Personal Views

The lottery of hospital admission

BMJ 1996; 312 doi: (Published 10 February 1996) Cite this as: BMJ 1996;312:384
  1. G T Cubitt

    A few weeks after the publication of an article written by my predecessor on the complications of shunts in adults with spina bifida (BMJ 1995;311:286-7) a young woman with spina bifida and hydrocephalus presented with typical symptoms of raised intercranial pressure, prostration, vomiting, frontal headache, and suffused optic discs. She lives at a college for disabled young people in north Hampshire where I am now the medical officer.

    I decided that a blocked valve was a likely diagnosis. I rang my helpful paediatric surgical colleague at Hospital A and after winkling him out from an outpatient session, got him to agree that the patient needed urgent assessment and admission. But he had no beds and anyway she was above the age limit for his unit. He suggested that I should contact his adult neurosurgical colleagues. Shortly afterwards I spoke to a harassed sounding registrar who told me that six of the eight neurosurgery registrars were on a course and he was struggling in the clinic; but he said that he would try to find a bed for my patient as soon as possible. Two …

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