Author Topic: I hate to do it, but . . .  (Read 581 times)

Dave

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I hate to do it, but . . .
« on: February 10, 2017, 07:15:54 AM »
I think that the British NHS, whilst having its problems, is not a bad system basically. But there do seem to be built-in problems and I feel the need to higlight these where they affect me and may effect others. Hence the letter below to the complaints manager at my local hospital.

"Dear Ms Madeley,

it seems that the gremlins in the system have it in for me this year.

I have not raised a formal complaint in this matter, yet. As I have said before I am more interested in the NHS finding solutions than anything else. That seems to be inherent in my nature.

In this case, briefly (all dates 2017):

20/01 - Optician appointment due to not happy with last (4 month old) prescription. Optician concerned of possibility of wet AMD. informs me that AMD can progress very quickly and gives me a letter for my GP asking for an urgent referral.

24/01 - This is the first possible appointment, despite my telling the receptionist that I had a letter asking for an urgent referral. GP agrees to make referral.

29/01 - GP actually submits refferal.

06/02 - (approx.) Matter reffered to PALS as an enquirey. I am eventually told that a provisional appointment has been made but the matter awaits ''vetting'' by the consultant.

10/02 - No letter of appointment as yet.

Once again it seems that the demands on the consultant's time is the bottle neck. however, in this case the matter of the patient's emotional and mental welfare could be more adversely affected than in my previous case.

Having been told, by the optician, that the patients condition could progress to blindness in a matter of days, having been given a letter using the word ''ugent'', having heard that the GP has then taking five days to make the referral and, two weeks and later from seeing the GP there is nothing from the hospital . . .

I feel sure that there will be patients who will suffer emotionally from such delays, anxiety being possible. I am, perhaps, fortunate in being practical, pragmatic and phlegmatic. I also have strong empathetic qualities, though I might look at it pragmatically I know that others might suffers.

I have actually monitored my eyes over the ten or more years duriing which I have suffered slight centre-of-vision distortion. Therefore I understand that there is a fair chance that I am not actually suffering the onset of AMD at the moment. I hope that I never do, reading and using computers is 99.9% of my leisure activity - I have no TV and the radio is a ''fill-in'' device.

I also understand the demands on the time of consultants (I am empathetic towards them as well!). My optician said there was a new ''third-party'' path for referrals, via a privately run agency (and we all hear of their poor reputations and cists) that the opticians refuse to sign up for - because it causes delays! I can only hope this is supposed to ''short-cut'' the vetting process and is run by fully trained operators with at least a smidgeon of vocational drive and empathy.

Catch 22? Perhaps the money spent on agecies might be better spent on in-house vetting staff specialised for such a task?

For the moment I will not push this further but I reserve the right to write it up for whatever use I feel might be in any way efficacious in finding a ''cure'' to this ''malaise''. This may include the media and my MP. I will be asking PALS for copies of any emails they sent or received in this case.

Regards"

"PALS" Is the "Patient Advice and Liason System", a hospital department that points complaints or comments at the appropriate party and forwards the responses. It has no advocacy function.

I do not think my GP is competent to judge eye oroblems such as this, he did not look at my eyes anyway.

Also I have had regular diabetic retinopathy screening, photography of the retina. I have not yet found out if this would shiow up any AMD as well, or even if that is looked for, though retinal photography is used for that.

There is now an app for the iPhone and a hand held adaptor (as opposed to the large, very expensive heavy duty tripod mounted job using a high end DSLR and needing a mains supply) that may spread screening for such problems.

Anyway, I am not actually panicking . . . . . . . .. . Yet!
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Dragonia

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Re: I hate to do it, but . . .
« Reply #1 on: February 10, 2017, 07:55:53 AM »
Your good nature and patience is astounding. You are so correct that others would be panicking in your same situation (and for good reason!)
It is NOT right how this has been handled and let slide, and it sounds like the fault lies all the way down the entire chain of responsibility.
I do hope you get quick results and that your eyes are in a holding pattern, ie, no wet AMD.   :foottap:
Be kind, for everyone you meet is fighting a hard battle. ~ Plato (?)

