I am given to looking for the good and bad in our public services when I come face to face with them. The other day I accompanied Mrs W as she attended the NOC as an out patient. (I am withholding the name of the hospital since I am not directly giving them the chance to defend themselves so my one sided account needs to be seen in the context of being my recollection of events!)

No doubt the NOC does a huge amount of excellent work and that it has thousands of satisfied customers each and every year. What you are about to read concern areas for improvement, however.

I used two toilets during our visit and whilst the pans and sinks and floors in the toilets appeared to be clean, other surfaces were filthy and hardly in keeping with the standards of cleanliness and hygiene that one would expect of a hospital: relatively thick layers of dust are easy to find. I am tall so maybe I can see dirt where others can't!

The nurse that we saw for the first stage of the process was good and Mrs W liked her and was reassured by her without reservation. She was calm, friendly and thorough; she constantly checked back with us throughout the morning and made us feel welcome and at ease.

We then met a doctor who was ponderous if not slow, he spoke faltering English and he delivered a clinical blow that we were not ready for: out of the blue he announced that the procedure we had been led to expect up to that point might not be possible and than an alternative procedure might be called for. The Dr's pager beeped three or four times during his consultation and at one stage he left the room to make a telephone call. This doctor may be an acceptable clinician but the level of his non technical English was relatively poor and since Mrs W is a teacher of English as a foreign language, she felt far from at ease. Mrs W virtually went into shock at this stage.

We then met another Doctor and as his consultation began, there were four people in the room: the Dr, Mrs W, our nurse and myself. Unannounced another gentleman joined us: this gentleman remained with us throughout the consultation but neither spoke nor was he introduced to us at any stage. Another nurse poked her head through the door and asked our nurse for something: satisfied with the answer she received she left. The first doctor we met appeared but then left as his pager beeped and he went to make a telephone call: he reappeared again shortly but then disappeared again fairly quickly after that.

Mrs W immediately made it clear that she was seriously unsettled by the news we had received and Dr 2 said that the prognosis of Dr 1 was correct: a defensive stance we felt but that was to be expected. I then said it would have been preferable if we had been given some indication over the last year or so that there might be a possibility that the procedure we believe we had elected for could be unavailable. After all, I said, at two out of the three consultations Mrs W has had this year, including this one, her previous X ray films had not been available as they seem to have been lost: so the Drs we have seen have been unable to put together a picture of an almost certainly changing situation.

Dr 2 said that it wasn't necessary to have seen the previous films and that the prognosis is a standard one as Mrs W really is on the borderline and the final decision will be taken at the last possible moment and at the time that is most critical.

Although we were clearly upset since we had just received startling news, we kept cool and calm but were firm. No one shouted, no one ranted and no one threw anything! Dr 2 was calm and measured even though it was obvious that he doesn't seem to deal with directness every day of his life!

We then talked about the future and the possibility of a second procedure: we have always been led to believe that this would be necessary, too. Dr 2 said it might not be needed. Accepting that second opinions really can be different to first ones, we said that this was the first time that we had heard that piece of news too: we felt that the second procedure would follow the first almost as night follows day!

After a short discussion during which Dr 2 explained himself fairly well he then said that he really needed the previous X ray films to help him to see what has been happening. Shared glances revealed more than could have been said at this stage!

The X ray films under discussion disappeared between January and June of this year and to my layman's mind they are vital pieces of evidence. To the trained eye, they aren't always needed for everything but as Dr 2's final observation shows, they are needed for some things!

Nevertheless, by the end of the discussion with Dr 2 we had been reassured to a large extent and Mrs W signed the necessary consent forms.

Towards the end of the morning we were asked back into Dr 2's consultation room to meet Prof MS: it looks as if we had left an impression with Dr 2 and Prof MS felt he should meet us and reassure us. Although Prof MS started talking before we had even put our things down and had sat and settled down, he did what he had to do and we left after a couple of minutes or so!

I see here further evidence of the serious under training of medical practitioners in how they relate to their patients:

• delivering a potentially knockout blow … it might be X not Y … TWICE in one morning
• having people in a room who are milling around during a serious consultation
• having people in a room who are not introduced
• fully failing to acknowledge that lost X Ray Films are a cause for concern

Update: the procedure has been carried out now and the big news is that Dr 1's prognosis together with Dr 2's supportive defence, has been proven unfounded. Once the procedure had got under way it was found that this was a straighforward case and not at all borderline.

In post operative recovery the epidural tube that was providing much needed post operative pain relief was accidentally ripped out by the nursing staff as they moved Mrs W but this wasn't noticed for as many as 12 to 15 hours. I got a phone call later on from Mrs W to tell me she was in agony ... at that time she had no idea why and it wasn't until she'd been moved to her more permanent ward that the nursing staff there discovered the problem.

Mrs W saw Dr 2 on Wednesday, following the procedure on Tuesday. She saw Dr 1 on Thursday. Otherwise no other clinical inputs at the time of writing, Sunday morning 23 November. The surgeon has been away at a conference apparently.

Two months on from the op and Mrs W was ready for her review with the chief medic. A week before the consultation we got a letter to say that he was not available. We were given a new date, time and medic. This would have been medic number 6 in 6 months so Mrs W talked to the appointments clerk who was apologietic but helpful and friendly.

The chief medic's secretary, on the other hand, was abrupt, aggressive and not friendly. Mr X is away and won't be back until March. Mrs W asked to see him then, then: Mr X has already nominated the patients he wants to see in March and you're not on his list.

We did a web search for the newly nominated medic and found him. Seems OK but how can we tell?

Well, we arrived in time to find they'd changed the location of the surgery we were to attend: just a bit but still different. We then waited for almost an hour past the appointment time to be seen by ... a completely different medic: not even the named replacement but someone else. Of course, we hadn't seen him before either.

Needless to say this chap started his consultation by inspecting the X rays: no good morning, no hand shake and he didn't even tell us his name! Mrs W found out during the course of the interview that he was the person who had actually carried out her op! He was friendly enough and patient with us and told us that he'd be seeing the chief medic later that day and would be discussing Mrs W's case with him.

What is it that PM Tony Blair says: to see the medic you want at the time you want at the hospital of your choice? My @rse!

 

© Duncan Williamson
12 November 2003 revised 23 November 2003 and 26 January 2004