Wednesday, December 02, 2009

Is there a doctor in the house?

I am a big fan of the NHS. My mother was in the first post NHS nursing set at the London Hospital in 1948. Two of my sisters have worked as nurses, a bil works in NHS management and my husband is an NHS employee.

As a family this year we have had huge cause to be grateful to the NHS. Not only did I have my little A&E encounter in the summer, but I've also had checkups both for heart disease and breast cancer (both thankfully ok). On top of that no 4 has had several hospital visits, including an ultrasound, an MRI and a bone scan to check out a strange lump on her foot (nothing serious either, phew). And if that weren't enough we've had mil in casualty after her fall two months ago, and then back again a month ago when she couldn't get up one day.

From the fall it was established that mil has a blood disorder common in the elderly which means she isn't producing enough red blood cells. Our GP got her into hospital and suggested she needed a blood transfusion. It transpired that she didn't, but she has remained in hospital ever since because her mobility is variable and her blood count is still low.

The first week she was there, she was very poorly, and we feared the worst. She spent two days being assessed in a Clinical Assessment Unit, where no one seemed to know anything, and despite bil and sil's best efforts, we had only fleeting contact with doctors. Then she was moved to a surgical ward because there was no room on the medical one. There, the flow of nurses was constant, there seemed to be no consistency of care, and we all felt we were banging our heads against a brick wall, when we repeated constantly that she suffers from a benign essential tremor and her medication had been altered, that she probably had an infection because she was confused, that it was likely she would just nod and say she was fine when she wasn't. And still we found ourselves unable to get any sense out of a doctor as to what was actually wrong with her.

Eventually she moved into the medical ward, which was much better, as it had just been done up. But there you feel a slight despair about the money that gets wasted in the NHS. As she arrived on the ward, there were engineers putting the finishing touches to a new state of the art, TV/Radio and phone system - so state of the art it's being trialled first in our hospital. The room mil was on was full of the elderly and infirm. Not a single one of whom was going to get any use or show any interest in this new system. I'd rather the money was spent on better communication with the medical profession frankly.

The only person I spoke to who seemed to have a clear understanding of mil's problems, and who also took on board our concerns that her level of confusion had worsened since her stay in hospital, and was different from the confusion caused by her infections, was a wonderful young OT girl. She wrote everything down I said, but whether anyone else took notice I don't know, because it seemed everytime we spoke to a nurse they had to consult the notes, or didn't know anything about mil.

On two occasions bil was told that the consultant would be in in the morning, only for him to turn up and no consultant would arrive. Eventually, after three weeks, though we did manage to see him. He was very nice. He was very informed. He knew what the problem was, but hadn't a clue that she was confused or that had got worse. But why, did it take us so long to get hold of him? The system caters always to the patient, asking the patient what their needs are, which is obviously a good thing. But anyone who's ever spent time in hospital will know, that even if you are relatively young and compos mentis, you will be hard pressed to remember what a doctor has said to you. For an elderly confused individual it must be impossible, and it's abysmal that no one thinks to consult the relatives more. What frustrated me the most is that, having spent the best part of this year being fully conversant with mil's problems, I know what medication she is on, I can give an accurate case history of what has happened to her, and I know (as we all do) that her condition is worse then when she came into hospital. There should be a better way of using people like me as a resource.

The care mil received was perfectly fine, but the ward she's been on was a busy one and not suitable for an elderly lady who needs a lot of help to get back on her feet. So fortunately last week, she was transferred to a local community hospital, where the pace is slower, the nurses ensure she is up and dressed every morning, she's getting physio every day, and she is much calmer and more content. And praise be the lord, the first day she arrived, the sister in charge of the ward actually asked me what had happened to her, and then said the magic words, what outcome do you as a family want? Better late then never, I suppose, but it shouldn't have taken three weeks.

As always in these situations, I can't help thinking about those poor sods who don't have irritating rels like me to fight on their behalf, or the elderly and infirm who don't know how to stand up for themselves. There must be so many of those kind of people who get lost in the system. I saw an elderly man discharged from CAU, who had had a fall. He could barely walk and was clearly in a lot of pain. It didn't seem right that he was being sent home. Neither did it seem correct that another lady who I assume was suffering from cancer, and who also was clearly in great pain, was being sent home to her daughter with whom she lived. The daughter said to me in despair, do you think she looks well enough to go home? It was quite clear she wasn't.

