UKC

I've got go to casualty to get something removed from my throat. Nothing embarrassing or funny, a mackerel bone.

Shall I go now? Wait until late at night? Or risk snow/traffic hassle in the morning? I have a lecture I really don't want to miss at 11am. I think by that time, the whole of West Yorkshire will have descended into snowy f^ckery of the very highest order, and I would rather not be in an inconvenient location, especially not with my car.

In reply to Jon Stewart:

Go now, get seen before the pubs and clubs start producing casualties.

In reply to Jon Stewart: if it really bothers you go now. Yes you may have a wait for a couple of hours, but they will see you when they can and have dealt with the more serious stuff.
You could chance 8am in the morning and hope there are no major accidents on the roads.
Generally more doctors and nurses are around in the day.

In reply to lowersharpnose:

On a Thursday night in west Yorkshire? Have I missed something?

In reply to Jon Stewart: Now cuz might interfere with your sleep?

In reply to Jon Stewart:

Still here ? Be gone with you , you really don't want to be trying to sleep with that in your throat do you ?

In reply to Poor&simple.: It's not much hassle really. Slept with it in there last night, hoping it would have magic'd away by the morning, which it hadn't. It's now slid into quite a comfortable position, but I've been advised by a doctor not to just leave it for a week until it's getting grown-in and infected, apparently that isn't very nice.

OK, I'll go then. Thanks.

In reply to Jon Stewart:

There are 4hr time limits in A&E. In these parts the time limits are exceeded quite a lot due to demand. If it were me I'd go now and get it over and done with.

In reply to Jon Stewart: not an emergency, don't go to A&E. go to your GP and have the nurse remove in the morning.

In reply to Moggsy: Been to the GP. The need anesthetic (I presume that's how they suppress the vomiting reflex?) and some long forceps to get to it.

In reply to Jon Stewart:

Try Wharfedale minor injuries unit? It's not an A&E but I think you can go without being referred.

In reply to Jon Stewart:

It's probably going to be a long wait whenever you go - X RAYS, wait for ENT SHO to turn up, wait for him to talk to someone senior who knows what they are doing, removal, more X RAYS.

Tuesday morning is the statistically the least busy time. Just go now and get it over with.

D

In reply to hokkyokusei:

He will get referred to LGI. G.P. / Nurse practitioners only at Wharfedale. Anything mildlly interesting will get sent on.

D

In reply to Jon Stewart:
To avoid an eternity of waiting I'd recommend 4/5 am.

In reply to timofy:

but not 4/5 friday,sat or sun morning when the ENT/MAXFAX SHO is sorting out students faces

D

In reply to Jon Stewart:

Go before it kills you ? If it's

In reply to New POD:

Well it doesn't look like it is going to kill me. I went last night and obviously no one who knew what they were doing was there, although they were all very nice.

There was just about 1mm of bone poking out from the folds of tissue around my left tonsil (earlier in the day about 2cm was visible, now I really wish I'd gone then). 3 doctors tried to grab it using not terribly appropriate tools ('cause all the ENT people who knew where the good grabbers were had gone home). They just managed to push it completely out of sight, which must have been as frustrating for them as it was unpleasant for me. So I had to go back today (in the snow - a long walk) to see the ENT people.

2 of these guys had a good go at finding it, but it's now so deeply buried it's impossible. Can't see it on x-ray, it's hidden by the jaw.

So it's just going to have to stay there. I have a rather sore throat, partly because I have a mackerel bone wedged deep inside my tonsil, and partly because 5 people have been poking and scraping around in there with various tools, most of them sharp.

2 lessons have been learnt: go and get foreign bodies removed while you can still see them poking out; and go to casualty in the day time when the people who have been qualified more than a couple of weeks are there.

In reply to Jon Stewart:

That sounds grim. Surely it can't just stay there? Getting tonsils removed sounds a bit drastic though.

I'll bear your lessons learned in mind for possible future needs.

In reply to Queenie:

The ENT registrar seemed to think it would be OK. It's not metal or anything so shouldn't cause too much inflammation and it'll probably come out by itself eventually as it's pushed up by new epithelium.

In reply to Jon Stewart: i know it might sound stupid, but im sure ive heared swollowing bread can remove a fishbone. if it dont get to a and e

In reply to taffyboy:

Ta, yes I've heard the bread thing. I've spent a lot of hours in A&E now, and seen the experts in the ENT clinic, and no one could extract the thing. I will get used to it being there, or the body will eventually expel it.

In reply to Jon Stewart:
Since the last time I went to A&E and they diagnosed my migraine (double vision) as a stroke and then sent me home and told me to rest I have little faith in their ability.. Mind you it was Stafford

In reply to Jon Stewart:

Proabbly too late now.

BUT PLEASE DON'T GO TO A&E for things like this.

Walking through the door of A&E costs your fellow-taxpayers between £70 an £100 depending on where you are.

