1. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    I got a telephone call this afternoon from the nursing home to say they had called an ambulance for my mum. She had been drowsy and hard to rouse so they had called her GP. He told them to send her to hospital - without even troubling himself to come out and see/assess her himself! As the nursing home isn't very far away I decided to go there first rather than straight to the hospital - the person on the phone wasn't someone I recall meeting and sounded about 12, she said herself that she was 'new' and I wanted to gauge the situation first. When I got there the ambulance was still there and it seemed obvious that there was no real choice other than to allow them to take mum to hospital. As mum seemed quite calm I decided to drive there rather than go in the ambulance, thereby avoiding a situation that has happened in the past where I have had trouble getting home afterwards.

    When the ambulance arrived I was told mum had had a fit in the ambulance so they had had to stop. She was then taken into 'resusc' (sp?) which should have alarmed me, yet strangely didn't. I was told to wait outside resusc but then was moved to another area when an emergency was expected in that 'wasn't going to be pretty'. Eventually I went in and a little later mum had an x-ray which showed a chest infection. They are keeping her in for a day or two (hopefully it won't be more) and she is on iv antibiotics. The saving grace is that she is very sleepy and therefore not too bothered about what is going on.

    The thing that is bugging me is - why on earth couldn't the GP come out to see her? Surely a chest infection would be relatively easy to diagnose and anti-biotics could be prescribed. I can't see that being in hospital will do her any good and it seems to me to be a waste of resources. I can't see that she will be looked after any better in hospital than she would be in the nursing home and she is probably a lot more prone to infections etc while she is in there.

    On the plus side, she was seen very quickly in A and E and didn't have a long wait to be admitted to a ward. I told the doctor in A and E that she had dementia in case it wasn't in her records, but she told me it was and she was aware of it. I didn't stay on the ward for very long so we will have to wait and see how things are there.
     
  2. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Dear Noelphobic

    Sorry to hear about your mum. I hope the infection isn't too serious.

    To give the GP the benefit of the doubt, if the NH told him it was urgent, he probably thought it would be quicker to get her straight to hospital.

    On the other hand, it's Saturday.............:(

    Hope all goes well. Keep us posted.

    Love,
     
  3. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    I think if the nursing home had thought it was really serious then they would have just called the ambulance themselves.

    Never let it be said that my mum cut into her GP's golfing time :mad:

    Brenda
     
  4. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    You're right. I was trying to be charitable, but I wouldn't have been if it had been my mum!:(
     
  5. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,852
    Kent
    Hi Brenda.

    A couple of years ago, my husband `s breathing was very bad, following a cold. When he was lying down, his chest sounded `bubbly`

    I tried to get the GP out but he refused to come, saying I had to get an ambulance to take him to A&E for a chest Xray. Without the Xray, he wouldn`t know how bad the infection was, or what it was, so wouldn`t be able to prescribe accurately.

    I thought it was a bit of an excuse, after all an infection is an infection, but when we got to A&E, he was put on a Nebulizer.

    I hope your mother will be OK.

    With love
     
  6. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    they did give my mum an oxygen mask in the ambulance. She also had one in A and E but kept trying to take it off so we gave up on that in the end.

    I had a cold that started 2 weeks ago but haven't quite been able to shake off. I was intending to give it a few more days and then go to see the GP if I haven't managed to shift it. I would expect him to listen to my chest and probably prescribe anti biotics. I would be flabbergasted if he wanted me to go for an x-ray and my flabber would be doubly gasted if he wanted me to go for said x ray in an ambulance and stay a couple of days in hospital! The only time I have had an x ray for anything similar is when I was actually coughing up blood (although luckily it turned out to be nothing too serious).

    My mum has had the same GP for a long time. When she first went to the nursing home they asked if we wanted to change to the GP they use for most of the residents but we decided against it. I am now having second thoughts, especially as, sadly, she is unlikely to realise who is treating her these days. They have said previously that 'their' GP is generally quicker at turning out than mum's. Also I think my mum's GP is unusual in this area for not using a locum service which also slows things down.
     
