Redefining “Urgent”

Posted on December 10, 2009. Filed under: Journal from behind the desk... |

Sometimes there is a real “urg” in Urgent…

Imagine the scene…It’s the end of a long and tedious day, you’ve been working a full week and scarcely seen daylight as it has now reached that time of the year when you get to work in the dark and you leave in the dark. You only get to see your garden at the weekends…(like some weird divorce settlement).  You think you’ve seen your last patient for the week and an appointment slot suddenly appears, with a patient’s details in it and a red line meaning it’s an urgent appointment.

OK, so I don’t want to spend ages doing a full cardiac assessment then waiting for the ambulance and be really late home, but fair enough if it is urgent….

I call the patient, no chest pain, no breathing difficulty, but she does have a headache…could it be a subarachnoid haemorrhage (for those who don’t know a subarachnoid haemorrage isn’t a bleed in an underground spider) or perhaps Meningitis? So I take a history from this rather well looking lady.

She’s had the headache for about 5 years….

Suddenly I think perhaps my adrenaline surge was wasted somewhat.

Why is it urgent? Because the patient has the afternoon off work and she doesn’t know when she’ll next be able to get an appointment….URG!!!

The same thing has happened to me a lot recently. One of the others was also a headache, for several years, that the hospital consultant felt was caused due to cervical spondylosis, but what could be causing the headache…. urm… cervical spondylosis perhaps!

Right that’s it. I want to make a poster for the waiting room defining Urgent….

If you require an URGENT appointment please ensure the following…


You meet one of the following criteria: 

*You are experiencing chest pains

*You are having difficulty with your breathing that can’t be resolved with a few slow deep breaths into a paper bag.

*You have had your symptoms for a few hours only.

*You really do think you are about to die.



You do NOT meet any of the following criteria:

*You need to be seen today as it is not convenient to be seen when the next routine appointment is.

*You’ve Googled the symptoms you’ve had over the last few months/years and now convinced yourself your demise is imminent.

*Your boss said you need a sick note before tomorrow

*You have several days of pain, and want a prescription, but haven’t taken anything from the pharmacist to help.

*You’re a bit bored and happen to be walking by the surgery when you saw the lights were still on.

*It’s raining outside.

*You only have one week left on your prescription.

Do I think it will help???  NO!

Anyway with Christmas fast approaching I will invariably be inundated with urgent cases that “wouldn’t have normally come” but… “don’t want to be ill for Christmas!”  ‘Tis the season to be a wally….Tra la-la la-la, la la la aarrrrg!


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