Sunday, 18 December 2011

The Secret of Medicine

Ah, the joys of plagiarism. 

What a fabulous paragraph, even if the article is a couple of years old. Click on the quote above to read the rest of the article by Dr. Thomas A. Doyle. No, I don't know who he is or anything about him either, except for the bit of blurb at the end of the article. But he has some very interesting things to say, don't you think? 

Change "America" for "UK", or anywhere else in the developed world, and I suspect that the same problems are present all over. 

So what do you think? Does he have a point? Are we really a nation of wimps? More to the point, does the medical system here just pander to too much? 

Case in point, particularly after the weekend just gone - The Booze Bus. Look at the photo. A transport ambulance, with a fully trained paramedic crew, loaded with three (that I can see, anyway) people who have nothing wrong with them other than an under-developed sense of responsibility and self-awareness. Should the health system really be paying for what is no more than a babysitting service for people who, a few years ago, would have spent the night in a police cell and woken up to a hangover, a steel door, a charge of drunk and incapable, and a large fine? Nothing's changed since then, except for the fear of litigation, and that in itself is well on its way to bankrupting our health system. 

I know the arguments for and against the concept of the Booze Bus (or, Alternative Response Vehicle, to give it its official title). I understand both sides, and I know that had it have been available last night around where I was working, I would have had four fewer patients. Or at least different ones. But I still feel that society as a whole needs to realise that the days of personal responsibility need to return, that the pot of money is not unlimited, and that sooner or later, whether we like it or not, charges will have to be made on certain categories of patients. I just think that the Booze Bus is as good a place as any to start. 


Anonymous said...

"But I still feel that society as a whole needs to realise that the days of personal responsibility need to return"

Never a truer word spoken.

Tom said...

Yes, we are all responsible for our actions. Given that I'm a student nurse, I have had many encounters with the effects of alcohol. From the acute setting of trauma and orthopaedics when I cared for a young drink driver who had put himself and other half in. It'd seem that ambulances are being used as a free alternative transport to a warm environment where they will be allowed to sober up courtesy of IV fluids. I wish that the coppers would nick a few more and let them sober up in the cells. However, I doubt that their desire to do their job has changed since those days, just that health and safety has too much to do with anything now. I believe most custody suites (aka the nick) have nurses there. They are able to provide any emergency care if needed. Then a hangover and a fine are left to the pleasure of the incumbent occupants of the cells.
Alcohol takes up too much of our health care system's precious resources. This is because people can wash their hands of their actions once they are on an A&E trolley and such like. I just hate alcohol, or rather what we as health care professionals are obliged to deal with because of it. Some things are so avoidable if people took responsibility for themselves or had their friends looking out for them on a night out. Or more importantly, knowing where to draw the bloody line.

Here endeth the lesson/rant.

Firefighter/Paramedic said...

I wonder if we would need to charge for certain services if we just started sending drunks to jail for the night. It used to work. I absolutely hate when cops say, "You want to go to the hospital or to jail?" If you can throw them in jail, do it. don't make the health care system suffer because you don't want to deal with a drunk (and the paperwork) overnight.

Tom said...

Precisely! If you're found drunk and pissing all over a car, you need a cell. Not a valuable A&E trolley for the night. A stern word or three with a custody sergeant too.

Anonymous said...

'But I still feel that society as a whole needs to realise that the days of personal responsibility need to return'


Should be read in conjunction with this post...

'These are people who misbehave. They misbehave in school, they misbehave at home. They misbehave on the streets. They cause problems for their parent, for their teachers, for each other and for you and me. Police officers are the only people capable of saying ‘No’ to these people and they don’t like it.'

hilinda said...

The problem around here is that the University as an alcohol medical amnesty program. If they go to the hospital, they don't get charged with underage drinking.
The purpose of the amnesty program is to avoid students not calling for help when they need it out of fear of being arrested, and I get that, but the result is that they (or their friends) call all the time.
I have personally rarely (maybe never?) seen someone so drunk they needed emergency care, although on rare occasions (like frat hazing) it may be necessary, but I have all too often seen them get it anyway.
Whatever happened to sleeping it off? That's all that happens in the ER anyway. They take up a bed. And mostly, these aren't even people who don't have their own warm bed to go to.

Eileen said...

Here where I live you don't pay for your ambo if it was an emergency. Being drunk out of your mind is your own fault and shouldn't consitute an emergency. Charge them, charge them the full cost of the call and care - they were happy enough to spend a lot of money on getting drunk so paying for the consequences seems perfectly fair. Once it has happened a few times, taken directly from their salary - most of them were office parties after all, they might think twice about their behaviour.

