Humiliated in A&E

Neyite

LLMMLL wrote: »

For a gay man who has unprotected sex absolutely.

It's medication that should be taken within 48 hrs.

The op states that it was a little over a day since exposure.

He (might be a she, the OP didn't state sex, so you shouldn't assume it's a gay guy) waited an additional 6 hrs and complained that they weren't in a more urgent triage queue.

He (or She!) had plenty of time to go to an STI clinic and get the medication in time. That's why the doctor referred them elsewhere.

njs030

gctest50 wrote: »

your capslock is stuck

anyway CUH have this :

Making smart comments doesn't make your point any better.

A pregnant woman with pain is a medical emergency yes.
A person with a 48 or 72 hour window for medication isn't.

Mr. Incognito

https://www.hse.ie/eng/health/az/H/HIV-and-AIDS/What-are-the-treatment-options-.html

t is sometimes possible to halt the development of HIV in the first 72 hours after exposure. This is known as post exposure prophylaxis (PEP). PEP involves taking anti-HIV medicines for four weeks.

PEP is often used when a person knows they have been exposed to HIV. This could be because they had sex with someone who they knew had HIV and the condom broke, or they were accidentally stabbed with an HIV-infected needle.

PEP is not guaranteed to work and the medicines that are used cause some unpleasant side effects, such as nausea, vomiting, diarrhoea and headaches.

If you are concerned that you have been exposed to HIV, immediately contact your local accident and emergency department or GUM (genitourinary) or sexual health clinic.

From the HSE Website. The do recommend going to A & E in fairness.

LLMMLL

Neyite wrote: »

It's medication that should be taken within 48 hrs.

The op states that it was a little over a day since exposure.

He (might be a she, the OP didn't state sex, so you shouldn't assume it's a gay guy) waited an additional 6 hrs and complained that they weren't in a more urgent triage queue.

He (or She!) had plenty of time to go to an STI clinic and get the medication in time. That's why the doctor referred them elsewhere.

Its effectiveness decreases with time. It's not a case of taking it anytime between 0-48 hrs guaranteed to work but taking it at 49 hrs guatanteed not to work. It's recommended to get it as early as possible with best results if taken within 48 hrs.

So no, the doctor absolutely should not have referred them onwards based on that criteria. There may have been other reasons why they did so but sounds more like he's an ignoramus.

Neyite

Mr. Incognito wrote: »

https://www.hse.ie/eng/health/az/H/HIV-and-AIDS/What-are-the-treatment-options-.html



From the HSE Website. The do recommend going to A & E in fairness.

They do, AND they also suggest you contact your local GUM.

They also state in their triage system that you can get referred elsewhere:

Patients are assessed by the Triage Nurse and given a priority rating which will determine the urgency with which they are seen. The Triage Categories are outlined below.

• Category 1 – immediate attention
• Category 2 – very urgent treatment
• Category 3 – early full assessment
• Category 4 – needs to be seen but can wait
• Category 5 – can be seen elsewhere

The OP states that just a day had passed since exposure. That's what, 12 or 24 hrs at the most. They were triaged as a category 4 most likely by the triage nurse. Being 12 hrs into a 72 hr window is NOT urgent.

Then the OP complained that they weren't in a more urgent queue. That was unreasonable of them. They were not an urgent case. Time sensitive certainly, but not urgent by A&E criteria.

When the doctor assessed the patient he likely downgraded the patient to a category 5. This is all correct procedure. They are not going to hand out scarce and expensive medications to people who have time to get it prescribed elsewhere. Because that means that the next patient coming in the door needing the same and who does NOT have the time the OP did, can get it right away.

What was not normal procedure was the way the staff handled the OP.But I suspect that the OP already had their card marked by insisting they were more urgent than those that were actually urgent. T

LLMMLL

Posting general a and E guidelines isn't helpful at all. The doctor Should not have referred them onwards based on the time limit. We don't know what the decision was based on but your suggestion that as long as it's within 48 hrs it's fine is downright dangerous if someone uneducated on the matter reads it.

