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.

@Daisymae15

DH is on the phone to the home now. Just to say all the residents have a DNR in place.

A DNR does not mean not treating at all for goodness sake. It's about attempting CPR if her heart stops, or what level of treatment is appropriate at the end of life. Not neglecting to get someone with a possible injury appropriate help and analgesia. My friend is in a nursing home and I would be furious if he was left like this.

@Yellowmellow2

the difference here is that she has not been seen by a paramedic and been checked , I am sure if she had the OP would feel a bit better about it . Not all 92 year olds are the same .

@LemonRoses

I’m curious as to what treatment people would want the poor woman to have? Surgery for a partially blocked carotid and a stay in a HDU unit? Anti hypertensives that increase her risk of falls?

What treatment are people thinking she might benefit from?

You don’t need to go to hospital for pain killers or good nursing care. You are safer in your usual home. People in nursing homes have a typical life expectancy of under two years from admission. They are approaching life’s end and recognition of this allows for proper holistic palliative care.

She has full mental capacity, she had a mini stroke and fall.

I’d expect her to have assessment to check for the severity of the stroke, possibly change of meds ie anticoagulants, have her head injury checked and check for fractures.

@frumpety

Absolutely. You don’t need an ambulance to get pain relief though

So at 22.15 at night , where is the best place to get pain relief for this lady ?

You get 111 to get a prescription to the late pharmacy, but you do it before 22.15 given she’s been uncomfortable all day. The NHS pharmacy search tells you where to get prescriptions out of hours,

[quote WeatherwaxLives]Why do all the residents have a DNR?!

Is this from earlier in covid when elderly and disabled people in care were subject to blanket DNRs?

Obviously if MIL has chosen to have a DNR then that's her right, but if she hasn't consented to it then it's absolutely not OK.

I find it unlikely that every single resident has independently consented to a DNR.

www.google.com/amp/s/amp.theguardian.com/world/2020/oct/12/inquiry-begins-into-blanket-use-in-england-of-covid-do-not-resuscitate-orders[/quote]
My thoughts exactly!

The home is absolutely at fault , how can they diagnose a minor stroke ? It could be all sorts of other things but ultimately she should have at least been assessed by paramedics or hospital staff

Sounds barbaric that you have to have a DNR in place to go into a nursing home .

having a DNR as a condition for entering the home well words fail me

Why? It is best to have these discussions sooner, and if it’s a condition of the home everyone will know not to rescusitate, and there’ll be no delay or treatment against a persons best interest.

If someone is well enough that resuscitation may be worth attempting, then they probably should be a different care facility.

My mum has had a DNR in place since I can remember. She’s an ex nurse, completely fit and well apart from the odd niggles that come with being 83. She sees the GP and her health is taken care of, but she absolutely does not want CPR, ventilators or other extreme measures.

We all know her wishes, fill her full of drugs and let nature take it’s course as peacefully as possible. She’s even made sure GP has a copy and contacted ambulance/emergency services so they know not to attempt it too.

People are too fearful of DNR’s. They’re a good thing.

Sounds barbaric that they have to have a DNR in place to go into a nursing home .

Home sounds utterly negligent.

My elderly aunt, had a fall - the staff knew as they had to help her up. She complained of sore neck... Some unqualified carers decided she had pulled muscle... . This carried on for SIX bloody months... She moved homes... It seemed she'd actually broken a vertebra... .

Leaving your elderly Mil in this much distress is unethical.

Hope the ambulance has arrived and they're treating her in situ or at hosp

@LemonRoses no, the lady had a suspected stroke, and she fell and banged her head. She’s is in pain and she needs to be checked properly.
It’s inhumane to leave her in pain like that.
While the elderly might be safer at the nursing home as opposed to waiting on a trolley for hours in hospital, waiting in bed for your death, in pain, is not a dignified end of life that you speak of.
Terrible.

Absolutely shocking lack of care by the home - if they suspected a stroke (they cannot diagnose one - ludicrous of them to say she's had a TIA without her being examined in hospital) they should have called an ambulance.

She had a fall and is in pain - again they should have called an ambulance.

Your husband needs to have strong words with the care home manager and report them to the CQC - they have failed her, DNR does not mean do not treat.

Appalling. Don't blame the GP.

No you should blame the GP too. You cannot possibly diagnose a stroke over the phone.

Both the home and the GP are at fault.

I’d be more upset with the home for not calling an ambulance and taking her to hospital. She’s had a stroke, mini or not, and a fall and can not lie down to go to sleep as she is in too much pain. The poor lady needs a hospital by the sound of it, not a GP.

The nursing home have the duty of care here. They need to be contacting the medical professionals.
Strokes and falls for the elderly are typically paramedic cases.
The relative is in a ‘Nursing’ home.
Why would a GP choose to or be able to enter a self isolating nursing home? This would put all of his/ her other patients at risk and could mean he/she would need to self isolate.

My grandmother was in a nursing home for the last few months of her life due to heart failure and a number of falls. A relative visited one day and found her slumped in her chair and her legs seeping with fluid creating a puddle on the floor in a semi conscious state. Normally she would be bright, alert and found doing a crossword and took pride in her appearance. The nursing home refused to call an ambulance saying it was to be expected with her age. With pressure the staff member eventually made the call but downplayed the situation when screening questions were asked. My relative then rang an ambulance herself and my grandmother was admitted and died in hospital the next day. We made formal complaints about the home and the GP surgery. There was a catalogue of missed opportunities to provide adequate care. The last few times the GP was called/had routine visits they were cancelled or medication changes were made over the phone without actually seeing her despite her deteriorating health. There was an enquiry and changes to policy and procedures were made as a result. My advice would be take matters into your own hands if you feel this is necessary.

