13 March, 2012 
After a two-week gap, I was back at Aberdeenshire Royal Infirmary this morning to have my fractured wrist checked.
The appointment started well: only a small queue of people waiting to be seen by the consultants, a small delay in X-Ray while a badly injured accident victim was seen to, and then in to see the doctor.
After asking how my wrist was going, the doctor asked why I’d not come in for check-ups as recommended by the senior consultant. I explained that we couldn’t afford the time or money to have the Other Half taking time off work to act as my taxi service, especially as we lived so far out of Aberdeen.
He nodded and said normally, with an injury as severe as mine, he’d leave the cast on my wrist for at least another week.
However, given the progress my wrist has made, the doctor said he would consider taking the cast off early and discharging me provided everything was to his satisfaction.
He studied today’s X-rays meticulously, then compared them with the previous three sets. He quizzed me about how I was managing my wrist.
Eventually, he said he’d agree to having the cast off early provided I agreed to use a wrist brace with two splints full-time for the next fortnight, then gradually ease off its use for the following 8-10 weeks. He went into detail about what I should do and when (no driving for eight weeks, no high impact pushing/pulling for at least 20 weeks and so on).
I agreed and the doctor said he’d see I was passed along to Plaster to get the cast off and Physiotherapy to get more advice.
Excellent, I thought, and went off to wait.
And wait. And wait. The queue for physiotherapy grew.
Eventually, a physiotherapist wandered over to tell us they were running late and we’d have to be bumped back. In my case, I wasn’t going to be seen until 11.45am. (The OH and I arrived at 9am for a 9.15am appointment and I was finished with the doctor by 9.50am).
I told the physiotherapist I’d have to talk to the OH as she was due at work around 12.30pm, we had an hour’s drive back to the croft and after that the OH had a further 20-minute drive to work. I headed off to the Fracture waiting room to talk the OH: she was prepared to phone work and see if she could get more time.
I went back to Physiotherapy and started speaking to the physiotherapist, only to have her say I couldn’t go on her waiting list as I still had my cast on. We went to Plaster, only to be told they didn’t have my chit and couldn’t take the cast off without it.
Physiotherapy wouldn’t put me on their list until the cast was actually off, so I was going to lose the 11.45am slot.
Bear in mind that Plaster and Physio are open rooms on either side of a corridor, while the Fracture clinic is about 30 feet further along the corridor.
It should have been easy to sort out—someone walks along the corridor and picks up the right chit—but that’s not the way the NHS works.
Instead, I was going to have to wait until the right chit appeared at Plaster, then go into the Plaster queue, then have the cast removed, then wait for the chit to go to Physio, then go in the Physio queue (which was already a couple of hours late) and then see the physiotherapist.
I said it wasn’t good enough, I was out of time and I was leaving. Politely, but firmly.
The physiotherapist said I couldn’t go. I said I could.
A red T-shirted male member of staff, who didn’t introduce himself, came over and asked what the problem was.
I said I couldn’t wait all day for treatment, the physiotherapist explained about incorrect chits, and the man said I had to stay.
I told him I didn’t have to stay.
A female consultant stood up from her desk to tell me I had to stay. I told her, no, I don’t.
She and the physio said the cast had to come off. I said yes, I’ll take it off myself and use a brace as the doctor advised.
They both said I couldn’t do that. And repeated that I had to stay.
I told them I could remove the cast. And I was leaving.
I walked away. The consultant, in particular, was quite annoyed that I wasn’t doing as I was told.
In the Fracture Clinic, I told the OH what was a happening and we left. Self-discharge done, self-treatment next.
A wrist brace with front and back splints is on order from an online medical supplies shop. When it arrives, I’ll cut the cast off and fit the brace.
I have an excellent guide to suitable exercises for rehabilitating a fractured wrist (thanks to the Warwickshire NHS Trust), I’ll see if I can self-refer to the nearest physiotherapy service to the croft (probably Inverurie) and I’ve made notes in my diary to remind me of the doctor’s advice.
No more chits, no more waiting for procedures and processes. I’ll get on with healing thyself.
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I don’t know whether you’re mad, hard or stubborn! I remember reading your blog post about picking yourself up off the road after a van mowed you down and going to the verge to check yourself over, then deciding that a fracture, cuts and bruises weren’t too serious so you’d continue on to your boys’ school. Now, you have a really bad fracture of the wrist but you crack on with digging the garden and managing pigs before hacking off your cast. I like to think I’m fairly capable–fit, do martial arts–but no way could I just crack on regardless after injuries like yours. I cracked three ribs a few years back and was a pathetic wretch for weeks, taking time off work (office job) and constantly whining to the then GF. I freely admit it and it felt justified at the time. But now? I realise I’m just a wimp. Obviously, there are injuries and there are injuries, but I suppose like a lot of modern peeps I’ve fallen into the trap of imagining anything and everything is a showstopper. As you show us, that’s not true. One question, though, how serious would an injury have to be to stop you in your tracks or are you like Monty Python’s Black Knight?
Keep up the writing.
Hi Stoney.
Self Diagnosis is no guarantee to return to full health. God forbid it all goes terribly wrong and you end up back in hospital. What’s the Doctor going to say “I told you so, you didn’t listen to us, what do you think we are here for”. No sympathy I rest my case and I’m not a Doctor.Remember the old saying Break a Leg you’ll probably shake someone’s hand and it’ll fall off. PS Hope you prove them wrong.
Walter
I had no problem with the doctor. We had a very good discussion about my arm, he assessed both my clinical needs and my real life situation, and advised accordingly. I plan to follow that advice and am competent to do so.