Neyite

LLMMLL wrote: »

Its effectiveness decreases with time. It's not a case of taking it anytime between 0-48 hrs guaranteed to work but taking it at 49 hrs guatanteed not to work. It's recommended to get it as early as possible with best results if taken within 48 hrs.

So no, the doctor absolutely should not have referred them onwards based on that criteria. There may have been other reasons why they did so but sounds more like he's an ignoramus.

No, according to the link Mr Incognito posted the window is 72 hrs. Not 48. And if you've evidence that it is guaranteed not to work in hour 49 then you should get onto the HSE pronto to get them to change their website.

The OP's exposure was 12-24 hrs max. They had time to get to the GUM clinic.

retro:electro

Mr. Incognito wrote: »

https://www.hse.ie/eng/health/az/H/HIV-and-AIDS/What-are-the-treatment-options-.html



From the HSE Website. The do recommend going to A & E in fairness.

They advocate you go if you know you've been infected. The OP didn't know, and was only speculating about infection due to having unprotected sex.
It sounds like there was a pair of them in it. A particularly narky and pressurised consultant coupled with a hysterical patient is a recipe for disaster.

LLMMLL

Neyite wrote: »

No, according to the link Mr Incognito posted the window is 72 hrs. Not 48. And if you've evidence that it is guaranteed not to work in hour 49 then you should get onto the HSE pronto to get them to change their website.

The OP's exposure was 12-24 hrs max. They had time to get to the GUM clinic.

I'm not trying to be pedantic Neyite. I know quite a bit about PEP. You are just wrong on this factual matter.

The window is 72 hrs but far less effective 48-72. Then within 48 hrs the earlier you take it the more effective it is. The wait for a clinic to open could be the difference between becoming positive or staying negative.

njs030

LLMMLL wrote: »

I'm not trying to be pedantic Neyite. I know quite a bit about PEP. You are just wrong on this factual matter.

The window is 72 hrs but far less effective 48-72. Then within 48 hrs the earlier you take it the more effective it is. The wait for a clinic to open could be the difference between becoming positive or staying negative.

As already stated it's the same as the emergency contraceptive so could women land in to A&E for it?

48 hours is quite a long time to find a sti clinic rather than overloading an already struggling emergency department.

nilescraneo

Mr. Incognito wrote: »

I'm sorry but this is ridiculous.

You had unprotected sex with someone.

Then you freaked out that you had HIV.

Then you went to an emergency department without a referral from a GP.

Then you demanded emergency HIV meds which are very expensive.

Then you threw a strop when the doctor, quite rightly told you not to waste their time and go to an STI clinic.

Then you threw what appears to be the mother of all hissy fits until they gave you the meds to go away.

You sound like a ridiculous dose of drama.

Please use protection the next time because you really seem to think that emergency services exist to service your needs and not genuine emergencies.

Such an ignorant post. HSE STI clinics ADVISE you to attend an A+E department for PEP if you are worried you have been exposed to HIV. OP did nothing wrong. Inform yourself before making such OTT statements.

Also the cost of a 1 month dose of antiretroviral meds (PEP) is far less than treating someone with HIV for life, which could be someone who read your 'advice' and didn't go to a+e to be assessed for PEP.

The statements you make about unprotected sex are none of your business and judgemental also imo.

Neyite

LLMMLL wrote: »

I'm not trying to be pedantic Neyite. I know quite a bit about PEP. You are just wrong on this factual matter.

The window is 72 hrs but far less effective 48-72. Then within 48 hrs the earlier you take it the more effective it is. The wait for a clinic to open could be the difference between becoming positive or staying negative.

All of that applies to the morning after pill in all the years I required it when it was prescription only. We still trotted off to our GP and hoped for the best because we would have been turned away empty handed with a telling off if we tried to clog up the A&E.

That aside, the doctor who saw the patient, referred them to the GUM. Because the OP was still in that 48 hrs window. The op themselves say it was "less than a day since unprotected sex." The OP had between 24 and 36 hrs to get to a clinic and still be within the 48hr window.

