Education How long do you wait for a doctors appointment?

When was I wonder that the medical profession joined the ever growing list of of institutions, call them what you will, that are now not responsible for their actions no matter what the consequences. We have had mmultiple deaths in a hospital and absolutely no one held to account.

They join of course bankers, social workers, the police and not forgetting mp's.The most these groups will incur is at worst a slap on the wrist but will probably be promoted of moved elswhere with no loss of earnings and if they are really lucky and someone has uttered some unkind words the a bit of damages will likely come their way.

But cheat on your benefits and expect the full weight of the law after being named and shamed.

 

Call like an mad-man for 1hr at 0800/1300 and hope for an emergency appointment or book a 2 day/1 week in advance appointment with GP.

 

My GP has an infuriating system.

You can't make appointments except for that day. There's no guarantee you'll get one, so if you need to take a day off work to see the doctor, you might find you're **** out of luck for that day and have wasted a day off work.

They claim it's to cut down on "wasted appointments", which I get. Doctors time is important. But why not just put a fee on missed appointments? Making it impossible for me to get an appointment even a few days ahead of time is unbelievably annoying.

 

I'm not saying that the NHS is perfect. No human system dealing with Real Life™ is. Neither is private enterprise.

The best way of thinking what can happen to health professionals is in terms of Zimbardo's experiments, group dynamics and burn-out. Overwhelm causes people to abandon ideals.

It is easy to blame social workers who do a messy, thankless job with lots of personal responsibility but (and here's the catch) little formal power. As for hospitals: people do die there. Some wrong stuff happens, but don't believe everything you read. That apocryphal story of thirsty neglected patients drinking water from vases in South Staffordshire Hospital? Where did the vases come from, if it is standard NHS infection policy not to have flowers on the ward?

 

What's the story with private healthcare / health insurance in the UK? Does it exist since the NHS is there.

 

Yeah. You can pay as you go for individual treatment or buy insurance. Most people in half decent jobs get private care - this works as a supplement to the NHS, typically kicks in for certain types of treatment, or if the wait for the NHS treatment is over 6weeks.

As it's supplementary the cost is pretty low - my employment cover is taxed at ~ £50/month for me and the missus.

I've never used it, but the missus has a few times - once for speed, and the other time so she could nominate the surgeon who would be poking around inside her shoulder (she's an anaesthetist so wanted to choose someone she trusted...).

From her experience, about the only time doctors can jump queues / nominate specific staff is for childbirth.

 

Should also say it's normally the same staff who also work for the NHS. In fact from her experience (she's worked in both private and public health) those who work exclusively in the private sector often do so because they failed exams/traning/the system in the NHS, though obviously that's not always the case.

She's about to be a consultant - her job will be 3.5 days a week public (plus all the obvious overhead management/training stuff on top of that) and will probably be 1 day a week private. Compared to what someone of her age/skill level gets in my line of work, her pay is about 1/3 - 1/2 of the amount, probably about 1/4 what she'd get in the USA at the same level.

 

I am an NHS professional. I know the good, the bad, the ugly of both NHS and private health care. I don't have private health insurance. Draw your own conclusions...

 

No argument its a deeply flawed system and doesnt work for you, but actually a fee for missed appointments would be one of the worst things to do. It serves to remove the social obligation to attend and turns it into a transaction. Has no effect on those who dont turn up now but increases the no show rate in the rest of the population. It makes the problem worse as it legitimises not showing up, which is one of the reasons they struggle to manage resource against need.

Neither is perfect but external impartial (but informed) perspective is typically better at seeing root causes and than internal innovation.
The Zimbardo reference seems a bit extreme. There was a lot more going on in Stanford prison. The early and sustained dehumanisation of prisoner population with inmate numbers, as just one example. If there is comparable experience in the health profession then we are in a lot more trouble than I thought and should consider nuking the site from orbit.

We're getting off the OPs topic though so I'll bow out rather than derail more

 

That's interesting, its something I've been curious about. Also an interesting point on private only medical staff.

You don't get paid enough?

 

Our GP waiting times are very hit and miss. If you want to see a nurse for something like a diabetic checkup then that's not too bad, a day or two wait for the blood appointment then a week later for the results / checkup.

A doctor however... get lucky and you could see one inside 2 weeks, more likely to be a month. Want to see a specific doctor and you could be waiting 2, 3, or even 4 months depending on which one you want to see. It's all to do with patient numbers, our surgery has too many registered patients for the number of doctors, and they're still accepting new registrations...

/*edit*/ Oh, forgot the 6 month wait or so for a physio appointment, by which time my back was sorted and I didn't need it anymore...

 

Two weeks standard here (North Hampshire).

Two weeks is a long time if it's something important, so I normally try and snag a quick telephone appointment first and let him advise further. Also great for prescription renewals.

