Wednesday, September 20, 2006

Tak. Mówię po polsku

Rozumiesz? Tak, tak?


We get a large number of callers who don't have English as their first language, especially since we became a national service rather than a lot of regional services cobbled together. Some people only know enough to tell us "No English" and give us their native language, others can make it through the initial assessment but can't comprehend enough to accurately answer the queries in the full clinical assessment. Often they'll have a family member or friend on hand to translate, but we can offer every caller an interpreter, if they feel more comfortable or it's safer, for them to speak in their mother tongue.
This next call was an absolute beauty. The caller was a woman who reminded me of Hyacinth Bucket so much that I was picturing her in a delightful floral frock, with immaculate hair, and a string of pearls. Her accent was so RP that she made the Queen sound like Jordan. She also had a touch of the probation officer from A Clockwork Orange and added a drawn out "Yes" (pronounced h-yeesssss) at the end of most sentences.

me : Good afternoon Moans 4U, I'm Trained Chimp and I'm a health advisor, how can I help?

HB : I'm calling on behalf of my lodger, yes? She's a student at my language school and she looks very poorly.. yes. Anyway she's Polish you see, and doesn't have a GP yet.

[takes patient details]

me : I can arrange for a Polish translator, it will only take a few minutes, and we can assess her symptoms and see how we can help her today.

HB : Oh no dear that's fine, I can translate yes? I have much experience with the foreign girls yes. Polish is not a problem, I speak many languages, yes.

me : Thank you so much, that would be great, it's always easier if there's a translator present with the patient. I need to ask a few routine questions first of all, to rule out any emergencies. Please just answer 'yes' or 'no' even if they don't seem relevant to you. Is that OK?

HB : Oh my yes. Begin.

me : Is the patient still awake and responding normally?

HB : She's Polish, yes.

me : Yes but is she awake, alert? Is she conscious?

HB : Of course, yes.

me : Does her skin tone look blue or grey, especially around her lips and mouth?

HB : No dear, she's blonde with blue eyes. Many of them are you know, yes.

me : Yes, but does her skin colour look different today? Are her lips pink?

HB : Oh of course dear, she's not dead you know ha ha!

me : Is she having any new or worsening breathing problems? Does she sound as if she's struggling to breathe?

HB : I'll ask her [I expect to hear Polish right about now]
"YOU BREATHING? YES? YOU KNOW PUFF PUFF PUFF"

me : *stunned* Excuse me, I thought you said you could translate my questions for her?

HB : Yes dear I am. Was I too quiet yes? Her breathing certainly sounds normal

me : Please, can I get a translator on the line? It would make this much easier.

HB : No dear I'm perfectly capable of translating a little bit of Polish, yes!

This went on for about twelve minutes. A normal call takes about four. She 'translated' everything I said, but here are a few stand-out lines that should help anyone who needs to ask a sick Polish girl some questions:

  1. Where is the pain? = IT HURT BAAAD YEEEES? IT HURT TUMMY OR IT HURTY DOWN BELOW?
  2. Does the pain go through to the back? = IT HURT WHOOOSH THROUGH HERE YEEEESSS? NOOOO?
  3. Have you vomited anything that looks like blood or coffee grounds? = YOU VOMIT? YOU KNOW 'WWWUUURRRRGHH'? YOU WWWWWUUUURRGGGHHH RED STUFF, YES? NOOOO?
  4. Is there any pain on urination? = WHEN TINKLE IT HURT? YEEESSSSS? NOOOO?
When I closed the call I added the following call reason "Abdo. pain and nausea - POLISH TRANSLATOR (speak directly to patient)" Fortunately it seemed poor Agnieska was only suffering from the adjustment to Mrs Bucket's cooking. That poor girl. Shouting broken English very loudly does not equal super linguaphile status!

Posted by Sick Sad Minion at Wednesday, September 20, 2006 | | Comments

Happy to help!

Here are a couple of particularly special calls I've taken. The first was on a GP Out of Hours line:

Me : Good evening Hammer House of Hypochondria. My name's Whitley Terms and I'm a health advisor, how can I help?

Caller (72yo F): *sniffling* My boyfriend stole my Lemsip last night, and I haven't stopped crying since.

Me : *biting through my headset cord* So what kind of help do you need from your GP tonight then?

Caller : I'm worried I might become dehydrated or damage my eyeballs if I don't stop crying. Are there any precautions I need to take?

Me : A nurse will call you back [click]

I only wish it had been a hoax, but I spoke to her again about three times, same problem each time.


I got the next call last August Bank Holiday. Calls were 40% above forecast, non-urgent and Health Information calls were running at 4-5 hours for a callback. We were getting absolutely hammered.