What you are saying is that everyone who has unprotected sex should present at A&E within 48hrs and get the drug, and that's not workable. I'll take you at your word that you know a lot about the drug so you know it's given to those who are knowingly exposed to HIV. The OP says they have no idea whether or not the partner they shagged had any STI. They also didn't state whether it was hetro or gay sex they had, we don't know if the OP was male or female. We don't know if it was a weekend or week night when they went to A&E. But the doctor who examined them knew all of those variables that determines exposure risks and made the medical diagnosis to refer the patient out of A&E, presumably because he knew that the OP had time in the morning to go to the GUM and take the medication.

lifeandtimes

Mr. Incognito wrote: »

https://www.hse.ie/eng/health/az/H/HIV-and-AIDS/What-are-the-treatment-options-.html



From the HSE Website. The do recommend going to A & E in fairness.

They say contact them, not arrive up unannounced

LLMMLL

Neyite wrote: »

All of that applies to the morning after pill in all the years I required it when it was prescription only. We still trotted off to our GP and hoped for the best because we would have been turned away empty handed with a telling off if we tried to clog up the A&E.

That aside, the doctor who saw the patient, referred them to the GUM. Because the OP was still in that 48 hrs window. The op themselves say it was "less than a day since unprotected sex." The OP had between 24 and 36 hrs to get to a clinic and still be within the 48hr window.

What you are saying is that everyone who has unprotected sex should present at A&E within 48hrs and get the drug, and that's not workable. I'll take you at your word that you know a lot about the drug so you know it's given to those who are knowingly exposed to HIV. The OP says they have no idea whether or not the partner they shagged had any STI. They also didn't state whether it was hetro or gay sex they had, we don't know if the OP was male or female. We don't know if it was a weekend or week night when they went to A&E. But the doctor who examined them knew all of those variables that determines exposure risks and made the medical diagnosis to refer the patient out of A&E, presumably because he knew that the OP had time in the morning to go to the GUM and take the medication.

It's possible the OP was assessed as not needing PEP in which case he/she wouldn't have got it at the clinic the next day.

However if the OP was assessed as needing PEP the doctor should not have referred him to wait until the clinic opened.

Il completely mystified as to how you don't get this. pEP is not 100% effective. Is more effective if you take it working 48 hrs. Even more if you take it within 24 even more if you take it within 12 etc.

Why do you think the STI clinics advise going to a and E at all? They don't say "only go on the weekends". The time frame matters hugely.

I don't have any opinion on why women couldn't get the emergency pill In a and E. That's nothing to do with what I'm saying.

The advice for gay men who have unprotected sex is to go to a and E if the clinic is closed. They may be refused PEP overall but they shouldn't be referred to a later time if they do actually qualify.

njs030

LLMMLL wrote: »

It's possible the OP was assessed as not needing PEP in which case he/she wouldn't have got it at the clinic the next day.

However if the OP was assessed as needing PEP the doctor should not have referred him to wait until the clinic opened.

Il completely mystified as to how you don't get this. pEP is not 100% effective. Is more effective if you take it working 48 hrs. Even more if you take it within 24 even more if you take it within 12 etc.

Why do you think the STI clinics advise going to a and E at all? They don't say "only go on the weekends". The time frame matters hugely.

I don't have any opinion on why women couldn't get the emergency pill In a and E. That's nothing to do with what I'm saying.

The advice for gay men who have unprotected sex is to go to a and E if the clinic is closed. They may be refused PEP overall but they shouldn't be referred to a later time if they do actually qualify.

Then op should have gone the first day instead of hanging around until the clinic closed and demanding to be seen ahead of actual emergencies.
You seem to be missing this point

LLMMLL

notjustsweet wrote: »

Then op should have gone the first day instead of hanging around until the clinic closed and demanding to be seen ahead of actual emergencies.
You seem to be missing this point

People do not always act in the objectively best way when in stressful circunstances.

Would you have any understanding for a closeted gay man attending a small regional hospital for this?

And how does it contribute to the OPs issue. Does everyone who acts imperfectly in a stressful medical situation deserve to be treated in a horrible manner by the medical staff?

