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Monday 20 June 2011

The saga of my little finger shows how badly the NHS needs reform

So, competition for the provision of health services between the NHS and the private sector has been 'put back in its box' according to the Liberal Democrats, the original radical reforms of the Health Service have been watered down, and everyone seems happy.

Except me.

My recent experience of both the private and the public health sectors has convinced me that the NHS is in very poor health and in desperate need of reform.

I was concerned when a small but growing and painful lump appeared on my little finger. My GP didn't know what the lump was but said that it should be removed and sent for investigation.

Within a few weeks I received a letter asking me which hospital I would like to go to. I went for Charing Cross in London – it had the shortest waiting time. I booked my appointment online and attended at the appointed time on the due date some six weeks later.

The receptionist told me that my appointment had been cancelled. Why had no one told me? Apparently they had called to tell me but when they 'heard a foreign ringtone' they assumed I was abroad and hung up.

The hospital had made no attempt to leave a message, send me an email, send me a letter or contact my GP surgery. They just let me turn up for a non-existent appointment. All they could do was make another appointment. I was not happy.

Two weeks later, another journey across London and an hour-and-a-half after I should have been seen, my name was called. Deja vu – the hospital doctor didn't know what the lump was but thought it should be removed and sent for investigation.

'You should get a letter within six weeks giving you a date for your surgery,' she cheerfully informed me.

Back at the hospital for the new appointment a month later, and a mere hour and 25 minutes after the time I had been given, I was in!

It was a full operating theatre in the plastic surgery department – three nurses and a doctor, all for a small lump on my finger. Eventually the local anaesthetic was administered, the lump removed and the stitches sewn. I was told to keep the dressing on and keep it dry for a week.

'It's in a very difficult place – how do I keep it dry?' I asked the nurse. 'Don't get water on it,' was the reply. Ah, of course. Silly me.

I was given a sealed envelope for my GP and no written advice, except to get my finger checked by the GP in a week's time. The hospital would write to fix an appointment within four weeks to give the results of the biopsy.

The letter never came.

A week later I went to my GP practice to check on the progress of my wound. It was a different doctor this time, of course.

Despite having kept me waiting for 40 minutes, he didn't apologise or even see fit to say hello. 'What can I do for you?' he asked, somewhat grudgingly I felt.

We unwrapped the finger, and there were four gruesome black stitches straining to pull together the two pieces of flesh on either side of the hole left by the removal of the lump.

'That's fine,' the doctor said. 'Do you have plasters at home?' I had, but surely it could not be true that a doctor's surgery in London in 2011 didn't have an Elastoplast? It was.

'OK, just don't soak it in water or the skin will go mushy.' No need to put a sterile dressing on it or keep it dry? Apparently not.

So I was sent out into the street with a gaping wound. The next day, I flew to New York, religiously applying a new plaster whenever the existing one got wet, which was about five times a day.

Two days later I was seeing an American doctor, my infected little finger approaching the size of my thumb. He removed the stitches and gave me a tetanus jab and a course of antibiotics. He did have a plaster – with a picture of Barbie on it (only in Greenwich Village). American healthcare provision 1 – NHS 0.

When I subsequently complained to the head of my GP practice that perhaps I should have been advised to keep the wound sterile, he said that they had 'learnt lessons' from my experience and that they have now invested in some plasters.

I was not getting the impression of an organisation operating at the leading edge of medical excellence.

Back in Britain, I called the hospital. An answering machine assured me that the plastic surgery co-ordinator, who made all the appointments, would get back to me.

After calling nearly every day for three weeks without any response, I phoned my GP surgery. They had a special hotline to the hospital.

They called back to tell me that the hospital would only give the result of the biopsy to the patient or the consultant. They had spoken to the consultant's secretary, who said she could not release the results without a request in writing. I still have not heard the result through that route, even though the surgery took place on April 28.

Worried that the biopsy might reveal cancer, I eventually got through to another number at the hospital and was given a plastic surgery outpatients' appointment.

This time, I found myself in a very crowded waiting room. A nurse announced that appointments were delayed 'as usual' as the doctors were doing ward rounds. If the doctors were doing ward rounds 'as usual', I wondered why didn't they book the appointments for an hour later.

At last, an hour late, I got to see a doctor – naturally, it was neither the one I first saw at the hospital nor the one who had performed the operation.

'So your GP has referred you to have a lump removed – can I see it?' Deja vu. Again. I told him the whole story, including the fact that I had been unable to get a response from the hospital.

'You're not the first person to tell me this,' he said. Apparently there is only one plastic surgery co-ordinator and she had been off sick for three weeks. When she is off sick, no one answers the phone, no one picks up the messages and no one sends letters out to patients for follow-up appointments.

After three months, three hospital visits, three visits to GPs on both side of the Atlantic, five hours hanging around in waiting rooms for doctors running late, countless unanswered telephone calls and a potentially serious infection, it turns out that my lump was a benign tumour.

This experience was in stark contrast to another minor plastic surgery operation I had had done privately some months previously to remove some skin growths under local anaesthetic. The plastic surgeon had rented an office where he could carry out minor procedures.

Although it was potentially a far more complex procedure than the removal of the lump on my finger, the surgeon had operated with just one nurse to assist and it was done during my lunch hour. I always saw the same surgeon, I was provided with detailed written instructions about how to care for the wound, follow-up appointments happened on time and everything was fine.

Surely if the American GP and the private sector in the UK can get it right, the NHS should be able to as well.

I am a Liberal Democrat, but is this the NHS we are trying to save?

Source: Daily Mail By Brian Paddick

 

 
 
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The Operating Theatre Journal, OTJ, is published monthly and distributed to every hospital operating theatre department in the UK. The distribution includes both the National Health Service and the Private Sector.

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