Hospital/doctor or what?

After reading this thread I'm not surprised the Nhs is in the state that it is and lots of staff are at the end of their tether...

Bx

(Who has just got in from a 12 hour shift in a and e and still thinks a and e is the place for an 'accident '...)
 
Illusion100 said:
I'm confused, are you saying I should have, (in my # pelvis scenario and in pain no longer bearable after 5 weeks of painkillers//anti-inflams), called GP practice and waited for an appointment? Then be referred again to a department that could perform x-rays? To diagnose a # and bed rest?
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Yes. As I did when I fractured my hip (minimal fracture) 5 weeks ago. You don't wait weeks for an appointment - they give you an urgent referral and you get seen that day. In my case they didn't even want to see me, they took the referral over the telephone. It saves waiting around on uncomfortable chairs with all the drunks...

Or a minor injuries unit of course.

Bitznbobz - I'm still on my night shift - getting pretty tired of samples coming to the lab with clinical details 'generally unwell' :(
 
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blitznbobs said:
After reading this thread I'm not surprised the Nhs is in the state that it is and lots of staff are at the end of their tether...

Bx

(Who has just got in from a 12 hour shift in a and e and still thinks a and e is the place for an 'accident '...)
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Maybe time to think of re naming the A + E Dept. Perhaps that's why people are getting confused.. I'm a Dr's receptionist, and I often get people saying to me that they will go to A+E if they don't get precisely what they want, when they want. Oh and that's after a Dr has spoken to them, not the "Oily Rag who knows nothing" :) . That's why its frustrating when you have people saying do whats most convenient, some people want a private service but through the NHS. Don't get me wrong, I am very sympathetic to those who are truely ill or injured., and not everything is black and white. I think we have lost the ability to look after ourselves with minor things (don't mean OP with her probs) Over the years parents not teaching children the basics of self care with minor health probls.
 
Another thing to remember is if you go to A&E they will say 'no it's not broken' and send you in your merry way. With a direct GP referral, not only will you be diagnosed, you will also be referred to physio etc which A&E don't do.
 
Fides said:
Another thing to remember is if you go to A&E they will say 'no it's not broken' and send you in your merry way. With a direct GP referral, not only will you be diagnosed, you will also be referred to physio etc which A&E don't do.
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incorrect IMC


Actually they did not once they X rayed my upper arm they sent me straight to plaster room where I was put in plaster and a sling.

A GP did not refer me hubby called an ambulance and I was taken directly to hospital no GP involved.
 
If you go to A&E as a walk in patient, unless it's empty (unlikely!!) then you will be a really low on their priority list and you'll end up being there hours.
Either go to your GP and they will refer you to the X-Ray department...I was only waiting 10 mins in there before I was seen so they are normally quite quick after being referred. I fell off my horse and broke my ribs, however didn't know they were broken until the x-Ray.
Or if your hospital has a minor injuries department go as a walk in patient.
Our hospital runs a Red, Amber, Green colour coding system. You see a nurse straight away and they give you a colour and that gives you a guide to how long it will take to be seen by a doctor. Red is immediately, Amber is a couple of hours and green is anytime after they have seen all the red and ambers!!
Personally I think A&E is for emergencies only, life threatening situations and too many people use them as a drop in service.
 
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So, A & E is not Accident & Emergency, it's just Emergency then? If i genuinely thought either I or someone else needed emergency care I would call for an ambulance. If I had an accident & believed I had broken a limb or needed a wound stitching I would go (by my own means) to A & E. Is this wrong?
 
blazingsaddles said:
So, A & E is not Accident & Emergency, it's just Emergency then? If i genuinely thought either I or someone else needed emergency care I would call for an ambulance. If I had an accident & believed I had broken a limb or needed a wound stitching I would go (by my own means) to A & E. Is this wrong?
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An accident can be an emergency but not all accidents are emergencies.
 
blazingsaddles said:
If I suspected a broken limb where should I go first?
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If it had just happened then I would go to A&E however if you have left it days then it wasn't an emergency so see your GP.
Each case on its own merits and use common sense.
I'm no expert and just my personal opinion but I think A&E is for life threatening stuff.
 