Nobody is suggesting leaving her in pain. Of course her pain should be treated.

She had a TIA for which aspirin is probably appropriate at her age. I’m not her clinician so cannot guess as what her ReSPECT form looks like and what the decision is about limits of care and treatment. I’d hazard a guess it’s not MRI, or surgery though.

You can be checked properly in a nursing home. Probably as well as by an FY2 in a busy Emergency Department. Any half competent nurse can check for signs of a head injury that required transfer - a neck of femur fracture would be more likely and that would certainly require transfer but there is no suggestion of that.

Being an old person held in an ambulance for three hours, being lumped around onto a trolley, lying around in a hospital gown, hungry, frightened, alone is not a kind way to appease the fears of relatives. It’s rarely in the best interests of a 92 year old whose fallen but not sustained significant injuries.

Of course she should have pain relief and be made comfortable. But that should be within the familiarity of her home, with staff she knows and who understand her needs.

That’s not waiting for your death (a tad over dramatic) it’s planned care and treatment that acknowledges the futility and detrimental effect of many interventions. Sometimes less is more. Sometimes it’s about the fear of doing nothing that means elderly people suffer iatrogenic effects of unnecessary hospitalisation.

@TatianaBis

No you should blame the GP too. You cannot possibly diagnose a stroke over the phone.

Both the home and the GP are at fault.

It doesn't even sound like the GP diagnosed a TIA over the phone - just the home. Also as another GP has pointed out upthread - if the home hasn't heard from the GP, likely the message hasn't got to them. And they won't attend anyway - the home has a Covid case and, again, this isn't for a GP to attend regardless.

@LemonRoses You mention painkillers and the OP's MIL being made comfortable without the need to be seen in hospital/by a GP - this is clearly not happening on either count. It's negligent.

@Daisymae15

DH has persuaded the home to call for an ambulance after a lot of pressing from him. They are going to call him when it gets to the home. Re the DNR all the residents do have one in place. It was a condition to get in the home last April. This was told to Mil as she has full mental capacity. We both have POA for health in place. They only have one registered nurse for each shift otherwise it's HCAs. This home has 60 patients. Regarding registrating for another surgery. 5 homes in town and 5 surgeries so it was decided that each surgery would take all patients in one home. This is something that happened from covid.

No, this is due to failures in the home your MIL is in. My DIL is a nurse who works on a team providing care to homes across the city we live in. She does not need to seek permission from a GP to call an ambulance or have residents admitted to hospital. If the nurses caring from your MIL haven't done this then they have massively failed in their duty of care.

[quote VaccineSticker]@Daisymae15 why do they have a DNR in place? Honestly I’m in absolute and utter shock![/quote]
How many times have you performed successful CPR on a patient in their 90s?

Please get pushy with the home or get her moved.

My MIL had a TIA which we diagnosed over the phone from 200 miles away as her speech changed so much (during lockdown when we weren’t allowed to visit). She then fell and DH ended up calling the ambulance as the home were reluctant to. Later on she was declining rapidly and the GP decided on an end of life care plan having seen her once through a closed window from outside! We weren’t informed until we tracked down the home manager and they refused to tell us if she had been consulted on this. We had to threaten legal action so DH could see her before she died. He was allowed 3x30 mins visits in the final 10 days of her life and he wasn’t allowed in on the day she actually died as it wasn’t convenient for them being the weekend. There was no ”care” in the care home’s actions and she died alone.

Its a very difficult subject but I do urge families to have a think about what @LemonRoses is saying. When a patient in a nursing home becomes unwell they are often brought through A&E and then to an assessment unit after a long wait. They have to have multiple examinations with full lights on, blood tests, double cannulas so we can put 3 types of antibiotics 4x a day through, IV fluids, oxygen, catheter which is monitored hourly, observations every hour if they are really poorly. We have to weigh them and slide them from trolley to bed multiple times throughout the admission process using a hard board through x rays and CT scans. Then often the next day it is decided that they will not recover from their illness and we have a mad rush to try and get them home including 2 x negative PCRs and more ambulance transfers and sadly very very few people in that situation make it home. If your parent has multiple comorbidities have the conversation with them prior to an event like this happening to know what they would want. I made sure my Grandfather had all the 'just in case' medications prescribed and ready to go as he had severe COPD and everytime he had an exacerbation his vital signs would necessitate a clinical emergency so the home would want to contact an ambulance but we wanted it managed where he felt safe and comfortable and I didn't want him taken through the hospital. It was not in any way the best option for him.

No one except the residents family and doctors or nurses and the carers would know if a dnr was in place or not they are not allowed to be told to anyone except who I mentioned and there not written anywhere public can see this. I worked in a care home and I knew through the residents care plans who had a dnr in place.

Please do not rely on the care home to do the right thing regarding phoning an ambulance. My husband had a call about my dad whilst he was in a home "just to let us know" that he had what they suspected at the time was pneumonia and they were going to make him comfortable but weren't going to treat him for it just pain relief. That sounds unbelievable now just writing those words. Of course we insisted an ambulance was called and met him at the hospital. He was very very sick with aspiration septicaemia and was given days to live. He actually managed to fight it off but died still, he had vascular dementia and his body shut down.

When dealing with care homes do not ever assume they will make the right decisions. Sadly underpaid inexperienced people are left with too much responsibility. I have many horror stories from my experiences . I really hope your mil can get well. Really scary to see such a dramatic change.