An out-patient journey by Heather Currie

My father is 85, a “not-quite retired” farmer, with cardiovascular disease and arthritis. He lives alone and manages incredibly well, considering all, with family and neighbourly help.

A few years ago he complained of a small annoying lesion on the bridge of his nose. Not believing the opinion of his gynaecologist daughter (me!) or his then medical student grand-daughter that it was likely to be of no real clinical significance, he attended his GP and was referred to a dermatology clinic in a hospital 30 miles away. He can drive but struggles with negotiating hospital parking systems, corridors, finding clinics etc so was taken by a family member, to be told that yes, he did have a lesion and biopsy was to be arranged. It was deemed necessary to arrange the biopsy of said lesion (which was approximately 3mm in size), on another occasion. In due course, another family member was enlisted to accompany him, each of these visits took half a day from leaving home to return.

Biopsy completed without complication. That should be that, or should it?

Three months later, just before Christmas, father received an out-patient appointment, again at the dermatology clinic 30 miles away, for a review. He instantly thought that the biopsy result must be serious, that he had cancer, that he would require major facial surgery, or else why would he need to be seen? Despite my reassurances, he could not be convinced that it was unlikely to be serious and spent the next two months, over Christmas, worrying.

A family decision was made that because this was “so serious” it should be myself, the only medic in the family, who should take him to said appointment. I of course was happy to help, took a day of annual leave, cancelled clinics, did a 200 mile round trip in the snow to oblige.

outpatients_main

We arrived early at father’s insistence, waited patiently and in he went. Out he came, 5 minutes later. “The biopsy was fine” said he with a smile. “That’s great” said I, but then “so why are we here?” I took the liberty of asking for the opportunity to pose this question to the consultant but no, how dare I ask to question the consultant. Instead I was allowed to have a discussion with the clinic sister. I politely explained the impact that this routine review appointment had had on my father, the family and indeed my own patients who’s appointments had to be cancelled, and enquired if the benign result could have been passed onto him by telephone, letter or through his GP. The response was disappointing, and yet not too surprising—“The consultant likes to bring all his patients back and has always done it this way. He would be concerned that results may be lost if patients were not brought back.”

Done-it-this-way2

My suggestion that a review of processing results rather than continuing to cause such worry and inconvenience to patients may be worthwhile was not welcomed!

 

Was this a good out-patient journey?

This did take place in the north of England, not in Dumfries and Galloway. We wouldn’t ever cause such unnecessary worry and inconvenience to a patient nor would we use NHS resources so wastefully—–would we??

Let’s always be aware of the impact, worry and inconvenience that we may cause by what may seem like a simple routine review appointment.

Dr Heather Currie is a Consultant Obstetrician and Gynaecologist at NHS D&G.

4 thoughts on “An out-patient journey by Heather Currie

  1. Regrettably, I have to comment that on occasion in Dumfries & Galloway, the perfectly understandable and laudable desire to ensure that nobody is ‘missed’ can still result in perhaps needless stress on patients. My own husband is scheduled for repeat endoscopy every few years, because of previously biopsied intestinal polyps. He had his routine repeat endoscopy in April, and the results were fed back to him fairly promptly, including the recommendation that it be repeated in 12 weeks. That duly took place as scheduled, but by that point he was obviously keen to get the result, because he knew that changes in the mucosa were being monitored. But when he phoned up to obtain the result, the locum doctor who dealt with the query actually then sent him a paper copy of the laboratory report on his first endoscopy – which included the recommendation of a further investigation. This obviously made him very worried indeed that in effect he had a bowel lesion that could be malignant or premalignant. I noticed the date on the lab report, i.e. April, and pointed out the mistake to him. Unfortunately, he then found when enquiring by telephone about the result of his second endoscopy to his GP and to DGRI, that there was nobody who was willing to telling him the result. Which unsurprisingly resulted in him worrying that there was something serious going on that nobody would tell him over the phone…. and of course he wasn’t going to accept my reassurances that this was a simple admin error, and that if something more significant had been found at the second endoscopy, a separate process would have been initiated.

  2. Pingback: Satellites, cricket, travel down under, and a ray in Wales. | weeklyblogclub

  3. Heather, you make a very good point – we needlessly worry people and waste precious time for all concerned if we bring someone back to a clinic when we could have phoned them and told them the result. If we are truly patient centred then we know that won’t suit everyone but maybe we should put the power in the patients’ hands and let them choose….?

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