Although I try my best for my patients, I am not infallible. Sometimes I make mistakes, and writing this blog has taught me to examine those mistakes.

The first job of the day was to an elderly day care centre, the sort of place where the elderly go to listen to music, paint some pictures, talk about the good old days and get fed and watered by the staff. Our patient was a 96 year old man, who was apparently 'confused, falling over with an irregular pulse' - a category A response. We got there as quickly as we could and were met at the door by one of the staff, who didn't know why we were there - however she soon found someone who knew what was going on - and we were led to the patient. On the way to the patient the staff was telling us how unwell the patient was, and how worried they were for him.

We entered the large dining hall to find a group of old folks who were quite happily sitting around finishing off their breakfast. Our patient was pointed out to us, so I went to examine him.

All I can say is that, should I reach my 90's, I'm as well as this gentleman. He was alert and orientated, had no pain, had no dizziness, was not confused and had last fallen over two weeks ago (and he showed me the bruising to prove it). He told me that the staff in the centre had seen a muscle in his hand twitching (he showed me, it was) and they had thought it was his pulse. They hadn't actually taken his pulse at any point, and when asked why just replied 'I can see his pulse, why would I need to feel it'... I ran a complete set of observations, blood pressure, e.c.g., blood sugar, pupil and motor response, mini mental state - the whole shebang.

Everything was normal, actually some results were better than mine, something I'm getting more and more used to.

So I asked him if he wanted to go to hospital - he didn't see the point, as he was feeling no different than normal, and I agreed with him.

But, the staff in the centre really wanted him to go to hospital - they had phoned the GP who had told them that he wouldn't be visiting the patient, but that they should get an ambulance because the doctor wanted the patient looked at by someone in the medical sphere.

And people still ask me why I dislike GPs so much...

I told the staff that, because the patient wasn't confused, and he was refusing an ambulance, I couldn't 'kidnap' him to hospital. So the member of staff who had been with us ran off to tell her boss. The boss soon turned up and basically bullied the patient into agreeing to go to hospital. I started to argue with her, but she just walked off saying that the patient was to go to hospital and that was that. Honestly - if it wasn't in a public area I might well have had a blazing row about her arrogance, and how she thought that she could know what was best for the patient if her staff couldn't be bothered to take a patients pulse. As my crewmate told me later, he saw me bite my tongue rather than start arguing at people.

So...I caved in, and took the patient into A&E. I had a chat with one of my favourite nurses and she looked after him for me until they discharged him later that day.

The thing is, it left me feeling angry. I was angry that the staff in this centre were so useless. I was angry that I let the boss of the centre bully me because I didn't want to cause a scene in front of 30 elderly people. I'm angry that the GP didn't visit the patient, and instead fobbed the patient off onto the A&E department. And I'm angry that I didn't do more to protect the best interests of my patient by not dragging a 96 year old man into an A&E department full of diseased, infectious people.

Now I have a tiny knot of hate in my stomach that I can feel now, just thinking about that job is making me angry as I type this up on my sofa. Perhaps next time I'll take the boss aside and make my position clear, in some scathingly sarcastic fashion.

Our next patient was a GP referral, who had arranged the ambulance without actually seeing the patient. The GP had then faxed a referral letter to the A&E department claiming that the patients blood pressure was 130/90, her pulse was 100, so on and so forth, and that he suspected a collapsed lung. I was very impressed by this GP who could check a patients vital signs over the phone, just by talking to the patient's daughter.

Grrrrr...

And in both cases, the patients and their families were very nice people.

One of the things that I really enjoy doing, and it is a guilty pleasure, is kicking down doors.

We occasionally get called to a 'trapped behind locked doors', which often means that a patient has fallen/collapsed/died behind a front door that they cannot open. In this case we are supposed to call the police and have them ram the door down with an 'Enforcer', which is a heavy ram - if you have seen the police knock down a door on the television, they tend to use an Enforcer.

But...

There is a visceral pleasure with kicking down a door. Once or twice I've managed to see someone who is really ill trapped behind a locked door, occasionally there has been someone who has just been unable to open the door. And once, I have kicked down a door that the patient refused to open because they were schizophrenic and didn't want to open the door, not that I knew that at the time.

I've even been surprised at the ease in which I can kick down the doors of the flats that I live it. Actually it would be more accurate to say that I am scared with the ease in which the doors can be broken. Oh well, it's not as if I have a lot to steal anyway...

My experience of kicking down doors has taught me which security features are useful when trying to prevent someone from stealing your TV and video.

If you have a deadlock type bolt, then use it - always. The skill of kicking down a door relies on breaking either the lock, or the wood holding the lock - deadbolt type locks are a lot more secure than the normal Yale type lock.

If you are in the house, and have a bolt to the door, then use it. It takes a lot longer to kick down a door when there is a bolt in the way. The skill behind kicking down a door relies on applying the force of your kick to the (hopefully) single point of resistance. If there is a bolt at the top, or the bottom of the door it makes it a lot trickier to break that door.

Windows in the door are a bad idea - they are a weak point that can be easily broken, and then a skinny hand can reach through and unlock the door easily.

If you really want to be safe then have a bar across the door - I've seen it once or twice, and if someone had a bar across the door then there is no way I'd be able to break that door down.

Just make sure you don't collapse behind it.