 

So the likes of the Stafford Hospital scandal was the fault of over zealous reporting, that is a relief. And if you want us to believe that poor feeding and drinking practices in manny hospitals pparticularly with elderly patients is not an issue then I would have to disbelieve a good friend's appalling care in this area and the many reports we seem to get with increasing frequency on our television news.

I also saw it first hand hen I was in for chemo. For some inexplicable reason on a ward with everyone suffering from the same and potentially life threatening illness and having poison pumped into our veins how so few staff their were. And people were being ignored, I doubt deliberately, but ignored all the same and some were patients were struggling to eat and drink.

 

Let me know when you find it.

If it seems extreme, then you're not grasping the underlying principle of group dynamics. Don't think of the prison element of it; think of the institutionalisation. And the whole thing is mutual: to an extent patients expect doctors to be gods. They expect nurses to be angels. And attachment theory tells us that their expectations can be complex and messy...

Bad feeding practices? I know they exist. Since I treat severe weight loss in cancer it's an issue I deal with continuously. I don't know why we don't just get a ton of volunteers in to help with these simple ward tasks that nurses simply don't get time for (and they don't. Notice how the government neatly sidestepped the issue of nursing staff shortage on wards by issuing recommendations but not regulations), even if there is some management attached to those volunteers (which can be like herding a bunch of cats).

But there is biased and sensationalist reporting, and that is not helpful. I don't trust the press, which I notice makes me feel defensive and tight-lipped about my work in the NHS. And that's not good. If you want people to feel able to whistle-blow, they have to feel OK about approaching the press.

 

So it is back to us patients then? We expect our doctors to be gods nonsense. We expect our doctors to what is best for us not what is best for the system. We expect our doctors to be honest, to be truthful to answer questions posed and not to treat us a little more than a number.
Which brings to mind an old joke told to by a consultant. "What is the difference between God and a consultant? God does not think he is. I have met arrogance beyond belief in some consultants who's belief in their own infallibility was astonishing and really should not be in their profession. But I have also met some fantastic people who still see their patients as people in need of help as opposed to a number on some government target requirement.

As for nurses I think we patients are looking for compassion, professionalism tempered with humour and above all enough of them on a ward that they have the time to spend with those that need a little extra help to eat and drink perhaps. Not angels.

 

I should never say that I'm not going to reply again...

You mean 'them'. There are myriad root causes to the ongoing poor performance of he NHS against the demands, expectations, and needs of the population. There is no silver bullet and you can't start afresh whilst still having anyone involved who was part of the old system.

On the contrary, I understand group dynamics and behaviour fairly well, I just don't agree with you.
Patients dont expect doctors to be gods. I suspect patients expect medical science to have power over God, and to be able to fix anything, which simply isnt possible. The role of the doctor is as a representative of science, a way to anthropomorphise the field. From your comments I guess you see a disproportionate number of people for whom this has been brought home with some finality and struggle to deal with it.

Patients do however suffer from authority bias whilst dealing with doctors and that means that they find it difficult to effectively challenge and query what they are told as the bias all but shuts down the parts of the brain associated with critical thinking in most people.

I dont mean this to be antagonistic, but your perception of mutuality in this regard seems likely to be a reflection of your own biases and possibly an example supporting my earlier point that external parties can see more clearly.
The mutuality of the exchange resides in the social/psychological contract between doctor and patient trust is contributed by the patient, and competence and capability is expected from the doctor. Note that judgement is not expected or wanted and many doctors mistake a patients willingness to be treated for a desire to be 'fixed'. I could say a lot more on here as I think this is a significant source of the 'god' complex - not understanding the underlying contract from both sides.

The angelic nurse is an archetype, an ideal, not an expectation. Competence, emotional intelligence, empathy; these are expectations. Granted, expecting all of the above from every nurse all day/week/year long is unreasonable. They are people too and will have bad days. But if that bad day is my experience, the good days count for squat with me.
My son was born in an NHS hospital and over the course of 30 hours in hospital with my wife, we had an incredible nurse, not an angel but someone who fulfilled our expectations and more. She went off shift and her relief was incompetent. She sat in the same room fiddling with her mobile and had to be reminded by me twice to change the saline drip. This is not meeting expectations. Neither was required to be angelic.

I dont think attachment theory plays a big role for the majority of patients, who won't have an ongoing relationship or regular contact with the same people. Again the people I suspect you see are a subpopulation for whom this probably does play a role. It may surface in some ways during traumatic experiences but you make the doctor patient relationship sound about as healthy as Stockholm syndrome.

Apologies if I have misunderstood or misrepresented your role in the NHS, or my assumptions are incorrect regarding the populations that tend to be referred to you. Please correct if I'm in error.

