Update of disaster graft saga

[Loopy-Lou]

I once received treatment in Scotland and there was a different quality of care methinks because they are less pressured than London services.

I know what you mean about medico's, for some academic intelligence doesn't mean they have emotional intelligence plus their humanity is often drilled out of them whilsting they are studying for their medical degree, then in their F1 year they can be treated like shit and it's a baptism of fire.
Surgeons especially can lack communication skills, there can be an education-gender thing going on for some, and within ophthalmology I think they can be cautious about giving us the level of information some of us might want either because they don't want us to worry or some might assume it's too technical for us.

[rosemary johnson]

Never had the pleasure (?) of neding medical attention in Scotland, so can't comment on how different it may be.
Have had experience of NHS in not only London but onso just outside Liverpool where we grew up, and in Oxford.
Merseyside: parents' GPs male patronising gits. Think if I encountered McPherson now I'd walk right out on him. Gray might have been better had I et him in better circumstances (he was trying to calm down parents who leaped to (wrong) conclusion from optician's refusal to give diagnosis that I was about to die of eye cancer!
Dragged round loads of hospital eye depts, full of patronising gits, lousy appointments non-systems and long long long waits in dark corridors.
Bloke hwo came to be my regular consultant there finallys tarted to thaw - suddenly turned human once he heard I was off to university. hich college?" he asked.
"Somerville," I said.
He gave me the first of those knowing looks and said "Keble." After that, remarkably human after all.
Before that, incredibly horrible and potronising optician's at school clinic. HIg St optician later I remember as also v patronising git, but maybe they didn't have a chance having been lumped in with the others.
The only one there who I got on with (before the "Keble" day) was the contact lens expert - to whose private practive the hospital contracted out their lens fitting. Very human, very nice guy, if anyone can entice him along to a KC group conf, will gladly renew acquaintance and buy him a beer (or two or...)
Saw him at private office - change from hospitals astounding.
Oxford: saw GP once - to get referral to Eye Hosp for first hydrops. Wnet in with letter from (private consulting office of) the ex-Keble-ite, got send straight round to Eye dept check in. Only other time I saw her was at the freshers' session about signing on with local GPs.
Brisk and efficient. She was one of college doctors, used to dealing with university students. Allegedly tried to get each and every Somervillian onto the pill. Didn't try this with me. Dunno whether she took one look at me and had more sense, or was too busy thinking about my eye.
Oxford Eye Hospital receptionists of the decidedly regrettable variety. They insisted on giving me loads of pieces of card with a blue stripe along the top - apparently the only funciton of these was to have my hospital number. I wrote hospital number and appointents in my diary. They always wanted these blue-striped cards. Even when I just read out my number, they got all bitchy and tried to give me a lecture on bringing the blue-striped card. By this time I had a whole deck of the things. They did manage to find me fromthe number I read out, though were loathe to admit it. After that, I took great delight in singling out an dbringing each time the card on whch someone had written the number down wrong.
Appointments system there too a joke, and often found myself sharing a waiting room with hoardes of screaming kids. I remember wondering whether it would get me called in any quicker if I sat there surrounded by these screaming kids and very prominently reading Gay News. Tried it once - it didn't.
Consultant there reasonable guy, also knew my college principal. Don't know whether she'd tipped him off about me. By the time of my second hydrops, she'd retired (very sad, for other reasons too).
Sent message through university internal mail to said consultant when I got back to college at start of my Finals term, saying had had a hydrops just like two years before byut inthe other eye this time, and should I fix to come and see him, and how?
Don't remember how, but went to see him. He took one look at the eye in question, turned to trailing entourage of medical studetns and introduced me as a very intelligent lady who'd diagnosed herself.
He too has now retired - shame, or I might have 2moved" back to Oxford after op when refused to see That Certain Surgeon again.
Eye hosp has now moved too.
I gather that most hospitals now have more enlightened appointments systems (though not all, including a certain one in London I see far too much of). receptionists seem to vary. And practitioners.
I don't know to what extent my recent eperiences have been related tobeing in London.
It is possible that part of problem with GPs may relate simply to being in a very deprived area - as in, who wants to work in a deprived inner-city area when you could work in a rich leafy green belt area? I rather suspect that if one were to pick up and teleport my current GPs and their team and swap them with the one I used to be registered with in Oxford, both would ahve a culture shock. Though I do wonder whether my Oxford GP's setup would cope better with a very deprived, very mlti-ethnic/nulti-nationality, high transient population, low level of average education, many non-English speakers, area than my current GP's setup would cope with a list comprising at least half Oxford university students, dons, graduates, librarians and staff at the university press.
As for social skills......
I'd rather they just ahd the attitide of treating people as intelligent fellow humans - as distinct from treating everyone as pretty ingorant really. My personal experience is that is more telling than learning emotional intelligence stuff.
In that, someone who has (learned to be) high on the emotional intelligence front can come across as most appallingly patronising if they don't mix that with the assumption the person they're talking to has a brain of their own.
Believe it or not that I'd say this but....... even That Certan Surgeon could and did have intelligent conversations with, once he was talking about the technical details of an intersting part of his subject area, and got away from what he wanted me to agree to him doing to my eyes in particular.
SOmething else that is undoubtedly true is that (some of?) the big London hospitals get referrals from al lover the place, so are no doubt rushed with a user base from all over the place. How much this applies also to hospitals in ig population centres around the country too, I don't know.
Rosemary

