Healthcare

I went to the After Hours last weekend, the second time in a week (and what ended up being three times in one week overall).  This time it was for me, as my asthma tends to tank when I have a bad cold.  I also had a tiny cut, but on a rusty nail so thought that I should get a tetanus shot (so pro immunisation I'm now seeking them out)!

Those of you who are parents, and particularly mothers, will appreciate that I got to go BY MYSELF.  The idea of being stuck for ages by myself reading magazines filled me with joy.

It was packed.

I was seen rather quickly by the triage nurse who was, perhaps without realising it, really rude.  Now, having worked in the field of healthcare, with a very strong consumer focus, I find rudeness by medical staff quite compelling to watch (like a 'how not to' video) and in this case I found it hilarious.  She kept cutting me off, so I made her work for it, history wise.  I told her that I would like a tetanus shot and she was all 'where is your ACC* form?'  It hadn't occurred to me that I would need one for a scratch, (the asthma meant I'd had 16 hours in three days so perhaps the old brain wasn't quite working).  I told her calmly that I was quite happy to go back to reception and get one.  She then had quite a conniption that I was drinking a cup of water. 
'Stop drinking that!'  She then nicely turned her back on me, and mumbled to the computer, 'I need to take your temperature.'  I interpreted this as "Please refrain from drinking any more of that ice cold water, as it may interfere with the results provided by a thermometer, and I would like to take your temperature."  (This is when I nearly started giggling).  She capped it off by standing in front of me, grabbing her watch and saying "Now I need to check your resps."  If you know about taking resps, you'll be laughing at this point; nobody gives a proper resp rate when someone stands over them for twenty seconds watching and counting your breaths.  I of course became hyper aware of my breathing, and I'm sure that my actual resps had nothing on the performance I gave over the next few seconds.

After about 90 minutes I got to see the doctor.  It was almost a pity because I was systematically going through the magazines in the office and taking photos of all the good recipes with my iphone.  My iphone is awesome.  Quick chat, listen to the wheezy lungs and the typical asthma med prescribed.  I then said, "Oh, I think I need a tetanus shot."

That is when the visit got very, very serious.

My wound was examined. Very closely (At this point I would like to point out that the diameter of the wound is probably the same as a drinking straw).   I was told that I would need the wee flap of skin chopped off, the wound cleaned out and topical antibacterial lotion.  It was the first time that I was actually taken aback on this visit.  I expect to encounter lengthy delays and the odd rude staff member but frankly I thought that the plaster I'd put on it was quite sufficient.  Now the typical steroid prescribed for asthma can interfere with healing but I was pretty impressed with the attention to my wound (should I write wound in capitals form here on?)!  During the visit with the doctor it came out that my husband was also a doctor.

This changed things as well.

I was handed back to my favourite nurse.  She was a lot friendlier.  It may have had something to do with the doctor telling her that my husband is a doctor (couldn't work out why that was important to handover but there you go).  Or it might be that instead of checking more obs of another patient (honestly the waiting room was full of people with the same respiratory viral infection - every second person was walking out holding asthma paraphernalia) she got to do something exciting.  She went and got a wound kit.  A sterile wound kit opened carefully to avoid touching any of the contents with her bare hands.  Sterile scissors were obtained, and the flap cut off.  The cut was washed out with saline, then a fairly elaborate bandaging took place.  This was covered with an ordinary plaster to hold things in place (and helps to I think perfectly highlight the smallness of the wound).  I was seriously told to keep the wound dry for two days, and to change the dressing in a couple of days.  I was given the rest of the dressing to take home for this purpose.  I then hopefully inquired as to whether this meant the shot wasn't necessary but no.  My arm was jabbed and then she carefully placed a plaster two centimetres below the injection site (I was just dying by this point - If my husband had been there I would have been having trouble holding it together).  I then promised to wait around for twenty minutes in case of anaphylactic reaction, and then forgot pretty much instantly and went to the chemist for my medication.

So for me a funny morning.  I'm not complaining about the service, the waiting room was packed, people were sitting on the floor and standing while waiting.  There seemed to be only two nurses on duty, and three doctors.  The nurses triaged

I've been thinking about patient complaints recently, and at the route of most complaints was either communication or lack of compassion.  Communication is pretty obvious on the face of things, but effective interpersonal communication is a skill I think you could spend a lifetime working on and still have trouble getting your message across.  Compassion is a tricky one, like communication you could work on this for ever.  Both are dependent on the people involved in the encounter and the stage in the overall process.  If you are not welcomed on arrival, treated rudely or briskly in triage and then have a doctor who doesn't seem to get why you are even there - it is quite likely that your response to these people will deteriorate during your visit as the cascading effect of a poor welcome takes over.   But imagine if you are welcomed and perhaps asked your name.  You are then invited by name to fill in the appropriate forms and oriented to the reception environment with a smile (eg 'please sit down werever you like.  The toilets are over there and the triage nurse will be speaking to you shortly to get some more information before you see the doctor.  Please return to see me if you have any questions or problems.')  The nurse then welcomes you and checks to see how you like to be addressed.  He or she sits or stands making eye contact and asking what brought you in today.  Observations are taken and then they ask permission to turn their back on you for a moment while they type this information into the computer. The nurse prepares you for the next stage of the process - either a wait back in reception, or to remain in the triage area.  The nurse gives you an idea of timeframes.  Perhaps mentions the names of the doctors on and gives you confidence that they will help you with your problem "Now there is a wait this morning, it will probably be thirty minutes before you see Dr X.  Dr X is just great - you will be in good hands.' 

Imagine feeling as though you and your reason for being there were important (instead of feeling as though you are using up time better allocated to sicker people).  Imagine feeling as though the staff worked as a team and were confident in each other's abilities (instead of being told to remind the doctor of X as he/ she 'always forgets.'

Just a thought for now.

The wound is healing well by the way!

* for the overseas readers we have a no-fault personal insurance scheme in NZ.  If you get injured, you do not sue.  The Government covers the cost of your treatment and rehab, as well as percentage of your lost income.  This is for as serious as a broken neck, and as minor as a tiny cut.  As you can well guess, I didn't need time off work for this injury!