Tag Archives: doctor

When an NHS relationship ends

Oh how sad it is when a relationship ends.  The pain of losing that one person who understands you more than anyone else.     No more chats as you lie in bed.  No-one around who you really trust as much as you trusted him.   Having to start a new relationship with someone else who might not prove to be as reliable, or thoughtful .

I have lost my consultant.   And I am grieving.

It sounds daft doesn’t it?  But for us NHS patients, having a long term  relationship with a doctor who we really trust makes a  difference.   I met my consultant  11 years ago.  I’d spent 2 or 3 years being passed around the NHS, short term dates with doctors who knew very little about my immune system problem and often couldn’t even remember my name.   I remember hearing his voice for the first time outside my  room, telling a cluster of junior doctors about my condition.   ‘This might actually be someone who can help’, I thought.

And he did.  I’d been warned to have no more children, but he said I could.   I’d been told there was nothing that could be done to stop the damage to my kidneys, but he said there was.  I’d been left with no hope but he gave me bundles of it.

Over the past decade, he has fought to get me the best,  and often very expensive,  treatment.  He has rushed me into hospital on a few occasions, insisted I got a bed on the right ward.   He’s overridden hospital procedure when it’s not in my best interests.   He’s been blunt with me about the future when I’ve been scared about new therapies. He’s given me his mobile for whenever  I needed to talk directly to him ( I’ve used it twice in 10 years).  He’s been the only person in a long line of medics who asked me how I felt emotionally after being put under sedation for five days in intensive care.  Without doubt he has saved my life on a couple of occasions, and without him my cheeky, lovely 9 year old son would not be here.

And now he’s gone.    And unlike most normal break-ups, I’m given no warning and no reasons.  I turn up to clinic a few times and he’s not there.  I ask and I am told that he’s taking leave, and then it’s extended leave, and then it’s ‘no we don’t think he’s coming back’.

It has to be this way of course.  Anyone is free to move jobs, retire, take a break.    You can’t have patients knowing about a doctor’s personal life.  It’s just not appropriate for anyone in the NHS to tell me why he’s no longer my doctor.  I completely understand and accept that.

But I am bereft.  And worried about him and his sudden departure.  I hope he is well.  I can’t even write him a note to thank him.  To point out to him the immeasurable effect he has had on our family.

Instead, somewhat wearily, I start the search for a new relationship.

Careless Words

I have an amazing friend.  After years of struggling with alcohol, she’s managed through a great deal of pain and endurance, and a little help from AA, to stay off the booze for 4 years.  She pointed this out to her GP recently.  His response? “Good .  Now you need to lose some weight.”

Another friend tells a tale of talking to a doctor about fibroids.  They discussed whether it could affect her fertility.  On finding out she was 35, the doctor said, “Well, what have you been waiting for? You need to get on with it.” She promptly burst into tears.

I can tell a couple of stories too.  The time a midwife gave me an injection just before I was due to have a D and C to remove my miscarried baby.  ‘Injection done.  That’s the worst over with.” Really?  The time a doctor berated me for putting on weight before realising I’d been on a large dose of steroids for six months.  The time a consultant who’d never met me before insisted I was facing the rest of my life on dialysis.  He was wrong.

Everyone can put their foot in it now and then.  I’ve dropped some right clangers in my time.  But I think working with patients requires an extra effort in choosing the words you use.

I have another story of a junior doctor, who came across me in tears after I’d received bad news.  “Fiona,” he said.  “This time will pass.”  He was right, and like the ill chosen words above,  those 4 words he uttered have stuck with me and helped me through the darkest of times.

Dear NHS staff.  Us patients are really vulnerable.  We’re often at one of the most difficult points in our lives.  Our conversations with you are about intensely personal subjects.   We’ve waited for hours for the doctors round on the ward.  Or months for the outpatient appointment.  You are the person who we think can cure us.  Or who we trust to care for us when we can’t care for ourselves.  We hang on your every word and analyse them after you’ve gone.

Careless words might not cost lives, but they can cost peace of mind.   And a loss of confidence in those who are treating us.   But well chosen words can bring hope too.  Remember that when you talk to us , and remember that your words will stay with us long, long after you’ve moved onto the next patient.

 

 

An NHS waiting List

Ok.  I have an NHS waiting list for you.  Oh.  Not that type.  That’s a completely different blog. I haven’t written it yet.  Too busy harassing my consultant’s secretary to find out when I’ll get the treatment I need.

