Dear UCLH – let’s talk Communication Skills

Dear UCLH,

Specifically, the neurology team. Now we’re all professionals so should be used to peer review. So here’s a peer review based upon my experience with you today.

Before we start, it’s prudent to note that those with Ehlers Danlos Syndrome often have difficulty with adrenal control. This would explain why I am frantically typing this at 1am despite managing fewer than 4 hours sleep the previous night. My anxiety levels peaked today causing a heightened state of fight or flight. Those anxiety levels could easily have been managed had communication with me and more importantly between departments been clear.


What Went Well: 

The appointment letter was clear & concise and received well within the given timescale. Upon requesting a change of dates due to childcare commitments, your administration team were extremely accommodating and did their best to inform me as best possible in terms of available times due to the required 2.5 hour commute to you (based on good traffic). Alternative dates were agreed, arrangements and payments were made for parking as we were not given details of the hotel (see below), congestion charge was duly paid to avoid the issue of trains & chronic pain.

The junior doctor who saw me (albeit for a reason not made clear to me) was lovely. She took the time to listen to me and treated me with respect & intellectual parity.

I regret this section is not longer.

Even Better If:

The time leading up to my appointment was unduly stressful due to the lack of detail provided regarding my planned three day stay at UCLH. The letter stated what tests may be performed and that a patient hotel had been booked. This identified neither the specific hotel, nor the times of the tests, in fact the letter states that details were to be given upon arrival. With my husband having planned to work from his London office over the three days, both of these pieces of information were required, but not provided, even upon arrival. In contrast, we were treated as a nuisance that should have been more aware of the planned procedures. I accept that I thrive on lists & feel far more comfortable when I am of an exact itinerary, however much of this is based upon mobility needs and being away from home, these are often not met. 

The first test was in fact a 24 hour blood pressure monitor & I was asked if my BP was usually so high. No, it’s usually quite low, however I was in such a state by that point that I was suffering with palpitations & chest pain. This was to continue to heighten throughout my stay & accumulate into the first panic attack in my adult life.

As highlighted above, your junior doctor acted with great professionalism when faced with an overly anxious patient who wasn’t fully aware of why they were seeing get this particular doctor (the feeling was that they had been asked to see me to buy some time to sort out the administrative mess as no real medical conversation took place). Unfortunately, the same cannot be said for other staff.

When addressing a person with disabilities, it is polite to address them directly. Only twice have I ever had to make this point vocally and directly to someone who had not taken the hint. Today was that second time with a staff nurse in your day care unit manning the nurses station.

In order to correctly describe using P-E-E (point, explain, example), let me expand:
I was not spoken directly to as part of my care in the hospital by your staff nurse in charge of the nurses station. The nurse repeatedly refused to speak to me directly, instead asking the on duty nursing assistant to relay a message to me despite me directing my question to her and all three of us being within a few square feet of each other. For example, I asked what tests were to be performed today. Your staff nurse appeared disgruntled to be disturbed by a patient & directed her response to the nursing assistant with “tell her…”. 

This is not only highly unprofessional, but incredibly rude. A wheelchair user u just that; they use a wheelchair, there need not be any mental impairment. This happened on multiple occasions.even if the person with disabilities is not able to answer for themselves, talking over them as if they are not there is inappropriate behaviour and requires addressing.

Returning to the first point regarding provision of information, the key point of mobility, specifically being a wheelchair user was omitted from the referral to the Day Care unit. The referring consultant failed to tick the box identifying that I am a wheelchair user. Because of this, the tests were not set up to be accessible and the person setting up my blood pressure monitor voiced concerns that the tilt table would not be suitable as I cannot stand. Upon returning to the day care unit, my husband phoned & informed me that the hotel room that had been booked for us was not accessible. In fact, he had taken my small manual chair into the room & couldn’t get it past the bed let alone into the bathroom. It was now 4pm and the hotel were unable to move us into an accessible room. A message was left with the administration team to try to move us to another hotel.

By this point, I had neither eaten nor drunk anything since 6am and had not had access to my standard painkillers. I was exhausted & in considerable pain. My ‘ambulatory tests’ had so far not allowed me to leave the hospital and we still had no indication of where we would be staying. Instead we were ushered into a room that appeared to be storing drip stands and offered supper. I was far too distressed to eat and felt that no one was listening to my concerns.

At this point we called time of the whole experience and stated that we were going home. The nurse who would previously not speak to me directly, told my husband “when we can’t find you a hotel, then you can leave “. I’m afraid that was the final straw. We removed the monitor, placed it on the nurses station and left. These tests ran the risk of exacerbating my symptoms & potentially inducing fainting. I was not willing to place my health in the hands of people who couldn’t arrange such basic things as accessibility and showed absolutely no compassion for someone who was exhausted, thirsty, & highly distressed.

All of this wasted time and effort could be easily solved in one of two ways. An additional letter to the patient with an itinerary including the name & room type that has been booked. This simple mail merge document plus a postage stamp could have highlighted almost all of the issues encountered today with the ability to solve them well in advance of the day of testing. An even cheaper alternative is to create an email mail merge – this saving postage, paper, even time stuffing the envelope.

Simple forethought, communication, and planning.

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4 thoughts on “Dear UCLH – let’s talk Communication Skills

  1. Hi Mrs Hippy Geek,

    I am so sorry to hear of your experience at this so called centre of excellence however I am not surprised having heard many of the same complaints from other PoTs patients, it is also one of the reasons why I have never bothered to make the trip (its also a 4 hour drive from where I live).

    All I can suggest is that you bypass PALS completely as they are in the hospitals pocket, they will say all the things you want to hear but will actually do zero. I have had far too many dealings with them to actually trust them to act. I have found it far better to go for the jugular on social media, Twitter is excellent if the hospitals CEO has an account. I would also send a letter in (when you have recovered enough) to the hospitals complaints department stating in your letter this issue is too serious to be dealt with by PALS, that way they can’t pass you back to them.

    I usually have the issue that hospital staff fail to realise the gentleman pushing my wheelchair is my husband not a male relative or paid carer. They seem to have an issue with disabled people being in relationships, despite the fact I have been married for 16 years and been sick for half of them.

    I hope you are ok and that you have managed to get some sleep. Again I am very sorry that you have had to deal with this crap from people whose very job means they should be more enlightened.

    Love
    Rach xx

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  2. That sounds so awful, I’m so sorry!
    I would have also been in quite the state of panic and anxiety! I still print out my email confirmations hotel rooms so I can show them at check in… I can’t even begin to imagine the amount of stress I’d be in if I didn’t know where I’d be staying! Especially once you add it on top of all of the other stuff.

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  3. Well said Holly …. approached with consideration and tact. It’s a cryin’ shame that so many NHS “organisations” treat lucid, intelligent people as absolute morons … Thanks for doing this …. a real eye opener .. Keep on Truckin’

    Liked by 1 person

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