Flipping Crazy

The cops in Devon & Cornwall have got a great plan for dealing with drunken slappers in Torbay.

They're going to make them slap even louder!

All we need now is an NHS presence outside the nightclubs offering a free liver transplant with every 15th Bacardi breezer.

Am I the only person who thinks that public money is being pissed up the wall?

All in a days work

My last patient before the weekend was a 40 year old mother of 4. She split up with her husband six months ago and has been struggling emotionally, socially and financially since then.
She had a night out with friends 4 weeks ago 'to cheeer her up'. She had a few drinks, a dance in the local club a kebab, a snog and then in time honoured tradition a one night stand with a young erect penis without a conscience.
She came to see me because she thought she might be pregnant again, as she has more experience than me, I took her word ( and 2 positive HCGs) for it.
We had a chat about her situation. Her husband ( soon to be ex) is already fixed up with a 25 year old chlamydia bandit - no support there then.
The donor, well she never even found out his name.
So having established a gravid state, her absolute inability to cope with another child in these cicumstances, and giving lots of words of advice and encouragement. FLMN makes the referral to the early pregnancy unit, for a termination, gives the lass as much moral support as I can and reassures her that all will be well in the end.
I had a card this week from the patient, nothing flash or extravagant, just a few words saying 'thanks for being a friend when I needed one'.
I earn a good wage in my job, have a degreee of respect from my colleagues and patients, but this, this knocks all that into a cocked hat.
I have a privileged job and I love it!

Judas

In the interests of improving my prescribing practice I recently bought a new book. A very 'useful, concise and practical introduction to the vast and complex subject of medical treatment', is how it is described in the blurb. I like the book, it is all that it says above, and I will keep it close at hand in my clinical practice. It goes on further to say that the book is 'useful for nurse practitioners' so that's me sorted then.
One of the authors, Hugh McGavock rang a bell in my dusty brain. Could it be this Hugh McGavock?. Mmmm. Probably is I think.
So, it's OK to have a pop at nurses who prescribe, and make totally outrageous and baseless statements about their practice. But on the other hand it's OK to make a few quid by pushing a book at them.
The balanced side of me says ' good old Hughie, he's realised that nurse prescribing is here to stay so he might as well further the cause with a helpful publication'. The cynic in me smells the faint whiff of hypocrisy and the tang of greed.
What do you think?
That notwithstanding, I recommend the book to all nurse prescribers.

All Change

Hi,
Sorry I've not posted for a while. If you were a regular visitor, you've probably enjoyed the rest.
I started a new job two months ago, I'm now working in a GP practice as a nurse practitioner again, and learning the ropes as best I can. Hence the gap in posting.
The job is great, supportive GPs and staff, couldn't wish for better.
As usual, the patients spring plenty of surprises on me, I'll keep you posted.

Money Wasting Tossers

Quiet day at work for a change today so plenty of time to surf the net and catch up with the news.

I came across this in several places.

Yet another unneeded, unwanted and costly government fuck up. You'd think they got their fingers burnt badly enough with the Millenium Dome and the spiralling cost of the Olympics.

Stupid, wasteful, ignorant, bullish tossers.

I voted for Blair in 1997, thought it would bring about a meaningful change.

Don't I feel like a mugged off cunt now?

Poor Judgement

I came across this sad and worrying case today.

I was particularly struck by the following:

'The nurse, Sue Lindsay, said she could not elicit any symptoms of psychosis in his voice and gave the 28-year-old a 24-hour crisis number to call.
Days later, on June 9 last year, degree student Mr Woodruffe, of St George's Street, Ipswich, jumped to his death off the Orwell bridge.'

I think that this is inexcusable. Making a decision on a patient's care, when they have obviously contacted you in crisis cannot be adequately performed over the 'phone. A face to face assessment is mandatory.

According the Mental Health Trust, guidelines were followed. Although they concede that they are now reviewing them - so that's OK then is it?

Fuck the guidelines, whatever happened to common sense and sound judgement?

Taking Responsibility

Dr Crippen draws our attention to the plight of Paul Gascoigne

Whilst working in A&E I've lost count of the number of times patients with drug/alcohol dependencey have presented in 'crisis'. Often with well meaning friends/family who are determined that this time he/she will 'kill the beast' and return to sobriety. I've also lost count of the number times I've walked out of the back door of the hospital and seen said 'convert' drinking, smoking or shooting up.

The main problem, in my opinion, is the medicalisation of these social/behavioural problems, I suspect it is often more about shifting blame/responsibility than it is about seeking treatment. Whilst Mavis' sentiments about Gazza's predicament is laudable. I can't help thinking that the lachrymose Geordie needs to buck up and take some responsibility for his lifestyle and it's inevitable result.

