Wednesday, 10 April 2013

A morning in clinic

Garden view through wrought iron gate
Sissinghurst, June 2012
I have a patient booked at 9am. When I looked forward over the clinic list yesterday, he needs an interpreter. I am still new to these hospital systems, is one booked? I asked office admin to check. Office admin called back a bit later, asking "Which language?" The records say ‘patient attended with interpreter’ but don’t say what language. A bit of detective work and deduction and I come up with a theory, but this morning, office admin regret to tell me they couldn't arrange an interpreter. Plan B: do as much as possible with drawing and hand gestures and make a new appointment, with interpreter.

I am expecting a busy morning. The nurse in charge says hello, and tells me that one of her colleagues was exhibiting symptoms of diabetes, they persuaded her to check her blood glucose, it turned out to be higher than it should be. A diabetes consultant happened to be in the clinic at the time, he agreed to see her, and now he's writing to her GP. Her blood glucose this morning was too high again, so it's looking likely that she has diabetes. I offered to talk to her after clinic about her diet.

RSB drops in to say hello. He’s officially off work on holiday today, but has some work to do towards a diploma and is more likely to get it done if he’s sitting in an office rather than at home. He admires my new purchase – a door wedge, Robert Dyas, £1.69 (I won’t bore you with the annoyance of small crowded rooms with spring-loaded doors propped open with bins and chairs). I resolve to treat him to a doorstop of his own. He offers to help with a difficult patient later on, and for the interpreter patient he suggests Language Line, which is a service where the interpreter is on the phone to both the therapist and the patient.

The nurse in charge says the receptionists have all the Language Line instructions and equipment. The receptionists fish it out of a drawer and say it’s fairly straightforward to set up, they will come and help when the patient arrives. They also mention that the difficult patient has rearranged his appointment – this is good, the slot with the interpreter was only 30 minutes which would be tough to manage, and now there will be less pressure. I reminisce about clinics at my previous job, where 30 mins would have been luxurious – most consultations had to start winding up at 10 mins. Now I can have a roomy 60 minutes if I need it.

I call up to RSB to let him know he won’t be needed for the difficult patient. The patient needing the interpreter is now 15 mins late – looks like he’s not coming. This is a huge relief, although I always feel slightly guilty about feeling glad when someone doesn’t come. Now I only have two more patients to see this morning, plus the possible new diabetic colleague. I talk to reception about re-booking the interpreter patient, and they are surprised he hasn’t come, because they have seen him a number of times before and say that he always attends his appointments. We look a bit harder at the systems, and it looks as though his appointment was changed from two days ago. If the change was made very recently and he was sent a letter with the new appointment rather than being contacted by phone, the letter would probably not have arrived in time.

Next patient – looks like another DNA. I dig a bit deeper, and it looks as though three out of the four patients this morning were switched from two days ago (the fourth is the difficult patient, who we already know won’t be coming). I am now not expecting a busy morning. I ask office admin when the appointments were changed. It was back in January, so that’s not it. I now have time to talk to my nursing colleague about what would be best to eat, and then the last patient does actually turn up - one out of four.

P.S. RSB was delighted with his door wedge.

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