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Crystal Bollocks

Me in my Vaudeville days



The skill that would help me most in my day-to-day work, and would almost certainly keep my sanity levels reasonably high, is clairvoyance. I wish I could divine the future, guess what was coming next. The Nurse Advisors have an easier time of it. They pick their calls from the queue. There's a surname, age, and brief call reason. We're instructed to keep call reasons short while giving as much info as possible, here are some examples:



  • D&V, LHS ABDO PAIN, FEVER - 2 DAYS

  • PAIN/SWELLING POST XLA YESTERDAY. SX WORSENING

  • PV BLEED, PELVIC PAIN TODAY -TOP AT 10/40 4WKS AGO, LMP 3MTHS

  • SLIGHTLY SOB ON EXERTION, DX CHEST INFECTION& RX ABX 3 DAYS AGO

So, from the top we have:



  • Diarrhoea and vomiting, with left-sided abdominal pain and fever for two days.
  • Pain and swelling after a tooth was extracted yesterday under local anaesthetic. Symptoms worsening with time.

  • Vaginal bleed with pelvic pain. Patient had an abortion four weeks ago, at 10 weeks gestation, and her last period was three months ago.

  • Shortness of breath on exertion, diagnosed with a chest infection three days ago, and prescribed antibiotics

So the nurse sees the call reasons, any notes we've made on the chart, then calls and speaks to the patient. On the other hand we're going into the whole thing blind. This wasn't as much of a trial when I took thirty calls a shift, now I could top eighty if I was on 'ready' all the time. When the 'beep' sounds in my ear, and I look at the phone display, all I know is whether the call is NHSD, GP or Dental. This could be how the first two hours of my shift goes:



  • "Where do I find a dentist?"

  • "My baby's stopped breathing"

  • "I've dropped a brick on my foot"

  • "Is there a chemist open tonight?"

  • "My dad has chest pain and blue lips"

  • "My testicle is swollen"

  • "Do I qualify for Tax Credits?"

  • "My hair smells funny"
  • "I've just taken 60 Seroxat"
  • "My toddler is choking"
  • "My son's just eaten plasticine"
  • "I've just been stabbed"
  • "I think I'm in labour"
  • "Is MRSA contagious?"
  • "My brother's making me have sex with him. I'm only 13 and my period's late."
  • "My sister's got a purple rash"
  • "I've just found out I have an inoperable tumour"
  • "I keep wetting myself"
  • "I've just been gang-raped and didn't know who to call"
  • "My throat hurts"
  • "My husband has AIDS and didn't tell me"
  • "I'm tired at nights"

  • "Is diabetes contagious?"
  • "I think I'm having a miscarriage"
  • "I've just woken up and my husband is dead in bed next to me"
Twenty-five sample calls there. I could have some of these people on the line for twenty minutes, some for three. The twenty-five I've listed have all been calls I've taken in the past, and sadly most of them are now fairly 'routine' with the exception of the gangrape. I'll probably get a random twenty out of these every single night, most of them will crop up more than once.

The stress of this often seems unbearable. To have to switch from trying to give someone a reason to ignore the voices and put the knife down, to explain why 'smelly hair' is not a reason to call your GP at midnight, is exhausting. I actually don't mind the 'big' calls where it really is life or death, or the queries about finding a dentist or chemist, but the sore throats and tummy bugs can really get me down sometimes. It's hard not to choke back tears when the fifteen year-old girl who took thirty paracetamol as a 'cry for help' two days ago calls with stomach pain and vomiting, or when the daughter of a man with inoperable stomach cancer and violent dementia calls, at the end of her tether, because she doesn't know where to get help. He's hitting her mother, but social services are reluctant to help. After all a psychiatric facility is no place for a dying man, but a hospice or hospital is no place for a potentially dangerous man, who means no harm but doesn't know his own strength. What do you say to the scared young girl who is terrified of telling her parents that she's pregnant again, or the lad who has caught an STI but feels unable to seek help because he's underage and gay.

I know we're an easy service to criticise, and it's simple enough to dismiss NHSD's employees as 'untrained operatives bashing away at a computer', but that really isn't the case. We're all only too aware of what can happen when it goes wrong. Even though NHS 24 is a different service to ours, uses different methods to assess, different algorithms and protocols, it's still telephone assessment and still carries risks.

