Archive for December, 2007

Care of the Elderly

Posted on December 27, 2007. Filed under: Journal from behind the desk... |

I work in an area that has a very high elderly patient area. As a general rule I like old people. A few things need to be considered when caring for the elderly….

Firstly I think elderly people should be given longer appointment slots than those youngsters.  It’s not the huge amount of past medical history or the complicated medications and allergies they have that take the time, it’s undressing them, and not because they have arthritic fingers and can’t undo buttons, oh no…it’s the body armour! 

It’ll keep the chill out!

For example I’ve just seen a woman, who had a vest on, then a bra, then a bodice, then a long sleeve thermal vest, long sleeve top, followed by a woolly jumper and a huge coat and scarf.  All I wanted to do was see her back! 

If the younger generation took this approach to dressing it would save the NHS serious money.  I’m sure they would still get the same amounts of spots and colds, but we wouldn’t be seeing so many girls for contraception. The boys around here struggle to pull their trousers up, let alone undress a woman.  The bra itself is a struggle for these young lads…most of them can’t even get them off a washing line….

  …but alas they can still have sex with or without their “birds” bra on! Now I think they would have less luck having sex with someone wearing a bodice, thermal knickers, long vest and thick tights. (Without even considering incontinence paraphernalia)

Second consideration about caring for the elderly is you have to not take literally all the things they say.  The worse case of this is the comment:

“Don’t ever get old, Max”.

OK lets look at the alternatives….

a: I drop down dead right now.

b: I get suspended in time and space either by some freak split in the time/space continum or in a Walt Disney esq. freezer unit.

Hmmm, thanks, but I think I’ll just grow old disgracefully!

My final consideration for this instalement is sound proofing the walls. Otherwise consultation become a 3 way thing:

Max: “I-SAID-HOW-IS-YOUR-HEARING?”

Pt: “YES, MY BOWELS ARE CLEARING!”

Everyone else in the building: “NO! I CAN’T HEAR WHAT YOU ARE SAYING, THAT MORON DOWN THE CORRIDOR IS SHOUTING AT HIS PATIENTS AGAIN!!!”

 Such fun!

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Christmas traditions!

Posted on December 13, 2007. Filed under: Journal from behind the desk... |

Sorry about my little Christmas sing song last week!  Cliff bloody Richards has been everywhere again recently – he is a bit like an old Christmas decoration, every year it gets dragged out and every year it looks a little bit older and people get a little bit more fed up with it!

Christmas is sometimes a time for reflection.  The main thing I find myself reflecting on is the difference between working Christmas time in the Emergency department and working in general practice.  The most obvious difference is that I don’t get to work Christmas day which is a joyous thing, especially with a little one at home! 

My wife who works at the hospital as a ward sister also gets to have Christmas day off as she is too expensive!  This means that if you are sick at Christmas you can guarentee you will be nursed by junior staff.  (Not at all worrying).

“I can’t find sister, I’ll ask mummy”

Anyway back to the differences between Max The Primary care NP, and Max the Emergency Nurse.

Christmas in general practice is a time that patients bring more chocolates and biscuits for the surgery staff than weight watchers can cope with for months afterwards.  We normally get enough biscuits to last until the spring, (probably longer if we didn’t all turn into starved pigs as soon as one box is finished and insist another is open!!!).

The main problem in GP land, is that everybody wants to be well for Christmas.  This means that we get madly busy, but with very few serious problems. It’s a case of:

“My nose dripped yesterday – I want to be better for Christmas”

..to which I want to reply…

“Well, come back when you are ill enough to diagnose, and I will see if we can find you something to help”

Or the patient says…

“I wouldn’t have normally come, but it’s Christmas soon and…”

…because as everyone knows, Father Christmas (I’m a Brit and proud OK?) issues us special cures for the common cold just before Christmas, that don’t exist the rest of the year!

Ho, ho ho – Give them Oral Christmasavir

The Emergency room is a different story completely…

Firstly no bloody chocolates, seasonal treats only come from the staff.  It is a bit of a rule – nobody buys presents for the Emergency staff- we’re either trying to chuck patients out after a long wait or pass them on to the lovely ward staff who give them food and love, thus they get all the chocolates!

Secondly, the Emergency dept. never shuts.  The annual arguements over who gets to work Christmas day usually start on the 26th December.

I recall one Christmas day an elderly lady presented with earwax, it had been a problem for months. When asked why she came on Christmas day, she said her wax didn’t normally bother her, but she wanted to hear the Queens Christmas speach!

Typically Christmas day is full of patients having “heart attacks”.

Notes read:

PMH: Full English breakfast, followed by 4 pints of Guinness, followed by 4 course meal with all the trimmings, followed by half a box of Quality Streets and a whiskey. Now has crushing chest pain. No previous cardiac problem.

O/E: Belching ++. Chest pain resolving with ant-acids. Epigastric tenderness++

Plan: Eat less. Ant-acids. Don’t be so stupid and stop rubbing it in that you’ve eaten well, when we’re stuck here with nothing but a few cheapo mincepies.

The saddest thing about Christmas in the Emergency room is the annual Granny dump.

“Hi- Grannies not been well-Could you just check her over?  We bought her suitcase, in case she needs to stay in-If you need to contact us we are in the Bahamas until the 2nd of January-She normally lives with us and can’t cope alone, must go, plane to catch” Vrooooom!

This tale is not based on a random case, but something that happened several times and every single year.  If they just need a bed and warm meals why not spend money on a nice hotel for them?  It was probably the most upsetting thing to see and certainly not a good way of spending tax payers money.

If I don’t recover from the works christmas doo until January I wish you all a grand and healthy Christmas.

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Christmas Cliff Hanger…

Posted on December 6, 2007. Filed under: Uncategorized |

Ahhh, It’s time for a Cliff song

Don’t kiss the boss or photocopy your bum,

At the party that is due to come,  

Dreams of bonuses, dreams of sleep,

Working for money the tax man will keep.

Christmas Time, Chocolate and wine,

Children coughing all the time.

With mucus in the waiting room and prescriptions for free,

A time for rejoicing in the patients we see.

A time for wheezing, a time for sneezing,

A time for giving and not dis-easing,

When you cough – use your hanky,

I don’t want you germs, they are manky.

Christmas time, chocolates and wine.

Doctors get presents all of the time,

With Ferrari in the car park and lunches for free,

How about a small bonus for me?

A time for drinking, a time for vomiting,

A time for over eating and in-digesting,

“Christmas is coming, cure me please”

Unfortunately the viruses don’t cease.

Christmas time, drunken behaviour is fine,

Nurses singing – oooh what a crime!

Working hours longer than most.

Perhaps we should escape to the coast!

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