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.