Fraudulent use of the Nurse Practitioner title

Healthcare Republic raises an interesting point.
The problem being, there is currently no protection of the Nurse Practitioner title. This is something NPs have struggled to remedy, there is alas, little support from the DoH.
This leaves those of us who are qualified NPs, and prescribers, with little recourse when faced with this kind of criticism . My personal view is that there is no attempt to defraud patients, but until the title is protected by statute. We will still be seen as quacks by those of our medical colleagues with little insight as to the positive benefits we bring to patient care.

Oh dear, oh dear, oh dear.

The venerable Dr Crippen has had another rant against those who have not entered the pantheon that is the GMC register.
This time interestingly, it involves the case of a consultant psychiatrist who, despite the advice of his peers, allowed a violent and murderous patient to be released from hospital. The sad consequences of which were the unfortunate deaths of two young women.
Good old Dr C alludes to further tragedies of this nature potentially being due to CMHTs, so detested by him. He belittles their work and attempts to shift part of the blame for this tragedy onto them. The facts as reported in the news make even more disturbing reading. Dr Birchall is held wholly to blame for this unfortunate episode, his conduct is criticised. There is no mention of any other individual or organisation being held to account in respect of this case. Much less the CMHT who Crippen would love to blame the whole fucking fiasco on.
Whilst I have the deepest respect for the difficult work of a consultant psychiatrist, particularly when there is such a sad end to the tale. I am vexed by the desire to turn it into another 'point' scored by the likes of Dr Crippen in his long game to smear the work of HCPs.

Fat Bastard

My nom-de-plume was not randomly assigned. It accurately reflects some of my physical characteristics. I've decided that I've been living the good life a bit too much recently. Whilst this is nigh impossible on a nurse's salary, those bits of batter at the chippy are often given away free if you stare longingly at them for long enough.
My expanding waistline is a painful reminder of this. To this end I'm going to make a concerted effort to lose some weight in the next three months. I've posted a meter on the the blog so that I can track my de-lardification.
The bastard of it is. I've just been delivered a case of rather nice Red, still I suppose it will keep until Christmas.

Take a head shot

Based on my experience of gunshot wounds. I'd hazard a guess that one in the head would defeat the stabbie - no sweat!

Infamy, infamy, the doc's got it in for me!

Two of my recent posts have both amused and infuriated the 'daddy' of medical blogs. The friendly, benevolent, nurse practitioner loving Dr Crippen.
Thanks John, my site traffic has gone astronomical, at least into double figures. The BBC have contacted me asking if they can mis-quote, mis-represent and lie about me and the Guardian wonders if they can mis-spell me. I've been offered a book deal by OK! magazine.
Perhaps we should collaborate on other ventures? Do you fancy working as a salaried dogsbody in the new nurse-led polyclinic Kharzi is going to let me have for my birthday? Send in your CV if you're interested.

That's no way to address a lady

Now I'm not a political animal, and American politics doesn't really inspire me but....


Anybody got a picture of Gordon with incompetent twat writ large behind his head?

Taking the piss - again.

Several medical bloggers have commented on this case:

Dr John Francis GRAY
From : 28 April 2008 To : 2 May 2008
Category : Fitness to Practise Hearings
Info :
Fitness to Practise Panel Planned dates: 28 April to 2 May 2008St James’s Building, 79 Oxford Street, Manchester, M1 6FQ The Fitness to Practise Panel will meet at St James’s Building, 79 Oxford Street, Manchester, M1 6FQ to consider a new case of impairment by reason of misconduct.

Name: Dr John Francis Gray

GMC Reference Number: 2277073

Area of practice: Lancashire

The Panel will inquire into the allegation that between about January 2004 and May 2006, whilst Dr Gray was working as a GP, he provided pre-signed blank prescriptions and pre-signed blank Med.3 sickness certificates for use by a Nurse Practitioner when he knew that she was not qualified or registered to do so.It is further alleged that during absences from his GP surgery, Dr Gray allowed a Nurse Practitioner to provide medical and emergency cover in the absence of a locum GP when he knew that she was not medically qualified or registered to so. Dr Gray’s conduct is alleged to be inappropriate, improper and not in the bests interests of his patients.In accordance with Rule 41(2) of the General Medical Council (Fitness to Practise) Rules 2004, the Panel may decide to exclude the public from the proceedings or any part of the proceedings, where they consider that the circumstances of the case outweigh the public interest in holding the hearing in public.