30% of attendances are neither accident nor emergency. If it's not life or limb threateing, think twice.

Call the out of hours GP service or go to an intermediate care centre or just wait until Monday and see a doctor.

The system is on its knees in many places because folk use A&E like an on-tap GP service.

In reply to JJL:


Man, get off the high horse!! He already tried his GP, and they told him to go to A+E! GPs are useless, what's the point of going there. At least in A+E you have a chance of getting someone to help you.

In reply to Jon Stewart:


There will be what's called a "foreign body reaction" around it, and it will probably re-emerge slowly. I hope it was a tasty Mackerel!

In reply to Jimbo W: in agreement with you here as a fellow health care professional.

In reply to JJL:

Thanks for the advice, but as I said above, I went to the GP, who sent me to A&E.

The ENT team said to me, "the GP didn't have a go at this did they?" with absolute clarity that getting fish bones out of tonsils is their job and no one else's.

In reply to Duncan Bourne:

Wow! "You've had a stroke - just go home and rest, it should resolve quickly by itself" sounds like a peculiar diagnosis and management plan.

As a trainee optometrist, I'd say you'd want an eye expert to check out double vision 'cause there are so many different things (including stroke, pituitary tumor, badly fitting specs, tiredness, migraine etc) that can cause it. The techniques to tell them apart require quite a lot of practice and good knowledge of theory, so I'd be impressed if a generalist could confidently get it right.

In reply to JJL: Do you read before you post at all? The GP told him to go there. In some areas there are no intermediate care options and A+E also deal with more minor non life-threatening stuff.

In reply to Jon Stewart:

Apparently my Mum was diagnosed as having had a mini-stroke from her double-vision symptoms. She went for multiple scans, tests etc. before they decided there was nothing wrong and she actually needed a new prescripton in her glasses! I say 'apparently', as I was at Uni at the time and despite a whole year's worth of worry and tests, she managed to keep it from me and I only discovered some years later!

In reply to Duncan Bourne:

No disrespect intended, but that's so bizarre I find it very hard to believe! Tell me more if you don't mind.

In reply to owlart:

The thing is, if someone presents with double vision, the inexperienced practitioner might think "great - this could be really interesting, I hope it's a lesion of the Edinger-Westphal nucleus or something" and that could sway their diagnosis away from the mundane "your specs are wonky/not strong enough/could do with a bit of prism".

In reply to JJL:


Could you please explain these costs? The problem I have is that money isn't saved by not going to A+E. It is staffed and as it has been found in parts of Greater Manchester if not enough people use such services they get shut down meaning your local A+E is 30 miles away.

In reply to Jon Stewart:

Jon - hope you get it out ok.

To all the folk going 'don't go to A&E', unless there is a local Minor Injuries unit (there's one 10 miles down the rd from me which is 24/7) where else is he going to go?

FWIW, I'd try the minor injuries unit first. Even tho it's a 10 minute walk to A&E from my house.

In reply to Jimbo W:


GPs are useless, what's the point of going there. At least in A+E you have a chance of getting someone to help you.


So patients should routinely attend A&E instead of their GP?

Not sure why in this case the OP was advised to attend A&E rather than being referred directly to an appropriate speciality but not sure your sweeping statement particularly helps anyone.

In reply to Thickhead:

I read a great book written by a GP who said that it was often better for the patient to send them to A&E than try and get them referred. They get seen much much quicker.

In reply to JJL:
This seems like a perfectly reasonable ED attendance to me and would be difficult to resolve in primary care. It would also fall outisde the scope of many minor injury/illness units

In reply to Thickhead:



Oh come on, get real. That would take time, and involve work!


Well it was a comment made in the context of a discussion regarding the removal of a fish bone, and meant as such. However, I do think anything outwith "core" clinical problems does seem awfully troublesome for GPs these days.


I would not advocate a primary care based health service, but that isn't to say I would advocate that A+E should be for routine use.

GPs have opted out:
- of out of hours work, for which they have blood on their hands
- of the family doctor role (and one of the crucial clinical advantages of actually knowing their patients), especially useful in the context of out of hours
- by failing to invoke the proper generalist training required (now absent after the loss of the floating SHO) in length. CG's recent success of achieving 4yrs (up from 3) is pathetic

In reply to JoshOvki:

Unfortunately, this is often the case.

This condition of the OP would have been extremely difficult to resolve in most primary care institutions.

Either referring directly to the on call ENT Dr or at least discussion with the ED may have been more appropriate to establish an agreed time/place to attend would have been helpful in this case, as I am sure the OP will agree (hence his original question).

That's how I would deal with it anyway.

However, you sometimes call the on call Dr for a given speciality and they say 'just send the patient to A&E'

In reply to Jimbo W:

Have you any experience of working in primary care?

Just out of interest, not a criticism.

Training certainly needs extending.

Laziness is rife throughout hospital medicine as much as any other trade or profession in the UK.

