Thursday, 31 May 2012

More tales from the hospital

Hawk head on with wings and tail outstretched
Harris hawk coming in to land
I have been trying to make friends with the reception staff at my outpatient clinic, partly because they seem to be nice people, but also because they can make the difference between a well-managed clinic and a chaotic nightmare. Last week's clinic gave me some opportunity to chat. The night before the clinic there were eight patients on the list, not a full clinic by any means, but a reasonable number to get through. By the time the clinic started, there were only seven - one had already called to change the appointment. The first patient was early, so I could see her early, and it's always nice a) to get ahead at the start and b) not to make people wait. But the next one didn't turn up, and after the third patient, the list on the computer had shrunk to just four - the others having presumably rung in on the day to cancel. The fourth didn't turn up either. So just two patients in the whole clinic, and although I bring down some stuff to do in case of DNAs, I had nowhere near enough to keep me fully occupied.

So I went out to chat to the staff on reception, not least to ask them whether it was just my clinic, or whether everybody was experiencing the same effect - perhaps it was caused by the first truly sunny, warm day of summer, when people might prefer to go the park rather than a hospital clinic? I asked them their names, and even gave them a box of chocolates that one of my two patients had given me. It was entirely unreasonable to have accepted the gift, because I had taken no part in the treatment plan - this was the first time I had seen the patient and all I needed to do was to discharge him, as he was doing fine. But it proved impossible to refuse.

This was the first time I'd been given anything by a patient, and then I was faced with the dilemma familiar to anyone who is trying to lose weight or maintain weight loss. If I took the chocolates to the office to share, then I would definitely eat some, but I don't want to eat them. So the answer was to give them to the reception staff, which is win-win because then I don't get any and they like me more and may be prepared to help out on the odd occasion when I might need them.

So far I haven't needed to ask any favours, but the other two basic grade Dietitians have both had the problem of patients brought by ambulance not being picked up before the end of the clinic. If this happens, then obviously someone has to stay with them in case they need help and so that the ambulance staff can find them. This should not have to be the Dietitian whose clinic they attended, who is unqualified even to help them to the toilet. Some arrangements have been made to bleep an alternative person to take charge, but this doesn't work reliably, and the Dietitian may be delayed for some time. If it happens to me, I want the reception people on my side trying to think up solutions, rather than walking away telling me it's my problem.

The outpatient clinic is only a brief interlude from working on the wards. One day last week, I was talking to a patient who was telling me that he was taking two supplement drinks a day. All of a sudden his eyes went a bit unfocused and he stopped responding. At that point my mind went into overdrive, fuelled by a burst of adrenaline I could actually feel, along the lines of "Oh my goodness what should I do he's died" but after just another moment I touched him on the arm and he started to respond again. He had a very poor prognosis so I wasn't about to leap on his chest and start compressions, but with hindsight, drawing the curtains round the bed and calling for a nurse would have been the next move. It was one of the more interesting experiences that I've had on the wards so far.

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