One of the joys of a daily conversation is your response.
A steady stream of emails full of insight, comment and opinion.
My choice of topic is often influenced from what I hear, what you send and what you think I should be looking at, or into.
This morning I though I’d share a conversation. For reasons that will become clear, I won’t name the person, nor their location.
It left me speechless. A spectator… watching a slo-mo film of one of those car-crash dummies, smacking into a wall… but...
… this was not slo-mo and it wasn’t a dummy. It was real and in real time.
I felt powerless.
>> Here we go... 8.58pm
"I’ve been home an hour. Going back in because the department is unsafe due to the number of patients.
Sixty-plus children in the department. There is a half hour wait, just for triage.
We are running low on antibiotics. Earlier today we ran out of ibuprofen.
… I held-the-phone for the nurse in charge, to eat her lunch… that was at 6pm."
I made a facile reply about how horrific it must be and felt like a spare part.
>> 9.16pm
"I’ve been up since 6am and at work since 9am. The best I can do is stay ‘till midnight, clerking."
I reminded myself a lorry driver can only drive for nine hours in a day and has to rest for eleven hours…
... must take a break or breaks totalling at least 45 minutes after no more than 4 hours 30 minutes driving.
>> 1.39am
"I just don’t know how we can get through this winter.
I saw the two sickest patients in the department and turned them around, solo, doing all the paperwork and the prescribing (some of it twice, as the computer crashed partway through and I had to retype a full clerk, again)."
I’ve lost count how often I'm told how poor ward level IT is and about crashes and log-in times. The sooner the Digital Dummies get some proper leadership that understands the basics, the better.
"I reviewed several other patients. I did bloods, cannulas and requested imaging.
I made an escalation plan with security and the nursing staff for a physically violent [patient] with suicidal thoughts, who’d been transferred from a mental health facility - to the care of the surgical team [?] who felt out of their depth and left it to me.
I went around every single patient who was waiting (over 60) to look at them and check they didn’t look sick. I gave a bottle of water to each member of staff and offered them to every parent.
If I’m lucky I’ll be home at 2am and back in for a meeting at 9am and full day of clinical work.
If I’m unlucky I’ll be called in, in the next seven hours."
I reminded myself, duty hours for a commercial pilot; 60 hours in any 7 consecutive days.
>> Next day 1.08pm
"… we had nearly 200 kids through the doors in 24hrs yesterday. We’d usually expect, max 100. Our highest previous is around 150, I think."
I was curious. Was there a common theme I asked?
>> 1.54pm
"Lots of anxiety about invasive group A Strep, which is understandable.
Lot’s of walk-ins and GPs sending patients to assess.
Lots of little babies in the first week of life who probably would be better looked after by midwives but everyone is scared of taking responsibility."
According to the RCM, England has a shortage of 2,000 midwives. There were 600 fewer midwives in April 2022 than in April ’21.
"Lots and lots of kids with complex neuro-disability and respiratory infections and there’s not much we can do to change that…
... but we will have to think about the level of care we can provide for these incredibly complex children who are biologically more like chronically, profoundly ill, elder people…"
>> Next day, 6.09pm
"We don’t know what’s happening with the nurses strike. The ambulance strike will hit when I’m on call…
... I feel like I’m practicing medicine in a Dickens novel. This is not what I expected medicine to be like."
>> I'm hearing - 48% of consultant posts advertised were unfilled and 20% of current consultants retiring by 2025.
>> I'm hearing - from a pharmacist:
Drug tariff price for December; Amoxicillin 125mg suspension, £1.32, loss on every prescription.
Amoxicillin capsules 250mg £18.04 £0.86, loss on every prescription
Amoxicillin 500mg, £7.62 = £1.92 loss on every prescription I dispense, £9.06. Completely unsustainable.
>> I'm hearing - NHS England and the UK Health Security Agency have issued new interim clinical guidance on diagnosing and treating children with suspected group A streptococcus infection.