Unfortunately we aren't psychic or omniscient. At the end of every, single call the caller is told "if the symptoms change or worsen, or you're concerned in any way, call straight back" Why? Because we can only assess symptoms happening now, not in an hour's time, not even in ten minutes. People rarely call back if this happens, I might as well be saying "I am a purple seven-legged antelope. If you enjoyed this call please send me a pizza-cutting wheel and 37p". Why call back when you can drag the whole family to A&E, blame us for not picking up on a symptom that didn't exist an hour ago, and then write to the fucking Daily Mail about it.




The public are confused because of recent press coverage (spoke to five people yesterday, concerned that they'd "be killed" because of our 'incompetence') and think that NHS 24 and NHS Direct are the same organisation and then share stories about how awful NHSD are, and how they once had to wait two hours for a callback about the splinter in their thumb, and "Oooh it could've been me that died!" It's a stressful and demanding job, and one that attracts derision and cries of "close it down, waste of money".

We take approximately half a million calls a month, a figure that's rising steadily, yet one thousand NHSD staff have been made redundant and call centres are closing all over the country. The pressure to perform is immense, and people are leaving in droves. What would these six million people do every year if we didn't exist? I'm the first to admit that telephone assessment is not ideal, but no system is.
A patient could present at A&E with symptoms that appear to be flu, be fully examined by a doctor, and told to rest at home, take paracetamol and keep hydrated. They could die within two hours of TSS or meningococcal septicaemia. My local GP (now retired) was a great doctor, worked in the community for thirty years. He saw a man in his forties who was complaining of chest pain and nausea, doc told the man that he'd feel much better if he wasn't so overweight. He'd seen the man smoking on the High Street the day before, he reprimanded him. The man thanked the doctor, walked out through the waiting room and dropped dead. I know that grief is a terrible thing, and the natural instinct is to blame somebody, but telephone triage is not the cause of all ills in society.
We are the black sheep of the NHS, but when we're dealing with people who are ill, we can't predict the future. People are misdiagnosed at hospitals every day, people become unexpectedly ill and die suddenly, human beings are curiously fragile. Unfortunately we're on the bottom rung, so we take the criticism and accept the blows thrown our way, and move on and try to do our jobs.

I should stop watching the news, reading all medical blogs, and get round to finishing off that Christmas vodka. I'm depressed, a combination of doing my job, and of hearing how worthless said job is every time I see the news or read a website. January blues? I wish.



You're probably as miserable as I am now, so here's something to cheer you up:




Whaddya mean 'Humans only?' Yes, a flu-ridden kitten using the NHS Direct Freeview service.

Posted by Sick Sad Minion on Sunday, January 28, 2007 at Sunday, January 28, 2007 |

I would never want your job. Ever, it would make me mad.

Having said that I'll still call you all the names under the sun when we turn up at something rediculus.

I dont mean it though; not really. Vodka always helps.

Posted by Blogger Iain MacBain - or maybe not!!?? | 2:33 am  

Yep, vodka is the one true friend of the beleagured NHS drone!

I think the last two years have been a bridge too far for a lot of us in the service. NHSD does play a vital role though, providing a steady income for the purveyors of antidepressants and booze! If they got rid of us all the Big Pharma companies would lose vital revenue from lost sales of mood-stabilising meds :)

Posted by Blogger Sick Sad Minion | 2:58 am  

I'd never want your job, and have never called NHSD yet; but if I did, I'd want someone like you on the end of the line.

Love the kitten.

Posted by Blogger Johnnie | 1:07 pm  

To be honest I'm not sure how much longer I can do what I do either! It may be time for a change of scenery.

Posted by Blogger Sick Sad Minion | 7:10 pm  

I have no idea what the solution would be. Ignoring the cost (easy to write) it would harm people to be treated with a high index of suspicion for e.g., meningitis or epiglottitis every time that they had a sore throat or to have a rule out scan for appendicitis every time there was gut pain in the 'right' place.

It's alway easy to criticise other people' performance, however, too often, all that such criticism indicates is ignorance of what that job involves or the skills needed to make it look effortless.

Regards - Shinga

Posted by Blogger Unknown | 2:31 am  

Currently, at NHSD we have to rule out meningitis on every call. This was introduced in late 2004 (prior to that it was only under 16s). This does not sit well with people calling about a cut finger or dog bite, but it has to be done in case someone slips through the net. It's the only way to stop accusations of negligence. NHS 24 did not have a similar system in place at the time of Shomi Miah's death, but apparently they do now. You just have to balance the pissed-off caller with the need for caution.

