Scenario 5 - Lower back pain

Hello, is that Mr Smith?

Hello, yeah.

Hello, Mr Smith. My name is Shaun from the Urgent Care.

Oh, yeah.

Hello, there. I am one of the urgent care practitioners ringing from the statutory doctors out-of-hours.

Yeah, yeah.

Mr Smith, can I just get you to confirm your full name and date of birth for me first, please?

Mark Smith. 15th of April, 1960.

Okay, so I understand from the notes this evening, Mr Smith, that you have got some problems in your back, is that right?

Yeah.

How long has this been going on for?

It just happened this afternoon.

Have you injured it at all?

No, I was just leaning over, putting something in my boot, in my car.

Okay. Ever had a problem with your back before?

No.

Okay, and what have you been taking for the pain?

Ibuprofen and paracetamol.

Yeah. And has that helped at all?

No.

If you... Oh, sorry, if you had to put a pain score on this, 0 is no pain, 10 is the worst imaginable, what would you score the pain at at the moment?

20.

So is it the worst pain that you have ever experienced?

Yeah.

So if I say 10 out of 10 then, rather than 20, yeah?

Okay.

Is that okay? So...

Jesus Christ!

I can understand you are in a lot of pain, Mr Smith. When did you last take your pain relief?

About a half-hour ago.

Okay, so we cannot currently take anything else. What did you take? How many paracetamol? What doses?

Just two.

And what about the ibuprofen?

I took them about dinnertime.

Okay, taking anything else at all? For any other, any problems?

No.

Do you have any medical history at all?

No, usually fit and well.

And apart from the ibuprofen, the paracetamol, you are on no medications?

No.

What about allergies, Mr. Smith?

No.

And who do you live with at your home address?

What?

Who do you live with at your home address?

Just my wife.

Is she with you at the moment?

No, she is out.

Okay, anybody else?

I am stuck. I am on the landing. I am stuck.

Oh, are you. Is anybody else in the house with you?

My son's downstairs, yeah.

How long you have been lying on the landing for now?

Oh, Jesus! Oh, well, I called you and then I came up to the toilet and then just coming out of the toilet, it was just, I just had to lie... Just for a minute lie there. I have only been up here for about 10 minutes.

Okay. And just going back to the back problem again, have you had any problems passing urine and opening your bowels at all today?

No, that is why I came up to the toilet and everything's all right in that department.

Okay, that's fine. Good. And any problems lifting your foot off the floor?

No.

Okay.

I can walk, I can walk, but the pain in my lower back and it goes right down my left leg.

Okay. So currently, as we are speaking, Mr Smith, you cannot move from this position that you are in at the moment?

I could, but it would bloody hurt.

How old is your son?

18.

Okay. I am just concerned that we cannot actually get you off the floor at the moment, Mr. Smith. That is going to be the problem. And I think we need to get you seen... You say you have done some kind of twisting action today?

It was just lean... Yeah, leaning over and just twisting a little bit, but it was when I just lean... I was putting a crate of wine in the back of the car.

Okay, you got no history of arthritis at all?

No, no, nothing like that.

Okay. I think what we need to do, Mr Smith, is get the ambulance service out to you, first of all, then we need to get you assessed properly, get some pain relief into you before they can move you. And then they can decide whether they need to take you to the hospital at all. Just confirm what area you live in?

ST16.

So you are in Stoke-on-Trent. So what I am going to do is I am going to arrange an ambulance. It would be within the next... Probably within the next two hours, I will ask for, when they triage it, that's what it will come out with, I am afraid, Mr Smith. So can your son make you comfortable there until the ambulance gets there?

Yeah, I can get him to come up and get...

Just pop a pillow under your head, and just keep you warm until they get there. What I would also say is, if the pain worsens at all before the ambulance service get there or anything else changes, will you ask your son to ring back on 999 and just say, you are waiting for an ambulance as an urgent, can you just check that they are still on the way, and we may be able to speed it up slightly. If there is any other problems or anything changes, you can ring back on 111 for some more advice as well. Is that okay?

All right. Okay. So I will wait here... Am I waiting for an ambulance?

You are waiting for an ambulance, and I will sort this now. If you get worse before they get there, then your son must ring them back on 999, okay?

All right. All right.

I will ring the ambulance now, all right, Mr Smith?

Yeah. All right, all right.

Okay, then. Thanks for your call, now. Look after yourself.

Bye, bye.