A rant about our local Accident & Emergency department

[Golden Phoenix]

Last week DH suddenly started being confused and disorientated, didn't know where he was, didn't understand questions, had trouble understanding what was going on around him and for a while, didn't recognise who I was or our own home. It was late and we had no way of getting to/from the emergency doctors or A&E. Through some trial and error we discovered that weirdly salty foods helped improve it. He also had some other symptoms, itchy skin and blurry vision.

We managed to keep it at bay until we could get him to the GP, or so we thought, yesterday he started to get worse and worse and nothing was bringing him out of it, a friend kindly took us up to our nearest A&E as NHS direct (website, not call) said it was a medical emergency.

We were called through to triage in less than 10 minutes. Then called through to see the doctor in less than fifteen.

The doctor asked DH about his medication and his mental health problems, asked why we thought that we needed to go to A&E for that, called the crisis team and told us to see the GP today (going to walk in service later) and discharged him.

He didn't in any way examine DH, not even the usual stuff they do without thinking, like taking your temperature or blood pressure. Meanwhile, DH isn't sure why we're at the hospital, which hospital we're at or why our friend is with us.

I just feel like as soon as mental health was mentioned the doctor immediately thought "Oh well, there's your problem, the mental guy's gone a bit crazy, nothing I can do." and packed us off home again.

I spent the night trying to keep DH calm.

I'm exhausted and scared and angry.

[Golden Phoenix]

Just got back from the GP, he has ordered a fast track neurological appointment and CT scan and MRI of DH's brain. He's taking blood samples and a urine sample to check for infections, temperature is normal, he's also taking DH back off one of his meds which is new and may be causing problems with some of his old stuff. He'll be having an ECG to rule out anything cardiac plus a chest x-ray for good measure.

*Phew*

Night and day, seriously.

[dalesys]

Are you naturally incompetent, Doc, or did you study hard for years to get this dumb?

[jedimaster91]

Hopefully it's just the new meds and not something more serious. The doc should have ordered a head CT at the very least to rule out a stroke. We had some issues a few years back in our hospital system with doctors not checking for stroke and patients coming back later in much worse shape.

[crazylegs]

Poor medical care at ED really bugs me. You may find it worth contacting, via email, the PALS for the hospital you attended.

For added clout you might want to CC in the CQC, I tend to find it helpful to list what areas of care were deficient and how they relate to the standards expected. Be aware though that while the CQC cannot take on your complaint they can use your email as 'intelligence' when they do their next inspection.

[XCashier]

We had some issues a few years back in our hospital system with doctors not checking for stroke and patients coming back later in much worse shape.

That's appalling. You'd think that'd be the first thing they'd check for (it's the first thing that came to my mind when I read the OP, and I have no medical training).

I hope that stroke isn't the case here, but that doctor was still incompetent to jump to conclusions like that.

[Golden Phoenix]

Well, it's looking like one of his meds is the culprit, he's back off the most recently added one and has shown some improvement. Still gonna go for the tests though, just in case.

[CrazedClerkthe2nd]

Glad to hear he's improving and you apparently found the culprit, but that was still a horrible experience with A&E.

[Golden Phoenix]

What absolutely boggles me is that despite a complaint of "confusion and memory loss" the doctor didn't ask a single question to determine if DH knew where, when or who he was.

And unfortunately the confusion has returned, he lost the layout of the house again today, MRI is the last test he's been sent for and that's on the 5th, but i'm thinking he may need to see the doc tomorrow again, something's not right.

The Mirtazapine should be out of his system and he should be showing improvement by now.

[Sparklyturtle]

I hope things get sorted out for you and him. That's scary. I'm a retired medical transcriptionist, and I know that often the type of medication mirtazapine is causes strange side effects. I don't know what age your husband is, but the medical personnel should never just assume that someone has dementia. Besides, sometimes just a strange combination of factors like drug interaction or maybe low blood sugar etc. can cause mental confusion.

[jedimaster91]

I don't know what age your husband is, but the medical personnel should never just assume that someone has dementia. Besides, sometimes just a strange combination of factors like drug interaction or maybe low blood sugar etc. can cause mental confusion.

Dementia can be much trickier to diagnose than you'd think. It's a long process with many different scans to find out what exactly is going on, and even then it's a guess more often than not. MRI is usually the first line to look for physical changes in the brain (way better resolution than CT). Nuclear Medicine and PET can show if the function is changing as well. Alzheimer's has a very distinctive pattern on FDG PET scans (glucose metabolism). Where I work, we don't really do much brain stuff (except for the occasional brain death scan to see if blood flow to the brain has stopped).

I just had to renew all my certifications and one of the articles was on imaging and testing for different kinds of dementia. Fascinating stuff from a clinical standpoint, but an absolute nightmare for patients and their families.

[Sapphire Silk]

Well, it's looking like one of his meds is the culprit, he's back off the most recently added one and has shown some improvement. Still gonna go for the tests though, just in case.

That was my thought reading your OP. The ER doc is a moron. He should have done a mental status exam and ruled out physical causes like infection, stroke, or seizure.

THEN he could send you off to the GP to look for the less obvious causes, like a med reaction. He's lucky it wasn't a stroke. A med mal attorney would have a field day in the US with idiot medicine like that.

Hope he's feeling better.

[greek_jester]

If you haven't already, I second the suggestion to complain, particularly cc'ing the CCQ. The sudden-onset confusion and disorientation are classic symptoms of a stroke or other major brain event and the doctor should have never turned DH away without a medical exam.

Please, for the sake of the next patient to be seen by this twit who may have actually had a stroke, complain. The hospital can't work to fix the problem if they don't know about it. If nothing else it'll save the hospital's budget being eaten up by compensation claims from people whose loved ones are left permanently disabled in ways which could have been prevented by earlier diagnosis and treatment.

[Golden Phoenix]

You guys have convinced me to complain, i'll start the procedure tomorrow. The worrying thing is that's the same hospital I'm due to deliver at in a couple of months time, i know maternity isn't A&E but still...Doesn't inspire confidence.

Urine, ECG and X-Ray are done. Fasting Bloods are tomorrow, MRI will follow next week.

Oh, DH is 37 btw.

The episodes of confusion are still occurring, and varying in severity, memory loss also still happening. DH got himself a treat from the shop while we were in town for his ECG, and later today thanked me delightedly for getting it for him because he'd been craving it...totally forgot that he'd chosen it while we were out.

Mirtazapine has a 3-day half life as far as I recall, so it should be well below any therapeutic threshold in his system by now, and he should, theoretically be showing improvement. It's just a waiting game.

[Shyla]

So glad you're getting the MRI. That kind of abrupt confusion is not something you just write off. He could be having small seizures or encephalitis or all kinds of things. Keep fighting for him. I'm sure it's all very tough if you're having a baby soon too.