Shit care for patients shitting blood

Our esteemed blogger colleague, Dr Crippen, performing a blood transfusion as a junior doctor.

Dr Crippen recently posted about the fact that the treatment seems to have changed for patients who are shitting blood (altered blood, called melaena, which indicates bleeding from the top end of the gastrointestinal tract).

Dr Crippen was asking if he had missed something, as when he was a junior doctor, all such patients were admitted and endoscoped urgently. Dr Rant remembers this too. We remember it because it was the correct management.

What happens is someone bleeds from an ulcer in their stomach. The blood comes out the other end 'black'. The patient appears ok because they only lost a pint or so. The blood tests are normal initially because they have not had a chance to 'dilute' their blood with clear fluids (water, cups of tea, whatever). However, a few days later they have haemodiluted, and are now anaemic. The bleeding then starts again, and, because they are anaemic to start with, they become much more unwell. Sometimes they bleed to death in minutes.

For this reason, the correct management is to admit them and do an urgent endoscopy within 24 hours. This is official. It saves lives.

There is a formal scoring system called the Rockall Score which is used to work out who is at higher risk of dying. However, this score is based partly on the endoscopy result (for obvious reasons - without an endosocopy you have fuck all idea what is causing the bleeding).

The New NHS We Have No Beds So Fuck Off and Die approach is to send the fuckers home if they 'look ok'. So some of them die later, shit happens!

Who gives a fuck if patients die? Who gives a fuck? Not Patricia Hewitt, apparently. Or she would not have put all the hospitals under such financial pressure to 'balance the books' (what the fuck does that mean? The budget is just some arbitary number she made up, for fucks sake!).

Doctors need to stop being such saps. They need to stop agreeing to provide bad care just because useless managers tell them there is 'no money'. Doctors need to start saying 'No, this is not good enough!'.

In the mean time, if you are sick, be afraid.

Be very afraid.