Slipping on ice and breaking arm, hospital treatment

[Ulti]

Hi Hexites,

I'm really unsure where to search and post/ask this so I've decided to post here.

Basically my girlfriend slipped on ice on Thursday at about 2pm and broke both the bones in her forearm, the radius and the ulna (I think that's what they're called). Unfortunately this is a "low priority" emergency so no ambulances came to pick her up after calling for one so I got a cab and got her to the nearest hospital. Just for info, we are only first year uni students so we're quite young still.

I understand it's quite busy right now but it took until 5pm for her to receive a caste and 7:30pm for her to get a bed in the hospital and during all that time she was just grimmacing and suffering in pain. Is this wait really normal?

She wasn't allowed to eat or drink after 11pm on that Thursday as they said she might have an operation so she cannot eat/drink orally, "Nil by mouth". I understand the food bit, but surely drinking should be allowed?!

Yesterday (Friday), in the afternoon they told her that she will have the operation to put a metal plate to hold the broken bones in her forearm but, without notice, they just cancelled the operation and walked out without saying anything, leaving her just waiting there after getting her hopes up. She then had to wait till the night before she was fed merely sandwiches in the evening before returning to the "Nil by mouth" situation.

This morning, they said she can have the operation again but then soon cancelled it again.

Seriously, is this right? We've wondered about changing hospitals but I fear this will affect her "location" on the operation waiting list, and also the journey will probably be painful for her arm. We're really not happy with how she is treated in this hospital though.

Is this whole "situation" normal? I can understand that due to the weather the hospital is probably bursting with patients right now but surely a broken forearm is no little matter? Especially as they were enphasising how unstable the bones in her arm are...

I probably sound very frustrated right now so do please accept my apologies, but I am not sure how to proceed with this matter; do I just let her wait in the hospital and suffer because there is no better alternative?

[GoNz0]

its the NHS, its the middle of a cold spell with lots of more serious people to attend to so you have no choice other than wait it out.

sucks yes, can you do anything about it, not unless you can afford private heatlhcare.

[Robscure]

Hi Hexites,

I'm really unsure where to search and post/ask this so I've decided to post here.

Basically my girlfriend slipped on ice on Thursday at about 2pm and broke both the bones in her forearm, the radius and the ulna (I think that's what they're called). Unfortunately this is a "low priority" emergency so no ambulances came to pick her up after calling for one so I got a cab and got her to the nearest hospital. Just for info, we are only first year uni students so we're quite young still.

I understand it's quite busy right now but it took until 5pm for her to receive a caste and 7:30pm for her to get a bed in the hospital and during all that time she was just grimmacing and suffering in pain. Is this wait really normal?

She wasn't allowed to eat or drink after 11pm on that Thursday as they said she might have an operation so she cannot eat/drink orally, "Nil by mouth". I understand the food bit, but surely drinking should be allowed?!

Yesterday (Friday), in the afternoon they told her that she will have the operation to put a metal plate to hold the broken bones in her forearm but, without notice, they just cancelled the operation and walked out without saying anything, leaving her just waiting there after getting her hopes up. She then had to wait till the night before she was fed merely sandwiches in the evening before returning to the "Nil by mouth" situation.

This morning, they said she can have the operation again but then soon cancelled it again.

Seriously, is this right? We've wondered about changing hospitals but I fear this will affect her "location" on the operation waiting list, and also the journey will probably be painful for her arm. We're really not happy with how she is treated in this hospital though.

Is this whole "situation" normal? I can understand that due to the weather the hospital is probably bursting with patients right now but surely a broken forearm is no little matter? Especially as they were enphasising how unstable the bones in her arm are...

I probably sound very frustrated right now so do please accept my apologies, but I am not sure how to proceed with this matter; do I just let her wait in the hospital and suffer because there is no better alternative?

As others have mentioned, this is the way the NHS works...

I've lived in the UK for the past 2 years and I've visited the NHS on a couple of occasions, all of which took quite a while. The most recent was two days ago when I had a 38.6c fever and could barely walk. It took about 2 hours to get seen and another 3-4 hours of waiting for results, etc...

But the good thing is that they made me feel better and they were polite and it was free.

Being an American, I know that if I went to the hospital like this, I may also have to wait in a waiting room, we do indeed have queues as well, although they may not be as long... it really depends... but the worse part is that at the end, you have a huge bill to pay, hundreds of dollars worth. And potentially hundreds more dollars for any prescriptions you might need.