If there’s a problem, I can walk to the doctors’ surgery in the village.
What I don’t need to do is bend the knee and tug the forelock to the system. They couldn’t do follow-up work in a timely and efficient manner, we couldn’t afford to lose more time and money waiting for them to get their act together and I’m capable of looking after myself at this point.
There were several other people in a similar position on the day—no dire clinical need, delayed for hours, other appointments to attend or jobs to return to—but other than muttering about the inconvenience and cost, they all subsided back onto their seats when told to do so. None complained. None left.
I’m not like that.
I ask myself, is there any logical reason for accepting this state of affairs?
Is the doctor happy with my progress? Yes.
Is the doctor prepared to order my cast removed? Yes.
Is the doctor happy with my management of the fracture? Yes.
Is the doctor happy with my competence to continue managing the fracture? Yes.
Has the doctor given me advice on how to manage the fracture in the future? Yes.
Is the doctor prepared to discharge me today? Yes.
Can the OH and I afford the additional time entailed in waiting to be seen by other departments? No.
Can we afford the damage to the OH’s hard-won professional reputation by her taking further, unexpected time off? No.
Can we afford further childcare if the hospital’s waiting times over-run even further? No.
Is there a clinical need for me to be treated in the hospital, by medical staff, today? No.
Can I remove the cast myself with minimal risk? Yes.
Can I access the same advice elsewhere that the physio would be giving me? (Bear in mind it’s a 10-minute appointment and would have had the same outcome as previously: I’m given a photocopied handout and taken through the exercises.) Yes.
Can I obtain a suitable brace with splints, as advised by the doctor? Yes.
Do I have access to suitable medical support closer to home, if needed? Yes.
Do I fear imagined consequences of not submitting to the hospital’s supposed authority? No.
In total, it is entirely logical to stand up, say the situation is unacceptable, walk away and do whatever is needed myself.
The way I see it, no-one should have to travel such a distance in order to have these things done. Why can’t these things be done in Inverurie, or Huntly. Any doctor should be capable of reading an X-ray image, and a technician with the correct training should be able to remove a bloody cast and fit a splint. It all needs to be a bit more efficient, particularly when one department is within spitting distance (perhaps not the most hygienic analogy) of another.
Afterthought: while it’s easy to criticise the NHS bureaucracy, at least we still have one in Scotland.
We have it easy compared with people from Orkney and Shetland. Each time I’ve been to the Fracture Clinic, there’s been someone there who’s flown down for a weekly or fortnightly check.
This system is crazy. It appears you did not follow the rest of the sheep when you went into the hospital. I think we are all supposed to do as we are told. Heaven forbid you have the audacity to question the authority of these hospital workers. As for having the intelligence to make a rational decision that conflicts with the wishes of these people, unbelievable!
The cast is off. The brace is on. No problems.
As i surmised from my own experiences, the problem lies not really with the quality of the front line staff (who are almost universally very good indeed), but with the systems laid down for them by the back-office twats…good for you Stoney!
You can get physio at Insch health centre.
Regards, Kev
Thanks. They have a central answering service for physio, which you phone and leave your contact details. In due course, someone phones you back. I’m waiting for that call.
I could have seen a physio at 2.30pm today, but the appointment would have been in Inverurie. There’s no way I could have got there and back in time to meet the boys from school, so I’ll to wait to see when they can fit me to the physio clinic in the village (it only operates three days a week, with limited hours). There are times when there are advantages to living in town, but they aren’t enough.
It sounds a little like the government department that sent me an ‘invitation’ to an appointment in the next town with a warning that “Failure to attend will mean ve take steps unless you tell us a couple of days beforehand” which was all very well except that the letter was posted on the day of the appointment and atived one day later. Fortunately the people working there were sensible and a quick phone call sorted the problem…
Sorry “Atived” should read “Arrived”.
And when people from Orkney fly to the fracture clinic, who pays for that?
At least one of them was paying for the flights himself.
Mind you, a number of fat people were wheeled in by ambulance technicians for check-ups on broken wrists and the like. They were transported gratis by the NHS because they’re disabled and on benefits. They whinged constantly about the inconvenience, the lateness, the timing of appointments (missing their favourite TV programmes) and the like. Strangely, they weren’t very disabled when the trolley came around and they raced off for their fizzy pop, crisps and chocolate.
A scaffolder who was in with a broken leg wasn’t very impressed—he couldn’t get patient transport, there was no way he was going to get in on public transport, and his wife was losing pay from her job to bring him in. (Same as us.) While we were waiting for an X-ray and after yet another moan from one of the fatties (it was ‘outrageous’ that she was missing ‘Jeremy’), the scaffolder said it was almost enough to turn him into a Daily Mail reader.
Can not any of the doctors in your local area consult with the others, or does your national system of health care forbid it? And, for your wife to have a problem at her job to take off for a situation such as yours, is just unbelievable to me. No wonder you are hands on person. No matter where you live, you can count on waiting and waiting!! Keep on reading those medical books. Next time you may not even have to go to the docs!!!
In theory, the NHS systems connect it all together: hospitals, GPs, physiotherapy and so on. In reality, there are holes and gaps everywhere.
The hospital’s computer system isn’t linked to our doctors, so we have to collect the files from the hospital and deliver it to the doctors. When I phoned the local physiotherapy unit, the lady I spoke to said they should have had my files already but didn’t.
Even within the hospital, there were breakdowns in the paperwork being passed along—physio had it, plaster didn’t so physio wouldn’t do anything until plaster had caught up.
The overwhelming majority of frontline medical staff are very good and try hard to make the system work for the patients, but the rest of the NHS leaves a lot to be desired at times.