Patient Centred Care – Your Actions Today by John McGoldrick

A wee story.

George ‘Geordie’ ‘Specs’ Hastings was 72 when he died on 29 January 2017 after a short illness.

StepsGeorge was one of the town’s characters, seen and greeted by many as he sat on the doorstep of his flat in Assembly Street, Dumfries. George had a very full and active life, working in many of the key establishments in and around Dumfries. He was a family man, a much loved Dad, Granpa, Great Granpa, a big football fan and just a popular guy who always had a smile, ‘hello’, quick quip and happy chat. He amused many with his stories and his legendary sun tan was achieved he claimed in (on) ‘Door Steppie’, many puzzling where that exotic place was. The volume of family and friends attendance at his funeral service reflected the status he had in our community.

George ‘took ill’ and was in painful, deteriorating health for a number of weeks in late 2016, culminating in his attendance at the Emergency Department, DGRI on 15 December 2016.  George had been under the care of his GP(s) and District/Practice Nurses, with little apparent improvement in his ‘sciatica’ as George intimated to folks.

His attendance at ED saw him immediately admitted to hospital, the duty ED Doctor recognising a significant deterioration in George having seen him some 3 weeks earlier and the review of George’s ‘on line’ recent blood test results indicating a significant health problem –news to his family. From then George was submitted to a range of checks, tests and treatments for what was quickly identified as tumours on his spine, bladder and lung. The immediate response and care provided by the ED medical and nursing staff was exceptional.

He was admitted to ward 7 and the medical team contacted the Oncology team in Edinburgh. This resulted in George being transferred to the Western General Hospital for a spell of treatment before returning to DGRI ward 12. It was here that he and his family experienced ‘Open Visiting’ which made life easier for all of them. Unfortunately though, due to bed pressures, George was transferred to a Cottage Hospital that did not have the same visiting freedoms. This led to extreme frustration for Georges family and friends as they had to travel some considerable distance to visit him only to find they had to wait for some time in an area they didn’t know to get ‘access’.

Why was George moved to a Cottage Hospital some distance from friends and family? Well this is sometimes necessary when beds are tight but is not seen as good practice however we must remember the need of the patients at the ‘Front door’ who need admission and maybe extremely ill. However in this case something was missed….George was dying, this was beyond doubt. There were no beds in the Alex unit but was he the best person to move to a CH? This is answered when it became apparent that George ‘needed’ a blood transfusion and required transferred back to DGRI to receive this.

Following this George was moved to a Nursing home where he died one week later on 29th January 2017, 45 days after initially presenting to ED. This last week was not the best for him as caring staff did their best with a dying man who was in pain and discomfort. This raises some questions; did George require a trip to Edinburgh in what was to be the last month of his life? Was it fair to move him so many times, 6 overall, when he was dying and needed a little comfort, love and continuity? Did he require the final move in his last days? DGRI was busy, it was the Christmas and New Year spell that often leads to real pressures but what happened to George? He just disappeared in the busyness and ended up being passed from pillar to post, not the best way for such a kind, respected man to end his life.

There may be no easy answers but there are some things we can do – our New Hospital will have open visiting on all wards and we can replicate this in all our hospitals. We can have more realistic discussions with patients and their families to prevent unnecessary trips either to Edinburgh or other major centres and for other treatments that may only prolong death rather than life. But the main thing we can do is remember George, and all the other patients like him. They are not simply ‘bed blockers’ or ‘the stroke in bed 3’, they are people, with lives, families, friends and stories. They matter and as such should be treated with kindness and respect.

Specs

Thought for today

George was a ‘Ten out of Ten’ chap.  His end of life care and treatment did not reach that standard.

We often hear that lessons learned and procedures put in place will make sure no repeat of the identified problem events.  As you go about your professional business today – will you really make sure that you listen to patients views and wishes, that you ask Whose Needs are Being met? and What Matters to Them? to do our best to ensure that there will be no other terminally ill patients who have to suffer a similar journey to that of George Hastings?

John McGoldrick was a friend of George Hastings

2 thoughts on “Patient Centred Care – Your Actions Today by John McGoldrick

  1. As someone who knew George for many years
    This blog defines the true character of George.such a tribute to him that highlights so much.

  2. Our family can speak of a similar experience to George in relation to our father a number of years ago. He died ten weeks after visiting his GP but not before undergoing aggressive radiotherapy and chemotherapy in Edinburgh for six weeks. Other health issues meant he did not have the resilience to cope with the impact of his treatment. No member of medical staff in Edinburgh spoke to the family. He returned to DGRI extremely distressed and frightened. I will never forget this.

    The care and treatment he received on return was first class. I still clearly remember the relief on my father’s face on wakening to find that he was not in Edinburgh but back in Dumfries. However, it was only when he entered the Alexandra unit that medical staff involved the family in discussions. The care and compassion shown to both my father and ourselves, by all the staff involved at that point, was excellent.

    Had medical staff had open and honest conversations at the beginning about what would be involved for my father, with our support, he may have opted for a different course of action. The time he had left may have been of better quality. But we were never included and he had no real appreciation of what was in front of him in terms of the impact of his treatment and likely outcome. Our memories of those last ten weeks are blighted for having witnessed a confused and sick man placed in a grim hospital 75 miles away.

    I welcome the current move towards ‘Realistic Medicine’. However, when I started nursing in 1981 open and honest discussions with patients and families was standard practice. Informed decision making about all aspects of care was encouraged and practised. What went wrong?

    Thank you for your blog about George and his experience. Hopefully the future is brighter in terms of patient and family involvement in decision making. After all, this is our future.

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