We have a lot to be grateful for in the NHS. It is there for us in emergencies. It is free and the majority of those working in it are dedicated and caring professionals. But there is too often a huge waste of resources, and communication could be hugely improved. I know people are busy and they have a job to do, but it is all too easy to lose sight of the person, and focus on tasks that need doing, particularly when dealing with the elderly. We are lucky that mil has ended up somewhere where she can be properly looked after, particularly as swingeing cuts mean that the number of beds available in community hospitals are being severely reduced, but it shouldn't have been so hard to get her there or fight for information. The patient is entitled to be told the truth about their condition, but when they are not in a state to make informed choices, families need to know to. Because after all, we can help.


Lisa Rullsenberg said...

I all too well recognise your situation regarding communication; it isn't about EXCLUDING the patient from the conversations, but about recognising there are other conversations to be had. Confidentiality about what is going on with a patient can be awfully erractically shared (sometimes only the patient is told, sometimes only the family) and relatives can end up feeling utterly bewildered: so imagining how the elderly patient may feel shouldn't be too much of a leap to medical staff to respond to. But sadly it is.

I think it is very important that you qualify your position re: the NHS. That it IS wonderful, and there are good people in it. But systems can be poorly implemented; priorities skewed (the expensive TV/phone system is a classic); and staff are often too pressed to take the time to work WITH patients and families.

The solution? More effective USE of resources, including thinking about the implications of certain projects and strategies which put technology in or place more bodies in locations but don't think about communication implications and effective hand-overs. There are not enough beds in the right locations, and despite all the theory about applying assessments for activities of daily living (Roper Logan and Tierney - yes I have read a lot of nursing essays) too many patients seem to be fed through the system and back into poorly funded social care in the community -- or even worse, placing strain on family/friend carers. Nodding and saying "I'm fine" is a classic trait in those don't understand what they're asked/don't want to understand/don't want to be a burden.

Thinking of you much xxx

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Sarah Duncan said...

It's an imperfect system in an imperfect world. Your situation sounds horrendous, but what's the answer - that they give a full run down of your mils condition to every relative who turns up? If it's a big family, then what? Or stick notes for all and sundry to read?

My lovely father was in hospital earlier this year and his stay was made miserable by the conduct of two other patients on his ward demanding this that and the other - I know my rights was frequently heard echoing around the ward, when abuse wasn't being hurtled at the staff.

I'd have happily shot them, but the staff coped with admirable patience and tolerance. We got my father home as soon as we could and the NHS provided brilliant care at home until his death. He had been a doctor himself and used to say, if we knew all the answers, doctors would never die - or have colds.

I'd agree that a lot of common sense has gone, and some plain old-fashioned nursing would be better than the reliance on technology - proper handwashing for example.

Hope the situation improves for you and your family.

Jane Henry said...

Lisa and Sarah you're both quite right to point out that a) the NHS copes brilliantly under pressure and b)there is another side to this.

I agree, Sarah, lots of people are very pushy, but the frustrating thing for us was that we could never talk to the same person twice and no one (until she got into the community hospital) seemed to listen. When we finally saw a consultant he was very good, but it was three weeks before we saw him. My experience at the other end of the spectrum with small children has been similar. So much time is wasted because information doesn't seem to get passed on, and you never see the same person twice. At one stage with my youngest I was the ONLY person who'd seen x rays taken two weeks apart showing a huge increase in rubbish on her lungs. No one seemed to pay any attention to my pathetic pleas that I thought she had a chest infection and needed antibiotics as well as nebulisers to control her breathing. Because she is asthmatic they treated that, and it was only after 2 days (on a second trip to hospital in a fortnight) that they give in and gave her antibiotics, after which she got better...

I appreciate not all families are necessarily helpful/positive and staff get a raw treatment from gripers, but they surely must be able to tell the difference, and take note of someone giving them useful info.