‘Oh … he is next to me. Having a cup of tea. Sorry, I errrr … forgot,’ she responded.
I picked up the phone ready for an argument. I had all my lines prepared. I had real ‘inappropriate attendee’ rage (a bit similar to road rage, but with fewer horns). I thought the best line I had prepared was ‘And what medical school did your receptionist go to?’ I was ready to go. Start off calm and then let the battle commence …
He was brilliant. He had obviously been on a ‘verbal judo/how to calm down irritated twats course’, because he was magnificent.
‘I am very sorry, Dr Edwards – I will look into it and retrain my staff as necessary. If you have any further problems, put them in writing. I would be most happy to meet you and discuss this issue face to face, etc., etc.’ I wanted a bloody argument not an apology. I wanted to be able to moan and rant, but I ended up singing the GP’s diplomatic skills. Maybe the reason he is so good, though, is because he gets so many complaints about his receptionists …
A set of seven nights and on night six I at last felt that I had done some genuine good and I remembered why I love going to work. At 1.30 a.m. a lady in her 70s came in peri-arrest (about to die). She had a blood pressure of only 60/30 and was becoming unconscious. We took her into Resus and while the nurses put in a cannula and gave her oxygen and fluids, I examined her and spoke to her husband. It was obvious that she had perforated her bowel and that she was losing fluid into her abdominal cavity.
Within half an hour, we had given her 3 litres of fluid and she was starting to perk up. However, she needed definitive treatment – a laparotomy (a major operation which would remove the damaged part of bowel and clear out the faeces that had leaked into her abdomen). I called the surgeons and anaesthetists and within half an hour she was in theatre. Two hours later, the perforated part of the bowel was removed and she was in the ICU. I phoned up the next day and she is doing so much better. A very good outcome as all of the A&E team worked very well with the surgeons and anaesthetist. Thanks to all of us, everything went perfectly and we saved her life – you would be surprised how rarely we actually get to say that. All in all, it was a very satisfying night.
This is how it feels like the NHS has been run the last few years
Gordon Brown pours money in. The senior nurses on the shop floor sensibly think we need more A&E nurses and so more are appointed. Then interfering politicians are concerned that the new nurses may not be very efficient and they are not getting value for money, so the managers appoint a ‘staff efficiency evaluator’ and a ‘patient pathway flow monitor’.
This ‘staff efficiency evaluator’ and the ‘patient pathway flow monitor’ (separate jobs, mind) also need supervision and secretarial support, so a senior supervisor is appointed and a personal assistant. More money comes in from Gordon and so, to satisfy the finance departments, quarterly figures need to be produced on how efficient the new staff are, and how many ‘direct patient contact’ episodes are occurring. A business manager is appointed to the staff efficiency evaluation team for this purpose. So that the local hospital journal knows about how wonderfully efficient the new nurses are and how patient contact episodes are exceeding expectations (i.e. they have been told to document whenever they say ‘hello’ to someone) a marketing manager is appointed to the staff efficiency team. In truth, their job is to write a small article every two months for the pointless glossy-paged magazine that the hospital wastes its money on.
New concerns about the new nurses are brought up. Are they helping patients make choices to deliver a patient-centred care pathway? A patient-centred care pathway manager is appointed to the staff efficiency team. The election is over and the trust realises it has overspent vast amounts of money and now Gordon is not so friendly.
A ‘turn-around’ team are appointed at great expense. But they are geniuses and worth every penny of their grand a day. They show the light that no senior nurse or consultant could ever have seen. The answer is lying before our eyes … the nurses are not efficient enough, are not performing enough patient contact episodes and have lost focus on patient-centred care. An efficiency report is needed.
The report is produced – indeed, it is the workers’ fault. The answer is patient-centred streamlined efficiency. This actually means they make the nurses redundant … but, remember, we couldn’t possibly lay off the staff efficiency team as we will need to report to the finance team on how good our ‘staff reorganisation initiatives’ have been. We can’t sack the marketing manager from the staff efficiency team as we need to tell people about staff reorganisation with a positive spin. The remaining nurses still need guidance and so the patient-centred care supervising manager needs their job protected. The business manager not only keeps their job, but needs a pay rise for doing extra work – handing out redundancy notices to the nurses.
And this is how I would like the NHS to be managed
The Prime Minister says here is some money. New A&E nurses are employed. A senior nurse is appointed to monitor their progress and education. Patient care is improved and everybody is happy. No interference occurs from politicians. There are no massive overspends so brakes do not need to be applied (obviously only after an election). So, in summary, we can keep our nurses and let them do the job they were trained to do in the way they see fit. Oh! How I dream.
How does a government that has put so much money into the NHS (and it has), given pay rises and improved many services, still manage at the same time to piss off just about everyone that works in the NHS. It is an amazing skill. What it has done wrong is interfere so very badly in the micro-management of the NHS, arrange ridiculous targets aimed at winning elections and not long-term improvement in patient care, and disengage clinicians from involvement in management. Then there is the problem of pointless involvement of the private sector making profit out of the NHS …
What also pisses me off is when the Tories have their ‘NHYes’ campaign and say that they are the saviours of the NHS. Remember, they very nearly completely buggered it up. Don’t forget the perilous state they left it in 1997.
What it seems to me is that neither party can be trusted to run the NHS. The NHS needs policies designed to look after health now and in the long term. It should not be used as a political football with short-term plans introduced for when general elections are due. We need the politics taken out of the NHS. Make it a semi-autonomous organisation, where management input comes from frontline medical/nursing trained staff and not management accountants (I am not so sure what they actually do). It needs to be run along the lines of the BBC – with guaranteed funding and an independent management board. Whichever party promises that, then they will get my vote.
P.S. Just had to let all the anger out – I just read in the local paper that my hospital was about to make lots of nurses redundant and I got upset.
Examining females is always difficult for a male doctor. I always take a nurse with me as a chaperone – it makes it easier for the patient and less stressful for me.
About a year ago, an attractive 21-year-old teaching assistant was rushed into the resuscitation department. She was having breathing problems and her heart was running very fast. I examined her and could hear a heart murmur. This was very unusual for a young patient. I asked her if she could take off her top so I could examine her in more detail.
I put my hand at the apex of the heart –