Oh - and charge the companies that encourage these office parties too. When I worked in the NHS many years ago every department/ward had a party. Not a drop of alcohol to be seen (unless there was some in the mince pies) but we had a great time and went back to work afterwards. You don't have to be plastered to celebrate and have fun.

Mental Lentil said...

I agree with Eileen's first point, charge them for their Booze Bus ride AND the 'care' they received... if they can afford to get pissed up they can afford the aftermath as well.
I was charged for MY big white taxi ride after my RTA (not my fault) so why shouldn't they get charged?

Emma said...

Well, I wanted to comment last night, but what with it being 11pm and me not being finished revising for an exam at 9 this morning... thought better of it. So let's hope I haven't forgotten any of what I wanted to say.

Yes, you're quite right. We absolutely should be charging these time-wasters.

But, it's difficult for several reasons. The first is: this is the NHS. And now we're charging.
Brits are incredibly privileged to have free at point of delivery healthcare - not only does it not exist in the US, but it doesn't exist on the continent either. Everywhere you go, you need to have health insurance, except in the UK; and that's a fantastic thing, which we should uphold with zeal. No patients being refused treatment because they can't pay.

Apart from the, well, money aspect, is the deterrent. The NHS is there for everyone, but it particularly shines when it comes to those who are really and truly desperate, and often it's the vulnerable people who don't have money. Given that, we absolutely must avoid at all costs the perception that there is a chance of a serious (by which I mean honest) call resulting in a fine, because vulnerable people are already far too good at coming up with excuses as to why they shouldn't go to the doctor.

So, the people being fined should be only those who never needed any treatment to begin with and, crucially, knew or should have known, because it was bloody obvious, that they didn't need any treatment.

And in deciding if that's the case, we need to be aware of the huge knowledge gap between NHS superpeople and stupid mugs. It's fair to say that any fool knows that if you've drunk lots and now you feel sick, you don't need medical care. What if you've drunk lots and and you feel sick and you can't see properly? What if you've drunk lots and you've been sick and you think you saw blood? What if you've drunk lots and you can't feel your leg? What if you've drunk lots and your speech is slurred and you can't smile straight...?
There's a fine line between "Fuck sake just go home and sleep", and "Well, actually those could be some serious symptoms, and it's not such an overreaction to call in the expert". Crossing it would result in the aforementioned deterrent effect, so we need to stay well, well back of it. If that means we don't get all the system-abusing leeches, so be it.
As a sort of relevant side note, compulsory PSHE classes should be doubled, and should include teaching on health other than sexual health.

Given the above, and given how easy it is for a doctor or medic to get more pissed off than necessary with what they know is time-wasting but the patient might not, after a long day, any fine probably shouldn't be an internal NHS matter. Why not introduce a new minor criminal offence (of the order of parking tickets), Wasting NHS Time, with a fixed penalty (which goes to the NHS) and a proper administrative appeal process, for those occasions when it's necessary? And, presumably, it would be used for repeat offenders only - hey, maybe it'd even act as a deterrent in its own right.

Lots and lots of problems, and difficult ones at that, to solve before a working system could be achieved. But it should be a goal, nonetheless.

TOTWTYTR said...

The colleges, at least in the US, don't want the liability. The college police are under orders to call EMS for "alcohol related illnesses" or an "unconscious person".

Mostly we have no recourse, because they can't validly refuse.

If the schools were serious about this problem, they would have a rule requiring suspension or expulsion for any student who drank so much that he or she had to go to the hospital.

Of course the liberals will tell us that that would have a "chilling" effect and people wouldn't call the ambulance and might die.


Yes, we have turned into a nation of wimps, and not just on this subject.

Anonymous said...

I totally agree with personal responsibility - I am no angel, I've had nights out where I've wondered quite how I got home in my youthful years but at the same time, knew how I was getting home before I went out..

I now live near a big town, and hate to see people stumbling around the streets half dressed, vomiting in doorways etc. I think people who require the 'booze bus' and similar should pay for it - its not fair on others to pay for their night out! Its a also a waste of valuable resources and of the NHS's time. I work for the NHS and am often fed up of how many ETOH patients we have - they require the most treatment and tend to be the most ungrateful people I've ever dealt with. Selfish and irresponsible.

Anonymous said...

People should be charged, for the cost of running the booze bus and for the cost of the treatment centre and then a little on top for being a twonk