And I'm sure if you had the risk of contracting HIV you'd think of it as an emergency. And the HSE does too. That's why PEP is available in a and E departments.

Neyite

LLMMLL wrote: »

The advice for gay men who have unprotected sex is to go to a and E if the clinic is closed. They may be refused PEP overall but they shouldn't be referred to a later time if they do actually qualify.

Where does the OP say they are a) male and b) gay?

They don't even state the sex of the person they had sex with.

All we know is that a person had sex with a person less than a day before the A&E encounter. That's literally all the facts we have.

In the end, despite a doctor diagnosing outpatient care, the OP got given the drugs in order to leave and stop creating a disturbance.

What would you say if that hospital had no stocks of PEP for the next patient, say, a Garda getting stabbed by a HIV+ needle or a gay guy who was unable to access healthcare for a genuine reason and was close to 48hrs since known exposure because someone with little or no risk factors stropped in order to get the meds they technically didn't need?

LLMMLL

Neyite wrote: »

Where does the OP say they are a) male and b) gay?

They don't even state the sex of the person they had sex with.

All we know is that a person had sex with a person less than a day before the A&E encounter. That's literally all the facts we have.

In the end, despite a doctor diagnosing outpatient care, the OP got given the drugs in order to leave and stop creating a disturbance.

What would you say if that hospital had no stocks of PEP for the next patient, say, a Garda getting stabbed by a HIV+ needle or a gay guy who was unable to access healthcare for a genuine reason and was close to 48hrs since known exposure because someone with little or no risk factors stropped in order to get the meds they technically didn't need?

It's absolutely possible the OP was in a category that does not qualify for PEP.

Bit your argument was based on it being ok to wait even if they did qualify which is what I was arguing against.

Either way the doctor behaved terribly

njs030

LLMMLL wrote: »

People do not always act in the objectively best way when in stressful circunstances.

Would you have any understanding for a closeted gay man attending a small regional hospital for this?

And how does it contribute to the OPs issue. Does everyone who acts imperfectly in a stressful medical situation deserve to be treated in a horrible manner by the medical staff?

And I'm sure if you had the risk of contracting HIV you'd think of it as an emergency. And the HSE does too. That's why PEP is available in a and E departments.

It's available for times when it's not possible to get to an sti clinic or for situations as described above like the gardai etc.
Not for someone who has spoken to a doctor and been told to attend a clinic the following day. The doctor knew the full story (which we don't) and made a medical decision that the op wasn't in a high risk category.

Again, no one knows the ops gender. Please stop making assumptions.

Neyite

LLMMLL wrote: »

It's absolutely possible the OP was in a category that does not qualify for PEP.

Bit your argument was based on it being ok to wait even if they did qualify which is what I was arguing against.

Either way the doctor behaved terribly

My argument was that only the doctor that examined the patient can determine the treatment based on the risk factors that were told to him and not to us.

We don't know that the doctor was negligent in this. If the OP feels that he was, then the best course of action is to write down a timeline (with specific timings) of events as detailed as possible while it's still fresh in their mind, and writing to the head of the A&E they attended to conduct a review of the doctor in question.

LegacyUser

50attemptaways wrote: »

TLDR; Went to get HIV drugs, GP told me they didn't have any, got angry and began shouting at me, lied, then suddenly had the HIV drugs.

The Doctor didn't lie, they told you shouldn't have gone to A&E for the medication as it wasn't an emergency and you had time to go to an STI clinic. Maybe they didn't act the best in the handling things but with a lot of these stories I find their version of events would paint them in the right light as you have done for yourself in your version and have you as much more demanding OP and if we line both stories up we'd get something like the reality. Unless there is information you are leaving out OP about the risk factor for exposure you shouldn't have gone to A&E. Is there a reason you think you had a higher risk of HIV exposure then any other STI OP?

There is a reason they have triage at A&E and if I find anyone at fault it's the intact nurse who should have told you of the better option to go to an STI clinic from the start rather than sit there for 6 hours. An STI clinic would have been a better choice as HIV is not the only risk factor from unprotected sex and they would have the time to run a full test screening and do follow up care while A&E does not have time for that.