[Andrew MacLean]

I think that centres of excellence draw referrals from outwith their immediate catchment. the hospital I attend seems to be a national resource, which is good for me because I live outside its catchment.

Andrew

[Hilary Johnson]

Hi R

Good luck for next appointment
Well done at getting all that sorted with the practice manager
Oh, and congrats on the rosette - should have said that last time.

I think another part of the trouble with doctors is that to qualify you have to do enormous amounts of rote-learning, and spend years working 72 hour shifts, and that either selects for, or creates, doctors with a rather strange mindset!

H

[Andrew MacLean]

I've been thinking about the profile of the ideal doctor, and i have concluded that the profile varies from discipline to discipline.

I rather like my GP to be erudite, interested in me and my health, witty and capable of sustaining an intelligent conversation. I also expect my GP to be an expert on all things that can go wrong with my body, and an expert on the specialists to whom she or he might refer me to get any problems sorted.

My eye surgeon I expect to know about my eyes, the problems that can arise in them and to be able to offer a coherent programme either to manage or rectify problems that arise. In the OR, I expect the surgeon to be focused on my eye, to be able deftly to cut away anything that has to go and neatly to sew in anything that has to be added.

General Surgeons I expect to have a comprehensive knowledge of all possible internal configurations of organs, to be able to find the thing (s)he is looking for, remove it and sew me up again without any co-lateral damage.

To be honest, I am not bothered about the 'bedside manner' of surgeons, it is more important to me that they can do the job and put things back neatly.

That said, I reckon I am blessed in West Central Scotland because my GP practice is populated by physicians who amply fill the remit. Surgeons who have attacked me with knives and scalpels have all been very good at doing what they do, and also nice people to boot! I count the latter as a bonus. But if I were needing surgery from someone with crippling social disabilities who was none the less competent or even expert at surgery, then I'd be happy; I'd just count "lack of emotional intelligence" as his or her problem, and not mine.

I also have a respiratory problem, and the team that treats me for that is made up of exceptionally good, nice and helpful people. And, to top it all, the sun is shining and the hills beyond the river are bathed in the sunlight and lushly verdant after recent rain.

Andrew

[Hilary Johnson]

he was trying to calm down parents who leaped to (wrong) conclusion from optician's refusal to give diagnosis that I was about to die of eye cancer!

OMG did they really!! Oh dear oh dear!!

I seem to remember they ALWAYS overreacted to anything wrong with your eyes - and I was forced to change opticians because I got so fed up of the one I was seeing spending the first half hour of MY appointments talking to whichever parent had brought me about YOUR eyes - unprofessional of optician and downright rude of both!

It was such bliss to see a new optician who didn't know - though in retrospect, the idea that I was at the age of greatest risk of developing KC, with a sibling who already had it, and was deliberately seeing an optician who knew nothing about it, makes me shudder. How come, in all their fussing, TheParents never once showed the slightest concern that I might get it, and even made my eye tests be rushed and skimped on??!!!!!????!

Any parents of KC kids reading this please note - however worried you are about them, it doesn't mean that your other kids no longer exist.

H

[rosemary johnson]

Hilary wrote: OMG did they really!!

