To ask to speak to a doctor ?

[3smallpups]

Not in an aggressive way , just does it seem like a reasonable request ?
my brother has been admitted to hospital with what is clearly alcohol related liver disease. He is in no fit state to advocate for himself , rambling and barely conscious . Having been there for several hours today , there was no sign of a doctor on the ward at all. The head nurse was able to answer some questions but only to say that his bloods were all over the place and he’s waiting for a scan.
i have a medical background and it’s pretty obvious what the diagnosis is, without the scan and I know that there’s lab work that can be done to establish prognosis etc, which hasn’t been done .
i know that basically the only chance of a positive outcome is steroids started early , but I feel they aren’t going to do anything till they have done a scan ( likely not to happen over a bank holiday weekend ) and it will all be too late.
if this was my husband , I’d be laying in the corridor until they found me a doctor to speak to , it’s that important . But I sort of feel
as it’s my brother , I don’t have the authority? But I am his next of kin, our parents are dead and he is divorced .
actually just writing this out makes me realise that I need to stand up for him.

Is he having obs done? Has he been written up for a drip for dehydration?

My alcoholic relative was in AMU for days, waiting for a bed on gastro, didn't make it onto a ward before they then developed pneumonia and went up to ICU on oxygen. Under 60 years old.

They go downhill so fast.

Have you spoken to the on-call hospital manager?

i think context is important as is quality of life. Some alcoholics are stabilised through meds only to life a life of misery and poverty along with humiliation.

However, it sounds like your brother has a life worth fighting for. Apologies if I sounded callous and wish him and you the best of luck in getting through this. And yes, don’t be scared to push the docs, sometimes they need it.

Email now to: CEO, Trust Clinical Director and copied to your MP. That will get things moving. A grunt will be checking the inboxes even at weekends/bank holidays.

It's a fucking disgrace.

Meanwhile, ask the ward sister to record in the notes that you are concerned that the seriousness of his condition is not being dealt with, that you have requested appropriate clinical intervention and specialost review and no action has been taken.

Wind em up and watch em go. It shouldn't have to be necessary but it is.

The nurses could escalate up their own management chain to a more senior nurse in the hospital. Have they not done this?

Oh op, I could cry for you and your brother. I know how desperate it feels to see someone deteriorating in front of your eyes, with no-one seemingly trying to do anything about it. You feel so helpless, and it must be even worse if you have a fair idea of what’s going on, and are aware of things the medical staff could be trying. Information about Martha’s Rule states:

If your concerns are not resolved, look for the Martha's Rule/Call 4 Concern posters or leaflets on the ward, which will provide a dedicated 24/7 phone number or point of contact.

I’ve just googled the Martha’s Rule contact number for my local hospital, so you should be able to do the same for the hospital your brother’s in. Request a rapid review of your brother’s case. I really hope that you get listened to soon by someone who can do something about his awful situation.

However, it sounds like your brother has a life worth fighting for.

Everyone’s life is worth fighting for.

I’ve been looking and googling for Martha rule here . It says the trust was one of the first to sign up , but nothing re phone or email contact . Seems you have to do it through the medical staff .

Agreed. Everyone has the same human rights.

It seems that a large part of the NHS closes over the weekend, especially a Bank holiday one. When my husband was chronically ill following a heart attack we were certainly led to believe there was one doctor covering the hospital. I hope you manage to get some help for your brother. At least he has you to advocate for him.

Hoping this might be of help -

To invoke Martha's Rule in the NHS, follow these steps: 1]
Speak to the ward team: First, raise your concerns with the nurse, doctor, or ward manager currently caring for you or your loved one.
Contact the rapid review team: If your concerns are not addressed, call the hospital’s dedicated critical care outreach team (often called 'Call 4 Concern') for an independent second opinion.
Every NHS acute trust has a dedicated contact number for this, which is displayed on ward posters and leaflets. Ask your ward nurse or check the NHS Martha's Rule Information for details.

