Turned Away

It's Good Friday and the beginning of a 4 day holiday for most people.  The Emergency Department is as busy as ever, and staffed like any other day of the week.  We have had 3 emergency cases through our resuscitation rooms in the last hour, and the effect of that brief spike in activity is that patients on the minors side of the department are now waiting 2 hours to be seen.

I am called to reception to see a patient who has just attempted to book in with a sore throat, and who has been told that he does not need to be seen in the Emergency Department.

He is not happy.

"I've come here to get antibiotics.  You can't turn me away!"

Wrong on both counts, I think, but not a conversation to have in the middle of reception.

We move into the minors triage cubicle, and I sense the questioning eyes from the waiting room on my back:

"Why is he being seen straight away?  He's only been here 5 minutes!  I've been waiting for hours."

"OK Sir, what can we do for you?"  I ask him.

 "My kids have had colds and now I've got a sore throat.  We're about to drive down south for 5 days and I thought I should get some antibiotics before we leave."

He is entirely well-looking, with no features of raging infection, swellings or signs of anything remotely needing antibiotics.

"Well, Sir, this is not a condition that we would normally see in the Emergency Department.  We have a policy that patients with minor illnesses such as this are asked to either self-care with advice from pharmacies in the community or NHS24, or see their GP.  I appreciate that your GP might not be open today, so if you feel strongly about needing to be seen by a doctor, we could ask our colleagues in the out-of-hours GP service to see if they have an appointment later on today for you."

"You can't refuse to see me!"

There are some signs of rage, rather than raging infection, now starting to surface.

"Well, with the greatest respect, Sir, I'm afraid we can."

"I demand to speak to whoever's in charge!"

"You are."

This goes on for another 10 minutes or so, with me trying to explain why the Emergency Department is not an appropriate place for either his full assessment or for any treatment to be dispensed, and why antibiotics are not recommended. 

He is consistent (at least) in his view that this is outrageous, not in the spirit of the NHS, and will cause him incredible inconvenience.

The interaction ends with him leaving, taking a complaints form with him on the way out, and refusing the offer of an appointment in the Lothian Unscheduled Care Service (LUCS) later in the day. 

"I've got too much to do to wait around for an appointment!  We're going on holiday!"

If ever there was confirmation needed of the lack of an emergency condition, he has produced it.

This whole scenario has taken me away from seeing other patients for 20 minutes or so, and will probably end up resulting in a complaint that will take a team of up to 5 people a couple of hours to answer. 

Remarkably, this gentleman seems to have very little (no) awareness of the consequences to other patients from his attitude.  I wonder how he would feel if he ever presented to the department with something requiring really urgent attention, but was unable to get treatment straight away because someone else was arguing over a non-emergency condition.  I imagine he would be just as angry.


The clue is in the title.

To make sure that any patient who has an emergency condition has access to the quickest possible assessment and treatment, the Emergency Department has to be open to all-comers.  Our team are uniquely trained to triage (sort), risk-assess and treat patients with life-threatening and time-critical injuries and illnesses.

The demand on this service is ever-increasing.  Since the hospital moved from Lauriston Place to Little France, our attendances have risen from approximately 85,000 per year to 111,000.  To ensure that we are still able to carry out our core functions, we have to protect our ability to see those patients that really need our attention.

This means that some people who attend will be turned away, or "redirected".  This is not to say they have nothing wrong with them, or don't need to see someone qualified to deal with their condition.  It is simply that they do not need to be seen by our team, at that moment, as an emergency.  This is not something that any of our staff like to do - we are a caring bunch after all - but we have to act in the best interests of all our patients.