol suppositories so I thought maybe doctor would give him them. Not pleasant but it would help bring temp down. Rather than out of hours as he had the temp more than 24 hours(which was why I felt needed a gp as normally it would have reduced itself slightly but he was fine in his self) the told me if we didn't get a call in 30bminutes expect an ambulance. Well less than 10 minutes later we had a first responder and ambulance at the door. Total over kill. If he just took some bloody calpol all would have been avoided.

letsall it's a diabetic foot emergency.

marmalade the practice nurse can't 'easily' check anything if her clinics are already full. People seem to assume you can just ring up and pop in.

@FortniteBoysMum

111 is shit no doubt because the NHS Pathways system that it uses is risk averse (it has to be) and 111 front line operators are not medically trained and, in general, have to follow the protocol.

But FFS if you know your son can't take oral paracetamol it is YOUR responsibility as a parent to have an appropriate anti pyretic available. Kids get temperatures from time to time, it's predictable.

I imagine that you'd have been better prepared if the out of hours call was priced at £100-£200, but it's free at the point of ab(use) and so people don't bother.

I've genuinely come to thinking that this country isn't responsible enough for a free at the point of use healthcare system.

@FortniteBoysMum

I called 111 on a weekend couple years ago as my autistic son had a temp of 38.9. I figured he needed to see an out of hours doctor as he will not take any medicine. His brother used to be prescribed paracetamol suppositories so I thought maybe doctor would give him them. Not pleasant but it would help bring temp down. Rather than out of hours as he had the temp more than 24 hours(which was why I felt needed a gp as normally it would have reduced itself slightly but he was fine in his self) the told me if we didn't get a call in 30bminutes expect an ambulance. Well less than 10 minutes later we had a first responder and ambulance at the door. Total over kill. If he just took some bloody calpol all would have been avoided.

That paracetamol suppository can be bought from a pharmacist. It may be worth keeping some at home for the future.

myriad leg ulcers are the remit of the district nurse here. They run clinics for patients able to attend and visit those housebound.
You're right, it is a game of pass the parcel. But in this instance OP has access to an emergency podiatry service who is exactly who she could be contacting. The podiatrist up thread said as much.
Jemima and in a nine hour working day with a 30 minute break, a 'quick glance' at your toe would in reality eat into at least 10minutes of that break, not only the consultation but the subsequent documentation needed to cover myself in case anything went wrong. You're an extra. Add to that the urgent bloods, ECG's the GP's want squeezing in, other 'walk ins' etc and I could then easily work a full day without no break at all.

@OnTheBoardwalk

As part of your yearly diabetes check you should have been given a foot advisory leaflet giving contact details if you have issues with your feet. We’re you not given this?

I am type 1 diabetic and I have, in about 16 years, NEVER been given one of these.

I'm a type 1 diabetic and foot wounds are a worry. If you've kept it clean, there's no redness and it's not sore I'd just keep a very careful eye on it for several days.

Might be an idea to wear socks with trainers for a few days to prevent any dirt getting in.

The last thing you want is a serious toe/foot wound and unfortunately all diabetics know that this is how it starts - unless you're careful to look after yourself.

I've never had a leaflet either. I do get foot checks when I get my almost annual review.

@Tupperwarelid

As a type 1 diabetic I haven’t had a face to face appointment with my consultant or nurse since March 2020 (just before lockdown started). It’s all been by phone so no-one has checked my feet since then. I would go to A walk-in clinic/urgent care/ a&e to be on the safe side. I’ve found whenever I’ve rung 111 or gone to the pharmacy as soon as you say you are diabetic they won’t touch you with a barge pole!

This is my experience too. I have found my blood sugar really hard to control, the stress of the pandemic,WFH, a child with SEN, it has been a lot.

I have been crying out for help and the only person who has seen me face-to-face is the GP practice nurse. To be fair, she was lovely.

I have finally turned a corner, but, it still feels like I am such shaky ground.

Yes, we've been seeing diabetics all the way through. The hospital haven't. They've pushed them back to us.

Bloody disgusting referring people to A&E, currently this service is on its knees due to mental health situations and dementia cases being referred to A&E. Its a dire problem.

My GP would refer that to the foot clinic as a 24hr emergency referral, I play rugby, foot injuries are part of it, I have always been referred, even if I have only phoned the GP.

Is the surgery normally good, or have they fallen short before?

@IncessantNameChanger

My mums surgery have told her they are no longer seeing people face to face so she had to go to A&E for a sore leg. The world has gone mad.

My surgery's E-Consult system (that you have to use to get a telephone appointment) (no f2f ones) appears to be on the default setting of 'Call 111' or 'Call 999'.

Not my council but this is the same leaflet that’s given out by them at the yearly diabetic foot check. The actual contact details would be filled in obviously

Interestingly is does say if no one available go to walk-in clinic or A&E but only after trying the GP and the podiatrist first

@cptartapp

marmalade the practice nurse can't 'easily' check anything if her clinics are already full. People seem to assume you can just ring up and pop in.

Hmmm no people ring up to make an appointment I believe?

[quote privateandnhsgp]@marmaladehound

I used to be an ED middle grade (admittedly a decade and a half ago) and we didn't used to charge for medication back then.

We had a big cupboard that had some antibiotics in it but most of the space was taken by box after box of Kapake (co-codamol 30/500) and it really felt like we handed them out like sweets.

Thankfully things have tightened up hugely since then![/quote]
Not sure where you are based? I have worked in 3 different EDs over the last 17 years. All have charged. Maybe the nurses just didn't bother with the charge? It's never been free and it can be a lot of hassle to get the patients to pay up!

@Shehasadiamondinthesky

I'm a podiatrist working in the NHS and I've seen sepsis, bone infections and amputations occur because of a splinter in long term diabetics. I cannot understand why your GP didn't refer you to NHS podiatry as a 24 hour emergency. That's what they do here.

I think podiatry services are a bit of a postcode lottery. Not great where I work nor where I live after big cuts have been made years ago.

Gosh, lots of replies!
Firstly, I am more than aware of the foot aspect of being diabetic. Hence, multiple stories about leg amputations following a splinter are unnecessary. I would’ve not managed 40+ years with no issues if I didn’t know what I was doing!

My point is, and I am still thinking this, that sending someone to A&E during a pandemic (there is no minor injuries unit) seems overkill. If it was infected, maybe, but was just to double check it was fine. This is why I, presumably naively, thought a nurse could quickly look.

Requesting ‘emergency podiatry referrals’ also seems like overkill (while possibly taking up a space for someone who genuinely needs urgent care), particularly without someone non-specialist looking first.

@SimonJT I think the surgery are normally ok, but I’m rarely there other than for annual diabetic stuff so I could be wrong 🤷‍♀️

@JemimaPyjamas wasn't aimed at yourself, just trying to make my job a bit easier as the majority of newly diagnosed diabetics that I talk to on a daily basis have not been given this info.