 

Okay, sure, I get that. But the way it works now makes it near impossible for me to ever see a doctor. Last time I went I got lucky in that I had a day off work anyway, but I've been trying for six months to get an after work appointment (Only on Tuesdays and only until eight pm). I'll let you guess how well that's been going.

 

You do, because you're a reasonably mentally healthy, intelligent rational human being. Not everyone is like that. There's £36 billion worth of patients out there who take little responsibility for their own health and expect doctors and nurses to fix it for them when it all goes pear shaped.

We do expect doctors to make the correct decisions about human lives in complex ambiguous clinical situations all the time, and the only way you can do that is by having an almost arrogant self-confidence. It's a tricky balance: too little self-doubt makes you arrogant and prone to mistakes; too much self-doubt makes you indecisive and prone to mistakes. Cognitive dissonance kicks in: "If I have all this responsibility and power, then I must know what I'm doing".

We also expect doctors to be able to break the bad news and watch people's lives fall apart, and contain their patients' distress and anxiety, over and over again in a busy clinic where perhaps they have no more than 20 minutes to spare. Over long working days, with many different obligations and priorities: not just the patient in front of them, but also the patients on the waiting list, the staff working under them, the resource limits imposed, accountability to managers who are held to account in turn for meeting targets and managing limited resources.

It is not a fun job. it is not even a particularly well-paid job. Interesting, sometimes. Worthwhile and rewarding, sometimes. It is a very stressful and demanding job, always. And health care professionals are not trained in how to handle that, generally, and therefore develop their own psychological defences. Some of those functional, some, not so much.

Just to clarify my position: I think that the treatment that you have been experiencing is unacceptable and that making a complaint is a valid way of addressing that. I don't subscribe to the idea that this is because staff are just uncaring or incompetent, although I certainly think that they could and should have been more helpful. Often people lower down the hierarchy are browbeaten into following a system unquestioningly. Challenging it simply becomes more than their mortgage and mental health is worth. I am in the more priviliged position of being fairly high up in the food chain, and outside of the medical hierarchy. I can afford to challenge things a lot. But even I have to pick my battles lest I acquire a reputation as a chronic moaner and people stop listening to me, and there are limits to my power to influence things.

That would suggest that people can't learn and change. Every change of government we "start afresh", try and change everything. How is that working out? You can't start afresh. You can't get rid of all NHS staff, systems and infrastructure and start from the ground up.

Moreover I'm not sure that there are external parties. We are all patients for one. I've been a patient in the hospital I work (interesting experience, that) and also a health professional and I am a tutor/trainer/clinical supervisor of health professionals and a manager of them. I try to look at it from all angles.

Then you know that Zimbarbo's experiment is not about the prison. It's about people subjugating personal identity, values and choices to that of the group that they are (often arbitrarily!) assigned to. It is about aculturation, institutionalisation, ingroup-outgroup dynamics; the loss/relinquising of ability to see oneself as an individual human being, and other people as individual human beings too.

Gods, high priests, representatives; same thing. The alternative to my rough definitions is huge walls of text trying to define my terms.

You make some good points. I must point out that I am challenging one position (many doctors and nurses are incompetent/uncaring) so it may seem that I am leaning towards the opposite position. I am actually in the middle on this. Also I am being a bit rough with my language to keep posts short.

Again, you describe patients from a rational perspective. At the same time there is, as you allude to, also an emotional perspective. This is reflected in your reasonable expectations from doctors and nurses, and acknowledgement of their human fallability, followed by the more emotional statement: "But if that bad day is my experience, the good days count for squat with me". That is a natural way to feel, but it is not a rational position. Yet both are valid at the same time.

Attachment plays a role in all relationships --even relationships to more abstract entities as the society one lives in, or the god one may believe in. It is always there. As such I think that attachment plays a BIG role in patient interactions with the health service --not just attachment to specific professionals but also to the caring services and medical science-as-god that they represent, and in terms of treatments as transitional objects. This is a healthy, functional process, not a dysfunctional one (although the attachment can be dysfunctional in patients who have experienced neglect and abuse in childhood), and even a necessary one. Stockholm syndrome does not apply. You must feel able to trust the doctor/nurse who treats you; feel safe with them, reassured and comforted by them, in order to engage in and benefit from treatment. Some health care professionals are very aware of that. Some totally aren't (which says something about their attachment). The NHS as an institution is still struggling with the concept. Another long debate we psychologists are having with the NHS.

At the same time there are many human processes happening in the health professionals. Why was that nurse withdrawn in her room fiddling with her mobile? You write insightfully about the human processes that go on in the patient (of which there are many of course, not just authority bias) but there are reasons why health care professionals behave the way they do, and that must also be acknowledged and understood if we want to change things. Just because there is a power imbalance between health care professional and patient does not mean there is no mutuality.