I think you would've had to spend a few hundred quid to get that cast on her arm in USA.

[Macman]

Ouch! Sorry to hear man, hope the missus has it sorted soon. As others have said, in the USA you would've also been stressed to deal with the financial side of it. Which at this time of the year wouldn't of been nice.

Keep us posted.

[Saracen]

....

She wasn't allowed to eat or drink after 11pm on that Thursday as they said she might have an operation so she cannot eat/drink orally, "Nil by mouth". I understand the food bit, but surely drinking should be allowed?! ....

Absolutely not, no .... if the planned surgery involved general anaesthesia. As I understand it (and this is a lay view as I'm no doctor), during a general, the normal swallow reflex is suppressed and if any stomach contents reflux, it leads to significantly increased chances of broncho pneumonia (aspiration pneumonia).

The issue seems to be that during the anaesthesia process, there is a period where the airway is unprotected, i.e. anaesthesia working, but intubation not protecting the airway. If, during that time, any stomach contents come back up, there is a risk of "pulmonary aspiration". I take that to mean getting material from the stomach into the lung system. That content could include irritant materials, stomach acids or even bacteria.

All in all, you really don't want to go there is the alternative is simply nil by mouth, so mildly inconvenient though that may be, it's a small price to reduce the risk of a nasty and unnecessary complication.

Ever eat or drink something and it "goes down the wrong tube"? If you have, and most of us have at some point, you'll know the fit of coughing, spluttering, etc that tends to follow, until you get the irritant out of the airway. and that irritation can go on for quite a while after you've cleared the actual issue. Now imagine the possibilities if you can't cough and splutter to clear it because you're out under a general.

So the standard instruction for ALL op's requiring a general is nil by mouth for at least six to eight hours before surgery. If the op was under a local, it'd be different. And there are alternative procedures that will be used (like in unscheduled emergency surgery) that don't require nil by mouth simply because it isn't possible, but they themselves carry alternate risks and implications, so are used only when they have to be because of circumstance.

However, nil by mouth apparently doesn't necessarily mean quite what it appears, with some leading medical journals interpreting that instruction as no solids for that period, and no clear liquids for two hours. In any event, my firm advice would be .... do what the doctors tell you. Ask questions, by all means, but take their advice.

If we have any doctors around, I'm sure they could clear up any silly lay errors in that explanation, but it's as I understand it.

Yesterday (Friday), in the afternoon they told her that she will have the operation to put a metal plate to hold the broken bones in her forearm but, without notice, they just cancelled the operation and walked out without saying anything, leaving her just waiting there after getting her hopes up. She then had to wait till the night before she was fed merely sandwiches in the evening before returning to the "Nil by mouth" situation.

This morning, they said she can have the operation again but then soon cancelled it again.

Seriously, is this right? We've wondered about changing hospitals but I fear this will affect her "location" on the operation waiting list, and also the journey will probably be painful for her arm. We're really not happy with how she is treated in this hospital though.
....

The lack of info does sound quite inconsiderate, but .... hospitals, and especially A&E, can only react to situations as they develop.

A few years ago, I went to A&E with flu, and a temperature. In fact, I was past the worst of it by the time I got there, having spend two days in bed alternating between sweats and shivers, and more or less continually hallucinating. It was rather like I imagine a bad LSD trip to be.

So, the nurse assessed me, and despite having walked in and not having any blood pouring from wounds or broken bits, and not being in any pain, escorted me past about 200 waiting patients and into a treatment room, where a doctor was with me about 90 seconds later.

Apparently, my temp (and it had dropped a bit by then) had caused a bit of a, well, panic is the wrong term, but "an instant reaction" would be fair. They recorded 105 degrees, and my thermometer had dropped about 2 degrees by then, suggesting something around 107 at it's worst, the previous day.

Anyway, thankfully, I was past the worst and recovering, and needed nothing more than paracetamol until the temperature returned to normal, and a couple of days of rest. But from what a doctor friend later told me, I was in very dodgy ground for a while, and if 105 got their attention, you can imagine what a couple of degrees more, from the previous days, would have done. I'd probably have been admitted, because 108-ish is getting into "it can kill you" territory.