I truly believe people are genuinely confused as to what A+E is actually for. It's almost as if self triage is needed, which a lot of people won't have the knowledge to do. Don't get me wrong, I'm confused a lot of the time but have the back up of asking one of the GP's I work for. Major blood loss, severe breathing problems, severe bangs to the head, injuries involving young children, severe allergic reactions, suspected heart attack, stroke, poisoning the list goes on. Anything that would be considered an immediate risk to life should be A+ E. But saying that some people ring the surgery first, if suspecting heart attack or stroke and get put through to GP immediately, who then triages and either tells patient to go to A + E or arranges blue light ambulance if appropriate. Any proper health care professionals feel free to correct me I won't be offended.
 
Fides said:
Yes. As I did when I fractured my hip (minimal fracture) 5 weeks ago. You don't wait weeks for an appointment - they give you an urgent referral and you get seen that day. In my case they didn't even want to see me, they took the referral over the telephone. It saves waiting around on uncomfortable chairs with all the drunks...

Or a minor injuries unit of course.

Bitznbobz - I'm still on my night shift - getting pretty tired of samples coming to the lab with clinical details 'generally unwell' :(
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Honestly Fides, I hope you don't take this the wrong way but if you have time - and it's probably a break I understand that - to be on H&H then you can't be
worried too much about allocating your time. What does 'generally unwell' mean? Is that from general public who feel they are unwell but don't know how to diagnose themselves?
 
I got my leg kicked by a horse who double barrelled me, 24 hours later leg was twice the size and a very nasty colour, take note I a nurse so thought it would just need time and pain relief. I posted a photo of said leg on fb proudly showing off the bruise, a friend,a midwife saw the photo and demanded I go straight to A&E as she thought it was probably fractured. Thankfully hospital is on my doorstep so I hobbled in. An hour later it was xrayed as medical staff were convinced there was a fracture. No fracture but a massive haematoma in the calf muscle which was infected. I was just hours off of having raging septicemia. It took a month of very strong drugs and the constant threat of surgery before I could walk properly again.

If I had waited to get a gp appointment the outcome may not have been so rosey.
 
asommerville said:
Hi folks. Sorry this has turned into a debate.....thanks for comments. I ended up phoning nhs 24 (I think a&e) is fir really bad injuries etc you see. Was told to go to MIU, xrayed, told its not broken - don't fall off, bye bye. Soooo still very painful - but not broken- as for tendon damage etc - I think I would need to go to doctor and probably be told to take ibroprufen!
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Go see your gp in a couple of weeks and ask about a physio referal as if there is a decent amount of tendon/ligament damage this may well be needed to heal it properly

Fides said:
Yes. As I did when I fractured my hip (minimal fracture) 5 weeks ago. You don't wait weeks for an appointment - they give you an urgent referral and you get seen that day. In my case they didn't even want to see me, they took the referral over the telephone. It saves waiting around on uncomfortable chairs with all the drunks...

Or a minor injuries unit of course.

Bitznbobz - I'm still on my night shift - getting pretty tired of samples coming to the lab with clinical details 'generally unwell' :(
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at least you get 'gen unwell' - half the juniors on my ward don't put anything in at all!


doriangrey said:
Honestly Fides, I hope you don't take this the wrong way but if you have time - and it's probably a break I understand that - to be on H&H then you can't be
worried too much about allocating your time. What does 'generally unwell' mean? Is that from general public who feel they are unwell but don't know how to diagnose themselves?
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'generally unwell' means that the docs have a patient that is unwell, ie feverourish, obs (like heart rate, blood pressure etc) are out of the normal range, patient might be confused which can suggest infection etc. Basically the patient is unwell within themselves and the docs aren't sure whats going on so send a fairly standard range of tests to give them a direction to go in as the blood work gives clues as to what is making the patient unwell which allows a treatment plan to be made.
 
I haven't read the whole thread, just a couple of pages and finding it a bit odd to be honest.

Not sure if anyone has mentioned this or not yet, but with such differing opinions and a desire not to waste anyone's time, perhaps just call NHS direct and let them tell you who you should go and see. That way, you can't be accused of wasting anyone's time!
 
Sorry OP but this IS what A&E is for!! If I'm unwell then I make a doctors app, If i fall off and hurt myself more than just bruising then it's off to Urgent Care i go. We no longer have a local A&E or Maternity ward, Less than a week after it being closed down a child died because they arrived 5 minutes after 'Urgent Care' closed and the nurses would not let the parents and child in. A 25 minute taxi ride to the next nearest hospital was too late for the child.
 
