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.