Now, what was that about the things I didn't know/remember.....?
No, I jest........ I think.
Apparently they did, yes. I didn't know till recently - wehn M was going on about "that stupid woman" in the opticians, as if I knew all about it.
WHy she thinks I shouldhave known what she was talking about was beyond me! - TheParents would never have been honest enough to tell ME!! anything like that at that age.
Or now, for that matter............
Apparently, woman in opticians told them they should take me to the doctor, wouldn't say why, and they had this fixed idea that health service people who wouldn't explain something must have some connection to The Big C Word.
Gave mother rather short shrift on that one - explained that woman in optician's wasn't allowed to diagnose and would have been breaking the law if she'd told them what she thought was wrong.
Also said it was a bloody stupid effect of a law (no doubt well meant, but result is, non-medically qualified practitioner who thinks patient/client should ask a gp about something but is legally bound not to say what or why, has choice of having their steer ignored, breaking the law, or possibly putting the frighteners on the patient to an OTT degree.
Still applies to me today.
M's reaction to my complaints of patronising GP was that he needed to calm them down. But her verdict on GP in question enitrely flavoured by story that he went off to Canada with a woman who was married to someone else.
Thin if I'd had to work for McPherson, I'dhave eloped to Canada at earliest opportunity!!!!
As regards opticians - entirely agree!
Don't think I'd have wanted my health discussed in front of another customer either, thanks!
Though, to be fair, I don't think anyone n those days knew there was a genetic link to KC, so probably had no reason to think you were more at risk than anyone else.
I never heard of genetic link possibility until people involved with Moorfields research project started asking me questions about whether anyone else inthe family had it, how old my mother was when she had me and loads of other stuff on which to run endless stats.
Now, methinks, it is much more widely known that there's a genetic factor, and they're much better at keeping a look out for it popping up in siblings/offspring
As you may have noted from current optician??
Thans for best wishes with apptmt, and congrats on rosette. Think best achievement in green rosette is that i was actually there and doing it. I don't thin I did particularly well..... but then, I suppose it's an improvement that I'm thinking how much better I couldhave done!
R

[rosemary johnson]

Andrew, interesting post.
Maybe this (yours and this reply?) should be a separate thread??? oh well, here goes for now.
First, I disagree about surgeons with no social skills. It may not matter to you (particularly if you're unconscious).
However, it is vitally important that the team in theatre work together as a team. And a surgeon with no interpersonal skills is likley to be a problem, or at least an irritation, to his/her anaesthetist, theatre technician, scrub nurse, etc. I don't want to be operated on by a surgeon who cannot relate well to his team. (I think the way That Certain Srueon treated his anaesthetist was pretty deplorable.....)
Yes,I do expect a srugeon to be technically competant. I also expect them to be able to have sensible discussions, realted to by life and overall health and concerns, about whether to have any surgery at all, and if so which sort, when, how, etc etc.
And, in my case, with past immense problems with a GA an dvarious adverse drug reactions, to be able to understand a) that my priorities have avoiding anything like that again at top of the list, and if that means a less-perfect job elsewhere, so be it, and b) if it MY life, MY health and MY decision, and c) I know what I'd talking about in saying so.
Yes, I expect specialists, in whatever area, to know their field, and to know when and where to pass on specialist in a related part of the field.
I also expect them to remember to keep that in context - that is, if something in their area is going to have an adverse impact elsewhere, that they remember that. And that they remember that it is my life health and decision what to do about any such potential conflicts.
For example: suppose I turn up in eye A&E one day with my grafted eye red and sore and stickya nd going foggy. I expect them to be able to tell me if it's rejecting, and if not what else it might be. And to know of options for dealing with whatever it is.
And if they say it is rejecting and want to put me onto lots of steroid eye drops, and I tell them I'm too hypersensitive to steroids to tolerate that, and I'd rather lose the graft that get teh effects of the steroids, then I expect them to understand the situation, to credit me with the intelligence to know what I@m talking about, and to accept that's my decision.
Of course, I'd also like them to know if there's a non-steroid alternative!
GPs - ah, now!
What I do NOT expect a GP to do is to know me from Adam when I walk in with a new health problem, to know all about my family and my past.
(If it's the second,third, etc..... time I've seen said GP recently, I would like him/her to remember where we'd got up to reasonably well.)
I do expect his/her to take the problem seriously, treat me as intelligent enough to know what I'm talking about, and accept that it's my health, life and decision.
I then expect him/her to apply their expertise to knowing whether it's something they can deal with, and if so how, or whether it needs a referral, tests, etc.
I don't expect them necessarily to know the precise details of the names and dosage of every drug, of the specialist departments or names of consultants for everything, but do expect them to be able to look these up when necessary.
In fact, I regard it as a plus point if they get their (well used) copy of the BNF off a handy shelf and look up which is the most appropriate one of a group of related drugs,and wht the dose should be, an ddouble check the contra-indications, rather than just scribble out a proescription in hope. After all, I'm ony going to look up what they've written in the online nBNF as soon as I get home!
If they don't know the best course of ction, and need to research it, or consult their colleagues, I expect them to say so, say when they'll be able to do it, and when and how they'll get back to me with the answers - and then do so, and get back to me on schedule.
I expect them to be honest with me, to keep competant records, not to write things in records or referral letters they are not prepared to say (and justify) to my face, and to give my copies of said records or letters on request.
I do NOT!!! expect them to refuse to attempt to do anything about what I repeatedly tell them is a newly-apparent problem because they haven't go t records have way back, nor to assume that if I appear to have a condition they don't deal with 20 times a week and is outside their experience of immediate recollection of theoretical knowledge, to assume that means I needs must be stupid, crazy and in need of immediate fobbing off onto mental health disservices!!!!!!
Cynic? Moi?
I also expec tthem to have friendly and competent reception and "back office" staff, and ways of ooking in for particularly appointments, or making sure you know when and where to go when it's your turn, without having to tell the whole waiting room about your current health problems or ongoing disability.
(For example: if you're partially sighted and can't read the screens on which they pop up messages saying "Miss JOhnson to see Dr Bloggs, Room 5", you don't want to have to have a debate withthe receptionists every time you come in about exactly why they need to tell the GP to call you on the tannoy so everyone in the waiting room knows you couldn't see the person next to you dipping into your handbag!
Oh, and I expect them to call me Miss (not Mrs!!!) Johnson if they want to be called Dr Whatever, and to settle on mutual first name terms assuming they have the confidence.
Rosemary

