Monday, 18 April 2011

"Get an ambulance!"



I can just remember a time (nearly 50 years ago!) when I had to go and ring for an ambulance for a member of my family. It was about a 200 yard walk to the nearest telephone kiosk and it was a very big deal. Currently it's all to easy to call for an ambulance and the service is overwhelmed.
Just the other morning I was asked by one of my receptionists to ring back one of my patients who had phoned for an emergency ambulance because of severe abdominal pain. She had been told that she would have to wait a couple of hours. I phoned and offered to visit straight away. I was confident that her abdominal pain was likely self limiting and would respond to an analgesic injection. When I phoned her back an hour later she was feeling a lot more comfortable and in fact her pain settled thought he day.
I couldn't help but reflect on how things have changed over my 30 years in general practice. When I started it was very unusual for patients to phone for an emergency ambulance, and they would virtually always ring their GP first who would generally visit and assess the situation in the home. Now even GPs advise 'ringing for an ambulance' when called about various symptoms without assessing the situation first. There' s no doubt that this approach is appropriate for severe chest pain when a myocardial infarction is suspected since speed of hospital treatment is of the essence, as it is in the case of stroke.  But being ambulance trigger happy is out of control. What is the answer?
I don't know but I do know that if  my recent patient with abdominal pain had been taken to hospital she would have had a prolonged stay in A+E with multiple investigations taking up many professionals and their time. It was a situation so much better dealt with in general practice. But GPs are so much busier during their daytime working hours and the interruption of a home visit during surgery can result in a rather backlog of work upon return to the surgery.
Answers on a post card please.
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