The 'urgent' appointment for my titanium nail replacement takes around three weeks. Not bad for the NHS. First, though, I have to attend an outpatients clinic. This takes places the week before the operation and is presumably designed to ensure the patient is ready for theatre, and to reduce the burden of the admitting nurses. By a strange turn of fate, my pre-assessment appointment is on the same day as a friend's, although his is in a different department. We go in together - and later compare notes.
First, find the clinic. Being an old hand at the RIE in Little France I know my way around now. Still, its a long walk to the clinic and the word 'adjacent' (to ward 109) is a little optimistic. The waiting room is small - only about ten seats. There's a television in the corner and a table with hot and cold drinks. The accompanying poster says that these are provided by the nursing staff and so donations are welcome (I wonder silently if this is allowed in the PFI contract - I've been told that the WRVS women are no longer allowed to sell drinks and snacks - and thus that particular source of funds has been cut off). Its kind of the nurses to provide this - the cafe is a long way from the clinic.
First I'm seen by my consultant. He spends around 20 minutes considering the details of my operation, examining my on-line x-rays and pondering where my artery to my graft is plumbed in. He promises to check this in theatre with his doppler. I am reassured and confident. Consultants sometimes get a bad press for poor communication skills or arrogance - but there has never been any of that - quite the opposite in fact. Mr Keanan explains that I will need to stay one night in the hospital, and to lay off the physio for a fortnight after my operation The nail replacement is a straight forward procedure, and he will not need to lift up my skin graft. I may end up with a plaster cast depending on how stable my tibia is when he opens it up. Its not possible to tell from the x-rays.
Back in the waiting room its another half an hour before I am called to see the staff nurse. We get off to a bad start, possibly because of my ill advised comment about data protection when I see my name writ large on a white board outside her room. The usual questions about medical history, swabs for MRSA, urine sample, weight and blood pressure, no small talk (despite my efforts to engage her) and then onto the discussion about my operation. And this is where it starts to go wrong.
Despite my protestations to the contrary, she insists that I am coming in for day surgery, and that I will need to report to the Day Surgery counter, somewhere else in the hospital. She hands me my the instructions. These conflict with the letter I had received, and the information from my consultant some half an hour earlier. Then she tells me that my operation is on the 14th of April, and when I protest she says that my consultant doesnt have a list on the 15th. Finally she starts listening to me, and heads out of the room 'to check'. On her return to appears that I am right and she is wrong. I am on the trauma list, not the Day Case list. Start again. Different forms. Different instructions. Same principles though.
Come alone. No valuables. No home cooking. Bring your own medication. Phone numbers for relatives. Fasting from midnight. Shower before arrival but no fancy products. Minimal jewellery. No valuables (and if you do have the audacity to bring any, 'we will not be held responsible if you lose them'). Drugs at 6.30am. Bring a book (presumably for the hours and hours of waiting). Assured of a physio check before I am discharged (re stair management) - and that's it. I escape, not forgetting to say thank you several times (important to mend bridges) and head off to the other side of the hospital to hear how my friend has got on.
Several hours later I am now contemplating my experience. I think overall it was positive. Attending the clinic should reduce the bureaucracy on the day of my operation. All the information has been provided, and I am well prepared. The leaflets on infection control and anaesthetics are concise and useful. All I need to do now is talk to the anaesthetist about a choice of anaesthetics, and we will be ready to go. But I was struck by the lack of humanity in a couple of aspects of the procedure. Particularly in relation to my experience at St Johns. Perhaps its not a fair comparison. I didn't, after all, go in to St Johns from home as an elective patient.
But the unwillingness of the staff nurse to listen to me, or at least check earlier in our conversation on which list I was on, demonstrates a lack of empathy. I know her job must be laborious at times, and patients' questions annoying. But still..... And the rules on arriving alone seem ridiculous. Operations are frightening experiences for everyone, even when you have had them before. Costs of course are behind a lot of this. Managing limited and tight resources in every increasing political and public expectations is really tough. But in the end the patient must come first. Patient centred care must be delivered in practice, not just on paper.
My friend is going for a much more complex operation than mine. And I (and I presume he!) am pleased to report that his pre-assessment clinic was excellent: timely, informative and compassionate. There are, then, an awful lot of staff at the RIE getting it right despite difficult working conditions. And a final turn of fate? My friend and I are both being admitted on the same day for our operations. He, unfortunately, will be in for a lot longer than I. It remains to be seen whether we are successful in smuggling in delicious home cooking to speed his recovery...
