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The Friday afternoon dump

Dr Shaba Nabi

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As far back as I can remember, I have had the pleasure of working a long day on a Friday and taking part in my fair share of on-calls. Although this has stopped me attending my kids’ sharing assemblies, or nipping off early for a weekend away, these problems are nothing compared with enduring the years of being used as a dumping ground.

For those of you unfamiliar with the Friday afternoon dump, let me enlighten you. We are basically the default position for any number of other healthcare professionals, who want to shift responsibility for tricky patients before the weekend.

Allow me to share some examples I’ve been collecting over the years:

• A mum referred to me urgently by the breastfeeding counsellor for a breast lump, which turned out to be… a blocked milk duct. When I tried to elicit the counsellor’s secondhand ICE (ideas, concerns and expectations) from the patient, I knew my evening was heading downhill fast.

• A rheumatology nurse specialist who saw a patient of mine with rheumatoid arthritis in her clinic and referred the patient back to me urgently to exclude Sjögren’s syndrome.

• A pharmacist who was unable to offer me any sort of sensible advice for substituting a patient’s HRT when Prempak was discontinued.

• Numerous psychologists who advise me (always late on Friday afternoon) that a patient is expressing suicidal thoughts. When asked if they had performed a suicide risk assessment, the inevitable response is: ‘That’s why I am calling you.’

• Numerous social workers calling up (again, always as dusk draws in on Friday) to state that Gladys is unsafe in her own home and is wandering more than usual. When asked how this is my problem, they pipe up with the stock answer: ‘We don’t know if there is an underlying medical reason.’

• A paramedic asking if I am happy for Bill to stay at home. It is 6pm (on Friday of course) and he called 999 with breathlessness, in the context of ischaemic heart disease, COPD and heart failure. Yes, I sigh, I know his observations are all stable, but I can’t really make that call without seeing him, so you must.

We're the fallback for anyone who wants to offload tricky patients before the weekend

And it doesn’t stop with community staff. I have lost count of the number of completely inappropriate Friday afternoon hospital discharges, from patients withdrawing from alcohol to the frail elderly with mobility issues.

The greater concern is that allied healthcare professionals are supposed to be our saviours, slated to fill the gaps in our threadbare workforce. But when they use us as a fallback for their own problems, how on earth are can they take on extended roles from primary care?

We have always been the risk sink but I shudder to think of the effect on our indemnity premiums as the vast wasteland of dumping becomes wider and deeper. Eventually this colossal swamp will have engulfed so much extra risk that the only option will be to offload it to an employer and become a totally salaried service.

I suspect this is all part of the bigger plan…

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (21)

  • Not to mention the child presented at 1755 on a Friday with " He's had it for three weeks but we are off to the WIndies tomorrow and wanted him checked out " !!

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  • This whole dumping by ambulance crews is ridiculous. They’re under pressure not to take to ED. But GPs cant be an ambulance liaison service- either a local GP service is commissioned like in our area or they go to ED

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  • Im not sure this is a Friday phenomena, it happens all week long. It's what the job has become. I suspect we notice it more on Fridays when the 1830 finish line is approaching and our sympathy circuits are well and truly fried.

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  • AlanAlmond

    The Friday afternoon effect is very real.

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  • I have a rule that if I am dumped on I will always reciprocate and ask them to do something back Can't be too careful..and possibly over time makes people think twice.

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  • Why are you speaking with paramedics?

    Bill is getting admitted. End of.

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  • You’ve forgotten the fax from the midwife requesting prescriptions for iron tablets for all the pregnant women they saw a couple of weeks ago. They have apparently tried to contact them all by phone without success but expect that you will miraculously get through.

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  • It will be difficult to beat the prize dump of an ambulance crew turning up to bring me a patient to check over in the middle of a surgery!
    They wanted me to drop everything and go to the car park into the ambulance to check the patient so they could eject him into our waiting room
    I used the tried ant tested old passive resistance of carrying on the surgery and ignoring them until they got bored and drove off to A and E

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  • Sebastian Pillon

    I once forcefully (but politely) demanded to speak to a dietician (“but she’s in clinic!”) to ask why a prescription for some food supplements was classed urgent.
    I played dumb, as if the patient’s very existence depended on a single Ensure, asking for her name, registration number and supervisor, so that I could refer the patient on her information directly to an intestinal failure unit for immediate nutrition.

    Turns out those Ensures “could wait until Monday”.

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  • Perhaps we should insist all referrals or requests to us need to be sent via a universal “GP ACTION FORM” which is 3 pages long with multiple exclusions and can only be faxed to a number which is checked twice weekly

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  • Shabi,an eminent educationalist and columnist is clearly struggling,note she offers no references with regard to this issue.
    Clearly colleagues have developed effective guerrilla tactics to address these issues,though you will not find these in any RCGP publications,because the college does not address these problems,because it does not address reality.
    You would obviously not mention these tactics in the exam,but you would be wise to follow them in practice.Follow Shabi for the exam.
    In my experience senior college members are as astute and effective as our respondents in guerrilla tactics.
    The college is failing in its duty of care to adequately teach hypocrisy,despite it's obvious skill,experience,and indeed excellence in this field

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  • Spot on TOM !

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  • Dear Tom

    It is very rare for me to respond to my own blogs, (I think this is the 3rd time in over 5 years) but today, I simply must.

    Firstly, I am struggling to understand the meaning of your comment.

    Secondly, I am not a paid up member of the RCGP. I am a paid up member of the BMA and a member of GPC England.

    Lastly, my name ends in the letter "a" and not "i"

    Best wishes

    Shaba

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  • Shaba noted,

    You are surely not claiming that the GPC is anything less than 100% behind the college ! please give us some references, as to the challenges it has made.

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  • Why would anyone want to be a GP ? Yet there are more GP applications than ever before. I find current General Practice utterly difficult, just like Shaba or Peverley or Copperfield.
    We GPs are all in the same trap, just different view points maybe.

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  • As Copperfield said "Its Friday, its five to five, and its crackerjack"

    Yes though of us of a certain age will well remember crackerjack. Here we are all those years later and that is the time that our colleagues head off home or to the pub and have to quickly hand over all their little problems to the GP.

    Our solution is that we are so busy no one can ever get through.

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  • Vinci Ho

    Guys
    Stop infighting
    Two things:
    (1) Dimping is f**k**g everyday , only more on Friday pm. I am on call every bloody Friday .
    (2) Beware that this bemoaning about Friday pm will be exploited by those seven day GP opening protagonists and they will say ‘See! The dumping is because you guys are not open the next two days of weekend.’

    Bottom line is the lack of expertise , time , manpower and of course , money in various frontlines in NHS.

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  • Vinci Ho

    Correction
    Dumping

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  • No I quite like Dimping.

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  • Just Your Average Joe

    Don't forget the blood results rung through at 6pm with INR 9, sodium 121, Hb 58.

    Patient has no up to date phone number!

    You get the drift.

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