Me: Good evening Circus of Terrors, my name's Papa Lazarou, how can I help?

Caller 2 (45yo F) : Hi yeah, I wore some shoes that were too tight, my heels are blistered, I want advice

Me : I just need to inform you that callback times are running at five hours plus for non-urgent calls, do you want to proceed?

Caller 2 : Yes please, I can't be bothered to get my other shoes out of the cupboard

Me : [there is no emoticon for how I'm feeling] "OK"

I wonder what these people did before we were there? I know Google's hardly the most scholarly or unimpeachable source, but I'd rather try my chances than wait till 3am to be told how to break in a pair of new shoes!

I really do love this job. Even Agenda for Change and Transformation cannot scare me off, i'm here to stay.

Posted by Sick Sad Minion at Wednesday, September 20, 2006 | | Comments

You want what?

Advice for some of my frequent callers:


  • No Sean, anal sex with your boyfriend won't get you pregnant. You've asked this very often, I'm worried, have a word with your mum or dad about the birds and bees.
  • Dorothy - I'm really not sure if cream crackers can be taken with tea or they're better with a cold drink, I checked the BNF but couldn't find any interactions.
  • Josephine - that flaky patch of skin on your nose happens to most of us in Winter. While I can't promise that it isn't cancer, the fact that you've been calling about it for two years gives me hope.
  • Dorothy again - I don't know about bread and tea either. Once again the BNF has let me down.
  • Tony - Remember how your CPN told you to stop buying meds from your friends, or swapping yours for cigarettes? It's sound advice, and you should take it. If you don't listen then you'll spend more and more of your time thinking you're a caterpillar. It's not productive. I desperately want you to become your inner butterfly!
*names have been changed to protect my sanity. If I see your real names again I will snap.

Posted by Sick Sad Minion at Wednesday, September 20, 2006 | | Comments

Tuesday, September 19, 2006

Reasons to be Cheerful

The following are genuine call reasons that I've personally dealt with:

  • Abdo. pain + vaginal bleed - caller had had a coil fitted that morning
  • 39wks pregnant, severe abdo cramps, pressure sensation in pelvis, watery pv discharge, nausea - caller said "But it's not due for two more days"
  • Child with red, sunburn like rash and high temp. - child had been sat in the garden all day during the July mini-heatwave
  • Vaginal bleed and cramping after taking the morning-after pill. How the hell do they think it works?
  • Oral pain following a dental extraction
  • 13 year old girl with vaginal bleed and lower backache - any idea what that could be? Caller commented that "it happened last month too"
and finally:

  • 11 year old girl with swelling under the nipples *ahem*

Posted by Sick Sad Minion at Tuesday, September 19, 2006 | | Comments

Introduction

There are some people that seem solely devoted to blaming NHS Direct for all the World's ills. I'm here to redress the balance slightly, open up how my job is done, and hopefully shed some light on what we have to put up with on a daily basis.



I personally deal with basic triage, dental enquiries, dental assessment, interim care advice, NHS directory services etc. You'll see examples of most of these, but the recurring theme will (unfortunately) be dental in origin. That's because we're having a spot of bother in this country with regards to state-funded dentistry. I'll try to mix it up with other stories, so as not to bore you to death, after all you're not getting paid to deal with it, I am.



Without further ado, I present the first installment.






I have toothache, hear me roar!


: Good evening, Palace of Pain and Human Suffering. My name's Three Week Migraine and I'm a Health Advisor. Can I please take the telephone number that you're calling from?


Caller: You don't need that, we called.. we called 10 minutes ago. My husband needs a dentist NOW, I MEAN IT!


Me : I can't access his chart without any of his details *already has chart open due to the magic of caller ID*


Caller: HisnameisStupidoMcCandybardateofbirth6thofJune1966


Me: Well I just about got all of that, let me see.. you called five minutes ago about your husband's toothache, yes? What's the problem?


Caller: We were told it would take 15 minutes for someone to call back. If he doesn't get to speak to someone immediately then he's going to take a whole packet of his antidepressants with some vodka. He's very upset.


Me: .............
So I had to get a nurse immediately, because some guy who's had toothache for seven months decides to blackmail us. Great start to the shift eh?


Me: Good evening. Theatre of Death and Mortal Misery, we're currently taking calls on behalf of your GP service. How can I help?

Caller 2 : Well the wife's done her back in, she's in fucking agony, she cannot move, she needs a doctor now. She taks fits man, we've got four babbies to look after [my good lady has an epileptiform disorder and stress causes her to have seizures. Who will help me care for our four children if she becomes incapacitated?]