 

Thanks for the reply I was asking about working hours as I wasn't sure what is expected as a full time job on the NHS. As the EU directive is 36 hours a week I was assuming that was the most likely amount.

Knowing a number of doctors and nurses, I know they all put in more hours than they are meant too, I wasn't saying otherwise. Personally, having nurses do 12 to 14 hour shifts is completely moronic, I work for 14 to 15 hours a day, the last 2 to 3 hours I tend to make more mistakes than the rest, I have no idea how nurses and doctors are allowed to work those kind of hours in day when they literately have life's in there hands!

As for the NHS being the most efficient in the world, wow, that is a shock to me! How bad are the others then?!

 

I've worked with a few central government departments and other public bodies through party changes and it is far from a fresh start, it changes nothing meaningful in operational terms and nobody that has executive control is changed. Yes I accept funding and policy impacts but its not starting afresh. That is just rhetoric.

Yes but you are applying extremes of group dynamics evidenced only in small closed groups to the 5th largest employer in the world (4th in you ignore McDonalds as most is franchised indirect employment). All members of staff in the NHS are members of other social and cultural groups as well. Zimbardo took his experiment to extreme by eradicating all balancing forces. I think I get your point but would suggest the effect your describing in closer to groupthink effects as seen in the bay of pigs fiasco. Which again supports my point that external perspective is necessary, as free as possible of bias, functional fixedness, in attentional blindness etc. The existing NHS management cannot see the gorilla and if they do, they think its another basketball player.

okay. Lets use terms that dont evoke mindless drinking of kool aid though.

I'm not a rational creature, nobody is. That is a fallacy which has been disproven. Uncomfortable but true. People are however, to steal the term, 'predictably irrational'.

My comment about the bad day not counting was unclear. Its not emotionally borne, but intended to reference that we use our experience to update heuristic models. If the perception of then populace is that the NHS is failing then the heuristics are supporting that view in the average case. Some is adverse impact from the media, but the staff in the NHS have their role to play in it. This is a subconscious and essential process but not emotional in nature we constantly improve our ability to predict the world by integrating our experiences to improve the mental models. If I get a bad experience my mental model is adjusted regardless of a logical understanding that this was only my experience, and regardless of being able to consciously slow down my thinking about subsequent issues (system 2) in Kahneman's terms.

I don't feel attachment to the profession, I have been fortunate to have very little personal need for it. Though my experiences result in a negative perception of poor emotional intelligence, conflicts of commercial interest, rudeness, and the very patronising arrogance you yourself mention. These unfortunately outweigh the fantastic doctor I saw on Tuesday about an eye infection, whose demeanour, willingness to be seen to look something up, ability to talk to me at my level, all overshadowed the fact that I waited to be seen 30 minutes after my allotted appt time of 9:30. (Rhetorical ?: how do you get to be running 30 mins late on 15 minute slots by 9:30??)

For clarity the talk to me at my level was positive in that he could talk intelligently without reliance on medical terminology that would be unfamiliar to someone outside the profession, but without dumbing down to the point of being patronising.

Anyways I think agree to disagree on attachment, I think its more relevant to a minority of patients that you likely deal with as a majority due to your role, whilst interpersonal dynamics adequately explain the majority of interactions between the professional and patients.

I do however strongly feel that all doctors should have a solid understanding on interpersonal impact and psychology. Particularly in terms of social contracts, behavioural economics, and heuristic biases. That they dont, and yet are placed in positions of situational power is wrong and I hope that those debates result in a change to doctors awareness.

There could have been a million things going on with her at the time but lax care of patients and dereliction of duties is unacceptable in any circumstance. In that specific case, used only as an example the saline drip was important and necessary and had been diligently monitored by the previous nurse. If a truck driver has an off day or urgent communications to make, they can't do it while working, it would be unacceptable. If I'm fed up and go to work behaving like it - checking facebook or the like, my clients won't pay me. If I'm dealing with stuff and need to distract myself then I should not be at work, period. One standard for all. They are being paid to be there and provide a service in a tough career, but one they chose, and continue to choose every day. If I see a doctor or nurse its unlikely I have selected them or had any influence or choice, that they will provide my care. It's not a question of situational power or disparity, or mutuality but one of personal responsibility on the part of the medical professional to deliver their end of the commitment they gave when they took the job. No different to anyone else.

Before citing excessive hours and pressure, (I accept that has impact) let me ask: Do you think, across the whole NHS, dropping the hours to reasonable levels would change all the negative behaviours or just remove an excuse for them?
My point is that the behaviours are institutionalised and internal but are not recognised as a result of groupthink and flawed definitions of normal and acceptable.

PS. Not typing a reply this long on a phone again.