  7. Tender Face

    Tender Face Account Closed

    Mar 14, 2006
    5,379
    NW England
    In defence of GPs

    Noelphobic, I'm sorry mum has to be in hospital - and what is the world coming to when we worry that's no longer 'the best place' ..... when someone needs medical attention ....?????

    I admit this comes from someone who has a fantastic relationship with my mother's GP and with mum at very different 'stage' - I have accepted 'telephone advice' willingly - and trust the judgement that he doesn't have to 'see' mum to make a recommendation when I have needed him to .....

    I'm sorry, but I would dread to think my mum's GP didn't get 'golfing time' - )or even time with his own family) ......we know enough here how worn out people can be giving 24/7/52 ...... don't want mum's first point of contact for professional advice to be so weary worn he can't help .....

    Karen
     
  8. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    I'm not sure what you are saying here Karen and I'm tired and stressed so may be misconstruing what you say. I just don't feel that hospital always is the best place for various reasons. It is very unsettling for people with dementia to be moved to a different environment. Sometimes it is unavoidable but I'm not convinced that this is so in these particular circumstances. It would have made more sense to me for a GP to see my mum and decide if she could be looked after in the nursing home. Had it been decided that hospital was the best place then that would have been fine - I just don't think that should have been decided on the basis of a phone call.
     
  9. Tender Face

    Tender Face Account Closed

    Mar 14, 2006
    5,379
    NW England
    Brenda, I'm sure - I know - you're tired and stressed .... and if you're anything like me when you're stressed and tired and angry and anxious ..... you want to pin blame ... and right now I think the GP is getting it ...

    Deep breath for a minute and what difference would have made if the GP had come out (physically) and advised hospital?

    Would that have made you happier? Would that make it any different for your mum just now if that was how it had happened?

    Not trying to be confrontational - just want to undertand why you seem so upset about something seems inconsequential in the great scheme of making sure your mum is OK ...

    Love and hugs, Karen, x
     
  10. Sometimes it can be a very frustrating ride with the medical profession, but a lot depends on who it is you’re dealing with.

    My father has had a very bad chest infection for several weeks. He’s so ill and weak now that there will be no turning back I’m sure, but it’s a painfully slow process that may well end in pneumonia sometime over the next month or so.

    At the outset his doctor recommended he should stay where he was in the nursing home because he felt my father probably wouldn’t recover and sooner or later we’d have to face the inevitable. It such a tough decision to make, acknowledging the end of the line is close and it’s better to embrace it.

    Not all doctors these days are particularly keen on admitting anyone to hospital too quickly especially an elderly person with AD. Just recently two doctors have mentioned to me that it’s not that safe (sterile) and there’s every chance of a loved one sitting in a draughty corridor for ages. I remember hearing of an elderly person who died under similar circumstances.

    That said, emergency care is more sophisticated, but much depends on the condition and age of the sick person. The wisest choice isn’t always the most palatable, that’s for sure.

    I really hope things improve for you.

    Sam
     
  11. alfjess

    alfjess Registered User

    Jul 10, 2006
    1,213
    south lanarkshire
    Hi Neolphobic

    I had to contact the Gp for Dad yesterday.

    He came out to the house and diagnosed a chest infection, prescribed antibiotics.

    So far I haven't noticed any improvement in Dad, maybe it is early days, but if the antibiotics don't work and he then has to go to hospital, I think it will take longer to clear the infection.

    I know where you are coming from in saying that more confusion will be inevitable, but maybe hospital is the best place to get the best treatment for the infection and your Doctor is covering all bases. As we all know with AD it is very hard to get an accurate history.

    Hope things improve for you

    Alfjess
     
  12. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    We had no choice in the matter as the home that Jan was moved to was 25 miles from the regular surgery.

    As it happens, it was a good move to change GPs. The one who looks after the home is firstly backed up by other GPs who understand the challenges of weakened people who have dementia. These GPs understand more fully when to act quickly, and when the home can manage things , with their help.

    The GP for the home will also have a closer relationship to the care home staff.

    That's not to say it should not have worked perfectly for your situation. Your GP was playing safe, in his/her terms. Given that your mum had a fit en route to hospital, the GP's judgement may have been correct?

    Sometimes these things escalate rapidly. Had the fit not happened [and there is no way anyone can know whether it was precipitated by the ambulance] then staying at the home on antibiotics would have seemed appropriate, to me, a non medic.
     