No, I’m referring to that other type of waiting, which is just as prevalent in the NHS but doesn’t get talked about half as much.  The one in outpatients where we sit for hours on uncomfortable plastic chairs, waiting for our name to be called, staring at posters reminding us of all the ailments we may yet succumb to.

It seems to be accepted behaviour within the NHS that patients will have to wait for anything from 45 minutes to 3 hours at outpatient clinics.  A consultant at once said to me, “You know how most people bring a book to clinics?  At this clinic we suggest you bring a tent!”  Ho ho ho.

If a clinic has an average waiting time of over 90 mins, (which mine does), surely there is something wrong with the way it’s set up.   And yet no-one within the NHS seems to take responsibility for it.  Us patients don’t complain of course; we’re too desperate to see our doctors.  And most of us accept that in our stretched-to-bursting NHS, there are too many patients, waiting to see too few medics, getting squeezed into clinics that are full already.

What to do then? The obvious answer is just not to put as many patients in the clinics.  But I want everyone who needs to see their doctor to get an appointment.   And I’ve been squeezed myself into too many clinics that are already full to complain about that.  But I do have an NHS waiting list, designed if not to solve the problem, perhaps to make the process of being ill, a little less painful.

  1. Information is everything. If I know my clinic is overrunning by two hours, and the reason why e.g. my consultant has had to attend an emergency, then I can decide to come later, nip to the supermarket on the way in etc.  My mobile phone number is checked by the receptionist every time I go to clinic.  Why then does no-one ever phone me?
  2. At the very least tell me when I get there. Take a tip from the train companies who have now mostly learnt this lesson. At the moment the only way I can work out how long I’ve got to wait is by eyeing up the pile of medical notes and the people around me.  Massive pile of files and 20 people scrunched up on the flip-down chairs with their legs being tripped over in the corridor equals a long time to wait.  Small pile and just a couple of people not looking too fed up, equals  I might be seen within the hour.   A more scientific means would better so I can choose to go and get a coffee or at least text my lunch meeting to tell them I’m going to be late.
  3. Barring emergencies, insist every clinic, yes every clinic, starts on time. It’s a tad frustrating to fight through rush hour traffic to get in for 0830, only to see your consultant arrive at 0915 and start making coffee for every member of staff there.   First patient is seen at 0930, an hour after they were told to arrive.   I love the fact my consultant is the human type  who would make coffee for everyone,  but frankly his brain is so huge it should be used for curing patients rather than checking who wants milk.   Get someone else to make the coffee.
  4. Treat us as human beings and make it as comfortable as possible for us to wait.  I’m not suggesting sofas and smart TVs but an apology,  updates on our place in the queue and some comfortable chairs for the elderly and infirm wouldn’t go amiss.
  5. So we wait 90 minutes to see the consultant, and then another 30 to get our blood taken. Guess what?  We’ve gone over two hours in the car park.  So not only have we spent all morning sat on plastic chairs with no one telling us how long we’ll be there, but the hospital trust is actually going to charge us an extra couple of quid in parking for the privilege.   There’s an easy solution to stop us muttering as we head to our cars.  Put in the sort of system that shopping centres have where you can get your car park charge reduced by getting it stamped by reception.  Job done.

A final thought.   If we’re not careful, we patients can head down into a spiral of self-pity.  The ‘why me’ thoughts.  Most of the time we try to forget our illnesses, make them fit around our lives rather than fitting our lives around our illness.  But an outpatient appointment is a stark reminder that all is not well and a long wait can lead to thoughts we’d rather not contemplate.  Keeping us cheerful as we squirm on the plastic seats might just help.

 

Dr Who (or the Physician Associate)

One of the things I’ve always found confusing in hospital is trying to work out who’s who. Is the person taking my blood pressure a nurse? If he or she is the same person who makes my bed, then possibly not. Is the person making decisions on my care a consultant with many years experience or a registrar who has only just stopped being a student, possibly more knowledgeable about Minecraft than medication?

Well now the government plans to confuse us patients even more with what they are calling ‘ a new class of medic’.  The Physician Associate.  A sort of Doctor’s Assistant if you like,  with fewer time travelling duties than Sarah Jane ,Rose or Clara, but with the responsibility of examining us, deciding on our treatment and admitting and discharging us from hospital.  Sitting somewhere in the hierarchy between nurses and doctors, the Physician Associate will be a science graduate with two years intensive training. They won’t be able to prescribe drugs.

