Friday was what my dear departed granny would have termed "A bit of a B' ".
One patient in particular posed problems that were not immediately solvable. Siobhan, a single mum not in the first flush of youth, had had a "funny do" eight days before. It had left her with a funny feeling in her right arm and leg, very tired, and perhaps a bit weak down the same side. She has high blood pressure and had a similar funny turn three years back which got better in less than 48 hours.
Investigations then were all normal, so she takes meds for BP and a daily aspirin and was well until this latest turn. Still there's enough here to make me worry about stroke. So I had to worry her. Unfortunately she hadn't read the "Stroke Care Pathway" and so, thoughtlessly, she had not made any childcare arrangements so I couldn't just send her straight in for work up by the physicians. Some people just don't think things through do they ;-) .
First I tried to call the Medical Registrar to see if there was any way to get her booked for her MRI without all the bother of "the pathway". Switchboard at the hospital tracked him down, but "We can't put you through on this line, do you have a mobile?"
No. Or at least not on me. I don't generally need one in surgery. If I do bring it in the kids just use it to update me on their missing sports kit / flute / lunch pass / lunch... so I don't do that any more.
"O K we'll get him to ring you back."
Siobhan was ok to wait for a while so I asked her to take five while I saw the next punter. Five turned in to sixty five and still no call back, so we agreed she should go home to await my call.
Twenty minutes later surgery was over and I called my friends on the hospital switchboard and finally got to speak to Med Reg. He's a locum and has less clue what to do than me. We agree to try to get Siobhan up to the Medical Assessment Unit as soon after she has completed the afternoon school run as possible,
So I now ring her back, and get diverted straight to answerphone. Leaving messages in such circumstances can be ticklish. What if it's not her that gets to pick up the message? What indeed if it's not even her phone?
I ring again to make sure I've dialled the right number. I have. It's the same message. So I leave a "George Smiley" type message vague enough to not let ant cats out of any bag, but clear enough (I hope) to make it clear that I need her to call me back.
She doesn't. So I go home, late, worrying.
Monday morning and there she is at reception when I come in. We reprise Friday's consultation and try again. This time all works to plan and she departs surgery for MAU within twenty minutes, referral letter in hand. Later she calls back to say she has had her initial x ray and bloods done and waits for an MRI date, but has been let home to continue to care for her inconvenient children.
I can't help feeling we ought to be able to do this better, but there isn't an arm of the pathway for "Single mum" or for "Carer for elderly demented spouse" or any of a dozen other little wrinkles that make the "Stroke Care Pathway" inappropriate for a great many patients who might be in need of it.