I didn't go to hospital (and I should have), what I have learned

I’m not entirely proud of this, but once, I was shearing, and while I was going up the neck (my total nemesis), I slipped, and (thankfully) the top of the handpiece hit my wrist. The wound was a decent size (bigger than an old 50 cent piece), on the soft part of my wrist. It looked a bit shredded. As you will know, it stung like blazes, so we washed it and I took some paracetamol.

My dad is excellent at first aid (he would have to be, IYKYK) and took me to the house (though we think he just wanted a cup of coffee (also IYKYK!). We cleaned it up properly, and decided it really needed stitches.

Here’s what we did...

Had a cup of coffee.

Was it a good idea? Not even close.

Did you know that you need to have your skin stitched or glued within 8 hours? Yes. I knew. But I still couldn't face the trip to town and the wait in emergency.

So – I know that we don’t always make good decisions (we are lucky it was actually just skin, that it healed (it’s a decent scar that still reacts to my watch) and didn’t get infected.

So – how do you make the decision? Especially when you don't really know.

On the whole most people ask me – “But what should I do with my injury?” Do I need to see a physio first?

With the massive GP shortage right now, it’s also hard to even see your GP to get a plan to know where to go to if you can get in to them. Your bone could have healed before you get to see them in some cases!

I’m also seeing people given information that’s not quite right for their injury which puts them far behind their rehab, or, just as badly, not seeing someone because it’s too hard to get in and the person hasn’t got time to hear them properly.

Firstly.

Just to be clear. If it’s obviously deformed – please go straight to A&E.

If you have back pain and your bladder and bowel control is compromised (if you are having accidents), go immediately to A & E. Don't wait. (Why are you still here?)

Secondly : If you can’t put weight on your leg for 5+ steps at any time (past that first panicked moment where the body is just in alarm mode), it’s time to get an x-ray (ankle or knee).

If the pain is excruciating and unmanageable, or (NOT and) you can't get in to your preferred provider within a reasonable time frame e.g. 2-3 days, then A&E or A&M are appropriate.

A note on pain:

If your pain is unmanaged and not allowing you to rest/ sleep/move -- go to A&E. It's a valid reason. If you are trying a cocktail of your own (or borrowed meds) to get your pain under control, that's also an excellent reason to go - leave medicines to the experts. Go to A&E for this one.

Imaging referrals in other situations

X-Rays and ultrasounds can be arranged by your GP or Physio with an appointment. This is for things like tendonopathy, sprains and tears and less often, bony changes. If it's the weekend - A&E for obvious deformities, and high pain, A&M if available if you are "not sure".

Ultrasounds are not recommended for assessing knee pathology, unless it's a tendonopathy near the surface (and these aren't urgent)

There are other reasons for an X-ray and Ultrasound, but these are not always as urgent.

ACC cover:

To get an injury covered for treatment by ACC in NZ, you can get a form completed by a physio, osteopath or chiropractor, or your GP (ED and A&M will do these too).

To get an “Off Work Certificate” so ACC will pay some of your wages, you need to see a GP, with a stand down period of 5 days before they pay you compensation.

Surgery needs to be approved after request by the surgeon.

MRI Scans:

With some specific injuries, your specially trained GP is able to refer you for an MRI. These include listed knee injuries (cruciate ligament, lateral collateral ligament and meniscus injuries), lumbar and cervical (low back and neck) injuries with pain into the leg, and some shoulder injuries.

If I see you and you fit the criteria, I can create a referral to the GP which includes my assessment, and states something to the effect of “this client fits the criteria for a GP MRI referral, do you agree?” This can be done online and in person.

A surgeon will also refer for scans if appropriate.

Specialist Referral:

If you need to be seen by a specialist, you can be referred by your GP or physio. You cannot refer yourself. ‘

ACC in NZ works as private insurance for approved injuries, so it's just as quick as your own private insurance

Fracture Clinics:

In Gisborne and Tauranga we are lucky enough to have private “Fracture Clinics” run by specialists. Clients need to be referred by a physio or GP. In other towns, some sports medicine physicians run urgent clinics on occasion.

In Gisborne I refer clients with significant injuries that have happened within the last 3 months, or where I need a second opinion on a recent injury. This is the same quality of service as seeing a specialist via regular referral, but the time frame is shorter due to the acute nature of the injury. It's an excellent system, and urgent injuries are being seen and treated incredibly well in the experience I'm having.

If you have a specialist referral, it is going to take you 3-9 months to be seen, depending on the specialist, the condition and referral. It is not possible to self-refer to a specialist. Your GP and physio can do this.

Other Options:

I also have a team of people I can send people to, including Sports Physicians and Specialist Physios, who can help unravel tricky diagnoses without always having the extremes wait times to see a specialist. They can often order imaging that I can’t, and have more specific knowledge in the areas than a general physio or GP.

When to see a GP:

A good time to see a GP for an injury is if you need medication prescribed for your pain or if you just want to see them. It's important to do this if your over the counter pain medication isn’t working, if your sleep is compromised or if the pain is shooting down your arm or leg and you cannot find respite. Taking pain relief that allows you to move better will generally improve your outcomes, as in most cases, moving as much as you can, without increasing pain levels more than 2 points is essential for recovery.

A GP is also excellent for general health issues and if you are unwell.

When to see a Physio:

If you have an injury or ache and pain that isn't changing and you need guidance on what to do next, or for rehab. Strength, mobility and pain management techniques are what I absolutely love. We focus on increasing function, understanding what's going on and pain management (among other things

I’ve created a series of workbooks that you can use to help you make decisions – when ED is definitely indicated (and whether it’s an ambulance or self drive), when you could just go to an accident and medical centre and when you can go to your GP or physio at your leisure. It’s here to help you make your decisions easier (though you should always use your discretion). Because sometimes we make decisions that are based on how difficult it is to get to ED, rather than “is it the best decision to stay home?”