  13. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    Dear Brenda, I can perfectly well understand and sympathise. When my mum was in her last home, I had almost the same situation as yourself.

    The locum service, however, acted exactly as your GP did, so I wouldn't place too much faith in that being an improvement!. It was out of hours and I spoke to a locum GP who said, without visiting, that the best thing to do was to send my mother to casualty.

    My mum had a nasty chest but the doc. would not come and visit. As it happened, we had already booked a GP visit for the following afternoon so I decided against calling an ambulance and gambled that my mum would be more comfortable wheezing away in the home than being shuffled off to hospital. (The last hospital visit resulted in a three month stay because the home wouldn't take her back despite her being deemed OK. That stay contributed to her rapid loss of mobility because there was, of course, no activity encouraged. )

    I was spitting feathers about the locum services. Once upon a time it used to be potentially a disciplinary offence not to visit a patient when asked. Don't know if this is the case now as the process has 'gone behind doors' since those days. Maybe the AS advisers know.

    I could not believe that there was no alternative for a 90+ demented lady other than to hot foot to A and E and I was muttering about this to the palliative care team nurses one day when they said ' Well your mum could at least have her own oxygen supply if she was at home'. They went ahead and pursuaded the GP to prescribe a supply of oxygen for my mum which then could not be administered by the home because they said none of their staff were trained to do so. The oxygen sat in a locked cupboard whilst my mum was there. ( There was a 'Wellness Nurse' in this 'assisted living' home but she wouldn't administer the O2 either and wasn't on duty outside 9-5!) However, that home was not a registered nursing home, whereas your mum IS in an NH and presumably could have O2 available if she needed it.

    As for the fit in the ambulance, who knows whether the shock of the transfer didn't bring that on? I speak as someone who always used to think precisely the opposite: that a hospital was the best place to be when you're poorly and that there was a conspiracy to keep people out of them. After my mum's admission last year, my views have totally changed!

    I agree with you, that it is far better to keep your mum in the home and get the services to come to her unless really really desperate, eg fractures. What is the point of having a GP service that is supposed to be a 'primary care' service if the doctors won't come out? At least a visit would have put him/her in a position to assess how your mum could have been made more comfortable. There are bugs galore in hospitals and noise and disorientation and grotty food and wandering patients ( IMHO). The hospitals don't need unnecessary admissions and the elderly patients don't need that environment.

    Before you change the GP, is it possible to speak to a couple or so of the other relatives of people in your mum's home, to try to see what they think of the home's GP? Sometimes the grass isn't always greener! You could also talk to the home about this admission and what had led to it and see if it is possible for the home to understand and accommodate your views in your mum's care plan. We have asked to be rung immediately if there is any intention to call a GP out and if there is any intention to send to hospital. We have made it known that we would want them to look after my mum in the home as far as is at all possible and want to be party to the decisions about urgent care. They don't always respect this but by and large her NH is aware that we don't want any surprises.

    Take care, good luck and kind regards.
     
  14. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    I think that it's possible that hospital could have been avoided altogether if the GP had come out and prescribed oral antibiotics. I know from past experience how difficult it can be all round when mum is in hospital and, since her last admission with the broken hip, I have fervently hoped that she would never have to go into hospital again.
     
  15. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    Hi Bruce

    I will definitely be discussing with my sister the possibility of changing my mum to the GP that the nursing home use. I was reluctant to do so when the nursing home suggested it for several reasons. She had been with the same GP for a number of years and I felt it was better for her to stay with someone she had a 'history' with. Geographically there was nothing to be gained by changing because her GP surgery is within walking distance of the nursing home. However, I now think that for all the reasons you mention then a move would be a good thing.

    Mum has had several fits recently and the GP has never come out to see her after those either. It is possible that the symptoms that caused the nursing home staff to phone the GP yesterday may have actually been CAUSED by an earlier fit that was not witnessed by anyone. I know when she has had fits previously they have really knocked her out for a few days. A few weeks she was also very aggressive for several days following a fit, which was extremely distressing.

