Thank you for publishing the letter by F van Veen-Zwart in November's Journal.1 We must learn from events like this. Questions are:
Why couldn't the hospital have given him a supply (say five) of sleeping tablets?
Why couldn't the hospital have arranged for a supply of oxygen to be delivered to his home?
Why couldn't the hospital have arranged a night sitter for the weekend?
Why was he told the Macmillan nurse would be with him on Monday whan she only arrived on Wednesday?
Why coudn't the night sitter be arranged for 7 days a week?
Why was the night sitter not allowed to have anything to do with the medication?
Why was the medication not given correctly on the Friday night (no oramorph, no diazepam)?
Why was a syringe driver not forthcoming on the Saturday?
Why was there a problem with the diamorphine dose and why did it take so long to sort it out?
We need answers, though many can be guessed:
1, 5 & 6: Regulations applied needlessly and even callously;
2, 3 & 7: Regulations may need to be changed;
4 & 7: Liason between different parts of the the service is still poor;
8 & 9: Professional functioning needs to be tightened up (nurses 8, doctors 9).
Overall, things don't seem to have worked too well at weekends.
Do I have an interest? Of course I do, having spent a lifetime in general practice, and now having been retired 10 years and therefore nearer to needing these services myself. Things seem very similar to those I battled with. Fighting and ignoring or overturning needless and inhumane rules are an essential part of a GP's life. I still miss it!
- © British Journal of General Practice, 2005.
