Sometimes I get so bloody annoyed.

Patient comes into casualty Friday afternoon with chest pain. Has a chest x-ray and gets admitted to the ward [1].
Saturday morning is seen in the post-take ward round and told it could be a PE. The doctor requests both a CTPA and a VQ scan [2], tells the patient they needs a VQ scan then sends them home on Tinzaparin  (a blood thinning agent), telling them to ring up the radiology department on Monday to arrange it.
Patient duly rings up the nuclear medicine department on Monday, who know nothing about the scan.
The patient chases up the ward while nuclear medicine try to chase up from their end.
The doctor worked the weekend, and has gone home. Eventually thwo forms, the one written sometime Saturday, and the one hastily written on the ward Monday finally arrive Monday lunchtime. The patient is contacted, but has a 40 mile drive to get to the hospital.
We finally finish scanning the patient at 4pm. Consultant radiologist has a look and tells us, and the patient, the scan is clear. We cancel the superfluous CTPA.
Unfortunately the patient has been told there is a small fluid level on the chest x-ray and, quite rightly, is worried. They don’t want to go home without some reassurance as to what is going to happen.

Do they go home? Do they go to the ward?
The ward know nothing. They suggest one of two doctors to bleep (depending on what time the patient was seen on Saturday) but can’t help otherwise.
I bleep one of the numbers given. Luck first time. This is the medical registrar.
He wasn’t working at the weekend.
He doesn’t know the patient.
But he has had a message left to tell the patient to stop the Tinzaparin if the scan is normal.

We know that.
What the patient want’s to know is the significance of the chest x-ray appearances?
Does it need treating?
Does it need treating in hospital?
Will it go away all on its own?

Ward or Home?

Weekends always seem to be a disaster waiting to happen. We have to rely on Chinese whispers and the hope that some form of continuity exists somewhere [3].

I hasten to add this is not a criticism of any one person or indead the medical profession as a whole but of the system in general; it goes on all the time and it has got worse since the weekend was split up into days.

At least in the bad old days with one team covering from Friday night to Monday morning they may have been knackered but they didn’t have to rely on messages being passed from team to team to team.

[1] Obviously has a lot more done too but this is probably irrelevant to this post.

[2] Incidentally has anyone noticed since the diagnostic targets came in there seems to be a scatter-gun method of requesting for diagnostic tests. If the past the most appropriate test was requested and further investigations were carried out if required.

Now there is an ever-deceasing window in which to fit all diagnostic tests and recently there seems to be an increase in multiple simultaneous examination requests for the same problem eg VQ scan AND a CTPA, Small bowel follow-through, labelled red cell scan AND a gastroscopy, MRI AND a bone scan of a swollen sterno-clavicular joint.

[3] If possible try to come into hospital on a weekday morning. That way you’ll have several hours of the same team looking after you. Don’t make it too early though. All the discharges will be waiting for their drugs to take with them and there won’t be any free beds.