Thursday, September 08, 2011

The Hospital Appointment

Today Stephen had a hospital appointment.

He has had a frozen shoulder for over six months now and is having some physiotherapy for that. But he has a lot of pain just about everywhere, and the GP thinks it's fibromyalgia.

Both these are chronic conditions which cause a lot of pain, and fatigue, too.

However, he's had no time off work because of them, and they haven't stopped him from cycling twelve miles a day in total to work and back. But sometimes the pain is so bad that he simply can't move for a while.

Stephen is not very used to hospital visits, or, indeed, doctors: - a glance at his medical records when he first went to the doctor's with the frozen shoulder showed that the last time he was at the doctor's was in the year 2000, and, before that, in 1994. So he doesn't really know how hospital departments work - - but, then again, why should he?

Anyway, finally, a hospital appointment for the fibromyalgia came through.

Stephen stood in front of the reception desk. The receptionist on the right was chatting in a gossipy way to one of the other staff. The receptionist on the left was looking at her computer and didn't look up. One of the queueing patients tried to talk to her but she cut him off by holding up her hand in a "what I'm doing is SO important, do not interrupt me" way.

Eventually she must have registered that Stephen was there, but didn't look up or speak: she merely held out her hand for the piece of paper he was holding.

She took it from him, but didn't say anything. Stephen waited for her to tell him what to do next. She didn't say anything. So he kept on looking at her, expectantly.

"Oh, do you need it back?" was her first foray.

"I don't know. Do I?" asked Stephen.

Then a nurse called him in. She was very pleasant but didn't introduce herself. She sat him on a chair and put a blood pressure cuff on his arm and left him for a while whilst it inflated itself. She didn't explain what it was, though, or why they were taking his blood pressure, or indeed what the result was when they had taken it.

Of course, because he cycles twelve miles a day, I'd guess his blood pressure is nice and low - - and couldn't she have said so, in a friendly manner?

Then she asked him to step on a machine to check his height.

"Shall I take my shoes off?" he asked.

"No, do it backwards," was the somewhat confusing reply, because she hadn't listened to what he'd asked and assumed he was asking which way to step onto the machine.

Finally he saw a doctor - or we will presume it was a doctor, since he didn't introduce himself.

The doctor checked all Stephen's joints lots of times. For Stephen was in the rheumatology department, and rheumatoid arthritis was clearly what this doctor was about.

Stephen kept explaining that his joints don't hurt: no, they don't swell up: they are fine. Everything else hurts, but not his joints.

"So, when do you get these aches?" said the doctor.

Stephen explained that they are not aches. They are sharp pains. They are everywhere except his joints. At their worst, he feels that he can't bear the pain.

"So, when do you get these aches?" asked the doctor, in reply.

Another doctor came in. Well, we'll presume he was a doctor, though he didn't introduce himself. The first doctor was very reverential towards the second doctor, so perhaps Second Presumed Doctor was more senior.

This doctor was foreign, with a strong accent.

"You should try Coblblblblblblbblblb for the pain" said Second Presumed Doctor.

"Sorry, I couldn't quite hear that," said Stephen, "what drug did you say?"

The doctor repeated it several times in exactly the same way. He didn't think to write it down, or to spell it out, and looked at Stephen as though he was displaying deep stupidity in not understanding.

First Presumed Doctor wondered to Second Presumed Doctor if the other pains and the frozen shoulder could be connected in some way.

"No." he explained, and said no more.

Second Presumed Doctor checked all Stephen's joints again. They still weren't swollen and they still didn't hurt.

Finally they decided that he should come back in two months to have all the same blood tests done all over again, although these blood tests don't seem to have conveyed anything of meaning. Not that they explained this to Stephen.

"It was the Sausage Machine school of medicine," said Stephen.

As regular readers (ohhh that sounds so grand!) of my blog will know, one of my jobs is to help to teach Communication Skills to healthcare professionals in different jobs.

Stephen was very unimpressed and I'd say that this was a lazy and thoughtless department. Many of the patients were "regulars" and knew exactly how the systems worked - - but Stephen was new, and didn't, and nobody bothered to explain, and their lack of communication skills was appalling.

The very least that a patient should expect is for everyone to introduce themselves - their name and their job: and to say what they're doing and why they're doing it: and to listen to the patient and to take on board what they're saying about their problems: and to reach a shared management plan with the patient so that both parties know what will happen next, and why.

Whereas what Stephen got was a couple of doctors who weren't listening to him, and hadn't the foggiest clue what was wrong, so passed the buck on to someone else in a couple of months' time.

Sometimes people say to me "Communication Skills? Isn't that just common sense?"

Yes, well, common sense is not so common, unfortunately. Some people just have naturally good communication skills. Others don't, and have to be taught. And some need frequent reminders.

I'll be starting to work with medical students again soon. Almost all of those I met last year were delightful, intelligent and keen to learn. So let us hope that things will - albeit gradually - change.

Meanwhile, Stephen's going to see if he can get a private appointment - he can get BUPA through his work and, ironically, that may well mean that they take him more seriously.

Things shouldn't be like that.


Blogger Jennytc said...

Obviously these 'doctors' were not among your past pupils, Daphne.

6:28 pm  
Blogger Yorkshire Pudding said...

I had a painful frozen shoulder last year for months. Though the pain has subsided, the extent of my shoulder movement remains reduced. I had three or four sessions with a physiotherapist but I am not convinced that recommended exercises are the way to tackle frozen shoulders which hurt and are stiff because of inflammation. Rest is probably the best medicine with gentle movements to keep the shoulder supple and then just pray it gradually goes away as happened in my case.

6:51 pm  
Blogger Silverback said...

I bet what's frustrating you the most is that you didn't go with him !

I suspect that if you had, then the receptionist, nurse and both presumed doctors would now be seeking therapy.

Hopefully in that same hospital.

8:21 pm  
Blogger Daphne said...

Jenny - - oh I SO hope not!
YP - yes, I remember your frozen shoulder. Stephen's not convinced that the exercises help, either. It is supposed to just get better on its own - - but it's taking a while -
Silverback - - I can only reply with a meek "yes, indeed!" I did think of going - though we'd probably both have been thrown out if I had!

8:25 pm  
Blogger Jan Blawat said...

Wow, I didn't know doctors treated men like that, I assumed it was part of their sexist philosophy, but I guess when you're looking down your nose at patients it doesn't really matter if they're men or women.

10:40 pm  
Blogger Helsie said...

What an awful, FRUSTRATING experience. When you are paying for it yourself , you won't put up with that so you might finally get somewhere - don't pay the bill if you don't !
My experience with shoulders is, if you don't use it you'll lose it - movement that is. Treat the inflamation and gentle movement(physio designed exercise) and TIME - but you will have to work hard on it to eventually get all the movement back.
Hope it improves soon.

11:22 pm  

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