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Patient power gone mad

The paramedics on Copperfield's patch are taking their customer service responsibilities seriously. A little too seriously.

On a couple of occasions in the last two weeks I have been fortunate, nay privileged enough to see the NHS's gallant front line staff in action. Clad in green and first on the scene - I refer, of course, to our esteemed friends and colleagues the paramedics.

I'm not saying that they didn't show up promptly when I let them know that I had a six year old choking to death on a chicken bone in my consulting room. No, I don't know why Mum and Dad elected to carry their kid a quarter of a mile along the road to my surgery, strike a pose in the waiting room doorway akin to the Creature from the Black Lagoon carrying the lifeless remains of another victim before telling anyone within earshot that Grandma had taken the kid to the local fast-food joint and since then it had all gone tits up.

They're parents and probably don't know any better. It didn't take us long to realise that the drooling and rapidly deteriorating kiddie needed to be shifted to a brightly lit room staffed by girls and boys who had paediatric laryngoscopes and weren't afraid to use them.

No time to lose, you'd have thought. A classic case of scrape 'em up and shift 'em out. A&E here we come, blues and twos, the whole thing.

Not so. The next thing I heard wasn't the squeal of gurney wheels on a laminated floor and the flap flap flap of the waiting room door as it caught the breeze of the departing stretcher. It was, 'Hello, Monica. My name's Zoolander. How are you feeling? Is it OK if we move you from the examination couch onto this nice blue trolley?'


Guys, she's six. And even if she was in a position to give informed consent she isn't actually able to talk. Could you possibly consider her mother running around my waiting room screaming, 'Help! Help! Help! Won't somebody save my baby!!!' as implied parental consent and get the hell out of my consulting room and into your big yellow taxi?

And this is absolutely not the time to start filling in your time sheets. Not while she's going a bit blue around the gills. I don't usually worry about much but even my 'Give a Toss-o-Meter' was starting to register high levels of, er, giving a toss. Just get up and go. Really. Go to Casualty. Go directly to Casualty. Do not pass 'Go'. Do not collect 200 brownie points for asking a moribund patient meaningless questions.

Moving right along..... right up until the end of this morning's surgery – or so I thought. A call comes in from the 999 service. They've got their hands on a middle aged patient of ours who's behaving oddly and whose BP is 208/100. Agreed, he was behaving oddly, in that he was refusing to go to hospital even though (1) he was a known hypertensive (2) he was a heavy smoker (3) he'd had his first stroke at the age of 43 & (4) he was having problems focussing on his PC screen.

'We're going to drop him off at home and you can visit him there.' Like fuck you are. Bring him to the surgery, I'll wait. Pause. 'Hang on Doc, we'll just ask if that's OK with him.'

Ten minutes later the ambulance pulled up outside Copperfield Towers. Our hypertensive, CVA surviving smoker was not doing well. There's no way he could have given reasoned consent to anything. He's walking and talking, but he's walking sideways and talking jibberish. He's stone-cold sober, with a normal blood sugar and alcohol free.

And his BP is 202/98. This is a no brainer. He should be in hospital having his BP lowered while he's under what the soap operas call 'observation' and we call 'a student nurse at the other end of the ward.' No papilloedema, no retinopathy. So far so good. But of course, he's still refusing to go to hospital. If they'd taken him there instead of heading for home he'd have walked straight in, just like he did to my surgery – but that would have conflicted with his right to choose; in this case to take his chances at home.

I'm all for patient choice but I don't expect patients to be asked to risk their lives for it.