Spit That Out said:
If you go to A&E as a walk in patient, unless it's empty (unlikely!!) then you will be a really low on their priority list and you'll end up being there hours.
Either go to your GP and they will refer you to the X-Ray department...I was only waiting 10 mins in there before I was seen so they are normally quite quick after being referred. I fell off my horse and broke my ribs, however didn't know they were broken until the x-Ray.
Or if your hospital has a minor injuries department go as a walk in patient.
Our hospital runs a Red, Amber, Green colour coding system. You see a nurse straight away and they give you a colour and that gives you a guide to how long it will take to be seen by a doctor. Red is immediately, Amber is a couple of hours and green is anytime after they have seen all the red and ambers!!
Personally I think A&E is for emergencies only, life threatening situations and too many people use them as a drop in service.
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Right so next time I fall off onto concrete and my lower arm is detached from the upper half I will go to the doctors first!!!!!!

Sorry but as I said above my humerus broken another injury >my hand is now deformed - my sciatica could have put me in a wheelchair for life - and the Cancer could have killed me.

Gp are fine for coughs and cold constipation anything else like that.

But accidents where you fall off a horse/ motorbike or car can be life changing if your GP dismisses it as nothing like mine, leaving me with this thumb out of alignment for LIFE.

I will be the best judgement for my injuries. I knew something not right with my arm (mainly the lower half not moving with the upper half.) So hospital is where I went and did not have that long a wait

Sorry but coming off a moving object or animal at speed is destined to have serious consequences, I mean how many people in a car accident go to the GP first before hospital??

so its A&E if I feel its more serious than just bruising
 
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Out of interest, I would like to know what constitutes an 'emergency appt' at a GP surgery. Twice now I have made such an appt in the past couple of years, because booking a routine appt involves a three week or more wait for one. The first occasion a few years ago, I was suffering severe depression/anxiety (undiagnosed at this point), and I booked myself for an emerg appt out of desperation on the day. The second occasion recently was due to crippling back pain causing me to have to take time off work. On both occasions I had the GP actually angrily tell me that I had 'wasted' her time booking an emergency appt for a non-emergency. Now, forgive me for being ignorant if this is not the case, but surely severe depression, and crippling back ache IS a GP emergency, as neither are ailments which can wait three weeks for a routine appt. Secondly, if they aren't GP emergencies, what the heck is? I assume that most people who are bleeding out, or have bones protruding will not book a GP appt..
 
Todmiester said:
I got my leg kicked by a horse who double barrelled me, 24 hours later leg was twice the size and a very nasty colour, take note I a nurse so thought it would just need time and pain relief. I posted a photo of said leg on fb proudly showing off the bruise, a friend,a midwife saw the photo and demanded I go straight to A&E as she thought it was probably fractured. Thankfully hospital is on my doorstep so I hobbled in. An hour later it was xrayed as medical staff were convinced there was a fracture. No fracture but a massive haematoma in the calf muscle which was infected. I was just hours off of having raging septicemia. It took a month of very strong drugs and the constant threat of surgery before I could walk properly again.

If I had waited to get a gp appointment the outcome may not have been so rosey.
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This is a good example of when to go. Injury recent and still developing. An injury that is a few weeks old can reasonably be seen elsewhere.


I think this thread perhaps highlights a need for greater understanding of what's available, what's appropriate and how to access services. Unfortunately as the NHS is politically governed things change all the time, including how we access services.

Maybe H&H could run an article on horse related injuries and the red flags to look out for, when to seek help and what to do. It would be helpful I'm sure. For anyone that's interested there is a company that runs first aid courses (they come to your yard) aimed specifically at horsey folk. Unfortunately the name escapes me at the moment!
 
