It was a weird morning; weird because it was very quiet. Obviously we never say the "Q word" whilst at work, we just ignore the elephant in the room. We chat away, drinking coffee, eating crap; all the while thinking ‘blimey it’s quiet'. We managed a nice breakfast in peace, a hot coffee and a newspaper. After 2 hours of relaxing we were finally sent a job! The cheek of it! There was only an address to go on so started trundling in the right direction:
“Diarrhea, really?! I’ve just eaten! Surely we will be cancelled?!”
Sure enough we were. Result! We pulled over and got back to the arduous task of doing nothing; sadly, this was short lived:
“66 year old female, diarrhoea & chest pain”
This stank to high heaven; not of diarrhoea, but of ‘been told you’re not having an ambulance quickly so ring back with chest pain-itis’. It’s a very common condition, and is a bi-product of a campaign telling people to call an ambulance if they get chest pain. It didn’t take long for people to realise that by saying those two magic words they would get an ambulance every time; quickly & regardless of age, sex, medical history. I believed the chest pain we were en-route to would be just that; a load of tosh (but I’ll stay open minded, ish!)
We pulled up outside of the block of flats; there was a huge grassed area, so we parked in the bus stop on the road and walked over. Because we were told chest pain and she was semi-elderly we took the chair with us, just in case. We made our way across the grass and up the stairs to the first floor. The door was ajar so we made our way in giving the obligatory ‘Hello, ambulance’.
To our surprise, there was a first responder on scene. His car wasn’t parked out the front so I assumed it was just us. He had a fed up, angry, dejected look on his face. He was kneeling on the floor in front of our patient who was sitting up in the chair.
“Hello guys, it’s not as given. This is Cheryl; she doesn’t have any chest pain or any diarrhoea for that matter. She has an appointment at the hospital for her eyes in 45 minutes and doesn’t fancy getting the bus. I was just explaining how this is an inappropriate use of the ambulance”
I think I still have a bruise on my chin from where my open mouth hit the floor. In the words of John McEnroe ‘YOU CANNOT BE SERIOUS?!’ Obviously I didn’t say that, but my jaw hitting the floor with a thud said it all!
“So can you take me to the hospital for my appointment then?”
“I’m afraid that isn’t what we do. We take patients with a medical need to accident and emergency and you have said you are not ill.”
There was a brief pause……
“I have some chest pain”
“You have chest pain?”
“OK, we’ll have to do an ECG etc here and then take you to accident and emergency where you will be booked in as a patient with chest pain”
“I don’t want an ECG but I do want to go to A & E”
We were powerless to do anything about it. She was playing the system and intending to self-discharge and get to her appointment. We are not allowed to refuse hospital to someone, let alone someone saying they have chest pain. She declined the offer of a chair and walked off to the ambulance. Oh, incidentally, the bus stop we had parked in was the stop for a direct route to the hospital main entrance. Oh, and she has a freedom pass.
“Couldn’t you have got the bus?”
“I didn’t fancy it”
“...Or a taxi?”
“That costs £16”
We drove to hospital in silence while I wrote the most sarcastically professional paperwork I could muster. As we arrived, I said:
“How’s the chest pain now?”
Hmmm, funny that! We took her into A & E, her appointment now 15 minutes away. I could sense she was waiting for an opportune moment to leave, luckily for us A & E is nowhere near the eye clinic and she needed directions. I gave a full handover to the nurse in charge. The whole time I was talking she was glaring at the patient.
“Where is your appointment?”
“At the eye clinic”
The nurse walked over the phone, looked at the list of phone extensions, picked up the handset and dialled.
“Hi there, we have Cheryl Smith (not her real name) in A & E with chest pain, can you cancel her appointment please………thank you”
She came back over to us:
“Right, your appointment has been cancelled, you can wait in the waiting room until your name is called, just be aware, it’s a 4-6 hour wait.”
With that, she signed my paperwork and walked off.
VICTORY!! Now why can’t we get away with stuff like that?! Her face was a picture, she whined and moaned, swore and shouted but it all fell on many sets of deaf ears.
Age is no excuse for bad behaviour and this is all this job was; bad behaviour. She simply called 999 to use us as a taxi. Seriously though, what can you do when someone plays the system like that? As a service, or as individual clinicians, we are in a very grey area when it comes to refusal of an ambulance or refusal of conveyance. We end up playing another game of ass -covering and passing the buck simply because that is what we are told to do, or realistically, not doing so is more than our job is worth. Until decisions are made at a high level, and I don’t mean ambulance management, I mean government level, nothing will change. This is a national policy problem and not something we can fix with well-placed lectures. Needless to say, I had an epic rant afterwards and spent the rest of the shift well and truly riled by the whole thing!