Photographer:Fotograaf: Loraine Bodewes/: A young man with diabetes wants to know if his blood glucose level is OK
Triage assistant GP Urgent Care Centre Maastricht & Heuvelland
Luc van Galen/ 23/ fourth-year student of Medicine/ works about eight hours per week/ earning 11.35 euros per hour excluding evening and weekend surcharges
“So your wife is in bed, in a lot of pain? And the pain started a few hours ago in her lower left abdomen?” Medical student Luc van Galen, wearing a headset with a microphone, takes notes on a computer. It’s Wednesday evening, half past seven.
At the recently renovated GP Urgent Care Centre (HAP) inside the hospital in Maastricht, van Galen and a number of female colleagues take turns manning the desk, the treatment room and the call centre. They’re triage assistants, the first point of contact at the HAP who assess the nature and level of urgency of symptoms.
The HAP is an urgent care centre, stresses van Galen, which people can only use in the evenings, at night and at weekends for cases of emergency that are so pressing they can’t wait until the patient’s own GP is available again. This is especially confusing to international students who are used to different healthcare systems. They drop in – often without calling ahead, which is rather inconvenient – thinking they’ll immediately receive care. But that isn’t how it works. So: always make sure you’re registered with a GP, Van Galen repeatedly tells us.
Van Galen enters the answers provided by the man on the other end of the line into his computer system. A 2 (on a scale of 1 to 5) appears on the screen, which means the situation is quite urgent. “Your wife isn’t pregnant? And she hasn’t been diagnosed with an enlarged abdominal aorta?” Then, Van Galen says: “Please stay on the line while I consult the GP.”
He turns to the GP on duty. “The patient personally thinks it may be diverticulitis, which she regularly suffers from. She wants antibiotics again, as they were very helpful during previous episodes. But I’ve already said we aren’t allowed to prescribe antibiotics without you having seen her. They’re being very difficult and don’t want to come in.”
Diverticulitis? “An inflamed pouch in the colon,” explains Van Galen. “This is a complex case”, he says. “The person in pain is refusing to come in to the HAP.” The GP: “Well, we’ll have to go there, then. Schedule me in for a car drive.”
Van Galen began his evening in the treatment room, where assistants care for wounds, test urine for infections, take blood and record ECGs. He then took over from his colleague at the desk, who went to have a bowl of soup. “At other GP Urgent Care Centres, medical students only work in the call centre. It’s a huge advantage of Maastricht that we get to do so many things.”
Van Galen has been working here since June. “People with a bachelor’s degree in Medicine can apply. Six other students started when I did. One quit because the work was too much to balance with his clinical rotations.” Van Galen is familiar with this problem: he’s currently on clinical placement in the Paediatrics department. “That’s why I prefer to work Sunday afternoons and evenings.” Including weekend surcharges, he earns about 17 euros per hour – quite a comfortable salary, from a student’s perspective.
The most important and most difficult task of a triage assistant is assessing symptoms. “We always ask to speak to the patients themselves; you can quickly tell whether someone is genuinely in pain. Apart from that, we have to go by what we’re told.”
As one of the GPs is on her way to the suspected case of diverticulitis, Van Galen takes a few more calls. Patient one is having chest pain. To the Observant journalist: “I’m asking him to come in straight away, I can hear him gasping for breath.” Patient two is a fifteen-year-old boy who’s been walking around with a deep wound in his lower leg for hours. He’d got stuck trying to climb over a fence. “His father says there’s something sticking out of the wound.” Patient three: “My dog hit my shin with his paw, it hurts a lot.” All three end up in the waiting room this same evening.
The diverticulitis story isn’t over yet. The husband is calling again. Van Galen, after he hung up the phone: “I’ve never had this happen before! The patient flat out refuses to be seen by the doctor at home.” The GP turns back, but not before calling the patient and urging her to come in to the HAP. It’s almost ten p.m. by the time she takes a seat in the waiting room.