Posted by: ayrshirehealth | July 22, 2015

A tale of the unexpected by @davidrhogg

BASIC GP support

The phone goes off.  Is it bad that I have a specific ringtone for Ambulance Control?

Picture with permission from Arran Banner

Picture with kind permission from Arran Banner

It helps put me in the frame of mind for the intensive relay of information which is about to happen.  Location, how many casualties, what I can do to help.

A cyclist has come off at speed in one of the more remote parts of Arran.  He has significant chest injuries.

Arran’s ambulance is on its way, but the crew have requested BASICS GP support due to his condition.

This is a Sunday afternoon; one with tentative plans to do more than is achievable.  A bike ride over the forestry paths, clear out the garage, a walk with my wife Kelli, perhaps with a trip to the Co-op to stock up – a ‘big shop’ in the words of Peter Kay.  Last night’s on-call shift for me wasn’t too bad: at least our Saturday nights in A&E are rather different from Crosshouse.  We were just about to decide what to do with our day.

Pants on the outside

Within minutes I’m on my way out.  It’s going to take 25 minutes to get there, but this time can fly by at scene, and I know the relief that an extra pair of hands can bring to a difficult, unwell patient.Pants on the outside

This is pants-outside-your-trousers general practice.  One end of the spectrum of the medical cover we provide at Arran Medical Group.

I like it just as much as offering brief cognitive based therapies in the consulting room, or perhaps some narrative based medicine – many of our patients have amazing stories, and if time allows, there are some incredible stories to listen to; a rich source from which to learn about life.

I once heard: ‘Knowledge without perspective is a higher form of ignorance’.

Occasionally ignorance is nice, it keeps things blissfully simple.  Life is complex however, and complexity muddies the waters of textbook medicine.  To understand complexity, you need perspective.  It’s what GPs are good at, so I’m told.

The trauma team

SAS HelicopterSome of our patients have received both ends of this spectrum from me and my colleagues in the space of a week.  However a narrative based approach couldn’t be more inappropriate for the tachycardic, slightly shocked 21 year old chap who I have managed to obtain IV access on, and who we can now give some morphine to settle his chest pain.  The dignity that effective analgesia can bring to trauma never fails to impress me.  It trumps everything else more fancy. Funny though that with pain control, often comes a desire to tell a story. We strike up a conversation about bikes and bike parts whilst I assess Chris for signs of internal bleeding.

The helicopter – with trauma team, as requested – lands around 30 minutes later.  ISOBARThe red suits worn by the team add to the drama.  I try to follow an ISOBAR method of handover – to tell my own story of what I have found, and importantly, Chris’s story of how he came off his bike in the first place.

Before long the consultant is doing a ‘FAST’ ultrasound scan in the ambulance.

This is modern medicine. Gadgets for the domain of the emergency doctor. The major trauma network in action.

His story is important too

While they do that, I have a chat with Chris’s father.  His story is important too.  The story he was hoping for – to return on the ferry with a chance to bond with his son, a chance to experience the raw pleasures of life away from the complexity of living – is shattered, like the bike that Chris was riding.  Arran FerryLogistics of getting back on the boat himself are now more important, along with the story he’ll have to relay to Chris’s mum, his wife.  I don’t envy him that.

I return home, pleased that we have achieved a ‘good outcome’.

Chris might not agree given that his plans for the next few weeks are rather changed, but with adequate analgesia, cervical and pelvic collars in place, stabilised observations and a timely transfer to a CT scanner and an expert team; this is what I hoped to achieve when I left my home earlier.

Weekly shopI now have a story too.  But for now, life rightly returns to the narrative I had abruptly left.  We do the big shop, go for a walk.  The garage remains uncleared.  Chris makes a good recovery from his spinal injury and sternal fracture.

Like others, he will rely on his GP for some follow up, for a listening ear for his story and to get back to the story he was trying to follow before all this happened.

And for the moment, I suppose we all live (relatively) happily ever after.

*Chris is not the patient’s real name.

This week’s blog was by @davidrhogg (David Hogg) who is a GP with Arran Medical Group, Island of Arran.

For more information on the Arran Medical Group click Arran Medical Group:

To watch their A-Team video click AMG – A-Team vimeo:

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Responses

  1. A helpful insight into rural life of the health care team; and a timely reminder of how technology is bringing care to the patient, and also how important to remember just how much care is delivered outside our acute hospitals

  2. I particularly liked this “To understand complexity, you need perspective. It’s what GPs are good at, so I’m told.”

    As a (regular) visitor to my GP In West Kilbride, I could not agree more.

  3. Wow! What a fabulous blog offering an excellent insight into life on an island and the different challenges that presents. Thank you for doing what you do.

  4. Such a good read, love that you choose to tell it as a story, it makes it more meaningful when people are able to put it into perspective.

  5. Really enjoyed this blog gave such an insight to your role and that the patient was at the centre of your story

  6. a great read, informative and interesting. Thanks for sharing this with us.

  7. Thanks for the comments… and our business manager Jenni for proof reading!

  8. […] item will offer some focussed discussion on the role of the trauma team.  We’ll reflect on a case that David Hogg had… with ambulance control helpfully prompting over the radio, ‘do you want the trauma […]

  9. […] It was a recent BASICS call for me that focussed my interest.  In the summer I was called to a young cyclist who took a different path to his bike, at high speed.  After we instigated initial treatment, the EMRS trauma team arrived by helicopter.  I was struck that their ultrasound unit was the size of an old-style flip mobile phone… and they were able to check for significant chest and abdominal injury at the roadside.  I wrote about the experience here. […]


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