Monday, 15 March 2010

Obstructing patient care - quack quack

It's a familiar tale in today's NHS, rather than primary and secondary care cooperating in order to help patients we have a system that revolves around the market with primary care and secondary care competing against each other. This has become a bit of a tit for tat war, the PCTs gradually squeeze funding for both with primary and secondary care engage in a pathetic battle of niggling for payments. This has led to the absurd situation of referral management centres, a set number of admissions that are paid for (if this is breached then the hospital is not paid) and the empowerment of administrators ahead of clinicians.

This ridiculous market based system is much more expensive, as competition results in the efficiency of cooperative networks being lost. It is also leading to a tremendous dumbing down of medical decision making because with the privatisation of services comes the cost cutting that results in the inevitable reduction of service quality. There are now numerous layers that obstruct a patient getting from a GP to a proper medically trained consultant doctor or surgeon. Virtually all of these 'reforms' result in the empowerment of less trained workers, whether in be the nurse who can now act as an approved mental health 'clinician' , the HCA being given the unsupervised job of a nurse on the wards or the paramedic who thinks it is their job to reduce A&E attendances by diagnosing chest pain as being anxiety related and not related to serious pathology.

I don't blame these new empowered staff, it is simply the fault of the establishment that allows the service to be dumbed down and wrecked in such a manner. At the end of the day patients are being let down by a crap service, the privatisation of services has led to the deliberate disempowerment of properly trained staff in order to empower the ignorant, it is easier to sell of the NHS in bits if no group of skilled workers has a monopoly on a providing a particular part of that service. Phil Peverley sums this up with three examples of how the decent care of patients is being obstructed in today's NHS, these are not rare one offs, they are more and more becoming the norm, we are letting our patients down by allowing this woeful dumbing down to continue:

Patient 1 came to see me a year ago after he’d crocked his knee playing football. I thought he’d damaged his anterior cruciate ligament and I referred him to an orthopaedic surgeon. I saw him again this week, and he was apologising for wasting my time. ‘I saw a physio nine months ago. She agreed with you I needed surgery, and she said she’d sort it out, but I haven’t heard anything. I phoned her but she’d left. I don’t know what to do.’ A call confirmed the physio had indeed high-tailed it out of the NHS, but had done nothing for my patient, other than discharge him.
Patient 2 has had bilateral tennis elbow for years. I referred her to our upper-limb surgeon, and after a few months I got a letter from a physio saying she was no better. My patient confirmed this; ‘I don’t know why I saw a physio. I thought I was supposed to see a surgeon. They poked a vibrating thing at me and it’s much worse.’ I wrote to the surgeon asking, in essence, ‘Why did this waste of time occur?’ and he wrote back answering, in essence: ‘I dunno. I never saw the letter.’
Patient 3 is undoubtedly more serious than the other two. This doughty, self-deprecating, highly-decorated World War Two hero started pissing blood late last year. He was due a diagnostic cystoscopy in November, but a nurse in the pre-op clinic managed to put a stop to that. ‘Your ECG looks funny,’ she told my patient. Actually it didn’t. I’ve seen the ECG and it looks normal, but the ECG machine thinks it looks funny. But then every ECG machine ever made thinks every ECG ever taken looks funny. You just can’t trust the little plastic bastards. It’s best to rely on your own expertise. If you’re a doctor, that is.Our pre-op nurse handed our noble but frail war vet a copy of the dodgy ECG (but no letter or any other communication) and told him to go to his GP to: ‘Get this fixed. Your GP will send you back when you can have your operation.’ Instead he went private, this man to whom we all owe so much, wasted fifteen hundred quid on unnecessary cardiac investigations, and was told there was nothing wrong with his ECG. He had his cystoscopy this month. His cancer is now inoperable. It might have been inoperable before. We’ll never know.
Stand up and be counted, you unqualified time-wasting shitehawks. Account for yourselves. Why are you standing between me and the consultant I wish to refer my patient to? Exactly how have you helped my patients get treatment? What are you FOR?Okay, so you’re just nurses who have been overpromoted into the jobs doctors used to do. Maybe you don’t know you’re only there to save money. The real culprits are those cynical managers – the medical stooges who collude with this managerial idiocy and the bureaucratic bean-counting tyrants who have forgotten what the NHS is actually supposed to be there for.Hang your heads in shame. If I could do to you what you’re doing to my patients, I wouldn’t hesitate for a second.


A disgusting snouth trougher said...

THese practitioners have emerged from innovative & rigorous training programmes. I should know. I established one such programme. I drafted in scores of enthusiastic applicants to join a physicians assistant programme. I cynically exploited this to gain a large national clinical excellence award. I waxed lyrical about how I'd developed, led & managed a high quality service. All the time, I shamelessly exploited the initiative to get as much time off clinical work as possible. Opportunistically, I revelled in the reflected glory. I thought it was a real laugh when the practitioners took work away from my former trainees, who are now unemployed post-CCT.

I'm not interested in patients, but I am very interested in getting a gong to go with my pensionable CEA. I'll continue to betray my colleagues for personal pecuniary advantage because I am a venal little sociopath. I've enjoyed my long career in medical politics, mainly because it has afforded me the opportunity to avoid clinical NHS work while raking it in, with large CEAs for sitting on my bum in committees.

Anonymous said...

Raising objections from within the hospital gets you threats from the general manager and medical director. Whistleblowing is career ending, and everyone feels helpless.

Anonymous said...

This is what happened to me. After a consultation with my GP he referred me to a specialist unit. I have to have faith and trust in my GP which I do and he has cared for me and family very well in the past.
Out of the blue a letter arrived informing me that I had an appointment with a different specialist in hospital. How I had got to there meant some enquiries.
No my GP had not changed his referral. Someone, in some office unlikely to have any clinical expertise at all decided I could have this surgery with another surgical team. What happened to the governmental mantra of choice ? I turned up for hospital appointment in case it was for further diagnostic test. It wasn't - it was a proper outpatient appointment with a different surgical team.Steadily increasing nervousness I don't want to be a guinea pig. I check with my GP again who does not know this 'team'. We are both angry that his referral has been interfered with. I am now re-referred to orginal specialist whom I saw yesterday, with op date set for next month. Meanwhile hospital phones and has arranged op. date ( quick date) but I am not interested in QUICK, I am interested in the best surgeon for my op. I explain this to the admin person who assures me that Mr ? is very good. I refrain from asking what qualifies her as a clerk / admin person to make a clincal judgement and I decline the offer of speed. I am sticking with my GP's referral HE is well qualified to make a judgement and I do trust him / I have to / to send me to the best surgical team for my problem. Hope all this makes sense.

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