I get so many calls that are top priority because of "Difficulty in breathing" or "Altered breathing", and when I turn up there is nothing wrong with their breathing (except they are maybe crying, whimpering, or have a runny nose).

So I've just come from a chest pain job which was sent to me as "Normal breathing" - and when I turn up the patient is hyperventilating (breathing way too fast). The one time that someone really does have altered breathing and I'm the last to know...

I spent an hour calming her down and getting her breathing back to normal - I really should work on my hypnosis skills for relaxing people quickly.

One of the bugbears that each party is addressing for the upcoming election is the concept of HAI's or Hospital Acquired Infections. So far the politicians have been mainly concentrating on MRSA, but this is not the only thing that you can catch in hospital.

I've just come from a job where a 95 year old female, who had spent a week in hospital for a blood clot on the leg, was suffering from some difficulty in breathing.

The patient had been discharged from the local hospital yesterday, and during the night had developed laboured breathing, a cough and a feeling of tightness in the chest.

Upon examination it seemed that they pain wasn't related to any form of cardiac cause, the tightness was worse when she breathed in, she had a slight temperature, and coupled with the cough and no history of heart problems it seemed like a simple chest infection.

The patient and her daughter were happy with this provisional diagnosis, but were glad that she would be going to hospital for some more tests.

But then the daughter asked me where her mother could have caught her chest infection.

And I really didn't want to say "from the hospital".

I imagine that the ward from which the patient had been discharged had one or more people with a chest infection. Having worked in a hospital I know that a lot of patients, and their visitors don't cover their mouths when they cough, and it seems completely reasonable that this is where the patient caught this infection.

It is probably unrelated to nurse or doctor hygiene (as these sorts of infection are often airborne), but instead due to something as simple as someone not covering their mouth when coughing. It might not have been another patient - hospital wards see a lot of visitors, including small children who are constantly exposed to, and incubating infections.

It seems to me that a lot of hospital infections could be cut if patient visitors didn't treat the ward like some form of hotel, tracking their infections in and out of the community, and generally acting like the rules of hygiene don't apply to them. I'm a big fan of restricted visiting for the majority of cases - and is there really any reason for children to be dragged around a hospital at all hours of the day.

It used to drive me barmy when I was running a ward.

But medical staff do need to improve their hand washing.