I don't agree with your views on OOH but would admit that some changes need to be made to the current structure.

In reply to Thickhead:


My impression was that the system where I live was that you go through A&E to get to the specialist, so that you've had multiple chances to be filtered out along the way.

I have no issues with the service I got but I would rather have had an appointment with the ENT guys rather than enduring the valiant but unsuccessful efforts of the night-shift crew, surrounded by the usual blood vomit and racial abuse that constitutes the ambience of Bradford Royal Infirmary A&E.

In reply to Jon Stewart:



Which is what I would have said is the most appropriate action. I never accept an SHO telling me to 'just send to A&E' and would be in contact with the ED Consultant if this advice was given.

Unfortunately hospitals are increasingly inept at treating patients properly and hell bent on removing beds so often the only place to be seen is ED.

Hope your problem sorts itself out anyway!

In reply to Thickhead:


I'm a pathologist with the usual low medical school exposure to primary care, 3 months with one practice during medical school, and a few weeks here and there throughout the rest of med school. Most of my experience comes as a patient, or rather as a patient's father, and coming up against people who don't even know the basics of, for example, asthma symptomology, and vicariously through my father, who was a GP who then went into general surgery and then A+E / trauma / pre-hospital care etc


Definitely, if hospitals keep closing, centralisation increases, and the governments plans progress to making GPs the linchpins of the NHS.


I see a binary class of people; 1 camp or the other, 1 camp is dedicated and inexorably hard working, others get away with what they can, there seems to be few in between, but the latter is not a majority. What I do see is much negative defensive medicine where doctors don't have the proper knowledge and subsequent knowledge to do their jobs confidently.


For me, it's contradictory to the reason for going into medicine in the first place. Sure there needs to be work flexibility for those with children, but going into medicine and training especially as a "family" doctor, is not compatible with a straight opt out of OOHs. In my discipline, its a different problem, we don't go out to seek work, for example, the post mortem rate is through the floor, which means that nobody is getting the ultimate audit of their clinical work (and believe me we need it - e.g. someone who died with metastatic cancer, who had no evidence of any cancer whatever at post mortem. Also, that pathologists are perfectly placed to do fundamental research that moves our understanding and ability to intervene with disease forward, and most pathologists are quite happy to just do service work.

In reply to Jimbo W:

The answer to the OOH conundrum is particularly difficult.

I just don't see what the attraction will be to work in small semi rural practices of say 3 full time GPs servicing 5-6000 patients if they have to do their own on call 1:3. I certainly wouldn't do it. I would head to a larger practice doing less frequent on calls but servicing more patients i.e busier on-calls but less frequent. Or work in a complete rural area servicing up to maybe a 1000 patients but all on your own so you would literally know your patients inside out i.e more on calls but less busy. If I did my own on-call for our 5000+ patients I wouldn't get any sleep on that night. Who would do the day job?

Hence I see we would head towards large polyclinics which the public are fundamentally opposed to.

There is a looming GP crisis, especially in Wales. This is because 1) Drs don't want to train as a GP due to various factors (one big one being negative press) 2) Those that are left working are coming up to retirement age. A huge proportion of GPs in N Wales are >50 3) The Government needs more GPs but Drs clearly need more training. Therefore there is a conflict between training needs and service requirement. Thus inadequately trained GPs are put into the coalface and young Drs/GPs are naturally feeling this pressure 4) as a result of various pressures GPs are "flooding" out of the workplace and retraining as specialists, taking up non-training hospital posts, working OOH/locums (which pays better) or going for much better terms and conditions overseas (Australia/New Zealand in the main with some heading to Canada).

The reason I ask about whether you had any postgraduate exposure to GP is that is a bit of an interest for me - in my opinion specialists should have to work in general practice for 6/12 as part of their training so that they have a realistic impression of how primary care works (or doesn't).

Anyway, this has gone a bit astray from the OP's question about what time best to attend A&E!

In reply to Thickhead:


Well I agree. The old system wasn't that broken. People could do SHOs in various different specialities, providing a service during that time, and gaining invaluable experience (even if they weren't "receiving formal training") and as a result they would find their niche before committing to their training.. ..as a result all doctors, but especially, GPs had several more years of experience before becoming the completion of their training. I see no reason why postgraduate doctors shouldn't get experience of general practice.

In reply to owlart:

Yeah, mothers do that. My gran managed to tell the whole family that my uncle's massive stress induced epilepic fit was "being a bit over tired", and my great aunts stroke, was "she fell off the toilet and banged her head"

My wife had an arguement with me, last week, because prior to my son coming home from university for the easter hols, she'd expressed concern that she might not be able to cope, without her afternoon rest, (She has ME), and she doesn't want him to worry about her. Of course I phoned him and said "Right then, You need to look after your mum, make her lunch, ensure she has an afternoon kip, do any washing up, do your own washing etc"

She went a bit mad with me for telling him.