The man was not aggressive, but he was angry, and at nearly 6ft he loomed over the nurse he was addressing.
‘Do you think it’s acceptable that my son’s been waiting four hours to see a doctor? He’s only three years old!’
The A&E nurse began to apologise and to give the usual explanations: we have to see patients in order of clinical priority; we only have so many doctors available; we’ll see him as soon as we can. The father was not placated.
‘But do you think it’s acceptable to keep a sick child waiting like this?’
I was sitting at the desk writing up the notes for my last patient. So far I’d kept my head down and out of the line of fire, but I could hear voices rising and tempers starting to fray. The department was full, and the nurse had already dealt with a few irate parents, in between rushing to triage children, give nebulisers and check observations.
‘No, sir,’ I said. ‘Of course we don’t think it’s acceptable. Unfortunately we just do not have enough staff to see everyone in a timely fashion. May I suggest you write to your MP?’
The man looked at me, silenced for a moment. ‘Right,’ he said at last. ‘That’s what I wanted to know. I just wanted to know if you thought it was acceptable.’ And he went back to the waiting room and sat down.
Before that conversation, my instinct was the same as the nurse’s: try to justify your department’s practice; stand up for your institution; make the best of a bad job.
Afterwards, I’ve changed the way I deal with such conflicts. There really is no point, these days, trying to pretend that we think everything in the NHS is rosy.
Is it acceptable that your wife’s been waiting hours for pain relief? Is it acceptable that your granny was told to use incontinence pads because there was no-one to help her onto the commode? Is it acceptable that the waiting list for child mental health services is several months long? No. No, of course it’s not acceptable, it’s disgraceful.
I’ve found that being open with patients – or, as a paediatrician, with parents – is the best, and sometimes the only, way to preserve relationships.
Families need to know that we also recognise there is a problem. They need to know that the power to address that problem may no longer lie in the hands of clinicians, and they may need to go over our heads and take up their grievance with the politicians.
They are our vital allies in the fight to preserve the NHS, and we may as well be clear that we are all fighting on the same side.
Miranda Barry is a junior doctor. She writes under a pseudonym.
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Great point! I will be doing this from now on!
Several times patients have bemoaned the fact they have had to wait hours to see a doctor, then added in with kindly indulgent smiles that they know it's not my fault. It's the immigrants and old people slowing everything down and gobbling up resources. I swallow my frustration at these attitudes and gently point out the current funding gap. I say that it might at some point be feasible to blame foreigners and the old (this lets them know I'm not a snotty liberal elite and don't think badly of them for expressing such shortsighted views) but that as long as we are running a health service with a lower proportion of GDP than any other developed western country it might be considered unreasonable to blame anyone but the people signing the cheques. They generally agree and often seem surprised to be unable to mentally label me as unpatriotic or metropolitan. I smile and carry on doing my job.
Well done Miranda!!
This is what I face daily as a GP. But even worse, it's not even my service that the patients are complaining about, but they think it's appropriate to make an appointment with me to complaint about (1) the fact they've still not heard about their hospital appointment, (2) they didn't like the consultant and didn't get any answers, (3) they still haven't had any results of their hospital investigations, (4) they've been lost to follow-up. I explain clearly that I do not actually work for the NHS, but provide primary care services as a contractor. I then explain that I am not responsible for the rest of the NHS, nor anyone who works for it. I am responsible for my own Practice and the staff I employ, none of whom work FOR the NHS, but for ME.
I acknowledge that the system is a mess, but that taking up my clinical time to complain about it does no one any good.
I then direct them to phone the service manager for whatever dept they are unhappy with, and suggest they offload their complaints to the appropriate person. It's for NHS managers to deal with complaints about service, NOT clinicians.
I wholeheartedly agree that trying to defend the political games that have led to the nonsense that's destroying the NHS is not your job, so don't do it. You will feel better for it. This is not North Korea. Say it, acknowledge it, then get on with your own job.
Been doing this since I started foundation year one. Any issue that is clearly about understaffing, I gently explain that cuts are causing the problem and ask them to write to their MP and the Trust complaints department.
Sorry about the above. I am a retired former senior consultant who dedicated his life to the NHS...but now am part of the old peoplenow seen as a problem. This is not a nice time to have a severely debilitating problem,,,and still to have not been able to actually see a consultant colleague about it in 11 months. Keep saying how the system is failing and insisting that it is not you who are failing.
You are lucky. All my patients and complain. PAL actually entertains the complaints even when that know the facts.
PAL and Hospital Admins are enjoying this? I feel.
From our point of view as patients doctors and nurses are the only point of contact with the NHS . A lot of us have gone the route of contacting mp's with not a lot of success
As a retired clinician now in the difficult age group as a patient, I very much sympathise with my younger colleagues both doctors and nurses I recall in our local A&E a large notice advising that this is NOT a queue, patients are seen in order of need When I am waiting + I relieved I was not seen in 5 minutes! I absolutely concur that our clinicians are being asked to do the impossible, both in Primary and Secondary care but i so grateful to all of them for care received They are worth waiting for!
Totally agree with all previous comments. I'm a nurse who looks after mainly elderly patients & some of them wait for months for care in the community, in the mean time they are taking up a hospital bed. They don't want to be there they want to go home or to residential or a nursing home - because of the cuts there is no care out there. I encourage patients & angry relatives to write to their MP's and to PALS
It's not until we inundate the MP's with complaints that anything will get done. In the mean time I'm looking to leave the profession that I love & have worked for of and on for over 35 years as I've had enough
Anonymous (the second one): Well done! But do you also point out to them that without all those immigrants things would be even worse, as we'd have significantly fewer doctors and nurses? Worth doing, I feel.
I've always been a believer that honesty is the best policy. Even when it comes down to admitting up to mistakes. Often when I've seen blood samples being rejected for being incorrectly labelled, I've observed staff, when challenged by patients, claim that "these are different to the previous tests we sent". I've always been honest and apologised, admitting that all the previous tests have been rejected because of a labelling error. Though patients often feel rather annoyed, they rarely complain and appreciate the honesty. If needed I gently point out that, as unacceptable as they are, mistakes do get made when wards are under-staffed, and it is a good thing that our labs are extremely effective in picking up on errors. This almost always placates the patient without the need for lying to them; and carries the additional benefit of increasing their understanding of the problems the NHS is facing.
I could not agree more - why should doctors and nurses have to take all of the complaints without pointing out the fact that the problems with the service are largely down to funding which is beyond their control.
Whether something like this is 'acceptable' is entirely arbitrary. But if patients are led to believe they will be seen in 10 mins / 1 hour / 4hrs etc, then yes, it is unacceptable if these targets are not met. We absolutely should not defend the indefensible.