The usual nurse bashers have had a dig, Dr Crippen, Ferret Fancier, and the usual bollocks is spouted about quacktitioners. It amazes me that both of them seem to think that this a good excuse to have a pop at nurses again.

So let me see if I get this straight. A doctor fucks up, behaves outrageously, and according to his medical brethren it's all the nurses' fault.

Seem to have heard that one many times before.

Have some self-respect!

I've just got back from a trip to the corner-shop.

Outside the shop, where there were several people gathered, including small children, a chap was having a loud argument on his mobile phone - clearly audible to all.

'Oh for fucks sake, you are a whining bitch, I fucking hate you, get some fucking self-respect!' He hollered into his phone.

I'm loving the irony.

Painkillers Revisited

I'm beginning to think that there is no such thing as common sense any longer. Easier access to heath care, via Walk-In Centres, Minor Injuries Units, NHSD, Out of Hours centres and soon enhanced access to GPs (i.e. making the poor sods work even longer hours than they already do!) has made the public lazy, feckless and thoughtless.


In my sphere of practice (Unscheduled care/Out of Hours) I'm ideally place to witness this phenomenon. I never cease to be amazed at the breathtaking way in which people treat the health service and how poor their own coping strategies are.





For example, painkillers - sorry to bang on about this, I've visited this area before, but...well...just... AAARRRGGHHHH!!!!! What the Fuck! Why? Why oh why? Why don't people give their kids painkillers, or take some themselves.


Recently, I saw a four year old boy with a six day old knee injury. I saw him at 10pm, yes 10pm! On a school night! He had a painful knee, it had been painful for 5 days and nights. Mum wanted it checked out because they're going on holiday at six o'clock tomorrow morning and it might be serious.

So that's how you make a holiday packing list then is it?

• Underclothes
• Shorts
• T shirts
• Wash bag
• Warm sweater for the evenings
• Mosquito repellant
• Swimming costume
• Totally unnecessary visit to the urgent care centre because I'm useless twat as a parent
• False teeth
• Dick Francis

Mum said 'he's been crying himself to sleep every night because his knee hurts' - as if that was supposed to impress me. I asked which painkiller he had been taking and how often he had taken it. 'Oh well, you know, with children you're never sure are you? You never know if they're really in pain do you?'

What! Shut the fuck up! Not sure if he's in pain! Oh for fucks sake!
You tell me in one breath he cries himself to sleep because it hurts, in the next you're telling me you don't know if he's in pain. And, to make it worse, you haven't given him any painkillers.

At this point in a consultation I begin to quietly, internally, weep.

Rude Bastard

I was taking a history from a patient ( I refuse to call them clients because I get fuck all cash from them) today. During our chat his mobile phone rang. Now this doesn't usually trouble me so much as it is either ignored, or a quick 'hello - I'll call you back' and then we carry on.

However.

This chap decided that a little natter with someone on the other end of the line was a better use of his time than telling me about his problem. On reflection, he was probably right because there was not much wrong with him and I soon sent him packing. But this is not the point. Am I alone in thinking this the height of rudeness?

In my clinic we don't insist on patients turning off their mobile phones - probably because most of the kit is too old to be affected by errant emissions anyway. We do however expect a bit of common courtesy.

Unrealistic expectations

I saw a lady recently with a painful foot - it was painful when she woke up. Doesn't remember injuring it, but; 'would like an Xray please in case I broke it rolling over in my sleep'!

Now I don't know about you, but since I had my kids I've been a fairly light sleeper and tend to wake at the slightest sound. Before the advent of nippers I would sleep like a log and be virtually unwakeable. However, if I injured myself during the night, I'm sure I would wake up - probably screaming in pain!

In order to break a bone in one's foot, it is acknowledged that significant force must be applied to the foot. It doesn't just happen when you roll over in the night.

So unless someone drove a car over your foot whilst you were sleeping, a maniac came into your room and twatted your foot with a sledge hammer, or you indulge in skydiving whilst asleep. It is highly unlikely that you have a broken bone in your foot. So an Xray is not indicated, is it?

Oh, and some bastard painkillers might help as well!

For Crying Out Loud!

I've had a fucker of a day!

Why do patients never listen to what we tell them. I have reviewed two soft tissue injuries today, both of which were seen in the past week and advised that STIs take a while to heal. Both of them came back expecting an Xray for their migratory, transient symptoms. Neither were Xrayed, both were cross, as their friend, relative, postman, hairdresser thought they needed an Xray. Neither had followed STI advice given on their previous attendance.

