Disgusted with the GP.

[Daisymae15]

This is not a bashing the NHS thread we are so angry with the GP.

My Mil 92 is in a nursing home last Thursday she had a minor stroke the home called the GP and all she has done is send aspirin, wouldn't visit.
Yesterday she had a fall, banged her head, shoulder and back. Not injured enough to call an ambulance.
The GP was called yesterday and was supposed to phone, as of 7pm tonight she still hasn't rung. When WE phoned the surgery told that she is on the list to be called.
The home are frustrated at not being able to give anything stronger than paracetamol. We are frustrated because of covid we are not allowed to visit.
(Someone tested positive on Saturday so they have gone back in lockdown)
We feel as though the GP is hoping she dies so she doesn't need to bother. DH has spoken to the home and they have said that they are worried about her, she is in a lot of pain, very depressed and not even got dressed today. Last night she slept in a chair as she couldn't lie down.

As I have said I'm not bashing the NHS as in the last year I have had breast cancer and my treatment has been first class.(Not under the same surgery)
We can't change surgeries as each home in town has an allocated practice.

Is covid to blame or is it possible that she is a shit GP.

She wasnt on aspirin before the ?Tia, it may not have been a Tia, the doctor didnt see her, they are only going on what the nurse described. It could be a slow bleed , the symptoms may not have resolved if she "fell" a few days later, she could have collapsed, she also suffered a head injury when she fell.

Fair enough, but the Dr put her on aspirin straight away and wouldn't there be continuing symptoms for an ongoing problem?

@DameFanny Aiui minor stroke and TIA are not actually the same thing. They've been used interchangeably including myself but they're not.

This lady does not have a diagnosis, she was not seen by a doctor.

A TIA/minor stroke needs to be assessed because there are different causes. And because they can be indicators, particularly in elderly, that a stroke could be on the way.

It's not true there's no treatment - it depends on the cause - if she has high BP or high cholesterol or diabetes her medication may need reviewing, she heart arryhthmia like atrial fibrillation she may need anticoagulants etc.

MIL may have fallen from a second minor stroke or from weakness or balance issues following the original one etc. The consequences of the first incident need assessing and potentially treating.

As she's in so much pain she can't lie down - her bones need to be scanned to look for fractures.

Oh absolutely she should have been assessed for pain relief purposes at the very least, but I would've thought if she had high blood pressure, cholesterol or blood sugar problems that would be picked up on regular assessments, no?

Residents in carehomes do not always have regular assessments, they might get a monthly bp reading from a nurse, blood tests are not always done routinely unless the nurses are concerned, some dont get a routine gp visit or medication review. Being in a carehome is very different to being in a hospital.

www.nhs.uk/conditions/transient-ischaemic-attack-tia/diagnosis/

@LemonRoses

If a ReSPECT form has determined the ceiling of care, an ambulance will most likely not transfer to hospital for most things. A home calling an ambulance to transport a frail elderly patient against a clinical decision isn’t acting in their best interests. They are not providing good care by so doing.

Most nursing home residents would be offered a natural and dignified death rather than a ham fisted resuscitation attempt and inappropriate transfer only to die on the journey or with strangers in a busy accident department. Resuscitation on a frail 90 year old is futile.

This absolutely. We should be ensuring our elderly population is treated with dignity. There’s nothing dignified about a very frail elderly person going through violent resuscitation which usually does not succeed, and if it does often leads to broken bones, stroke, brain damage and a very poor quality of life.

The poor woman has had a minor stroke and a fall, why would anyone be offering her 'a natural and dignified death' at this point? Resus is not an issue at this point.

If you want to treat elderly people with dignity then ensure appropriate medical treatment.

[quote TatianaBis]@LemonRoses a slapdash senior clinician apparently.[/quote]
Far from it. One that recognises we do not know many of the actual facts and that sometimes transfer is both unkind and unnecessary.

When you don’t know the actual facts transfer is necessary to establish them - eg broken bones. We know the GP doesn’t know them as they haven’t seen the patient.

@TatianaBis

When you don’t know the actual facts transfer is necessary to establish them - eg broken bones. We know the GP doesn’t know them as they haven’t seen the patient.

What nonsense - I meant neither you nor I know the facts and therefore should not sit in judgement. The care home staff will know the facts, the agreed plan of care and the person who is resident.

I can sit in judgement perfectly well thanks.

How can the care home staff know the facts of MIL’s condition with no medical training and the GP hasn’t seen her?

And agreed plan of care is irrelevant when dealing with a new incident.

@TatianaBis

I can sit in judgement perfectly well thanks.

How can the care home staff know the facts of MIL’s condition with no medical training and the GP hasn’t seen her?