Inevitably my initial reaction to this, along with most of the other patient groups, is one akin to Clara when she sees her doctor change from a youthful Matt Smith to a grizzly Peter Capaldi.  I want a real doctor please.  With seven years training, a stethoscope and notches in his or her belt of complicated cases.  And while you’re on my case, NHS, can I also have a proper nurse to take my blood pressure, an eagle-eyed cleaner with obsessive qualities, and a Michelin starred chef to make my toast?

Ah. My Utopian NHS. We all know the NHS hasn’t got enough money and unless we fancy paying a load more taxes, that isn’t going to change. It doesn’t mean we shouldn’t all be entitled to see a doctor when we need to of course. Mark Porter, chairman of the British Medical council,  is right when he says these posts cannot replace doctors. They can ease the burden though, so that when we do need to see one, they are able to give us their full attention for more than a couple of minutes.

But it is absolutely vital that we patients are completely clear about exactly WHO is standing at the end of our bed, something which is a tad hit and miss at present. Then, if we’re not happy with the level of experience of our Physician Associate,  we can ask to see a real doctor.

So NHS, here’s what I propose. For a start make everyone wear a name badge with their rank on it. No, I mean really make them. It seems to me it’s a rule followed by some nurses and healthcare workers but not all, and virtually no doctors. Make it a disciplinary issue if they don’t. Us patients need to know who they are.
Then in every ward put up a notice explaining the different levels of experience that different staff have. That’s right – there’s plenty of space between the Clean your Hands posters and the leaflet telling us your survey showed everyone was happy with the food. And when you do it bear in mind barely anyone outside the Health service knows what a registrar or a house officer is. And don’t kid yourself in thinking that we can tell who someone is by what they wear. Thats a sort of NHS secret code that us patients generally can’t decipher. Frankly a white coat can mean the person is a doctor, a pharmacist, a dietician, a physio, a student nurse, an agency nurse or that science kid from Cloudy with a Chance of Meatballs. How are we supposed to know?

So by all means bring in your Doctor’s Assistant. The physician associate might be able to get on with some of the routine stuff leaving my doc to scratch her head over complicated issues. Just make sure I know who I’m dealing with. More Dr Know please. Less Dr Who.

 

Gods (or hospital consultants)

What you have to realise as a patient is that however important you are outside hospital, however many lackeys jump to your call, inside hospital you are merely the patient in Bed 10. You are no more important than the patient in Bed  11. Or 12.  Yes you’re the reason the whole place exists …but  the man or woman who calls the shots, for whom everything stops on the ward, is the consultant.

Not surprising then that some of them have God-complexes.  The worst one I ever had  used to stride into the ward with his team of junior doctors, medical students and the ward sister scurrying after him.  He’d barely look at me…and would call me Mrs Brown throughout,  much to the consternation of everyone else around him.   But contrary to popular belief,  my experience is those types are few and far between and actually it’s us, the patients who have a tendency  to put consultants up on a pedestal.  The highlight of our hospital day is when they appear at our bedside. We listen intently to their every word, desperately trying to remember what they’ve said so we can repeat it at visiting time.  We assume they are all-knowing and all-powerful in their ability to heal.   Sadly that’s not always the case.

It must be quite hard not to develop a God-complex if you’re a consultant.  They live in a world where the patients are desperate for a word of wisdom from their lips, and in a hospital hierarchy which places them firmly at the top.   They are always surrounded by at least two or three  minions to take notes, hold the stethoscope, or pass them a pen.  They test their minions all the time too.  What does this C4 complement result mean Junior Doctor?  What’s your diagnosis Lowly Medical Student?  Watching from the bed as the Gods torment their minions can be most entertaining …… or agonizing.    And of course consultants have the ultimate God characteristic.  Their decisions can decide if someone lives or dies.   What power ……and responsibility.

In reality even they can’t perform miracles.   Sometimes the superheroes just don’t know why your body is functioning so poorly or what to do to make it better.  The realisation as a patient that your doctor doesn’t know everything, that he or she is actually human, can be pretty depressing.

I now have a  consultant who having decided in an outpatient appointment that I needed to be admitted straight into hospital, zoomed across town on his motorbike to get my medical records from one hospital to another.   As he strode into Accident and Emergency in his leathers with his helmet and my notes under his arm, in my head I gave him superhero status, right up there on a pedestal  where he’s pretty much stayed  ever since.  It helps that he’s super brainy and has saved my life on a fair few occasions.  He also always remembers the names of my kids, and was the only person in a long stream of doctors to ask me how I felt emotionally after five days under sedation.   I used to think I was special, that my complex medical needs (or alternatively my witty personality), was why he remembered me but over the years  I’ve eventually worked out he’s like that with all his patients.  Somehow in that God-like way, he makes us all feel special.