Anyway .... the point of all that is when they schedule surgery, it can change in a hurry. Someone like me arriving with no obvious problems and no pain could actually be a much more urgent case, because, harsh though it sounds, your GF was in pain but no apparent immediate risk. I could have been dying. So if there's a nasty car crash, or even some unanticipated medical (as opposed to trauma) emergency, like a heart attack, aneurysm, etc, those with unpleasant but non life-threatening conditions like your GF will get bumped for theatre places, and sadly, it can happen more than once.

It's never going to be nice, and a bit more "bedside manner" with explanations would be nice, but sometimes an apparently surly "leaving without saying anything" might merely mean they're run off their feet, very tired and have higher medical priorities waiting.

I know it's hard, but I think we just have to cut them some slack when this kind of thing happens .... and consider yourself lucky that you (or your GF) is not the patient that is the higher priority.

....
Is this whole "situation" normal? I can understand that due to the weather the hospital is probably bursting with patients right now but surely a broken forearm is no little matter? Especially as they were enphasising how unstable the bones in her arm are...

A broken arm is not trivial to the owner of the arm, no. But for others, minutes may be the difference between life and death. I know someone rushed into hospital with a major artery that had burst, and the comment that was made later was that had the right surgeon not been in the hospital, that patient would have been very unlikely to have lasted long enough to call him in from home. Minutes made the difference between living or not!

So is it "no small matter"? It kinda depends on the context, do you not think? I'll ask this hypothetically because I'm sure what your answer would be, but what should a hospital treat .... a major issue like that, or a broken arm that's been waiting longer, while the other patient dies in a waiting area?

Sadly, that's the reality. We can't afford to have resources so that absolutely everything can be treated the instant it comes in, regardless of fluctuations in demand, and the sad reality of that is that preventing pain isn't as important as saving a life. It's what hospitals and governments mean when they talk about treating according to medical priority.

I have a lot of sympathy for your GF and, had I (or the wife) had the broken arm, I'd not be happy about being treated as you were. But looking at it with the benefit of impartial detachment, the hospital have to treat according to medical need and if sometimes that means with putting up with the pain while you wait, well, sadly, that's the way of things. It's not nice but it is both right and necessary. If your GF was kept waiting while the doctors finished their card game in their lounge, you'd be right to be fuming. But without knowing what else was going on when they cancelled on her, it's hard to justify criticising the decision to do it. It might have saved a life, and next time, if could be the GF who's life is at risk and gets the priority in the theatre schedule.

Of course, it could also have been that a theatre that was scheduled to be running was closed because the surgeon called in sick, or got stuck in snow, or ..... well, all sorts of things. But it could also have been sheer medical emergency.

[Saracen]

its the NHS, its the middle of a cold spell with lots of more serious people to attend to so you have no choice other than wait it out.

sucks yes, can you do anything about it, not unless you can afford private heatlhcare.

Even private healthcare is no guarantee of that not happening. If essential surgical staff got stuck in snow, they got stuck in snow whether private or NHS. You might reduce the chances of some reasons for delay in a private hospital with no need to react to A&E demands, but you don't eliminate it entirely.

[Singh400]

If you are unhappy with the hospital treatment, I would contact your local PALS service, before you register a complaint. During the winter missions A&E admissions shoot up, but the staffing levels remain the same (or in the future will drop - thanks Tories!), so naturally.

[Alex]

Speaking as a doctor working on calls in a busy hospital, and having done atrauma and orthopaedics SHO job a few years ago, I'm afraid your situation is not unusual. Nor is it something that can be either predicted or easily dealt with.

The basic issue is that there are only a finite number of doctors to see you, assess and treat you. This number of doctors can't really fluctuate to meet demand - the trusts will employ people for a year's post and that's their fill for the year. You can't have extra people employed during winter and the icy months (which are much worse - think if your girlfriend broke her arm, who is young, fit, and with a good sense of balance and bone strength, how often little old ladies fall over and break a hip), what would they do for the summer months? And would you really want someone operating on you who hadn't operated since March?

This is on top of the fact that there aren't enough doctors in the NHS, at least in Wales where I work. There are plenty of unfilled posts and no-one taking the jobs. Although the Daily Fail likes to point out how gold-plated doctors jobs are, I think the fact that there are empty jobs despite the pay/pension says a lot about how hard work it can be.