Dave

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Re: I hate to do it, but . . .
« Reply #2 on: February 10, 2017, 09:09:06 AM »
Your good nature and patience is astounding. You are so correct that others would be panicking in your same situation (and for good reason!)
It is NOT right how this has been handled and let slide, and it sounds like the fault lies all the way down the entire chain of responsibility.
I do hope you get quick results and that your eyes are in a holding pattern, ie, no wet AMD.   :foottap:

Not so much the chain of responsibility per se but how well it works, this is a "logistics" problem. I have a previous complaint currently on hold because the consultant asked to investigate it says all his time is devoted to seeing patients in his clinics and on the wards. The eye consuktant has dimilar demands on his time. Thus I understand but it gets in the way of finding any solution that might possibly prevent future occurences.

Thus the real problems is in the Ps: people, protocols and practices. If you are short of people you have to look closely at the protocols and practices - are those people used efficiently whilst still being safe. If their use is inefficient and unsafe . . .

I learned many years ago that throwing a wobbly don't solve no problems!
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Dave

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Re: I hate to do it, but . . .
« Reply #3 on: February 10, 2017, 10:16:13 AM »
BTW

This was not intended as a thread just for my grumps at the NHS, if you have had, are having or facing a future, "I hate to do this . . ." situation on any subject please feel free.

Sometimes we feel guilty, afraid or unsure about things that we, deeply, know needs some sort of specific action.

I actually hate complaining - much rather help find a solution. But there are times you have to shout a bit to get listened yo.
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Essie Mae

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Re: I hate to do it, but . . .
« Reply #4 on: February 21, 2017, 07:40:52 AM »
Well all the best Gloucester; I so would be throwing a wobbly, though I agree it would be pointless. I still think though that your excellent letter is a mite too restrained; it says it clearly as it is, but you are almost letting them off the hook, though it would be great to see a positive response.
ESs
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Dave

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Re: I hate to do it, but . . .
« Reply #5 on: February 21, 2017, 09:46:03 AM »
Well all the best Gloucester; I so would be throwing a wobbly, though I agree it would be pointless. I still think though that your excellent letter is a mite too restrained; it says it clearly as it is, but you are almost letting them off the hook, though it would be great to see a positive response.

I have found that throwing a complete wobbly just gets you a bad reputarion. Reasoned argument works better.

Outcome was that two months (my appointment is mid March) is within the policy guidlines for "urgent" cases - only emergencies get bumped to the front of the queue.

My complaint will still be based on patients who have been given the "blind in a few days" description of wet AMD and had the urgency of their making an appointment emphasised may be liable to suffer emotional trauma when things move so slowly.

I am aware that much of the cost in the NHS is due to late or inadequate treatment leading to the need for more intensive treatment or loss of everything up to life. Save £100 at the GP level and spend £10000 or more later.
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Essie Mae

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Re: I hate to do it, but . . .
« Reply #6 on: February 22, 2017, 05:41:13 AM »
Cripes! If 'blind in a few days' isn't an emergency, what is? Could a solution to this particular problem be to train opticians to treat patients? They're the ones who diagnose after all.
ESs
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Re: I hate to do it, but . . .
« Reply #7 on: February 22, 2017, 06:26:27 AM »
Your letter was very nicely worded Gloucester, and I must say extremely polite and guarded with only the slightest bit of sarcasm that I could detect after having translated it from the Queen's English to "Merican.

Must say if I was in your shoes my letter would have been a bit brassier, and most likely would have contained one or two finely-placed words of slang.

Amazing constraint you have, admirable it is.
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Dave

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Re: I hate to do it, but . . .
« Reply #8 on: February 22, 2017, 07:43:14 AM »
Cripes! If 'blind in a few days' isn't an emergency, what is? Could a solution to this particular problem be to train opticians to treat patients? They're the ones who diagnose after all.

Seems there's a can of worms, or three, here.

Highstreet optometrists are not actually counted as medical professionals. They are technicians trained to manipulate the kit and interpret the results. An optthalmic optician will be further trained to recognise eye disease.

