The Friday afternoon dump
Dr Shaba Nabi
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