In healthcare, we do love a label, and we rush to find one as soon as we possibly can. No sooner as an elderly patient booked in to the reception desk than thoughts turn to whether or not she’s an ‘appropriate’ attendance. For Mrs Smith, an 87- year old grandmother of four who worked as a nurse here for decades, that’s hardly an issue. She’s poorly and, whatever the context, has, by arriving at your unit, declared a need for help. And that’s absolutely appropriate.
Picking up her notes you reflect on what the role of ‘primary care’ could, should or might be in her management. But that’s a difficult judgment because you don’t really know what ‘primary care’ really means. Is it a GP? A district nurse? A therapist? Or is it just anything which doesn’t involve a hospital? It must be different to ‘general practice’ because that is a separate label. It doesn’t matter to Mrs Smith – nor should it. But we make it matter to ourselves. She has only been in the building for twenty minutes and already she is an ‘inappropriate primary care attendance’.
Assessment reveals a respiratory tract infection and in all probability things can be managed without the need for an admission. But someone somewhere has already taken some blood samples on Mrs Smith. And our ‘inappropriate primary care attendance’ is now also ‘waiting for bloods’. Nobody quite knows why this is so, but the blood tests have been taken so we may as well await their return. Mrs Smith is 87 and her blood indices will not have been ‘normal’ since 1995. But that isn’t really noticed.
There is no surprise to discover that her U&E results are not deemed satisfactory. Although she in herself is keen to go home, it’s Friday, and because the ‘out of hours’ service isn’t yet operational, yet the GP surgery has no appointments to offer, it seems best just to run this case past the medical team. They’re busy, of course, and so Mrs Smith is now not only an ‘inappropriate primary care attendance’ who ‘awaited bloods’, she’s now a ‘breach’ because of capacity challenges.
In fact, such is the delay to be seen that Mrs Smith, who still really wants to go home before it gets dark, is now almost a ’12 hour trolley wait’. She is comfortable enough; space is available to care for her in a rapidly-cleaned cubicle. And, by and by, a bed is identified on an ‘outlier’ ward for her. If only there was an ‘outlier doctor’ free to see her. But there isn’t. The next day is a Saturday and nobody thinks that Mrs Smith will manage unless she has a commode and a carer to put her to bed. She herself thinks she’ll be fine. But what she doesn’t know is that she’d steadily becoming a ‘bed blocker’ because no carer can be had until Monday.
Come Monday, Mrs Smith goes home. She came seeking help because she thought that was the right thing to do. Her chest infection is getting better, but there is much more to it than that. Without even trying, this elderly lady, who worked here all those years ago, has been ‘inappropriate’, a product of failed ‘primary care’, has ‘waited for bloods’, been a ‘breach’, a ’12 hour trolley wait’, an ‘outlier’, and a ‘bed blocker’.
48 hours ago, she was just a retired old lady who felt unwell.
The vital elements of care are lost in translation as we rush to describe models premised upon meaningless labels. We don’t even know what they mean. Words matter. We must do better.