[rosemary johnson]

Been feeling really exhausted.
Not sure if this is the heat, the antihistamines (loratadine - allegedly non-drowsy; anyone else find they send them to sleep?) - or the effects still of whatever it was caused me to flak eout last weekend.
Got to stable syesterday - brushed Duke and cleaned his feet. Lunged two mini-Shetlands - both going very lethargically, for once.
Lunged Duke for about 10 minutes, then climbed aboard and rode him for aout 5. Too tired to do much more, let alone ride another horse.
Too tired to do anything much today - got to supermarket, then went back to bed.
Thursdy, went out for ride (on another horse, not Duke) round the nearby nature reserve with two others fromt he stables.
Came back very very stiff and thorougly exhausted - and decidedly queasy, from riding over a lot of rough, up-and-down paths and wading through long grass round field edges and never quite sure whether going up, down, flat or where. Decidedly uncomfortable.
Managed notto freak out completely, throw up or get off in tears. More by determination than anything else.
We when got back, we put the horses back in their stables, took off saddles and bridles, and Danny said we'd all go to McD*n*ld's for lunch.
If I felt queasy on his horse, there's nothing like his driving for making me thorougly seasick in his land rover.....!
Good thing I've got the strong stomach necessitation by 7 years working with pathologists!!!!!
Feels like I haven't recvered from the tiredness that ride caused, even if the queasiness OK.
Nor the back ache - seem to get a lot of lower back ache.
anyone any ideas??
Felt mad craving for bananas yesterday. Bought a bowlful from stall at street corner today. This room i'm in now full of banana smell and I can't face one.
Going back to bed in a minute.
This is ridiculous!
Rosemary

[rosemary johnson]

Gpt tp St Rabbitwarren's Hospital today, for blood tests in endocrinology dept.
Beg its pardon; Barts.
Rabbit warren probably easier to find way around.
Nruse took one copy of appointment letter, looked around her desk for the pre-prepared pack of what she needed fo rme, didn't find it. Retreated into staff room and seemed to spend a long time at computer.
Cam back with no fewer than FIVE (!) tubes to fill with my blood.
Was it any wonder I was feeling tired and ever so slightly faint when I got home??!
Told nurse the irony was, I confidently expected all the tests to find nothing wrong as I thought it was a hypersensitivity reaction rather than actual abnormal levels.
She was very unspecific about what they were to be tested for.
SHe does think they've got a copy of the referral letter. Let's hope it hasn't got too mangled at GPs since I wrote the draft!
Found way round St RW's as far as coffe bar - gasp gasp as not allowed breakfast.
Then managed to find the way to the bank. Tell me, why do banks these days have luxurious foyers full of machines and people greeting you with encouragement to use said machines, and all the cashiers (all two of them) tucked away downstairs inthe basement?????
- and no lift in sight, sure this must be a disability discrmination issue!
I now have to wait for the blood samples to be tested and to be sent a letter with next appointment.
And hope someone with some sense has read the letter - and the results - and knows what to do with them.
Still no foal yet, as of this lunchtime.
Rosemary