From David Maughan Brown in York: Collateral Damage Part 3

September 3rd.

111 is a magic number, to which a variety of superstitions are attached.  Perhaps the best known one, at least for anyone who has an interest in cricket, where it is referred to as ‘Nelson’ (one arm, one eye, one unmentionable) is that it is unlucky and that the only way to combat the incipient bad luck is to make sure that one’s feet aren’t touching the ground.   So when a batting side finds itself on 111, or multiples thereof (‘double Nelson’ etc.), all the members of the batting side in the pavilion are wont to sit down and lift their feet in the air until the score moves on.   Umpires who are superstitious in this way do, however, have some difficulty in levitating.  The portly David Shepard was a commentator’s delight whenever a batting side reached Nelson or multiples thereof, as his sterling efforts to keep his feet off the ground always made it look as if something exceedingly uncomfortable was happening in his nether regions.   Wikipedia boasts a wealth of esoteric information about 111 in the unlikely event of anyone being interested.   For those who correctly point out that Wikipedia will often be found to be very much less than reliable when it comes to factual accuracy, I can only respond by saying that it is, at least, far more reliable where the truth is concerned than the members of Her Majesty’s government’s cabinet, either collectively or individually.   For those who might, not unreasonably, think I have cracked under the strain of the lockdown, a brief discourse on the magic properties of the number 111 is not quite as irrelevant to the topic of collateral damage as it might seem.

Yesterday saw a good deal of further engagement with things medical.  Apart from the promised and hard-won mid-morning blood-test, I needed to talk to a doctor about what I suspect are some unpleasant side effects from the blood pressure tablets.  So the day got off to a déjà vu (my spellcheck thinks that should be ‘deejay’ – which would be a welcome alternative) telephonic start as I set about getting a same-day gold-dust opportunity to talk to a doctor.   The automated voice tells me that the line is very busy but kindly offers to ring me back when I get ‘near the head of the queue’.   This it does sometime later when it informs me that I have been promoted to the dizzy heights of third in line to speak to someone.  But my hopes are dashed when the someone I eventually get through to tells me she is sorry but all the morning slots are taken, so I need to phone again at 2.00pm.  

By this time I need to start thinking about trundling across town to the blood-test appointment mentioned in my previous instalment.  All goes well, not least because this clinic does actually have the promised bell to ring, the masked figure who comes to interrogate me manages to convey a degree of friendliness from behind the mask, and it all goes to plan.   The thimbleful of blood is duly extracted – an entirely painless process these days, given the scar tissue built up over the course of donating over 500 pints of blood for plasmapheresis, in the later years for the production of serum for the treatment of rabies, which I always feel obliged to explain away lest it be assumed that I’ve been mainlining for the past fifty years.  When the process has been completed, I indicate that I am puzzled as to what was so dire about the results from the last test that I had to take another so soon, so the blood-letter kindly says she will have a look for me.  She starts off by telling me that the results indicate that the sodium reading is a bit low and then pauses before saying ‘Oh dear!’.   ‘Oh dear what?’ I ask, fearing the worst.  ‘The message they sent you says “a further test is advised” – it should have said “in four weeks time” but the doctor who sent it forgot to put the “four weeks” bit in.’  So the visit to the clinic to pick up the form, the further visit for the test, the low-level anxiety in between, were all entirely unnecessary.  And, joy of joys, I will need to go through the whole process again in just over three weeks time.

So home I go to take the 2pm telephone endurance test involved in trying once again to talk to a doctor.   When I eventually get to the head of the queue again, the telephonist makes a show (in so far as anything can be shown via the telephone) of looking at her booking form and tells me she is very sorry but all the slots are taken today – I must phone again tomorrow.  “Well, if I really can’t speak to anybody today, can I book a slot for tomorrow?” I ask despairingly.   No, I can’t.  These days they only deal in same-day appointments, it is impossible for her to book an appointment for tomorrow or any other day.  I must phone again in the morning.  Is it any wonder our Accident and Emergency departments find themselves under pressure from people who haven’t had an accident and don’t really think it is an emergency?  She agrees that it is an impossible system for patients, but she is very sorry there is nothing she can do about it.  After we have spent a minute of two mutually agreeing what an ordeal the whole business is for her, me and all the Medical Group’s patients, and trying to console one another on our lot, she says, her voice conspiratorially lowered, ‘You could try 111.’   I tell her I’ve had experience of telephoning the NHS non-emergency line before and found it completely useless.  ‘Ah, but it is different these days,’ she says mysteriously.  ‘Are you implying that someone on the other end of 111 might be able magically to find me a slot with one of your doctors this afternoon when all the slots are full?’ I ask.  ‘They sometimes can,’ she says cautiously, sounding as if she might be worried that she has let a black cat out of the bag.

So I phone 111, get straight through to someone who asks me a long but sensible series of questions which seem designed not only to elicit my answers but to leave me glowing in the knowledge that I must have an IQ of about 250: every time I give an answer, apparently always the right answer, he responds by saying ‘Bril’ with ever increasing enthusiasm.  When he has finished massaging my ego he says, ‘Right, I’ll get someone to phone you, but it may not be for ten or fifteen minutes.’  10 or 15 minutes – I’ll believe that when I see it.  Intrigued by what I am discovering, I ask him as a matter of interest how may slots he has available for the medical practice I belong to.  ‘There are only eight or nine left today,’ he says.  ‘Do you always fill them all?’ I ask.  ‘Usually,’ he says.   Sure enough the phone rings ten minutes later and the Holy Grail of a same-day conversation with a doctor has been achieved.

So, unbeknown to most of the long-suffering, both literally and figuratively, patients who stick with the practice, a significant slice of every day’s doctors’ appointments (all telephonic) is allocated to 111 and entirely beyond the control of the employees of the practice whose wretched responsibility it is to have to bear the brunt of disappointed, angered and unwell patients anxious to talk to a doctor when the practice’s limited allocation of its own appointments runs out.   If that isn’t collateral damage I don’t know what is.  I got the impression that the practice telephonists have been trained to try avoid letting prospective patients know the magic number unless and until the they give the impression of being about to spontaneously combust or expire in more mundane ways on the other end of the line.  They probably withhold the magic formula for good reason: I won’t bother to go through the ordeal of phoning the practice in future, I’ll just dial 111 and keep both feet on the ground.

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