Me: Could I possibly speak to her?


Caller 2 : Nah she's in too much pain to talk, I keep telling yer.


Me : [explains service, requests that the caller mind his language, and takes patient details, asks ABC questions] How did she hurt her back?


Caller 2 : We were out on the drink the other night. She had a few too many and fell.

[sound of patient in background talking perfectly, telling him not to say that - I try to ignore it]


Me : So.. how many days ago exactly, and has she had any treatment for it?


Caller 2 : About four days ago . She didn't want to go anywhere, she was hungover, and she felt bad because she hadn't taken any [very important anti-seizure meds] so she could drink.


Me : *dies inside* [takes a few more questions, confirms details, gives a call back time of half an hour which I've actually asked permission to shorten from one hour as I'm concerned]


Caller 2 : WHAT?? No fucking WAY!! She's got hold of two of the babbies now, what if she taks a fit and drops them?

*cue assorted moans in the background*


Me: Someone will be in touch very soon. I suggest you put the children somewhere safe, get her to rest until she can get some advice from the nurse, and call back IMMEDIATELY if her condition worsens.


Caller 2 : *grumble, whinge, moan, fucking NHS etc*



I checked later to see what had happened. A nurse had called them within 13 minutes. The original caller claimed the woman had had twenty-seven seizures in that time.

Head - meet carpark three floors down.




Me : Good evening, Sixth Circle of Hades. My names Beelzebub's Minion and I'm a Health Advisor, can I take your telephone number please?

Caller 3 : ROOOAAARRRRR WAAAAAAARGHHHHH MMMNNNGGGGGGFFFFFFFF

Me : Ow. OK. Your TE-LE-PHONE number please?

Caller 3 : WAAAAAAH I've called five times today, I need a dentist NOW!

Me : I still need your telephone number, I can use the one on my caller ID if you don't know it.

Caller 3 : [gives number] This fucking pain is fucking killing me

Me : Hang on while I look at your chart...

Caller 3 : {butts in] I've been calling since 7am and no-one's fucking helping, and it's not toothache it's PAIN!

Me : OK. So you called at 7am and were given an emergency appointment for 8am tomorrow, is that right?

Caller 3 : I can't FUCKING wait that long

Me : Calm down or I'll terminate the call. Now it's a Sunday. There are a very small number of weekend emergency appointments available in your area but they're gone now. If they were gone at 7am today then there won't be anymore until tomorrow. I understand that you're in pain, but honestly, unless it's a situation where you have massive facial trauma or bleeding then you won't be seeing anyone today. You've actually been very lucky to get an appointment for tomorrow

Caller 3 : It's not GOOD ENOUGH. I'm in pain, don't you understand? I've phoned five times today

Me : I know, I have your chart here. However, if you were told at 7am- there were no appointments, 9am - there were no appointments, the same at noon, again at 2pm and once more at 4pm and were told very clearly that there were NO. MORE. APPOINTMENTS. LEFT. THIS. WEEKEND., then why did you think there would be any now? It's nearly midnight!

[the 'five times' bit and the 'no appointments' reply were repeated about seven times, by which point I was almost in tears of frustration]

Caller 3 : *howls of rage, profanity* But my MAN has to look after our children because of this!

Me : [Oh my, how awful for him] If you're not registered with a dentist then there's nothing I can do. You only have just over eight hours left to wait. All I can do is get a nurse to call you with some pain-relief advice

Caller 3 : But they already did that, it didn't work!

Me : Did you follow their advice?

Caller 3 : Well no, I have no paracetamol or anything in the house.

Me : So.. wait.. have you taken anything?

Caller 3 : NO I JUST TOLD YOU!

Me : Nothing, all day? Because if not, that's why it's not WORKING!
She then told me she intended to go to her local A&E, I told her not to bother as this was neither an accident nor an emergency situation, the clue's in the name, see? At that point I started to lose all hope in humanity, and advised the caller that she'd be better off waiting, and gave her the details of several dentists she could register with after her EDS appointment. When I was searching for her chart I found a duplicate chart with slightly different identifying details, where she'd posed as someone else at 3pm and 5pm to try and get an appointment. She certainly gets an award for her persistence. The prize? I'll take suggestions!



I'm happy to answer any genuine questions as to how the service works, what we do and what we're for. So I'm extending this to the public and to other health professionals. Want to know why the callback times are so high? What the stupid questions are for? Why we don't have 60 million GPs and dentists available so that no-one ever goes without? Leave a question in the comments and I'll address it as best I can.
Sick, Sad Minion

Posted by Sick Sad Minion at Tuesday, September 19, 2006 | | Comments