Once both types were allowed to directly refer patients to the local hospital, now they have to go via a qualified medical practicioner. There are not enough surgeons to perform a triage function - though the GP can use a "short cut".

I had been told, ten years or more ago, that I had "cellophane retinopathy". I mentioned this to the optician, don't know if he was an optometrist or opthalmic one, latter I think, whom I saw in January. He claimed there was no such thing, that it was a term used by "lazy opticians".

The second optician I saw said that he was wrong but did not elaborate. Later research indictes the latest (of at least five other terms) label for it is "macular pucker". It is long term, usually not progressive (mine has not noticeably changed since first noticed), is treatable by eye surgery under local anasthaetic but is left alone unless it seriously affects the ability of the patient to function. Don't think that covers being able to drive though.

My other problems, floaters and the first stages of cataracts, are also fixable. They can drain out the vitreous gel and refill the eye with saline!

I have the advantages of the right kind if intelligence, a pragmatic and phlegmatic nature and the willingness to seek sources of information and, largely, understand what I find and how it fits the pattern.

Some patients do not and I am empathetic enough to feel for them. But, it is not an uncommon problem in many medical fields, just that some have a bigger emotional impact. Loose my eyesight or a foot or even a hand? Keep my eyes every time!
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Tank

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Re: I hate to do it, but . . .
« Reply #9 on: February 24, 2017, 10:29:25 AM »
...
My other problems, floaters and the first stages of cataracts, are also fixable. They can drain out the vitreous gel and refill the eye with saline!...
I had cataracts in both eyes a while back and had both lenses swapped out for plastic ones. The operation is better than going to the dentist. You have to be a bit creative with your glasses afterwards though!
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Dave

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Re: I hate to do it, but . . .
« Reply #10 on: February 24, 2017, 10:34:08 AM »
...
My other problems, floaters and the first stages of cataracts, are also fixable. They can drain out the vitreous gel and refill the eye with saline!...
I had cataracts in both eyes a while back and had both lenses swapped out for plastic ones. The operation is better than going to the dentist. You have to be a bit creative with your glasses afterwards though!
Was that private, Tank?
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Tank

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Re: I hate to do it, but . . .
« Reply #11 on: February 24, 2017, 10:42:35 AM »
...
My other problems, floaters and the first stages of cataracts, are also fixable. They can drain out the vitreous gel and refill the eye with saline!...
I had cataracts in both eyes a while back and had both lenses swapped out for plastic ones. The operation is better than going to the dentist. You have to be a bit creative with your glasses afterwards though!
Was that private, Tank?
No. NHS. It's actually quite fun. You can still see (al bit it very blurred) while they do the operation. And that sounds a lot worse than it actually is! On the second op the anaesthetic stopped my optic nerve from working. Guess what? Everything go white not black. So the brain's default position when starved of input is white.
 
If religions were TV channels atheism is turning the TV off.
“Religion is a culture of faith; science is a culture of doubt.” ― Richard P. Feynman
'It is said that your life flashes before your eyes just before you die. That is true, it's called Life.' - Terry Pratchett

Dave

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Re: I hate to do it, but . . .
« Reply #12 on: February 24, 2017, 10:47:28 AM »
...
My other problems, floaters and the first stages of cataracts, are also fixable. They can drain out the vitreous gel and refill the eye with saline!...
I had cataracts in both eyes a while back and had both lenses swapped out for plastic ones. The operation is better than going to the dentist. You have to be a bit creative with your glasses afterwards though!
Was that private, Tank?
No. NHS. It's actually quite fun. You can still see (al bit it very blurred) while they do the operation. And that sounds a lot worse than it actually is! On the second op the anaesthetic stopped my optic nerve from working. Guess what? Everything go white not black. So the brain's default position when starved of input is white.
Takes a certain kind of person to think it is fun. But like me in a near fatal condition, lightly sedated, having stents inserted but still aware and asking, "Why do you . . .?"

Oh, and being, very firmly, told to keep quiet.
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