The doctors were kind to me. They did the right tests, I assume. They explained things as best they could. They told me what would happen. And they seemed to provide effective treatment.
The phlebotomists, healthcare assistants and nurses were great. I saw moments of love and courage on the ward that will stay with me (amongst patients and carers too, of course).
The ward environment was hard to take – the smells, light and noise in particular. The lack of privacy found me at one stage unwittingly eavesdropping on conversations I had no right (or inclination) to hear – the breaking of awful news, the ‘mobilisation’ of a man in agonising pain, the indignities of humans in naff pyjamas almost making the toilet.
All this is common place. All the surveys in the world show this sort of stuff.
But here is where the light does not shine.
On my first day of admission to hospital, I had a CT scan. It showed something “weird” and they said they would provide ‘conservative management’ (with a small ‘c’ thank god). It was either a ‘diverticular abscess’ or “something more serious”. It was not a great moment in my life. They put me on enough fluids to flood a city and took my temperature down with intravenous antibiotics. I asked them what food I should eat. They said ‘soft’. That was the extent of the dietary advice I had while in hospital. My menu options were chick pea curry, chilli con carne or white fish. I went to Costa and had yoghurts most nights. For all I know, I could have been making my condition worse.
I got used to assuming that I had the gut abscess and seeing my temperature decrease and my energy return a little. On the third morning a different consultant on the ward round hesitated at the computer screen on his wheeled trolley and scanned the scan. From the way he was looking, I assumed it must have been the first time he had seen it. He felt my belly and announced that I might need a ‘biopsy’. I have no idea whether he read my notes. I was back to black. All week (and a bit still) I yo-yo’d between optimism and catastrophising.
Meanwhile, back on the ward: In the next bed, was a young Albanian man who had broken his ankles while jumping off a falling ladder. He spoke no English. During the morning ward handover, while the nurses were otherwise occupied, an anaesthetist strode into the ward. He paused at the lad’s bed and spoke LOUDLY and s-l-o-o-o-w-l-y to him: “You have to have an operation now. Please sign this form”. The lead nurse appeared and pulled him angrily from the ward. He came back later, and with the help of google translate, ‘consented’ (is this now a word?) him to surgery. He seemed in a rush. The clinic was ready, and things had to happen now.
After I got out of the hospital I went for a second scan. This was to see whether the ‘mass’ had reduced and to see if it was an abscess or a tumour (or again try to). The results were due on Friday 9th August. I rang on Tuesday 13th. The secretary said the consultant was on holiday. She apologised and said she would “write an email to the managers” and find another doctor who could do the report. I told her that I needed results before I re-booked a holiday and tackled the insurance company for cover. I rang again last Friday and was told today another doctor would be in touch by the end of this week. I will be away – damn it, I thought, I am going anyway – when the original doc gets back.
Join The Dots
Or join the docs.
The examples above are simple. And not easy to solve I guess. It’s about ‘joining the docs’ – to each other, to nurses, to wards, to interpreters, to dieticians, to medical secretaries. And making sure that the information goes along those dotted lines to make them complete lines of communication. Both ways. And with patients and carers.
My issue is co-ordination. Consistency. Call it ‘integration’ if you want (though the posh wonks and policy big boys have pinched that one for their highfalutin strategic plans that will not solve much IMO). Maybe we could get these simple things right before we try to be too grandiose.
Of course it is not just docs. What about the gaps between health and social care; one ward and another; one hospital and another; commissioner and provider, etc?
One theme that runs throughout my forthcoming book ‘The Patient Revolution’, in terms of the gripes patients have, is co-ordination and consistency.
In the book, we argue that these sorts of issues will only be rectified when patients have true power as equal partners in decision-making. We have skin in the game – nobody else in a healthcare organisation has the real nous and keen focus on the ‘gaps’ in care to do it. We could ‘bang heads together’, or in less confrontational language could help be the glue. After all, we all want to be ‘patient-centred’ don’t we? Shouldn’t that be the vision for any partnership?
Without patients in the room – and, more importantly with a seat at the leadership tables - pathways may be redesigned, but they will remain disjointed, cracked and crooked.
Isn’t it time we all joined together in order to join it all together?
‘The Patient Revolution - how we can heal the healthcare system’ by David Gilbert is published by Jessica Kingsley Publishers. It is available on the 19th September and is available for pre-order now. https://www.amazon.co.uk/Patient-Revolution-Heal-Healthcare-System/dp/1785925385
© 2019 David Gilbert