The patient and carer trained, what about the doctor?

Here we are, just a couple of weeks after posting the Fistula Health training program, and Daquon writes this:

Hi Greg. My mom is 42 she been on dialysis for 5 years. Recently her fistula had been getting big and the Dr. at dialysis told her she should be careful because it was thin and she could bleed to death. From me reading your responses on everyone else, they are supposed to fix her fistula when they noticed it was swelling up.

But lo and behold they didn’t, and a week later she woke up and blood was squirting out her arm. I call ambulance, they took her to the hospital. She got surgery done on her arm but she came home yesterday and she told me she had to change the bandage twice a day and when I help her take the bandage off it was a big hole in her arm leaking blood to the white meat. We had to stuff the hole with bandages and wrap it back up.

When I send this, tears come to my eyes. I just want some information on what’s going on and is she going to be alright. the only thing she told me is that it was infected.

Wow. Daquon’s mother was a classic candidate for a fistula rupture: swollen, thin walled and infected, and what happens? The doctor both recognises and acknowledges the life-threatening problem, then he tells her to be careful and walks away.

This the very person, the saviour, the white knight expected to act, to fix the problem!

Of course the fistula ruptures. Luckily Daquon is there to help. He acted quickly to stop the bleeding and called an ambulance. The patient/carer training worked just fine.

When we go to dialysis,  we assume that each party in the circle of dialysis care will actually do their job. I think that mostly this is a fair assumption. Mostly.

But the best way to be sure of that is to make a very public fuss – even a legal fuss – when they don’t. Sometimes the only motivation to improve care is financial. So I have sent Daquon the details of a lawyer who is working on a US fistula rupture negligence case right now.

At the very least he should see the dialysis unit manager and make a formal complaint about the doctor’s lack of action. He should also ask to see his mother’s care record to see what has been documented and what care has been recommended. In many cases, this material is hard to get because the dialysis unit owners don’t want to admit liability. -“It was nobody’s fault- it happens” just doesn’t cut it. The blame for this kind of inaction can and should be laid at the door of the dialysis unit and poor training of staff.

In many cases, this material is hard to get because the dialysis unit owners don’t want to admit liability. -“It was nobody’s fault- it happens” just doesn’t cut it. The blame for this kind of inaction can and should be laid at the door of the dialysis unit and poor training of staff.

It is hard to say what was done at Emergency, but his mother clearly needs to see a vascular surgeon to have her fistula fixed properly. So Daquon should also ask for an immediate referral. Hopefully the surgeon will do more than just tell her to be careful.

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