The Doctor Will See You Now [Non-Fiction]

Chapter 66: Acute Medicine

Jan is a 70-year-old woman who has had chronic back pain ever since a bad fall and a break in her lower back a few years back. She is admitted from A+E for lower back pain onto the medical ward.

Yeah, thanks, A+E. Lower back pain belongs to orthopaedics. But because her blood pressure is sky high from the pain, she gets admitted to the medical ward for 'high blood pressure'. You might as well slice off her leg, let her bleed for a bit, then admit her under the medics for 'anaemia'.

Jan gets three days' of physio and then is fit for discharge. Her blood pressure is fine now.

Jan says she needs another three days of physio. She gets three more days.

She then says she needs another three days. I tell her, no, she's had enough inpatient physio. We'll arrange outpatient physiotherapy for her. She has no acute need to stay in a tertiary hospital.

Below are the list of issues Jan raises and how we tackled it.

Jan says her outpatient physiotherapy isn't until the end of the year.

So we arrange day patient twice-a-week physiotherapy sessions for her for the next two months. This includes free transport to and from her home.

Jan says she can't be discharged; she can't look after herself (she lives alone).

So we ask the social worker who advises for a nursing home. Jan refuses.

We refer her for home meal deliveries. Jan says she can't afford the service as she is on government assistance.

Jan says she wants a TENS machine for her back pain as she finds great relief from it.

So we ask the physio to arrange getting one for her. Jan says she can't afford it.

So the physio seeks quotes for her. There's one across town that's the cheapest that social work can get full funding to buy for her. Jan refuses that one because if the machine breaks, she doesn't want to travel across town to get it serviced. She'll get one from this hospital instead, at a higher cost. The physio arranges for her to claim some money back from social work once she purchases her own TENS machine from the hospital.

Jan then says she can't afford to buy her own after all. So the physio arranges social work to get funding for her and to get it delivered to her front door step.

Jan then says she doesn't know how to use that model. So the physio arranges to teach her at the day hospital that we arranged in the first point raised.

Jan says she needs a doctor's certificate to allow her sick leave plus several extra days.

I ask her what she needs sick leave (and extra days) from, seeing as she apparently isn't working and is on government benefits as a result of that, plus she's 70 years old. She tells me she needs it for an insurance claim for the fall from a few years back as the lawsuit is ongoing.

I tell her no insurances need medical sick leave from a doctor as those are for employers only. I offer to write her a doctor's letter confirming she has been admitted to hospital. She demands a doctor's certificate. I said no.

At this point, Jan has wangled herself twelve days of inpatient stay with no acute medical need but just half an hour of physiotherapy daily on weekdays. On an acute ward in an acute hospital. At a time when our wards are at 150% capacity. So I tell her she is fit to go home, whether she likes it or not. She berates me for my attitude and tells me she doesn't even like staying in a hospital anyway because it's noisy and full of germs. She says we do observations too frequently and the blood pressure machine hurts her arms. She says our need for observations stress her out and makes her blood pressure go up. Fine, I say, go home, then. You're fit to go.

Two hours later, Jan refuses to be discharged.