You can ring switchboard and ask to be put through to outreach either on their phone or bleep

Would you be prepared to say which hospital? Someone might be able to help you track down the right number.

marthas law should be accessible directly (a key point is that you don’t have to access via the medical/nursing teams) I hope you get somewhere soon 😢 phone switchboard if not

Hi OP, sorry I didn’t want to read and run.

My experience is slightly different as I have 0 medical background and no idea what more I could have done in hindsight. I received a call that my estranged relative was in hospital on a Thursday, went up to see them on the Friday. He was in the exact same way (also an alcoholic for many years) but their primary concern was end stage cancer. I never saw the same nurse / doctor the entire weekend I was there and he too couldn’t eat or drink, also just left there with unopened food on the table. I kept asking for the doctor and after two days of pressing they finally sent someone on the Sunday who gave me maybe 2 minutes of his time, told me exactly what all the nurses etc were telling me. He told me there are no doctors in over the weekend and that he was basically covering across departments until they’re back on the Monday. Monday came, spoke to the registrar and palliative care as well as SALT referrals were made. But the gist I got was that you’re getting no answers over the weekend as the doctors that are actually looking after your relatives aren’t there and nobody wants to speak on their behalf.

There will be a Consultant on call. The Registrar on duty may be reluctant to call them (on a sunny bank holiday) but they have to.
Unfortunately you may have to raise the risk of them not doing anything by documenting and being clear you are documenting everything, so if there is an ‘unexpected death’ you can take ‘appropriate legal action’. It sounds unfair and difficult but may be the only way to get people moving.
(yes, I work in the NHS)

In our Trust a Consultant in virtually every specialty has to be physically present in the hospital 7 days a week. There’s definitely a Gastro Consultant in, they do have two hospitals to cover here, so it’s the morning in one, then over to other for the afternoon.

Having lost someone to alcohol related liver disease they should be giving him detox drugs to stop him having withdrawal seizures, pabrinex infusions to prevent Wernickes encephalopathy & trying to feed him up. If he has ascites they may consider doing drains & he would need albumin infusions.

@darksideofthetoon my late db was a functioning alcoholic, owned his own home etc and I think the negligence of our gp contributed to his death at the age of 57. Dm has had the MP involved and lots of meetings with the surgery so we hope others are given the right treatment regardless of their other issues. Db didn't want to die!

When ds was very ill a couple of years ago dd1 insisted I asked for an urgent review by a doctor as she was concerned the sepsis pathway was not being followed. After multiple requests the doctor came, was absolutely horrified with ds's condition and treatment and actually put a treatment plan in operation.

According to the nurses there is no chance of getting a consultant tonight ( bear in mind I started asking at 4 pm )
the junior doctor gave them permission to put him on fluids and they promise me that he is on the list to be seen at some point tonight , and that a consultant of some speciality will be present in the hospital tomorrow .
I’ve left a letter for the junior doctor , explaining my concerns and what needs to be done and that I will escalate the case if needed .
ive also emailed the patient experience email
I just want documentation now so if I do have to have more of a fight , they might feel held to account .

Why was he admitted to hospital, patients can have treatment without a scan. Have they got a diagnosis yet.

Doctors don't give permission to nurses to put fluids up, they are supposed to review the patient, look at obs, check-if they need bloods, fluids, medication then review again or at least act on any abnormal findings.

Please write a detailed timeline of every conversation and concern you've had, including anything you remember about his condition at each point. This is really concerning and it's sounds like he is being dreadfully let down. It's not the nurses fault per se, but they also have a responsibility to pass on any necessary information to the doctors about their patients and that may not be happening properly here (it also may be but the doctors just aren't prioritising it, it all depends on what info is being relayed about his state).

I would ask the nurses to be documenting your exact concerns and request to speak to a doctor every single time so that it is appearing in his record.

The hospital has to do the tests to prove and admit treatment. You're able to provide information and request but they can't go off word of mouth. Hopefully they will listen to you, check his history and be able to do as you advise. Xx

Its not just about a discussion with a relative, if he's clearly deteriorating and is becoming drowsy then he needs an urgent review. It's usually the nurses who hopefully notice, escalate to the doctor and monitor the patient, if youre lucky they will contact the outreach team if the doctors are busy .