Then, a nurse friend of a patient thought that she needed an Xray for a nose injury and told her to come and see us 'to get it Xrayed', cue one pissed off patient when I patiently explained that we don't Xray acute nose injuries.

There seems to be a belief that an Xray has some curative properties, sure if you've got a tumour in your head, frying it might make a difference. But for muscle strain, ligament injury or a sore nose; nada, rien, fuck all use.

Then I see another patient with a two week old injury that he hadn't bothered to see anyone about until now- potentially quite disabling. Decides that a fracture clinic appointment for the following day isn't convenient and probably won't bother to attend, by this point I'm past caring. So bollocks to him!

Off now for a drink, and some normalcy with Mrs Fat and the little Fatties.
Back to more of the same tomorrow - deep joy!

Bigging up Nurse Practitioners

As an NP, part of me thinks I should be really pleased to receive news like this.
Another part of me makes me think....are we being used as pawns in a larger game?

Although I disagree with much of what Crippen and some of his pals say about NPs; they rarely present a balanced view, preferring rabid hyperbole instead. Some of what they say is food for thought.

NPs cannot manage patient care in isolation, sure a diabetic nurse working in primary care can probably manage a caseload of diabetic patients, but can he/she provide the full package? I would stick my head above the parapet and say no.

At the risk of being flamed by some of my NP colleagues, I propose maintaining the status quo: Nurse Practitioners and GPs working as a team the better to better provide patient care, utilising the strengths of each team member.
The them and us debate, which now appears to be politically led, is damaging our professional relationships. The medical and nursing professions need to move on from this and work collaboratively to defend primay care from 'Grim' Gordon, 'Grinning Al' Johnson and the other numpties stripping our NHS of its' assets.

Together we stand, divided we fall.

What do you think?

Shagging Nurses

First we're all promiscuous sluts, with dirty finger nails as well .
Coming from an ex-junkie, that's a fucking compliment - cheeky twat.

Now we're busy knobbing the punters.

Someone, somewhere is getting Fat Lazy Male Nurses' portion. Perhaps I should re-invent myself as Grubby Promiscuous Drunken Nurse, I might stand a chance of getting a knee trembler!

Not doing us any favours

I had a referral from a fellow NP recently. 'Patient has painful wrist, ? fracture. Needs an Xray.'

Now I'm a miserable bastard , and lazy, at the best of times and dislike this approach. If you think the patient, needs an Xray, then refer them to Xray, with a signed request. Don't expect me to do your work for you!



Anyway, I thought I'd better chat to the patient first, just to check out his story.

Right handed manual worker.

Painful right wrist for a week.

No history of injury to wrist.

Pain worse on exercise, moving wrist.



So. I took a look at his wrist.

No swelling, bruising, redness or deformity.



I had a feel.

No bony tenderness at wrist, elbow or hand.

Tender over Abductor Pollicus Longus.

Grating/creaking sensation on moving thumb.

Finkelstein's test +ve.



Cut and dried case of Tenosynovitis. No Xray needed, revealed by simple history and physical exam. Missed by a colleague who didn't do the basics.

The patient was very impressed, he did wonder why he had been told to come for an Xray as he didn't remember injuring himself. He was amazed that the NP in the surgery had managed to decide he had a bony injury without looking at his wrist, never mind prodding it to see if he squealed.

We have had a long hard slog to gain acceptance as NPs in whichever field we practice. There are many out there who detract from us, label us as quacktitioners, and mock our work.

Don't give the bastards any ammunition!

I don't want to hear it

Opening gambit from punters guaranteed to annoy.





I'm sure I'm wasting your time but.......

Yes you are, now fuck off and take some paracetamol.



Well, it's my wife you see, she keeps nagging me to do something about this lump on my foot, finger, arse, back - take your pick. It's been there for a couple of years now.....

Why oh why have you come to an Urgent Care Centre then? Fuck. Off. Now. Before I beat you to death with a tendon hammer!


My friend, whose mum used to be a dentist's receptionist said I need an Xray.....

Did she, well you'd better get her down here to sign the request form then, because I aint gonna do it!


Someone said I need a butterfly stitch.....

Who the fuck is someone? Why do half of my patients listen to this character's advice and completely ignore me. Someone must know some serious juju, because he/she is responsible for many, many attendances at my place of work. Oh, and what the fuck is a butterfly stitch - can someone tell me?


I've come to get checked out.....

This is a healthcare facility, not the fucking Ritz! I am a nurse, not a bastard receptionist.

On the way out:

I'm sorry to have wasted your time.......

So you fucking should be, never darken my doors again unless you have actually got something wrong with you.

