Yesterday morning, I had an appointment to see the oncologist. (I no longer say ‘my oncologist’ for the same reasons I have never said ‘my cancer’: I’m not taking ownership of something that doesn’t do me any good.) My appointment was at 9am, and I arrived at 9am, to a clinic waiting area already crammed with people. (There were two other clinics – Spinal Clinic and AAP Clinic, whatever that may be – going on in the same space.) Even though I was the first person to be seen and had the first appointment, it was 9.20am before I was shown into a consulting room, and 9.30am before I saw anyone. ‘Twas ever thus…. but I dread to think how long the people with the last appointment at 12.30 had to wait. They are probably still there now. I hope they brought sandwiches. (And knitting.)
Anyway. I saw an oncologist (or registrar, or senior house officer) I’d not met before. This is always a little cause for hope in my foolish breast(s) but it was clear pretty much straight away that the ‘hooray! some support and interest from the oncology department!’ bunting could stay in the box in the loft:
Oncologist: So. You’re three quarters of the way through your herceptin!
Me: I thought I was having herceptin for a year?
Oncologist: (flicking through notes) Yes, I should think so.
Me: So that will be 18 treatments?
Oncologist: Something like that, yes.
Me: I’ve had 7.
Oncologist: OK, so you’re half way.
Me: (doggedly) Well, just over a third.
I’m sorry, but as I’m trying very hard to be realistic and not round things up, I don’t see that other people should be allowed to do it on my behalf. And the last time I looked, 7 was three quarters of nine and a third, and half of fourteen. Hmph.
Anyway. we had the Last Period Conversation
that we always have, and I talked about my tooth – let’s just say that I’m glad I wasn’t holding out any hope for help with that – and then there was the question of an echocardiogram. This is an ultrasound scan of the heart to check that all is well, and it needs to be done every 3 months when you are on herceptin. Apparently I’d been due one on 4 December, but I didn’t get the appointment – it’s still Postal Strike Aftermath Central round here – so we needed to arrange another one. (I’m writing this as though it all happened in one conversation, with one person, but actually there was so much coming and going that it was like a French farce, only without the sex and the laughs. And the vicars.)
So. As the oncologist was done with me I waited while someone else tried to re-arrange my echocardiogram appointment. I stood in the waiting area, and the person on the phone talked to me from the desk where she was on hold, over the queue of at least 6 people waiting to be checked in. All the time, the oncologist, registrar, Macmillan nurse, and two drug trial nurses were coming and going, interrupting each other, trying to sort out several things at once…. while the oncology patients waited, grey-faced and resigned, for their turn. I offered to go to the Cardiac Investigations Unit on my way out and make my own appointment. This was greeted with some consternation – why didn’t I wait 10 minutes and then they would call again – but I took a deep breath, put on my snowball hat, and turned my back on oncology clinic for another 3 months. I really couldn’t stand it any more.
When I got to Cardiac Investigations – which is in the new wing of the hospital, so is bright and fairly spacious and lacks the underground-bunker quality of Oncology – I explained the situation to Pamela, the receptionist, who asked me to take a seat while she found my record. I did. After less than 5 minutes, she came out from behind the desk, came over to me, and asked whether I would like to have the echocardiogram now, to save me another trip to the hospital. I said that I would, and I was called by Katerina before another 5 minutes had passed. She knew why I was there, and she did the echocardiogram, and afterwards she showed me the screen with the results on, and I saw a picture of my heart, chugging blood through ventricles without a care.
Now, I am a huge supporter of the NHS and am proud to live in a country where healthcare is free at the point of need to all. But I’m frustrated by the poor organisation and leadership of some areas – I think we know which clinic we are looking at here – which have little to do with resources and more to do with a lack of connection to the patient. Especially when other areas can provide an outstanding service – that’s you, Cardiac Investigations (and an honourable mention for the continuing good work of the Trevor Howell Unit).
Here are the things that Cardiac Investigations did that Oncology could do:
- go up to patients and talk to them, rather than calling across rooms/desks/waiting areas
- look at the notes before seeing the patient
- treat the patient as an individual and a person rather than a walking disease
- have one conversation at a time
- keep conversations between staff about patients to a minimum in public areas
- have a system for seeing patients that works.
And here are some additional tips for Oncology, just out of the kindness of my still-beating heart:
- if the first appointment is at 9am, either arrive at 8.30am to prepare, or have the first appointment at 9.30am
- if you keep someone waiting, let them know how long they will be waiting, and apologise – don’t assume they have nothing to do but sit around while you scurry about
- get organised with everything you need – file, data, appointment history, blood pressure monitor – before seeing a patient
- remember that the people you are dealing with may be scared, and tired, and probably see this appointment as an important part of their recovery, and treat them accordingly
- remember that just because it doesn’t interfere with treatment, doesn’t make it unimportant
- and – I know I said this two minutes ago but I think it bears repeating – at a bare minimum, have the respect for your patient to READ THE NOTES. Or, just don’t bother with the notes and have the same conversation every time. One or the other. I truly don’t mind which. But don’t walk into my appointment carrying my file and then immediately demonstrate that you haven’t so much as opened it.
I’m willing to admit that because of the nature of the work that I do – working with teams and organisations to help them to be better, stronger, more efficient, more focused, led more dynamically – I may be more prone to being annoyed by these things than the average cancer bunny. But even so…. I don’t think this kind of service is on, really. Do you?