Showing posts with label consultants. Show all posts
Showing posts with label consultants. Show all posts

Tuesday, 7 October 2008

Abstract Thoughts

I was sitting at the dining room table yesterday (Sunday) writing letters to some friends-I do like to practice my ABC’s, and I use a fountain pen, I really think it’s nice to receive a hand written letter.

Any way, I had a lapse in writing because the rain was absolutely pouring down and it was destroying the roses, when a thought came to me.

I don’t get them very often so I usually write them down. The thought was “what is life really like” deep eh?

The answer I came up with was “I don’t know”. There are the usual sayings such as “It’s a bitch and then you die” but it isn’t because we all die and “life is what you make it” which isn’t apt because some people don’t have a choice in the way their life progresses.

And then of course there is “life is like a box of chocolates” which is crap because we all know that there is a piece of paper in the box that tells you what every chocolate is.

Then I thought (here I go again) life is about people, it’s about attitude and caring, and not looking for recognition or status but what you can do to make other peoples lives a bit better, by saying hello to people, smiling, having respect for others feelings, being less selfish, having consideration or thinking before you do or say something.
Because when you help someone else you help yourself.

Doesn’t it sound wonderful?

But people are all different we start life with varying advantages and disadvantages, some are rich, some are poor and some are good or bad.

I think that those of us who are lucky enough to be able to take advantage of “good fortune” are in a much better position to change other peoples’ lives.

I don’t include my self in this category, I have faults-I can be arrogant, bombastic and downright stupid, but that is what makes us individuals.

Then I thought about growing older, I am not old- 57 , but tell that to my body first thing in the morning when I crawl out of bed.

There is a great quote from Billy Connelly-“ a wise man once told me that there are three things to remember when you reach sixty.
1. If you get the chance to take a piss, take advantage of it.
2. Never trust a fart.
3. If you get an erection use it even if you are on your own.”

I think I am at all three stages now.

I love older people, I love their wit and humour, they have a dignity that no longer seems to exist in the “Thatcher Generation”, I love to talk to them and listen to them “I’m 89 you know” how wonderful. What memories and wisdom is contained in their brains, what changes they have seen, and what hardships and emotional turmoil they have endured. But what courage, love and compassion they have shown.

My wife would be 57 this year but she passed away three years two months and seven days ago (but whose counting), I promise I will not bang on about this but it is a “life changing experience” when you watch the light go out in someone’s eyes and hear their last breath.

It makes you look at life from a different angle.

Which then made me think about the NHS.

I have had a fair amount of contact with that venerable institution over the last five years or so, and it struck me that hospitals are like life, good, caring, uncaring or just downright bloody-minded.

I know hospitals are not people but, they do have a character, they seem to take on the persona of the people who work there.

I recently had cause to use the NHS, I kept having dizzy spells, the falling down and lying in your own vomit kind, and no I do not drink.

I went to my GP; well not really mine as the GP I had known for 30 years had retired, we “grew up together” and would chat about normal things like kids and holidays, the medicine part almost seemed an afterthought, he is a good man. I tried to make an appointment with his replacement, but I think it was a five-day wait so I accepted an appointment with anyone who had a slot free.

The doctor was young (nothing wrong with that) and very pleasant and efficient; she did the usual tests, blood pressure etc, looked in my ears, and gave me a prescription.

I got the tablets, and they worked, the problem was that these dizzy spells were random, and the pills only worked if you took them all the time. Being an old fart I would forget to take them, and if I took the pills when the spell began I would vomit them up, which rather defeated the object. So it was back to the surgery.

The second doctor I saw (still couldn’t get an appointment with “my” doctor) was middle aged male and morose, he berated me because I smoked, then preceded to tell me how wonderful life could be after the person you loved more than anything else in the world had died, and that I should take up sport (remember the getting up part). All I wanted were some tablets to stop me vomiting.

Went home and made another appointment-success it was with “my” doctor.

I had not seen him before but he seemed caring and “normal” and I got on OK with him, he had an attitude much like “our” GP.

He said he wanted to refer me to a consultant, possible brain tumour?

I used my vote and decided that I wanted to go to the Royal Surrey Hospital, which I knew from my frequent visits with my wife.

The appointment came through quickly and I attended the appointment. The consultant was Mr Valentine, he was great, I felt at ease and he made me do some strange things such as facing a mirror with my eyes shut, my arms out in front of me and marching on the spot. When I opened my eyes I had almost done a 180 and was facing in the other direction.

He showed concern and said he was going to send me for an MRI scan of my head.

I cannot fault the service; he was competent, caring and communicative. A nice man.

The MRI appointment came very quickly, it was on a Saturday, and I attended and endured the face cage and the noise.

The second appointment with the consultant came quickly, but before that date Mr Valentine sent me a letter saying that the scan was clear, there was no tumour, my only doubt was that they actually found a brain.