The main problems with the service are two-fold - 1)it's not meant to be a replacement emergency service and 2)at the initial callhandling stage it would be impossible to cover every eventuality, it would take hours. We have to run with whatever the patient thinks is the most serious symptom. If Mrs Bloggs is calling about this appalling vomiting Joe is having, she'll invariably downplay the chest pain he's had since last night and go ballistic when you start asking questions about it!

Posted by Blogger Sick Sad Minion | 9:08 pm  

I stumbled across this while blog-hopping, and I have to say, I wish I could give you a big hug/shot of vodka. I could never, ever do what you do, and I admire you and those at NHSD so much for it. I've called NHSD once with chest pains (stabbing, accompanied by blurred/whited vision and lightheadedness) and although I was advised to seek medical attention, I didn't (I have social anxiety and it took me all my courage just to call and speak to someone). I feel awful knowing had something bad happened, you, or someone like you could have been blamed. While I didn't take the advice of the man I spoke to, the very act of taking to someone calmed me down and even made me feel a lot better.
After reading this, should I ever call NHSD again, I'll be sure to take their advice. Either that or leave specific instructions that, should I die, me and my stupidity be blamed instead of the poor frazzled person on the other end of the phone.

Posted by Blogger Unknown | 12:37 am  

I have an interview for NHSD next week. I would love this job and am really looking forward to starting. If you have any hints or tips that would be really useful. I'm currently browsing the web for up to date info and loved your article. I suspect you really enjoy your job mostly but are frustrated by the general publics' ignorance.....not everyone has the same opportunities in life regards education and morality and general 'nouse'. Ask me how I feel about the public in 6 months time when the naivety has worn off eh? Ha.

Posted by Blogger Unknown | 6:45 pm  

I am also a Health advisor and absolutely hate it. It’s a glorified call center, nothing more nothing less. Why are we called Health Advisors? We don't advise on people health; we are not supposed to as we are not medically trained. We are call center operatives or call handlers as we once were called. I suspect the name change was an attempt to make stressed and unhappy employees as well as potential future workers feel they were doing something beneficial and helping people. In fact all we do is process demographics and isolate the more needy from the less needy. In layman’s terms those who need an ambulance and those who don't. To be even simpler who is dying and who isn't. That is all we do. On busy days - most days are busy now - we get call after call after call re-sighting that ridiculous salutation of 'Good morning you are through to NHS Direct my name is ....I am a Health Advisor, can I start by taking the telephone number you are calling from please' and so begins the tedium. Vomiting, diarrhoea, chest pain, suicidal ideation, burnt fingers and toes, overdoses, sad and lonely hearts. Don't get me wrong; of course I feel for the needy, I am after all human and, prone to largely the same symptoms I here day after day. However my empathic nature or lack of is not on trial. In my eyes what is on trail is the job itself and the moronic management who think that reductionism is the way to go in the NHS, simplifying jobs down to tedious enterprise akin to factory assembly workers. On some shifts I never get a chance to utter a word to anyone, even those sitting three feet away. This is becoming the norm and how management wants us to be performing. How many other jobs exist where you hardly chat to colleagues during an 8 hour shift? Each month we have the dreaded call review. Your line manager picks out a handful of calls with problems attached to them, not repeating a name spelling, not issuing a moronic platitude that they call empathy, 'I am sorry for your loss', being to familiar .Don't get me wrong these things are important when you miss them out entirely or don't realise you have done them. But it doesn't work that way, we are criticised for making one mistake in error even when we haven’t done it on other calls. The sick rates are shocking at best and the staff turnover rate would make shocking odds at the bookies it’s currently at 50% what does that say about the job? We are told to meet targets of so many calls an hour. Why are me made to feel pressure about getting people processed and off the line and yet at the same time, asked to listen carefully for hidden symptoms and to make sure we understand which aspect of their situation is the most imperative were diagnosis and welfare are concerned? Therefore what is more important here? Patient health or target rates? No prizes for the correct answer. I could go on about the problems and the factory farming expectations of Heath Advisors...........believe me if you care, have intelligence are sensitive, then don't do it! Beware you risk losing a shred of your humanity at the very least!!!!

Posted by Blogger Porkypine | 4:33 pm  

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