Here is a little story about patient-centred care. It’s also about fitness for purpose, organisational management, and attitudes. It’s about ‘training’ people to do tasks and then being thrown when the requirement is to go beyond the task. And it’s about putting yourself in the patient’s place, and listening to what is coming out of your mouth. It’s a learning experience – as they say.
Today someone had a bit of a meltdown at the GPs. Don’t get this wrong – the GP is very good. They have a fab appointment system which means you get seen the same day, you can have a telephone conversation if necessary, they always call back within an hour, it works very well. Their system works very well – until you have to go beyond the GP to other services. So, let me tell you what happened – to a Friend, of course.
Friend goes to the GP with breathlessness on exertion, and in the cold. She gets wheezy, it goes away if she rests for a few minutes. There’s no pain, just wheezing and trouble breathing out. GP and friend decide lung function tests and an ECG would be a good idea. Friend goes to the receptionist and books an appointment for lung function tests and an ECG for the following Monday morning at 9am with Sister Somebody. So far so good. Over the weekend Friend receives two reminders of the appointment and asking her to remember to cancel if she can’t go for any reason. All very sensible.
Friend arrives punctually. Checks in on the computerised system. She is called in promptly. A woman in a striped tunic checks that she is there for an ECG. Yes, says Friend, and for lung function tests. Ah, says Striped Tunic (friend doesn’t know who or what she is because her name badge is a)small and b)covered up by her cardigan) I won’t be doing your lung function tests because I don’t do them and you’re in the wrong room for lung function tests and your appointment isn’t long enough anyway.
Oh, says Friend. Then who will do my lung function test which was booked for today?
No-one says ST. We will have to rebook it.
Hang on, says Friend. I have booked it. For today. Now. With Sr Somebody. I assume you’re not Sr Somebody?
No, and I don’t do them, says ST. The person who does them (Sr Somebody) is next door and she’s down to do bloods today. So the room is busy and the person is busy. So you can have your ECG because I can do that, but we will have to rearrange your lung function tests.
Friend is calm-ish.
Friend: OK, maybe you can do the ECG and then the person who does lung function tests can come and do those.
ST: She can’t because she’s booked up with bloods and you’re in the wrong room.
Friend: OK. Can you do bloods?
Friend: How about you go and do her bloods and she does my lung function test?
ST: We can’t because you are booked into the wrong room.
Friend (less calm now): Her bloods patients come in here to you for their bloods, and I go in there for my LFT? Seems pretty straightforward…
ST: I’ll go and talk to her.
5 minutes go by.
A different woman in a striped tunic comes in – Friend can’t see her name badge because it is too small so she don’t know if she is Sr Somebody or not. Friend can see the smiley face on the badge though so she knows it says ‘Hello, my name is…’ but can’t see the name. She sits down and Friend catches a better glimpse of the name badge, she can see it says ‘Sister’.
Sr Somebody apologises. There has been a mistake. Friend can’t have the lung function tests because Sr is fully booked with other patients.
Friend: But I am booked with you for lung function tests. I don’t understand. I have an appointment, which I have received two reminders about, and now I’m here I’m being told that my appointment is with the wrong person, in the wrong room and not for long enough. This really doesn’t feel very efficient, or very patient-centred.
Sr Somebody visibly bristles: I must disagree with you there. Our care is very patient-centred, there has just been a mistake. We have a new receptionist and she didn’t realise how lung function tests have to be booked.
Aha – something’s gone wrong, let’s blame the lowest person in the hierarchy.
Friend: So the new receptionist has got this badly wrong? She was new and working unsupervised?
Sr: She had supervision.
Friend: So the person supervising her doesn’t know how to book lung function tests either?
Friend is given A Look. Friend is rising towards the ceiling.
Friend: how will you make sure this doesn’t happen to someone else?
Sr Somebody: well I’m not in charge of the receptionists but I can go and speak to her.
Off she goes. Back she comes.
Sr S: The receptionist says she tried to get hold of you but couldn’t.
Friend: Well, I was home sick on Wed, Thur and Fri of last week and no-one rang the house phone or my mobile. I was in all of those days and, also, there are no missed calls or messages on either of those phones.
Sr S: Well, she says she rang you. Of course, I can’t prove that she rang you.
Friend bites her lip. In her head she is saying: No, but it looks as though I can prove that she didn’t. Friend gives Sr A Look. Sr apologises again. It’s a mistake, there is nothing she can do but apologise. Friend suggests that perhaps she can rearrange the lung function appointment as quickly as possible. Sr S sits at computer, then comes the straw that breaks the camel’s back. She says, OK, let’s see. Do you work?
Inside Friend is exploding. Do I work? If I do, then presumably I can wait for a convenient time. If I don’t, then my life is so empty that I have nothing at all to do except fit myself around the surgery staff possibilities. Do I work?
Calmly, and quietly, but with feeling Friend asks: What has whether I work or not got to do with anything?
Sr S is silent. She clicks a few times. Then she says: Can you come this afternoon at 2pm? She apologises again for the inconvenience. She apologises for the mistake. The appointment is agreed. She leaves.
The first Striped Tunic says: Do you want your ECG or do you want to rearrange that now?
Friend has the ECG. Friend goes home and lies down in a dark room.