First, find the clinic. Being an old hand at the RIE in Little France I know my way around now. Still, its a long walk to the clinic and the word 'adjacent' (to ward 109) is a little optimistic. The waiting room is small - only about ten seats. There's a television in the corner and a table with hot and cold drinks. The accompanying poster says that these are provided by the nursing staff and so donations are welcome (I wonder silently if this is allowed in the PFI contract - I've been told that the WRVS women are no longer allowed to sell drinks and snacks - and thus that particular source of funds has been cut off). Its kind of the nurses to provide this - the cafe is a long way from the clinic.
First I'm seen by my consultant. He spends around 20 minutes considering the details of my operation, examining my on-line x-rays and pondering where my artery to my graft is plumbed in. He promises to check this in theatre with his doppler. I am reassured and confident. Consultants sometimes get a bad press for poor communication skills or arrogance - but there has never been any of that - quite the opposite in fact. Mr Keanan explains that I will need to stay one night in the hospital, and to lay off the physio for a fortnight after my operation The nail replacement is a straight forward procedure, and he will not need to lift up my skin graft. I may end up with a plaster cast depending on how stable my tibia is when he opens it up. Its not possible to tell from the x-rays.
Back in the waiting room its another half an hour before I am called to see the staff nurse. We get off to a bad start, possibly because of my ill advised comment about data protection when I see my name writ large on a white board outside her room. The usual questions about medical history, swabs for MRSA, urine sample, weight and blood pressure, no small talk (despite my efforts to engage her) and then onto the discussion about my operation. And this is where it starts to go wrong.
Despite my protestations to the contrary, she insists that I am coming in for day surgery, and that I will need to report to the Day Surgery counter, somewhere else in the hospital. She hands me my the instructions. These conflict with the letter I had received, and the information from my consultant some half an hour earlier. Then she tells me that my operation is on the 14th of April, and when I protest she says that my consultant doesnt have a list on the 15th. Finally she starts listening to me, and heads out of the room 'to check'. On her return to appears that I am right and she is wrong. I am on the trauma list, not the Day Case list. Start again. Different forms. Different instructions. Same principles though.
Come alone. No valuables. No home cooking. Bring your own medication. Phone numbers for relatives. Fasting from midnight. Shower before arrival but no fancy products. Minimal jewellery. No valuables (and if you do have the audacity to bring any, 'we will not be held responsible if you lose them'). Drugs at 6.30am. Bring a book (presumably for the hours and hours of waiting). Assured of a physio check before I am discharged (re stair management) - and that's it. I escape, not forgetting to say thank you several times (important to mend bridges) and head off to the other side of the hospital to hear how my friend has got on.
Several hours later I am now contemplating my experience. I think overall it was positive. Attending the clinic should reduce the bureaucracy on the day of my operation. All the information has been provided, and I am well prepared. The leaflets on infection control and anaesthetics are concise and useful. All I need to do now is talk to the anaesthetist about a choice of anaesthetics, and we will be ready to go. But I was struck by the lack of humanity in a couple of aspects of the procedure. Particularly in relation to my experience at St Johns. Perhaps its not a fair comparison. I didn't, after all, go in to St Johns from home as an elective patient.
But the unwillingness of the staff nurse to listen to me, or at least check earlier in our conversation on which list I was on, demonstrates a lack of empathy. I know her job must be laborious at times, and patients' questions annoying. But still..... And the rules on arriving alone seem ridiculous. Operations are frightening experiences for everyone, even when you have had them before. Costs of course are behind a lot of this. Managing limited and tight resources in every increasing political and public expectations is really tough. But in the end the patient must come first. Patient centred care must be delivered in practice, not just on paper.
My friend is going for a much more complex operation than mine. And I (and I presume he!) am pleased to report that his pre-assessment clinic was excellent: timely, informative and compassionate. There are, then, an awful lot of staff at the RIE getting it right despite difficult working conditions. And a final turn of fate? My friend and I are both being admitted on the same day for our operations. He, unfortunately, will be in for a lot longer than I. It remains to be seen whether we are successful in smuggling in delicious home cooking to speed his recovery...
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