    Brenda
     
  16. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    I think that is an excellent idea and one I have already been considering. I was a bit put out at the way the home 'communicated' with me anyway, although I can't see that anything will be gained by making a fuss about that. I didn't know the person who phoned me and think she was a new and fairly junior member of staff. When I got to the nh I asked who was in charge and was told their name. However, they had already seen me and said nothing about my mum or the situation. The person concerned is not someone I find it very easy to talk to so I will try to see the manager or one of the other senior members of staff. I can then discuss the GP situation and try to reach some agreement on how to proceed in future. It is very difficult to tell someone you don't know that you would prefer to keep your mum out of hospital if at all possible, without it being misconstrued and them thinking you don't care and don't want the best for your mum, which is far from being the truth!
     
  17. DeborahBlythe

    DeborahBlythe Registered User

    Dec 1, 2006
    9,222
    More on GPs , and a list.

    Hello again, some more thoughts, to ponder upon. When I was so vexed with the GP practice, I did very little about it as regards them or even changing practice. Coward? Yes, and this is why. GPs are independent business people. Whilst they are nominally 'part of the NHS', in effect they can act pretty much as they choose where patient lists are concerned and have been known to throw people off their lists for any or no reason. It is very difficult to even raise mild concerns about GP services without upsetting them and jeopardising the 'doctor patient' relationship. So, unless one is very sure that another surgery would suit you better (and actually has vacancies on the list), keep quiet.

    I think that this situation is dire, :( but I wasn't prepared to stir up a situation which might have resulted in my mum being forced onto someone else's list. I had no idea whether the other practices locally were any better, and being one of nature's sceptics, (a polite way of saying crabby ole trout) I doubted it. Also, I think that complaining about GPs will get you a name, and may make it more difficult to actually find another GP. This is all parlous and despicable, but I didn't want to risk anything.

    Don't know if it is golf which is tempting the GPs away from us, or whether the comfortable salaries they earn is too much of a distraction. There are great doctors out there and yes, of course they deserve their leisure as much as anyone else working in the NHS, but I absolutely think that out of hours care for people with dementia needs improving and 'Send her to hospital' is a really poor reflex where people with dementia are concerned.

    In case you are worried about the home's reaction to trying to keep your mum there, here is a list of reasons to think about.
    Hospitals and why to avoid them if you have dementia:
    More bugs and infections MRSA, Clostridium difficile etc
    Standard of food , and who is ensuring that a confused person is actually eating? (See Age Concern recent survey)
    Unpredictable patients and relatives around causing noise, possible upset and disorientation
    Unfamiliar surroundings causing disorientation
    No social activity
    No tailored physiotherapy/games/ stimulation
    Few staff actually trained to cope with the needs of people with dementia. ( I actually saw confused patients being shouted at when my mother was in hospital. The nurse in question turned around and laughed at me as if expecting my understanding and approval.)

    Perhaps compare the Nursing Home favourably on these issues, it may help. Dunno
     
  18. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    Hi Deborah

    If I do make any kind of complaint to the surgery I will do so when my mum is safely on another GP's list!

    I phoned the ward this morning and was told that mum is 'still confused'! I can't wait to see how they are going to cure that! She has also been for a CT scan, although I don't know what they are looking for exactly - results are expected tomorrow. I am hoping for her to be discharged tomorrow but will have to wait and see. The visiting hours seem strange - 12 to 2 and 5 to 7 - as you would think they would interfere with meal times. Anyway must go and get ready for said visiting.

    Brenda
     
  19. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    We have an old lady living next door with serious heart issues [she had a triple bypass a short time ago but is still having problems.

    Invariably, if she calls the surgery and says she needs a doctor, the response is - call an ambulance. Recently she and her daughter [who lives some distance away] have insisted on having a doctor visit at home, as generally, a hospital is not the best solution for her. The doctor then comes.

    Seems to be a standard thing, with new GP contracts and short appointment times with doctors - get 'em in, get 'em out... any prospect of more than seven minutes... pass them on to someone else, ah yes, the hospital.
     
  20. noelphobic

    noelphobic Registered User

    Feb 24, 2006
    3,452
    Liverpool
    The paramedics did say that they commonly are called to take people to hospital who just wanted their GP to visit. It seems like a shocking waste of resources to me. :(
     

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