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8 March 2012

Something I learnt today

We see countless numbers of alcohol dependant patients with all sorts of medical and social admissions in hospital every day. Some of them are brought in to hospital because they are intoxicated. Some are admitted because of the complications of chronic alcoholism such as Liver problems, gastritis, pancreatitis, nerve and brain damage and the list goes on. Some of them come to hospital, asking for help with their alcohol problems. 

When we are really busy, we get annoyed by the time that we have to spend trying to get some history out of the intoxicated patients. Some of them, we have to leave them in their cubicles until they are less drunk and can make a bit of sense.

At the same time, I have heard so many stories on how important medical conditions are missed or nearly-missed when it comes to alcohol dependant patients. I heard from a friend that one of the hospitals left one intoxicated patient at the main reception so that he could walk out when he sobered up. They completely missed his head injury and he died at the reception area with brain haemorrhage. I personally came across similar scenario a few months ago.

One patient was left in a cubicle for 2 hours with impression of alcohol intoxication. It was my turn to pick up new patient, just to find him with weakness at left arm and leg. There was a large haematoma (Bruise) on right side of his head also and urgent brain scan confirmed bleeding inside his brain. Because he was drunk, no one could ask questions properly and we almost missed the part "he was so drunk that he lost his balance and fell down stairs from top to bottom".I always want to be a good doctor and try to see every patient without prejudice. Today, again, I saw this gentleman who was discharged from medical ward yesterday. He re-attended today because of stomach pain. We have policy that if someone come back within 24 hour of discharge, it is called failed discharge and that person can go straight back to the same ward without being assessed at Emergency department. During busy day, I was very tempted to let him go back to his initial ward. However, for that particular gentleman, I thought his stomach was very painful to touch and my gut feelings told me that something else was not quite right. I asked surgical registrar to come and see him at resuscitation bed at Accident and Emergency. Surgical registrar initially was not keen to come down but advised that patient could go back to medical ward. But after a little persuasion, he agreed to come and see patient. Once he examined him, he agreed with me and arranged an urgent CT scan for our patient. It showed ruptured spleen and our patient was taken to theatre immediately. If, only if, I did not see him properly thinking "Another alcohol problem" and sent him back to medical ward, where he might need to wait a few hours to be seen by a doctor - who knows what might happen!