It had been a few months so before the appointment I decided to stop the tablets and see what would happen. The dizzy spells had gone.

When I saw Mr Valentine again I explained that the spells had gone and he said that it happens a lot, apparently the medication given for nausea and dizziness often cause nausea and dizziness. I was confused but he was pleased that it was not serious and wished me well.

As I said-a nice man.

But that is the “character” of the hospital; it seems to have taken on the attitude of the people that work there. From the outside it looks like an office block, the usual 1970s architecture, but once inside it gives the feeling of care and safety, because surely a hospital is the one place you should feel safe.

The Royal Surrey is not a foundation hospital, it doesn’t brag about how many stars it has, but it is committed to actually caring for the patients (we are not customers), there isn’t the great urge to tell everyone how wonderful it is and how it meets every target, and that the management are doing a wonderful job. It leaves it to the patients to decide how good the standard of care is and they vote with their feet and choose it because it is the best at what it does.

I have visited other hospitals; some are neutral- all business, and some are uncared for and “arrogant” taking on the attitude of the people who work there.

I have access to one of the wonderful Foundation Trusts, the difference is I think that the foundations control their own budgets, they still get their money from the government but any surplus which for this trust in 2007/2008 is £9.2 Million (despite the fact that clinical negligence cost £2.011,000) is allowed to be kept by the hospital for the improvement of services to the patients, and they are allowed to set their own pay-scales. Yeah right and I am the queen of Sheba.

When you consider that in the year 2006/2007 the going rate for a CEO is £150,000+car allowance.
Medical Director-£ 180,000-£190,000.
Nursing Director-£105,000-£110,00.
Director of Personnel-£100,000-£105,000.
Director of Performance (whatever that is)-£100,000-£105,000.

An increase of £10,000 per person over the previous year.

A total I believe of over £600,000 for just 5 people.

Agency/contract staff cost over £3 Million

And £500,000 was wasted on a failed merger with other hospitals.

This hospital comes under the category of neglected, pompous and arrogant.

The feeling when you enter the building is, cramped, outdated, uncared for and anonymous.

Make your own conclusions.

Then I thought about doctors.

I believe there are probably three types of doctors.

1.Those that actually like people and try to care for them to the best of their ability.
2.Those that don’t really like people but treat them although they would rather be doing research so that the “nasty” patients don’t distract them from own little world.
3. Those that don’t like people at all and don’t like treating them but want the prestige and the money that comes with being senior consultants.

The majority of doctors are in my own opinion of type 1. They are the hard working GPs and junior doctors, as well as the caring and talented consultants.
They probably constitute 99% of all doctors.

The other 1% is divided between the type 2 and 3 doctors. The type 3 is probably the worst, they are senior consultants, and they have got to their exulted position by hard work, dedication and pandering to the right people. By playing golf with those of senior rank and giving dinner parties for the same people, they are political animals they have nurtured the outward impression of calm and proficiency, and would probably make good actors.

The type 2 are those that treat patients more like a hobby because patients supply a steady stream of data for their “real work”. They are the ones who take course after course and end up with more letters after their name than the alphabet, but would really like to be in research or lecturing in a university. But as the saying goes “those who can’t teach do” I know, but it fits better.

There are of course some who are a mixture of type 2 and 3.
But they don’t really know what to do and end up doing virtually nothing but still taking the money and prestige.

So why are some hospitals good and others not so good?

It all comes down to the attitude of the senior doctors in charge of training, and the senior management. Why do some consultants bully junior doctors? Is it because they were bullied or is it because they can, and can’t remember the days when they were junior themselves? Do they not understand that junior doctors need nurture not torture, we all make mistakes, but surely it is better to discuss the mistakes in private, a bit of respect goes a long way. And lead by showing honesty and integrity, put your hands up when you have cocked up, tell the patient what happened, people are much more intelligent and forgiving than medics give them credit for.

Are consultants out of touch? Should there be a scheme where all consultants must dedicate one day a month to actually doctoring, by perhaps shadowing district nurses and changing dressings, or attending to people who are near the end of their life. Let them see what happens after the patients leave their closed world.

Should the same sort of scheme be applied to all senior managers, spend a day on the wards feeding patients and talking to the old and sick, so that they will form some sort of idea what actually happens in the floors below their offices. Because not many of them are in touch with the real world.

Would this type of thing change attitudes? Because if we can’t change the attitude of some senior doctors and managers then the NHS will degrade into something nobody wants, a health service that is governed by administrators and ambitious senior consultants who will only be interested in showing the country how wonderful they are and “look at all the targets we have met”.

The NHS is not about targets or personal ambition, it is about patients, the poor and the rich, if they have paid their contribution then they are entitled to the treatment, but the prime intention is about the sick. If those doctors don’t want to realise that then let them bugger of to America where health care is really cut throat and if you fart in the presence of a patient you will get sued.

Please give us back the NHS as it should be, for the good of all sick people.

Angus Dei