Education How long do you wait for a doctors appointment?

I see extreme (and less extreme) group dynamics working on large scale international levels, and small scale interpersonal levels. It's all Venn circles within circles --or reiterative fractals if your mind bends that way. Of course Zimbardo's effect is not the only game in town.

Including health care professionals.

Possibly by his willingness to look something up and talk at your level? Listening to patients takes time. Do you want a good consultation or a punctual one? See how it works?

Attachment influences all our relationships. You can't get away from it. It's not just about who's your mommy/daddy. It's also about: can I generally trust others? Do I matter? When it is functional we're not aware of its pervasive presence. When it is not, it becomes pretty obvious.

I totally agree. Communication Skills training is now part of the doctors' curriculum. We're also rolling it out in our hospitals. Of course staff who attend have to be backfilled and that is difficult and costly. Last 4 x 2 hours training session we did for one ward cost £32000,-- in backfill alone.

I totally agree, but how are you going to address that? We tried the punitive approach and that doesn't work. So understanding (which is not the same as exoneration) may be involved.

God no. I think that excessive hours and pressures are the least of the problem. Failing to acknowledge their impact is. Punitive rather than supportive management is. Denial of the human fallibility of staff is. How can you expect staff to behave humane if you don't acknowledge their humanity?

In one of our hospitals we now have Schwarz Rounds. It is basically hospital staff coming together for an hour to talk about how they feel about their work and the stuff that happens in it. It is about expressing those feelings and hearing them acknowledged and validated by others who feel the same. There are no fixes, no solutions, no changes; just an acknowledgement that we have feelings too, and if we acknowledge them we can manage them professionally rather than them leaking out all over the place very unprofessionally. That stuff works. I've seen patients who before were unhappy and had a difficult relationship with staff before now feel very happy with the same staff and services.

 

Lol. my appt lasted less than 10 mins. he gained time with me.

Well, based on our exchanges so far, social and workplace norms seem pretty strong on impact...

Sounds like a good step

 

Probably so. Research shows that good consultations tend to take less time. Patients who get what they need move on readily. Patients who don't, hang on trying to get it.

We're essentially talking about culture change. That is always slow. And it begins at the top...

I'm surprised that it worked so well, so quickly. Getting staff to attend is still a challenge (again: who can get away from the ward?) but when they do it is powerful. It is based around the principle of mindfulness: if you recognise and acknowledge your feelings you can manage them consciously and professionally, whereas if you don't they risk come out in inappropriate ways (in psychodynamic terms we could be talking about transference and counter-transference).

This requires a culture change from the old ideal of the unemotional, rational health professional who is in control, knows the answer, never doubts, never cries, and keeps professionally distant, to one who cares, empathises, allows doubt, allows not knowing, allows sadness. And in allowing this manages it professionally, without shame.

One year ago one of my cancer patients had a difficult time. Her health was failing fast and she appeared to be dying. The consultant (without liaising with her oncologist, natch) concluded that there was nothing more they could do. He left a young registrar to break the bad news. Of course the husband was Not Happy At All and blew up.

In response to his challenge the case was reviewed. Some treatment was tried. The patient recovered (she is still alive today). The young registrar meanwhile was very miserable with the role she had been pushed into. She expressed to the family her feelings of trapped-ness between the instructions of the consultant and her recognition of the patient's need for her to do something and give the family hope. The patient said that it seemed to her that the registrar really cared. The registrar burst into tears.

The consultant was angry. How could she have been so unprofessional! To the patient and her husband however it was a turning point in their relationship with the ward. The staff did care! They did struggle with this situation as much as they did. To them her tears were comforting and empathic.

Needless to say when the patient and husband told me this I hurried to the registrar and had a long conversation with her that empathy is good. Sharing one's feelings with the patients can be incredibly helpful for them, and there are all sorts of professional and therapeutic ways to do it. And although her crying may have felt awkward and embarrasing, the family valued her highly for it. One should not be ashamed to be human. We want human health care professionals.

 

last night at 10.30 pm called out of hours doctors re my daughter (NHS 111) , was called back by local out of hours within 10 mins - was seen at the local clinic within 30 mins of initial call.

she had anti biotics by 11.30pm

whilst she had a high ish temp during the day , shot up 38.8 whilst at doctors and her throat glands swelled up. today? much better and no temp spikes.

 

When my PEG fell out called NHS 24 at 18.30 was called back at 12.30am and told tp make my way to the Royal Infirmary and have it reinserted there. This would have entailed an expensive taxi journey, I suspect claimable. I chose to wait until the following day at a more suitable hour to contact someone at the Western General to get it reinserted as the extra time made little difference on the op required to put the PEG back in.

Why NHS 24 could not have done better remains a mystery as the records for my call and return call some 6 hours later had mysteriously been deleted.