Moomin1 said:
Out of interest, I would like to know what constitutes an 'emergency appt' at a GP surgery. Twice now I have made such an appt in the past couple of years, because booking a routine appt involves a three week or more wait for one. The first occasion a few years ago, I was suffering severe depression/anxiety (undiagnosed at this point), and I booked myself for an emerg appt out of desperation on the day. The second occasion recently was due to crippling back pain causing me to have to take time off work. On both occasions I had the GP actually angrily tell me that I had 'wasted' her time booking an emergency appt for a non-emergency. Now, forgive me for being ignorant if this is not the case, but surely severe depression, and crippling back ache IS a GP emergency, as neither are ailments which can wait three weeks for a routine appt. Secondly, if they aren't GP emergencies, what the heck is? I assume that most people who are bleeding out, or have bones protruding will not book a GP appt..
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It can be a minefield can't it? To me an emergency dr's appt is when you need to be seen that day not in 3 weeks time! My surgery is actually very good and the doctors don't accuse you of wasting their time (well they haven't yet!). When I used to live at my parents it was a nightmare, the receptionists were so rude and almost like the hounds of hell! You had to get past them first before getting close to a doctor.

Moomin, when baby arrives they should never refuse to see a child. In fact, one doctor at ours really enjoys seeing the babies. I hope your back is better now?

OP are you sorted now?
 
An emergency appointment at a gps is within 24 hours of request - anything more urgent than this is a and e... Most gps refuse to see injuries day one... As that is an a and e job not a general practice job -- for lots of reasons ... But it is ABSOLUTELY INAPPROPRIATE to see a gp if you think u might have a broken limb - we don't have the facilities to deal with it.
 
Fides said:
Yes. As I did when I fractured my hip (minimal fracture) 5 weeks ago. You don't wait weeks for an appointment - they give you an urgent referral and you get seen that day. In my case they didn't even want to see me, they took the referral over the telephone. It saves waiting around on uncomfortable chairs with all the drunks...

Or a minor injuries unit of course.

Bitznbobz - I'm still on my night shift - getting pretty tired of samples coming to the lab with clinical details 'generally unwell' :(
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Watching the drunks is the best part of A&E! ;)

I am having difficulty understanding the issue of attending A&E with a suspected # for example. Surely Triage assesses urgency and prioritises patients.

A GP can refer to x-ray at hospital or the treating Doctor can refer to x-ray in A&E. 'My' Minor Injuries Unit is in A&E which is surely where I'd be sent to if GP referred for x-rays. Is it not more efficient to therefore attend A&E instead of using up GP's time (as they are also very stretched) for them to send me to basically A&E?

To be fair the next time I break something (very likely!) and try to ignore it until that's not possible, I'll call GP for a referral. Although the drunks are hilarious......those uncomfortable chairs, not so much!
 
HGA-12 said:
Right so next time I fall off onto concrete and my lower arm is detached from the upper half I will go to the doctors first!!!!!!

Sorry but as I said above my humerus broken another injury >my hand is now deformed - my sciatica could have put me in a wheelchair for life - and the Cancer could have killed me.

Gp are fine for coughs and cold constipation anything else like that.

But accidents where you fall off a horse/ motorbike or car can be life changing if your GP dismisses it as nothing like mine, leaving me with this thumb out of alignment for LIFE.

I will be the best judgement for my injuries. I knew something not right with my arm (mainly the lower half not moving with the upper half.) So hospital is where I went and did not have that long a wait

Sorry but coming off a moving object or animal at speed is destined to have serious consequences, I mean how many people in a car accident go to the GP first before hospital??

so its A&E if I feel its more serious than just bruising
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I think you have taken this thread a bit personally, the OP's issues are nothing like yours.
Nobody has said don't go to A&E if you need to and you may have lost your faith in GP's but there are plenty of very good ones out there and I wouldn't discourage anyone going to see a GP just as I wouldn't encourage any one to go to A&E for a non emergency.
People need to use common sense on a case by case basis.

If you fall from your horse and as you say, your arm is detached from your body then yes, I would hope you go to A&E as that is an emergency. However not all falls from horses require A&E some just need a doctor to piscribe stronger painkillers!

Stay safe out there everyone :)
 
Spit That Out said:
I think you have taken this thread a bit personally, the OP's issues are nothing like yours.
Nobody has said don't go to A&E if you need to and you may have lost your faith in GP's but there are plenty of very good ones out there and I wouldn't discourage anyone going to see a GP just as I wouldn't encourage any one to go to A&E for a non emergency.
People need to use common sense on a case by case basis.

If you fall from your horse and as you say, your arm is detached from your body then yes, I would hope you go to A&E as that is an emergency. However not all falls from horses require A&E some just need a doctor to prescribed stronger painkillers!

