|Basilica of Esztergom, Hungary, October 2012|
There has been nothing exceptional in the last week. I have seen some patients, and started writing letters. It appears that no letters have been written following dietetic patient consultations for quite a long time, so this is more exciting than it sounds. I think that letters should have been written, at least for the first consultation following a referral, and for any significant change of treatment or discharge. I am now familiar enough with the department to be confident that my opinion that letters should have been written is correct; therefore, I am now going to have to write some.
Of course, there is no 'writing' involved in writing letters. There are two options: one is a word processing system whereby I call up an appropriate template and type the thing myself, then print copies for file, referrer, GP and patient, and attempt to ensure that all copies go to the correct destination. This is the option I have been using for my first few attempts at letters, because I don't really know what I'm going to say when I start, and the alternative is a dictation system. I've never done dictation before, and am not looking forward to it. Eventually I shall move to dictation, because then all the formatting and printing and filing and envelope-stuffing and posting will be done by the admin staff rather than me, and this will make up for the amount of time it is likely to take me to dictate a letter in an effective way.
However, it has not gone unnoticed by the admin staff that the Dietitians who previously were not writing letters are now writing letters, and this suggests an increase in the volume of work that they will have to do. There appears to be some ambiguity about the status of Dietitians in the Diabetes administrative setup, which accepts Doctors and Nurses as entitled to dictate letters, but is not sure about Dietitians. So we will see how many dictated letters it will take before there is a revolt, and the Managers are invoked, and Dietitians will temporarily have to return to the word processing template system while people argue about budgets.
Meanwhile, the cell that RSB and I share by way of an office has suddenly become a sauna. We have no window or air conditioning, so there is nothing we can do except turn on the fan on the filing cabinet and blow hot air around. At home I wear jumpers and fleeces and Mr A and I sit on the sofa under a duvet, and at work I wear thin tops, anti-perspirant, and look forward to my clinics (where it is not so hot). The important meeting to decide the future location of the Diabetes service has taken place, and unsurprisingly, no decision was made, although the process by which a decision might be made was laid out. So I don't anticipate that we might have a more habitable office any time soon.