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Too much seasonal good cheer can cause upsets!

Kathleen McGrath
RGN RSCN CTCert
Founding Nurse
Medical Advisory Service
For more information on MAS contact Debbie Smythe or June Reed on T:020 8995 850

The nurse-run charity Medical Advisory Service runs its telephone lines 24 hours a day over the Christmas holiday, often in conjunction with local television and radio initiatives.

The premise for the provision of the service is that medical information can more difficult to access over the holiday period as many of the population are away from home and not aware of current local services in the area to which they have travelled. This brief report outlines the approach for dealing with this nature of enquiry, using established telephone triage principles .

Gut instinct
Callers to the MAS helpline often seek advice for gastrointestinal (GI) symptoms, related in the main to seasonal overindulgence. Commonly, callers have eaten and drunk things that do not form part of their everyday diet. Some are looking for commonsense coping strategies, while others (our nurses suspect!) are looking for excuses to continue to overindulge!

In line with other helplines run by MAS, a protocol for best dealing with this nature of enquiry has been developed in collaboration with pharmacy, industry and professional guidelines. The aim is to provide a professional, proactive service, while also identifying those callers who should be encouraged to seek medical advice rather than self-treating or continuing to self- medicate.

Three major groups were identified:

  • The worried well (80%).
  • Callers with existing GI disease (15%).
  • Those with potential emergent problems (5%).

The worried well
The majority of callers in this category are those experiencing mild to moderate symptoms. Many are quite aware of the likely cause of these symptoms but want reassurance and advice on the use of commonly available products.

Nurses need to have an understanding of the basic physiology of the symptoms and their management. For example, in the case of uncomplicated heartburn and indigestion, appropriate use of well-known antacid and H(2) antagonists, frequency of use and commonsense dietary and lifestyle advice is offered.

Using such resources as OTC directories, our nurses are able to advise on tried and trusted bands that are available both with and without advice from pharmacists. It is our belief that knowledge and use of such products has decreased since the development of the more nuclear family, with less support and advice being readily available from older, experienced carers in the family unit. Throughout all communication, however, guidance on how and when to seek advice from other healthcare professionals (especially pharmacists) is key in encouraging a common sense approach to self- medication for GI conditions.

Callers with existing diagnosed GI disease
These chiefly comprise people with irritable bowel syndrome and inflammatory bowel disease for whom seasonal indulgence, change of lifestyle and travel may lead to an exacerbation of their existing condition.

IBS and IBD patients are frequent users of the MAS telephone helpline service because the number has been available to these groups of patients for several years, in conjunction with ongoing communication projects.

The other main category is those with existing ulcer disease. Usually well aware of how to manage their medication, these patients often ask for lifestyle advice - some need to be reassured about the acceptability of consulting with the doctor or specialist over the holiday season if they experience difficulties not managed by their current medication.

Those with potential emergent problems
Callers whose symptoms are indicative of a problem more serious than a seasonal GI upset are referred to relevant appropriate services (GP/GP deputising service, A&E department or pharmacy advice). MAS liaises closely with general practitioners and specialist GI and pharmacy advisors in order to provide appropriate and accurate advice. Among the reported symptoms/problems described in this category are:

  • New, unexplained symptoms.
  • Unexplained change of bowel habit lasting more than a few days.
  • Symptoms not relieved by OTC or usual prescription medicines.
  • Unexplained weight loss.
  • Vomiting/diarrhoea in adults that lasts more than a couple of days/is causing undue distress/ accompanied by other symptoms.
  • Vomiting accompanied by severe headache/ photosensitivity.
  • Rectal bleeding, blood in stools.
  • Unresolved pyrexia/fever.

Summary
In conclusion, the Nurse Managers at MAS are, for a set period of time, managing the perceived (and real) gastrointestinal problems caused by the holiday season. There is a natural reluctance on the part of many callers to "bother" the doctor at this time. On the other hand, many patients become anxious as services appear to close down or go on hold.

In addition, it is a period of time at which many of our callers travel to visit relatives or go on holiday. Away from their usual doctor, hospital or pharmacy, many feel stranded and anxious.

It will be interesting to see the effect of such government initiatives as NHS Direct on the level and nature of calls taken by MAS in all categories in which we offer assistance.

However, the trends may develop, and whatever other sources of information become available, it is interesting to note that currently a significantly high proportion of calls, in all categories, are referred by NHS Direct on a constant basis.