But what do I say?

• It's OK, it's what we're here for.
• We'd rather see you and reassure you.
• Well it could have been have been something serious.

I sometimes wonder why my teeth are grinding when I repeat the above.


Oh dear, sometimes I get so cross I think my head will explode.

The Menace in the Garden

I have kids, I try to keep them safe, that's my job. I look out for them, I nurture them, I want them to grow up free from hurt and pain. I try to reduce their risk of serious injury and being maimed. I'm sure I'm not alone.

That is why I don't have a death trap lurking in my garden. I don't provide the means for my kids to break bones, tear ligaments, render themselves or their friends unconscious, or knock their teeth out.

How do I do this?


I don't have a fucking trampoline in my garden, that's how!


It's half term, I am seeing a constant stream of children and the occasional adult who have managed to bounce themselves into trouble on these damn things. Most of the time, the incident is unwitnessed. i.e. The child is unsupervised.

In my opinion these trampolines should not be sold without a safety net, and should only be used under adult supervision. However where I work, the parents are often kids themselves so it's probably best they just steer clear altogether.

Cooking with Kids

Saw a child recently with a minor head injury and laceration. Mum had rubbed some almond oil and turmeric into the wound. The kid smelt like marinade - but the bleeding had stopped. I looked this up and apparently turmeric has been used for ages on small cuts/wounds.

http://www.american.edu/ted/turmeric.htm

Perhaps I should get a jar for my first aid kit.
There's no mention of almond oil, perhaps mum just added that because she likes the smell. It certainly got me salivating.

On a different note, when I worked in A&E we often dealt with burnt kids whose parents had applied a large dollop of butter to their burn before bringing them in. I was often reminded of Delia and her advice to always baste your meat thoroughly.

Prescribing for children

Now then Mrs/Miss/Ms Scrote, let me get this straight.
You have insisted on a home visit because your child has had a cold for a week and it hasn't got any better.
The reason you couldn't attend the surgery was because you had no transport.
The two cars on the drive cannot be driven because you and your husband/partner/current squeeze/casual shag are too pissed to leave the comfort of your two large, comfy, inviting looking leather sofas.
You are plonked in front of £1500 worth of High Definition TV, with your £50/month Sky + box, watching a newly released film. I can fully understand you didn't want to be distracted from this whilst I enquired about your child's health, and examined him.
You can smoke at least two cigarettes each in the time I spend in your delightful company and chat on your top of the range mobiles.
So why can't you go and buy some paracetamol, for your child, from the all night shop down the road? Instead of getting the arsehole with me when I refuse to prescribe some.

Pain Relief

Please, please, please.
If you fall over and twist your ankle, stub your toe, or have a bit of toothache lasting over a week. If your child fell over 6 hours ago and has been crying since. If you've had a sore knee, for no real reason for a couple of months.
If then, you then come to see me about it , bitching that it hurts and you can't sleep at night. Help prevent my eyeballs from rolling out of my head by taking some FUCKING PAINKILLERS first!

GPs to undergo nurse training!

GPs should be given the same training as nurse prescribers to help make savings on drugs, according to an RCN adviser.
A report by MPs on the House of Commons Public Accounts Committee last week said the NHS could save more than £200 million a year if prescribers increased the proportion of generic drugs they prescribed......
Molly Courtenay, RCN prescribing adviser and a Reading University professor, said: 'Doctors don't receive the same prescribing training about generics and responsible prescribing that nurses do. Perhaps some of the nurse prescribing programme could be integrated with GP training.' Follow this link for more.

http://www.healthcarerepublic.com/bulletin/IndependentNurse/article/777891/Call-give-GPs-nurse-training/0CF040D78F65F3CC924D8EECF1F0D128/?DCMP=EMC-IndependentNurse

Well, that should stir them up a bit!" I'd like to hear what Crippen has to say about this.

Use us properly!

Working last week in an 'emergency' out of hours clinic - for those who cannot wait until the following day to see their own GP. What 'emergencies' did I deal with?

• A request for re-prescription of emollient cream (moisturiser).
• Some haemorrhoids that had been itching for over a week.
• 7 patients with coughs, who think it has 'gone to my chest and I need antibiotics'. it hadn't, they didn't.
• A painful ankle, for the past six weeks. When I enquired about painkillers I was met with a blank look worthy of Victoria Beckham.
• Someone asking for advice on how to claim housing benefit.
• A child with a scratched knee, which even the father admitted he couldn't actually see.
• A nose bleed which had stopped after 5 minutes - 4 hours ago.

Is it just me or is there something wrong here?