And agreed plan of care is irrelevant when dealing with a new incident.

Probably better than someone who ‘knows some doctors’.

You are showing your lack of understanding. A care plan should include the agreed actions in events such as a fall, the criteria for transfer and what the ceiling of care is. That helps inform the decision about whether to move someone or not.

Nursing home staff should be able to differentiate between a minor bum and a subarachnoid haemorrhage and an injury suggestive of a more serious pathology that requires and would benefit from orthopaedic attention.

You’ve demonstrated a marked lack of understanding through the thread and your bizarre posts have run contrary to every medical professional who has bothered to post.

Nursing home staff cannot possibly diagnose a subarachnoid haemorrhage without medical testing, any more than doctors can. There aren’t many things of ‘more serious pathology’ brain aneurysms (one cause of the above type of haemorrhage) so that’s a really odd comment and ‘orthopaedic attention’ is non sequitur.

You’re clearly way out of your depth so I don’t know why you persist in posting.

@TatianaBis

You’ve demonstrated a marked lack of understanding through the thread and your bizarre posts have run contrary to every medical professional who has bothered to post.

Nursing home staff cannot possibly diagnose a subarachnoid haemorrhage without medical testing, any more than doctors can. There aren’t many things of ‘more serious pathology’ brain aneurysms (one cause of the above type of haemorrhage) so that’s a really odd comment and ‘orthopaedic attention’ is non sequitur.

You’re clearly way out of your depth so I don’t know why you persist in posting.

No obviously they cannot be certain a SAH is that without a scan. However, they can use their professional knowledge to ascertain there are no symptoms indicative of serious head injury. Not every bump needs a blue light to an emergency department, obviously. That would be both traumatic and wasteful.

I’m not out of my depth at all, but there are those who despite limited understanding have significant opinion (that goes very contrary to best practice) based on knowing a doctor.

It’s tiresome debating with the very ill informed, so let’s leave it there.

LemonRoses, you did say you were a senior clinician, if you are a medical doctor do you think you would have reviewed this lady yourself or arranged for a hospital admission after a nurse called about a possible Tia followed by a fall that caused so much pain she couldn't lay in bed. What happens now if this poor lady deteriorates and it is later discovered she had a cerebral bleed and fractures that no doctor had actually seen.

The best practice, as evidenced by the posts of medical professionals on this thread, has contradicted everything you have said.

Equally, with elderly relatives in good care homes who have had minor strokes and falls themselves, I note the contrast of their treatment with that of MIL’s care home and your subpar theorising.

This is awful. She may have a broken bone. It's not normal that after a fall someone can't get into bed.

No it's not normal, plus the elderly can be much more fragile and prone to fractures, I always think what would I do if this was my relative. I also consider am I happy and confident to justify my action or inaction if there is an inquest, complaint or investigation. I hope OP mil is ok.

@FleasInMyKnees

LemonRoses, you did say you were a senior clinician, if you are a medical doctor do you think you would have reviewed this lady yourself or arranged for a hospital admission after a nurse called about a possible Tia followed by a fall that caused so much pain she couldn't lay in bed. What happens now if this poor lady deteriorates and it is later discovered she had a cerebral bleed and fractures that no doctor had actually seen.

My actions would be informed by the care plan, my knowledge of the patient and the knowledge of the home staff. It wouldn’t be a hearsay judgement.

Nobody actually knows the facts or even an accurate assessment of symptoms. One would want a conversation, but transfer is not likely to be in her best interests if the symptoms suggest a TIA or less and a soft tissue injury.

What one doesn’t want for a 92 year old is an unnecessary but physically and emotionally traumatic transfer, for assessment by an FY2 and sitting around in an ED for hours for no good reason.

[quote TatianaBis]@FleshInMyKnees Of course she’s not a medical doctor, she can’t be a nurse either given her poor grasp of pathology. Perhaps she works in a beauty clinic.[/quote]
Bless. No, no beauty clinics. Plenty of friends who are clinicians just like you......... plus professional registration and significant experience/qualifications and understanding of the needs of the frail elderly. Very good knowledge of the pathology of ageing and current best practice in gerontology and end of life care. Lets not split hairs though. Clearly you think your personal opinion based on very limited knowledge trumps all.

You’re very rude when someone is better informed than you, aren’t you?

But what if its not a soft tissue injury, how would you know what was causing the pain and you later discover it is a fracture. How would you feel if that is the case.

Are you a doctor LemonRoses

and understanding of the needs of the frail elderly

Which is precisely what you demonstrably lack. You seem to think they all need to be on end of life pathways. I reckon you’ve got an NVQ in elderly haircare.