Stay safe out there everyone :)
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What you say is true but in fairness what can a doctor see if you go in there after falling off a horse??? The truth is nothing (unless obvious lacerations on bone sticking out). They do not give you a full examination, All they do is pop pills as they go by what they see not what is going on internally, so then dismissing a patient who has back ache with pills saying its nothing bruising. How do they know there is no hair line fracture and sending a patient home who would carry on as normal and then a few days- hours later the fracture turns into a complete fracture of the spine.


Or for example as which case with me after a fall in 1979 when I got thrown off and could not walk straight without pain etc, GP said its nothing take these pain killers- 2 weeks later still pain- GP said heres stronger ones- two weeks later here you go stronger ones. Eventually pain cleared.

zooooom forward to 1981 my back went out could not move. Went to Osteopath who said (and I remember her words clearly) " quote "you have damage L 3-4-5 and if you had had this sorted when you did the injury you would not be going to go through what you later will go through in life" unquote "

She was right many many many many back outs not being able to move then resulted in a slipped disk - then the sciatica which I still have over 30 years later and I nearly ended up paralyzed with it..

I am not taking this personally I am trying to explain that the GP has no X ray machine etc, truthfully what can they do (refer you) which NONE of them did or pop pills of some sort into you.



Not once did this other GP in 2002 say to me I will refer you despite me going in explaining twice I could not use my thumb or move it and I first went in there on the day it happened. So patient once again has a life changing disability because a GP was to quick to get me out the surgery to get the next one in to refer me on to hospital.

I am not alone there must be 100's of people out there with life changing injury made worst or life changing disability becasue the GP did not refer them.
 
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It depends on what procedures are set up locally.
One area I worked in I could send directly from gp surgery to xray thus cutting out a and e.
What I work now, I can't do that...I can either send you to a and e or arrange a routine xray. If, on clinical examination I cannot exclude bony injury then I would direct you to a and e.
We tend to see most of our patients same day anyway, unless it is a pre booked advanced appointment so for me, I wouldn't see it as a waste of my time seeing you and referring you on. I like to see injuries now and again, keeps my clinical examination skills up and I like to check back and see if I was right :)
 
It's a minefield but it just takes a bit if common sense- if it's your finger then likely only need MIU although obv if it's really not in a normal position then A n E maybe more appropriate as may require surgery. If it's a major limb (leg/arm) then you want A n E generally as most MIU aren't equipped to deal with breaks at this level- wrists fall in the middle category so it's a case of doing which you think best!

The number of inappropriate patients in A n E is shocking and most of those have come via anbulance so what chance does john smith have of going to the right place!
 
blitznbobs said:
An emergency appointment at a gps is within 24 hours of request - anything more urgent than this is a and e... Most gps refuse to see injuries day one... As that is an a and e job not a general practice job -- for lots of reasons ... But it is ABSOLUTELY INAPPROPRIATE to see a gp if you think u might have a broken limb - we don't have the facilities to deal with it.
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I realise that it's within 24 hours, but I meant what type of ailment is classed as a GP emergency? I don't think I worded it very well. I just fail to see how severe depression and excruciating back pain are not a GP emergency, yet my GP said I had wasted her time and should have booked a routine 3 week waiting time appt for those. :-(
 
Hippona said:
It depends on what procedures are set up locally.
One area I worked in I could send directly from gp surgery to xray thus cutting out a and e.
What I work now, I can't do that...I can either send you to a and e or arrange a routine xray. If, on clinical examination I cannot exclude bony injury then I would direct you to a and e.
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That's interesting to know - we (in the hospital) are led to believe that all GPs are able to do a direct referral to X-ray. I'm currently looking for a new Gp and that is one thing I am going to ask when I pop into the surgeries.
 
Fides said:
That's interesting to know - we (in the hospital) are led to believe that all GPs are able to do a direct referral to X-ray. I'm currently looking for a new Gp and that is one thing I am going to ask when I pop into the surgeries.
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I moved jobs, from one CCG to another, the differences in local policies are many, and not for the better.....I was a bit....hmmm.
 
Hippona said:
I moved jobs, from one CCG to another, the differences in local policies are many, and not for the better.....I was a bit....hmmm.
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Yeah so was I when you said it. We are having it rammed down our throats at work that we should be offering the same service as other labs to eliminate the postcode lottery, I assumed that GP practices would have to do the same.
 
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