Behaviour - Melbourne Grove Medical Centre

[dulwichrich]

About a month ago I was having a drink the EDT.

While I was at the bar, a 55-60 year old chap started having what looked like either a stroke or a heart attack, shaking foaming at the lips and collapsing to the ground.

Two people phoned for an ambulance, who said it would take 45 minutes, which I thought was odd given that Kings is under a mile away.

I knew Melbourne Grove was close, so I ran to them, knowing they were due to close in 30 mins. I arrived and no one was in the waiting rooms or in with the doctors.

So I spoke to reception and said a man in the pub is having a stroke/heart attack, we've called an ambulance but they have said it will take 45 mins, is there a doctor who could come and take a look at help while we wait for the ambulance.

To my great surprise the receptionist replied: 'Is see registered with us? Is he a patient of ours?' to which I replied 'I don't know, the guy is on the floor in a bad way, is there anyone who can help?'

So the receptionist began typing on her computer chat program to the doctors sat in their offices. After 2 minutes of tapping away, she simply said 'ok, you need to call an ambulance'

I was completely and utterly shocked and outraged at this behaviour. How can doctor's turn down assistance to a member of the public in need of help and perhaps the most shocking was the receptionist asking if the guy was registered with the practice.

[JohnL]

That is terrible

But there should have been a first responder arriving very quickly.

That's what happened when some guy collapsed on the bus - motorbike arrived within 5 minutes.

[Penguin68]

Whilst the behaviour seem callous it is worth noting

(1) GPs are not up-to-date trained in emergency work - they will have done a tour of duty in A&E - possibly some time ago - but they will not be up to speed with modern methods.

(2) GP surgeries do not carry the necessary portable equipment for A&E work - i.e. defibrillators - where they have equipment its probably not packed to go.

The most useful thing a GP could do in the circumstances is diagnosis - but calling out an ambulance was (likely) the outcome of such diagnosis. It might be different in the case of a road traffic accident - where doctors could more usefully offer first aid until an ambulance came, staunching bleeding and making sure the patient was kept stable and not moving.

[JohnL]

One note: I hope they don't assume pub calls are from drunks (as no doubt they get false alarms from drunks).

I think the best hope is a nurse is in the pub.

[IlonaM]

A GP can administer first aid like any other person trained in first aid. It is disgraceful that a GP did not come out to talk to the OP and go to investigate. It sounds as if the patient needed basic first aid initially to ensure a clear airway etc.

When a child was knocked over by a car outside the surgery (not the one at issue), during my appointment I might add, my GP went to help until the ambulance arrived.

[Sue]

If this incident was a month ago, I don't understand why the OP is posting about it now.

And I also don't understand why a GP should be expected to come from their surgery (and Melbourne Grove is not that close to the EDT) to come and help somebody who has collapsed in a pub.

[Loz]

dulwichrich Wrote:

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> I arrived and no one was in the waiting rooms or in with the doctors.

How did you know no one was in with the doctors?

[alice]

A gp will have a defibrillator

[Penguin68]

A gp will have a defibrillator Portable? Boxed and ready to go? GPs are doctors, they are not either first-aiders or (more importantly) trained paramedics with necessary equipment. I have known GPs call ambulances to surgeries rather than attempt to treat patients themselves. As generalists they tend to be aware when it is a good thing to call in specialists. Responding to accidents (RTAs) may be different - but there non-emergency doctors will attempt to stabilise patients until ambulances arrive. Calling for an ambulance immediately was the right thing to do - if there was a 45 minute wait for paramedics for a suspected heart attack that's appalling so close to Kings - but that's also not the GP's bad. [And by the way medical insurance means that if it wasn't the doctors registered patient then he/ she had no insurance cover to treat them - registered first aiders - i.e. St John's - do have such cover].

[Mark]

I assume there was a proper reason for the doctors not to attend, they have an oath to do the right thing (paraphrased) but it'll be interesting to hear the other side of the story.

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> perhaps the most shocking was the receptionist asking if the guy was registered with the practice.

Really? The medical practice could have found out useful medical information if this guy was registered there.

On a side note, I'm a bit surprised (sort of) that people in a pub can't deal with someone having a fit, and also don't know the difference between a stroke and a heart attack. I'm really not knocking the original poster for running off to get help, which is more than most will do but please spend 4 mins reading the following. It could stop someone from dying / save someone having to run 10 mins to a doctors / make you a hero / whatever your motivation.

Stroke symptoms http://www.nhs.uk/Conditions/stroke/Pages/Symptoms.aspx

Heart attack symptoms http://www.nhs.uk/Conditions/Heart-attack/Pages/Symptoms.aspx

[Cardelia]

Penguin68 Wrote:

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> if there was a 45 minute wait for paramedics for a

> suspected heart attack that's appalling so close

> to Kings - but that's also not the GP's bad. .

There is no ambulance dispatch centre at King's, it's drop-off only. The nearest one is probably Forest Hill (or Brixton) but if they were very busy then an ambulance would have to be called from further away and could easily get stuck in heavy rush hour traffic. 45 minutes does seem like a long time to wait though.

[Mark]

I forgot to ask, was the guy ok in the end?

And how long did the ambulance take to arrive?

[JohnL]

Cardelia Wrote:

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> Penguin68 Wrote:

> --------------------------------------------------

> -----

> > if there was a 45 minute wait for paramedics for

> a

> > suspected heart attack that's appalling so

> close

> > to Kings - but that's also not the GP's bad. .

>

>

> There is no ambulance dispatch centre at King's,

> it's drop-off only. The nearest one is probably

> Forest Hill (or Brixton) but if they were very

> busy then an ambulance would have to be called

> from further away and could easily get stuck in

> heavy rush hour traffic. 45 minutes does seem like

> a long time to wait though.