So hospital consultants, if you are reading this, it’s simple.  The best consultants keep their God- like tendencies (and egos) firmly in check, just bringing them out to dazzle us when we really need their  healing powers.  And us patients hang on your every word.  We live for that 3 minutes every other day, or once a week, that we might see you.  We all like to think that we are your most important/medically interesting/favourite patient – so please be nice to us and if nothing else, make an effort to at least remember our name.

A single room in hospital

 

Okay, let me first of all put you straight on a notion that I was once stupid enough to hold.   You might think that being allocated a single room in hospital,  i.e. a room to yourself, is good news.  In most cases, it’s really not.

I remember  being wheeled on a stretcher to my first single room.  ‘Never mind love.  At least you’ve got a single’ said a kindly porter.  Oh yes, I thought, how lucky.  Privacy.  No snorers. No other patient listening in on my so-called private conversations with my consultant.  All true.  All good.  But completely offset by the following.   Unless you are very,  very lucky, there are generally only two reasons why you might be given a single room in the NHS today.

1) You are deemed to be officially just too irritating for other patients to bear.   You can of course take advantage of this premise.  Find yourself in a mixed ward with a snorer on one side and an incessant talker on the other, then by all means have a go ….pretend you’re a nutter for a couple of days and you might just get moved (or sectioned).  But singing Kylie on a loop for 48 hours or taking off all your clothes every time a nurse comes in, can be a bit debillitating in itself.  And the staff aren’t daft.    Anyway watch out for the other patients if you decide to take this path.  We’re an unforgiving lot what with our confined space and bad food.  I once found myself in a single room opposite another single room whose occupant  had such issues.    At first I was sympathetic  to his shouts of Help every 3 seconds.  When it continued remorselessly for 24 hours, I was less sympathetic  and raging at the system that had put someone with drastic mental health issues in a room next to me.  When ‘Help’ turned into racist taunts of the staff, smearing his excrement on the food trolley, and throwing furniture into my room once a day, I lost all sympathy and am ashamed to admit I spent the days that followed planning a detailed operation to pass on my superbug by spitting into his water jug.  (Didn’t actually carry that one out).

2)  Single room in hospital equals superbug.  Most commonly MRSA or C Difficile (which I had).   OK so you might be vomiting for England but hey, at least you can do it in peace.  And you get to amuse yourself by watching the various means the staff come in and out of your room.  First we have what I call the Stormtrooper approach.    Masked, hooded, gloved – is there a nurse in there?   You watch the major dressing up operation just outside your door and wonder if you’ve actually got leprosy rather than a vomiting bug.    Then we have the Indiana Jones types.  Minimum apparel, a quick push on the handgel, and then before you have chance to say MRSA, somehow Indy has got across the room, retrieved your full bed pan and got it outside with barely any surfaces touched and  nothing more than a whipcrack of the plastic gloves.    And then sadly we still very occasionally get the parliamentary candidate approach.  Press the flesh as much as possible without thinking of the consequences and then sally forth into the next ward, without so much of a glance at the handgel, to press yet more flesh.   In my years in the NHS I thankfully see fewer of these types but they’re not extinct quite yet.

I’ve always felt quite isolated and vulnerable in a single room.  The reason you’re in hospital in the first place is because you’re pretty poorly and you need some attention.   In a single room, unless you’re in intensive care,  you will spend large swathes of the day alone, trying not to be a needy type and pressing the call bell too much.     If you’re on a ward with other people at least you can grab a nurse as she walks past, have a bit of conversation with the other beds, listen in to everyone else’s ward round consultation.    And the staff glance at you when they walk past, a quick check to make sure you’re ok.  I once spent three weeks in a single room.  I’d got into the habit at night of shutting the door so I could ignore my mad neighbour and sleep. Then they let me home for a night during which I had several seizures, fell out of bed and had to be blue lighted back to hospital.  My husband was there in the room with me.   Had I been on the ward in my single room, I’m not sure anyone would have found me until the next morning.

So when you’re sat on your bed, desperate for some privacy,  irritated by the woman in the next door bed,  fed up of sharing a loo …just be careful what you wish for.   A single room in hospital isn’t always worth a supplement.