Sunday, 10 August 2008

Rageing mums

Posted by Dr. Thunder

There's something in the water over the last week, I've always said that the Aussies are a bit more aggressive than the Brits and Irish, who used to keep a "stiff upper lip" about things. If they had a gripe, they'd complain to their friends and family, rather than to me. That's not neccesarily a good thing by any means, but that's the way it was.

Here in Australia, it's very different. People complain. A lot.

It's one of the few things about life as a doctor over here that's tougher than being a doc in Ireland or the UK. I've definitely been hollered at more (by staff and my patients' parents) here than I ever was in Europe. In some ways it's a good thing. You usually know if people aren't happy with the care you're giving their kids, and you can explain the reasoning behind it. So, in some ways it's actually conducive to a better working relationship.

But in other ways it's just a pain in the arse. Like this week

Parent 1 went to see the paediatric orthopaedic surgeons about an infected wound. The surgeons had put it in a cast, for some reason best known to themselves, and told the kiddy to come back for review in 3 days. At the follow up appointment, the cast was removed, and the wound was still infected. So, they rang the paediatric registrar on-call......me.

"Hi Dr. Thunder. Its Dr. Bone from orthopaedics........blah blah blah.......we think this it's cellulitis., that will require IV antibiotics. Can you come and review?".

"OK", I said "But limb celulitis is something you guys can manage, so can you start the IV antibiotics? I'm stuck in the emergency department with quite a few sick kiddies, so it's going to be about 2 hours before I get there".

"OK, no problem".

2 hours goes by and I ramble onto the ward to see this kid. I walk over to the bed and say "Hi, I'm Dr. Thunder, how are we all doing?".

The torrent of abuse was unforgettable. It's also unrepeatable here. I was lambasted by this indignant mum for taking "2 WHOLE HOURS" to come and see her sick child.

I explained that there were 3 very sick babies in the emergency department, and I simply had to prioritise. Most people can see that kind of logic. But not this lady......"But we've been waiting TWO WHOLE HOURS" she repeated.

So, then I changed tact. I told them that the diagnosis of cellulitis had been made and that the antibiotics had been started, so any delay on my behalf wouldn't affect the outcome, as I was just here for a second opionion (In relaity I had no idea what I was there for, but I'm known in the hospital as someone who rarely refuses a referral for a consult. I'm a soft touch).

"The fucking antibiotics haven't been started yet. That's YOUR fucking job".

She was right. Nobody had bothered their arses starting antibiotics on this kid.

So, I sat there for a few minutes listening to some abuse, while writing in the notes. I have no idea what she said to me. She was screaming at the top of her voice about how I'm lazy and incompetent and the whole hospital should be shut down etc etc.

I walked off without saying a word. I paged the othopaedic surgeon with the following message "I can't believe you sent me into the jaws of hell without warning. Revenge will be mine. And don't think I'm cannlating that kid for you either!".

Parent number 2 rang me directly. She convinced switchboard to put her through to the on-call paediatric registrar. I answered the phone..."Hello Dr. Thunder, paediatrics".

"I want a prescription for Omeprazole 20mg twice daily, salbutamol 2 puffs as required....are you writing this down??.

"Eh, can I ask who's calling?".

"Mrs Smith....I also need some lamotrigine......".

"Hang on just one second. WHO ARE YOU?? Why are you ringing me up to write you a prescription?"

She sighed loudly, and started to speak very slowly and condascendingly."My son is a patient of the hospital. He gets these drugs. He's run out, so you need to write him a prescription".

Fine. I can do that. It's his own doctor's job, but if he's run out, then fair enough. So, I took his name and patient number so I could get his notes. I told his mum I'd prescribe whatever is in his notes. She said "OK, I'll be in at 11am tomorrow. Bye".

She hung up.

At 11, the pharmacy rang me. "Eh, this crazy lady is ranting and raving because you've prescribed the wrong drugs".

So, I went dowstairs to see her. Apparently her GP had changed a few doses since their last visit to the hospital, and she wanted them prescribed. I told her that I'd have to check with her GP first. At this point she went flipper. "Are you saying I'm lying?? I've been waiting half an hour for a simple prescription. This is outrageous. I'm going to write to the hospital about this".

So, I lost it. I shouldn't have, but I did.

"Listen. I don't know your son. I've never met him. I don't know him or you. I don't know if you're trying to scam drugs out of me, or if his GP did prescribe them for him. But I can tell you this much...you'll either wait for me to check with his GP, or you'll get someone else to write this prescription for you. I'm doing YOU a favour, and I won't be spoken to like this.

I was quite proud of myself.

"But I've been waiting half an hour and it's just a prescription".

Oh sweet jesus.

I phoned the GP. Her story checked out. I wrote the new prescription. I brought it out to her. She just grabbed it out of my hand, and stormed off, as though she'd just dealt with some faceless, obstructive beauraucrat.

You can't win 'em all, I guess. But It would be nice to win once in a while :P

I've posted this not to have a go at anyone. I guess it was merely to point out that it's not all rosey in the garden of Australian healthcare. It's a damn sight better than what you deal with in Ireland and the UK, but we still have a way to go before we have a totally contented bunch of junior doctors.

Dr Thunder

5 comments:

  1. Dr. Thunder, I think absence may have made the heart grow fonder... Irish patients and parents can be a LOT ruder than what you've described... come on, you guys are meant to be selling the Antipodean dream to us disillusioned SHOs! :-)

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  2. I have noticed, Dr. Thunder, NZ patients have a genetic inability to wait for anything, particularly discharge prescriptions! To me, a person healthy enough to discharge does not come very high on the priority list. Last week, a woman was reduced to screaming, sobbing and hysterics because her husband's discharge papers had been promised at 15:00.....and she didn't receive them into her hand until 15:03!!!! Luckily the charge nurse was AWESOME-she stood in front of this woman and said loudly-"Are you serious?"

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  3. Oh, so enjoyed that...thanks Doc! Sorry for your troubles!

    Wound infection...cellulitis...IV antibiotics... MRSA?

    How is the MRSA scene in Oz btw?

    "The fucking antibiotics haven't been started yet. That's YOUR fucking job".

    *Steph makes mental note to adopt this tactic for her next trip into hospital* ;-)

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  4. MRSA isn't quite as bad here as it is in Ireland, from my experience.

    The abuse levels, however, did escalate over the weekend when I was on-call :P

    Dr. Thunder

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  5. two whole hours! what an impossible time to wait!

    parents like this are why I don't like doing paediatrics.

    as for placing things in a cast: immobilising a limb helps for wounds over joints because the tissues aren't as abused by movement.

    MRSA: it's about 30% of isolates from abscesses here, I think. I'm not sure about other conditions. Systemic disease still tends to be MSSA unless they've been in hospital lots (I had a guy convert from MSSA to MRSA in his osteomyelitis after about 4 weeks of IV antibugs.)

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