The same goes for nurses, theatre staff, anaethetists and so on. There's only so much you can do in a day, and as Saracen said, as a doctor you have to treat according to clinical priority. I was working over winter 2008-2009 in T+O and saw several people waiting 4 to 5 days for their surgery - and there's nothing you can do about it.

Communication could and often should be better, but it's very hard to explain things well when you're already stressed, and you know that most people (speaking from experience here) will have a massive go at you for something you can do nothing about. Sitting down and explaining everything often ends up taking 15-30 minutes, and if you have 10 patients waiting for theatre but getting delayed by a massive car crash, you don't want to spend 5 hours explaining when you could instead be dealing with the problem.

I'm sorry that you and your girlfriend had a rough time, but I'm afraid neither is it the expection, nor is it likely to be a problem in the NHS that is soon resolved. It is simply not possible, dealing with finite resources, to do everything in a timescale suitable for everyone it treats.

[badass]

This is on top of the fact that there aren't enough doctors in the NHS

And that is the essence of the problem. Approximately 2/3rds of the £110 billion NHS budget is financially flushed down the toilet. It's not just the waste at the patient care level with the total disorganisation of the staff and managers*, that waste is repeated every single level to the top. The peter principle is rife as is bullying and incompetence.
My girlfriend, my brother, his girlfriend, my other brothers girlfriend and my mother all work for the NHS at different levels in different areas of medicine.

Of course, now someone will pipe up about how their life was saved by the NHS so it's all OK. That is irrelevant. Every health service in every country saves lives. They generally don't kill as many people as the NHS though. I could tell you some real horror stories about what goes on particularily in hospitals manily due to junior staff not getting enough supervision that are really common.

To get the waste in context, removing all waste from the NHS for one year would be about the same size of the total cuts the coalition government is planning over the next 5 years.
Of course i know that this is an impossible task in any organisation - I am just putting some context into how badly run the NHS is.
*usually due to a lack of training because they don't have enough time of money due to waste

[Tumble]

Happened to me. I had to wait 2 days eventually as old blokes kept coming in with broken hips and things. Sucks, but there you are. I didn't even get a cast.

[Alex]

I don't really know about what it's like in England, I've only worked in Wales since I qualified around 4 years ago.

The lack of doctors isn't just down to the lack of funds though, there aren't enough doctors in the UK, not just the NHS. Yes, people are put off staying in the UK by bad experiences, I've been moved 4 hours drive away from my wife and home for a year shortly after getting married for example, but I think the problem isn't too many doctors moving away, it's that there aren't enough to start with.

There's lots of reasons for this, for a start this is a system where you should have more juniors than consultants. Most consultants would have a team of 3 or so junior doctors working for them, but then most of a doctors career is as a consultant. This means that it is often difficult to get a consultant job or GP job, but there are still not enough juniors. I think this puts some people off a bit, or makes them leave the NHS.

There are often jobs available, but in places where people don't want to work. As I mentioned above, I live in South Wales, I own a house here and my wife works here. Despite this the job I started with was in Rhyl, 4 hours drive away. People who live near to Rhyl, in Liverpool, don't want to apply to Wales as they may end up in Cardiff, miles away from what they know. The system doesn't allow you to apply for a specific job, you apply to an area, which can be as large as Wales or Scotland, and not know until after you've accepted the job where in that area you'll be.I think this is a reason people move abroad - even though you're living now thousands of miles away, you can at least know you have the job for a determined length of time, and they can't just move you to a different place seemingly on a whim.

I don't know how much people are put off by the media, but I find it really hard how much the papers, especially the tabloids, like to have a go at doctors. Every week there seems to be a negative article about how we're paid too much, have too big a pension, constantly make mistakes etc. How we're all 'abandoning the NHS' was one of my favourites - as if we owe anything to the system any more than any other employee owes to the employer. Waiting times are our fault, the lack of giving everyone expensive drugs is our fault (not NICE's, obviously), the lack of money in the NHS is because we're paid too much.

Overpaid NHS doctors and too few practitioners 'knocks three years off Britons' lives'

Now if, on top of that, the medical students now need to pay their tuition fees, that's up to six years at £9k a pop. I'm not saying it's wrong to ask doctors to pay that - I don't resent the £27k of student debt that I'm paying off, after all I'm benefitting from it. All I'm saying is that it won't help lure people into the profession.