This is why they have the first responders - although maybe they are only parts of Central London (we were by Elephant)

When it happened on the bus a nurse was stood right next to the guy - she seemed to know who to call and administered first aid - first responder came in 5 minutes on a motorbike (but some use push bikes) then the ambulance was another 10 minutes.

[Penguin68]

they have an oath to do the right thing (paraphrased) but it'll be interesting to hear the other side of the story.

Actually, not necessarily. The Hippocratic oath is no longer administered (as it stood, including non Christian religious aspects, it never was in the UK) and although many medical schools do use some form of oath as part of the graduation ceremony not all do. Most versions of the oath that I have looked at (on Google just now) do not require the doctor to attend patients willy-nilly, wherever they should be (the oaths are inter alia about the way you treat people who are your patients). French law does require anyone first at the scene of an accident to offer aid (this wasn't an accident, and the GP wasn't at the scene).

Refusing to treat someone seems harsh, but if the GP believed such treatment was either beyond their competence (or that someone else would be more competent) probably justified.

[ianr]

Mark Wrote:

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> Stroke symptoms

> http://www.nhs.uk/Conditions/stroke/Pages/Symptoms.aspx

> Heart attack symptoms http://www.nhs.uk/Conditions/Heart-attack/Pages/Symptoms.aspx

Epileptic fit symptoms http://www.nhs.uk/Conditions/Epilepsy/Pages/Symptoms.aspx#tonicclonic

We've not yet heard evidence of the conversations with the ambulance emergency call centre. From TV documentaries I take it they're fairly practised at getting information on the patient's state, signs and symptoms, and in providing advice on and talking you through any immediate first aid action. They have, after all, to make a professional decision on the priority to assign to each call, and how to achieve the best possible outcome. They could even, I assume, have been able to advise whether bringing the patient to A&E yourself, if possible, would be best in the circumstances.

[Lynne]

I know a psychiatrist who saved someone's life after a road accident. He just did what he'd been taught to do years before, as he was the only person there with any medical training.

[Penguin68]

RTAs are very different from heart-attack or stroke. There the most important issues are normally posture, bleeding and airways. Very different issues from dealing with heart-attacks or strokes - with heart attacks resuscitation (chest pumping and mouth to mouth) may help - but this is an immediate recourse - going off to get doctors from surgeries may not be quick enough. And the symptoms as described could also have covered (as has been noted) a fit - possibly epileptic. In which case being a patient of the surgery might be relevant, as has also been noted if there was a medical history to hand.

The problem of reporting an incident which happens at a pub is that it may be immediately (and wrongly) assumed to be drink related - a different sort of emergency and perhaps not so pressing.

It would be interesting to know when help did eventually arrive (and of course, for humanity's sake, how the patient fared).

[dulwichrich]

Hi all

I see some interesting debate has opened up. Which is healthy.

I can confirm that a first responder arrived after around 40 minutes and then called for the ambulance which arrived 1 minutes later. The patient looked to be in a better condition as they left. So I hope he's ok now.

I would say that the call was at around 5:30 on a Tuesday so it wasn't a drink related thing and the chap was only on halves by the looks of it. His son and wife were with him and followed him to the hospital. So I hope all is now ok.

[heartblock]

If you are a health professional and can administer basic life support for someone having a coronary event or possible TIA you are the first responder if asked to help. One of the GPs or practice nurses should have responded as they should all be up to date with BLS skills as per NHS statutory training. There isn't anything else to say on the matter.

[binkylilyput]

I work with many doctors and nurses but not in A&E. If there is a medical emergency anywhere in my building they will respond. I have also been with them in public when there has been a medical emergency and seen them leap right in there to assist where they can- which may be relatively basic first aid but could save a person's life.

A GP surgery would have a portable defribrillator (it's a requirement) and ALL NHS GPS receive regular training on how to use one. In fact, if you work for the NHS in a clinical setting most staff are trained annually in CPR, even non clinical staff.

https://www.resus.org.uk/quality-standards/primary-care-quality-standards-for-cpr/

CPR or defib may not have been required in this case obviously.

The staff at the GP surgery would not have a duty of care for this person but I would see it as a personal responsibility perhaps. The fact that it was a pub does impact upon people's decision making

[KalamityKel]

Did anyone actually speak to a doctor?

Unless I've misunderstood there's only been mention of talking to reception...

[rendelharris]

KalamityKel Wrote:

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> Did anyone actually speak to a doctor?

> Unless I've misunderstood there's only been

> mention of talking to reception...

"So the receptionist began typing on her computer chat program to the doctors sat in their offices. After 2 minutes of tapping away, she simply said 'ok, you need to call an ambulance'"

[KalamityKel]

rendelharris Wrote:

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> KalamityKel Wrote:

> --------------------------------------------------

> -----

> > Did anyone actually speak to a doctor?

> > Unless I've misunderstood there's only been

> > mention of talking to reception...

>

> "So the receptionist began typing on her computer

> chat program to the doctors sat in their offices.

> After 2 minutes of tapping away, she simply said

> 'ok, you need to call an ambulance'"

Did the reception say "excuse me whilst I message a Doctor in their room"? That's making quite an assumption.

[rendelharris]

I don't know, I wasn't there! But as the OP says that was the case I see no reason to doubt them - yes, I presume a receptionist would say "I'll just check with a doctor" or something similar.

[Jules-and-Boo]

I've had issue with a locum at this surgery and made a complaint to the manager. I was dealt with promptly and effectively.

In the situation you explain, there is lack of fact about the receptionist liaising with the doctor or not. In any instance, I would have made a formal complaint and sought an explanation.

It seems highly unlikely that a doctor would ignore a call for medical help in an emergency.