What the ward round reveals
‘The sight went funny in my left eye and then I got a banging headache and felt sick’said the first patient, a young woman admitted the night before.
I’m on the post-take ward round for the first time since…never mind, a long time ago. Aha, I thought, classic migraine, quickly followed by: What’s she doing on a noisy acute medical ward? She should be lying down in a darkened room with a dutiful partner supplying regular painkillers and TLC.
The admitting registrar said her CT was negative for sub-arachnoid haemorrhage and the (locum) consultant confidently pronounced tension headache as the diagnosis but also ordered a brain MRI. I stemmed the blood from my bitten tongue and felt better listening to the registrar chuntering to himself, reasonably grumbling that a tension headache does not require an MRI.
In the next bay a nonagenarian was cheerfully tucking into a hearty breakfast. She was being treated with oral antibiotics for a chest infection and was completely unphased by the pronouncement that she would be in for a further four or five days. I mentally rattled off the litany for early supported discharge: occupational therapist, physiotherapist, generic domiciliary care, meals on wheels, district nurse, a partridge in a pear tree and a visit from her GP.
‘You’ve missed off some of my tablets,’ said a fit looking bloke in the next bay. He held out a piece of paper with diazepam 2mg. written on it. He had lung cancer with known metastases in his scapula and had been admitted by the out of hours service for ‘pain control’ two days ago. He was on a respectable dose of slow release morphine but no-one seemed to have tried him on a non-steroidal anti-inflammatory or, more importantly, a quick phone call to radiotherapy, who are only too pleased to oblige with some analgesic, secondary zapping, gamma rays on request.’”We are going to refer you to oncology’, said our consultant which reassured the patient but started to heat my blood.
The next patient sent me over the top in terms of colleague criticism. A healthy thirty-something year old had had a cough since Christmas. As have I but I’m not languishing in a hospital bed Tweeting about hospital food and burning £500 a day of healthcare resource. As we walked back to the notes trolley cum COW (computer on wheels) as terminals are known in secondary care, I cracked.
‘What did his GP admit him for? What was he thinking?’The registrar met my gaze and said ‘Prolonged cough, as we discussed.’
‘But he’s fine,’ I said “He should have been managed in the community. ‘ The registrar patiently waited for me to finish and then turned to the keyboard and punched a couple of keys. A chest x-ray appeared on the screen with one lung a complete white-out.
‘We’re going to drain his chest. Maybe you want to do it?’
Peter Weaving is a GP in Cumbria and GP Clinical Director for North Cumbria University Hospitals Trust