Now I really like my job, I like working where I do, and although I'm on a quite good wage I work hard and long hours for it. I wouldn't be doing anything else, but I can easily see why so many are put off either being a doctor, or working as a doctor in the NHS.

Sorry if this little rant is completely OT!

[Allen]

Same thing happened to me when I had appendicits a few months back. The doctor even told me I should've been sent straight to the surgical assessment unit when I arrived due to the seriousness of my complaint, and this was after about 4-5 hours of waiting.

Still, whilst I was waiting, I saw several people come in after me and go through to the doctor very quickly with what looked like much more minor injuries which was a bit annoying. Although I was baffled by the guy with what looked like quite bad head trauma who was left in the waiting room for ages with blood pouring from his head...

I don't quite get how they prioritise patients.

[Terbinator]

I'm not going to lie, i was expecting to see some awesome pictures -sorry to hear it was quite serious and it taken that long for your girlfriend to get treated.

As mentioned by others now isn't the prime time for the NHS and in some cases the speed and efficiency of care is probably like this all year round, depending on your trust.

I damaged (no breaks, just sever bruising and a dislocation) my arm back a few years ago while playing football, nothing was broken but the initial impact genuinely left me feeling ill and was sparked out on the playing field for around ten minutes.

Once we got to the hospital i was seen fairly quickly, but it was around another two hours before i left home after various tests or scan and getting ushered from one place to the next. On one hand i spent a lot of time waiting around, getting popped back into place and so on, but on the other, they did a thorough job when it came to it

[TheAnimus]

If you are unhappy with the hospital treatment, I would contact your local PALS service, before you register a complaint. During the winter missions A&E admissions shoot up, but the staffing levels remain the same (or in the future will drop - thanks Tories!), so naturally.

Sorry but going to have to pick this up. Labour cut by 6.2%, Tories, 0.6% iirc.

Compounding the problem yes, but not the cause.

What annoys me about the NHS thou, is often how much it costs them. I had managed to pull my shoulder a bit last week, having broken my body enough (I was never really good at rugby, or hockey, or cricket, or climbing...) I knew it was just a muscular pull. After failing to get through to my GP (which is fine, I'm just in pain and haven't slept properly for two days, I'm hardly front of the line triage) I ring NHS direct. They tell me I need a muscle relaxant so I can rest it and actually sleep (pain kept waking me up if i moved), they tell me to head to a drop in centre, one and a half hours queueing in the centre the nurse tells me they don't have a dr so can't prescribe me anything more than cocodamol (gee, I hadn't thought of that).

What gets my goat thou, is the cost of all that uselessness. Ultimately its always paid by the tax payer like me, so its important we actually get value for money, otherwise scrap the NHS and have a more Singaporean system of government underwritten insurance to stop people been discriminated on because they might be a heradatory risk.

[xiphrex]

Im just going to throw this out here.....bed managers have zero medical training. They dont know the difference between an appendix and a coccyx, but they have the power to tell experienced registrar doctors to discharge patients on the basis that they need the beds. They control the beds and who goes in them.

I will just give one example of the sort of policies that are impairing patient's care, as there are many. Recently a policy was introduced to separate male and female patients to retain patients' "dignity". Its obvious this policy was thought of by someone who hasnt been on the wards working and seeing whats going on (i.e. a health professional). That's because this policy is only for patient's, it does not include relatives or the people caring for the patients (nurses, doctors, physiotherapists, pharmacists, occupational therapists, etc). This means that you could be on a "male only" ward but 90% of the staff working there are females, and when its visiting time no one tells the female relatives they cant enter. So whats the point you ask? Well thats what is bewildering. It wouldnt be that bad except for the fact that this policy is impacting of the availability of beds for patients: a male only ward cannot take female patients and disperse them in amongst the male patients, they either need to shut off a bay and make that female only, or just sit tight and wait for a bed on a female ward.

There are many of these policies which make no sense, local and national.

With regards to the ops story, it sounds like there was very little communication going on between staff and yourselves, and fundamentally that is what is causing your frustration. That should not be happening.

[badass]

Im just going to throw this out here.....bed managers have zero medical training.

If all bed managers were binned tomorrow service would improve and costs would drop. Even if only by their combines salaries. They are only there because they are required to hit labour targets.
Let's hope the coalition government realise what a waste of time, effort and money most of them are and forget those kind of targets.