Problems with the NHS

I'm not going to harp on about the coalition government and the management structures, funding problems, patient waiting times and the likes, this is a personal, insider's view of what the bloody hell goes on on wards in our hospitals.

As a medical student i am acutely aware of the idea that doctors treat everyone who is not a doctor atrociously. This summer i trained as a health care assistant at my local hospital in Bristol. I worked on the bank, which is a big pool of trained staff who get shipped to random wards that are understaffed. This is probably the most valuable thing i could ever have done- i learnt more in the 4 weeks that i could actually get shifts than i have in the year of communications training and the 2 years of academic training i have under my belt.
Not in terms of disease pathways, physiology and anatomy, but i can navigate my way around any ward now, chaperone intimate exams, clear up any type of body fluid, make 10 beds in half an hour, wipe innumerable amounts of bottoms, bed bath, assist with shower, spoon feed, remove venflons and help change dressings.
I was wary of telling people that i was studying medicine but my inquisitiveness gave me away most of the time when i would ask if i could accompany a patient to surgery or if i could watch cannula insertion or whatever. Every nurse i encountered, every HCA was more than willing to feed my hunger for knowledge. They all said that they thought every medical student should have to do the basics so they learned to respect all members of the Multi-Disciplinary team. I wholeheartedly agree.
Something i noticed on the ward was the distinct lack of communication between the doctors in charge of the care of the patients, and the people, the nurses and HCAs who were doing the 'care'. We are the people who notice the minute by minute, hour by hour changes in the patients, who do the 'care-plans', who note the shape and amounts of the stools produced etcetc. Never did a doctor ask me how the patient seemed, in fact never did a doctor meet my eye as i staggered past with 10 beds-worth of blankets or a bucket of vomit or whatever.


However, later on in the summer my grandma had a fall and broke her hip. My dad and i went to visit her in hospital and i honestly have never been so frustrated in my whole life at the lack of knowledge about what is going on. NO ONE KNEW ANYTHING!!! And what was worse i could peruse her obs sheets as i had spend my working summer doing, and i could see her b.p was high or whatever but no one ever came to speak to us about the surgery, the physio, how she was getting on daily. Visitors are just there to perk up the patients, they are ignorant to the daily goings on, and when they want to know about anything they are brushed off. We arrived on the Thursday and they told us they suspected a UTI. On the Sunday dad and i came in to see grandma after a trip to the zoo and she was honestly raving mad. She was convinced that there was a terror plot involving snakes that had occurred on the ward the night before- but don't worry, she had informed security and it had all been dealt with and hushed up by the morn.

WHAT!?!?!? the staff hadn't even noticed this. i know i know i know there are 3 shifts a day and you don't necessarily return to the same patients, but for someone who had gone from being totally lucid to a complete loon overnight i would have hoped this was noticed. even just little star on the handover sheet that says 'suddenly gone mental' would have been better than the surprise as my father explained to the ward staff that his mother did not usually talk about covert terror operations.

'we'll order a uti test, they often cause acute confusion'

'well there was actually one ordered on Thursday'

'ah yes well the results aren't back yet, so we'll try and get another one'

'what about a urine dip? that ought show white blood cells or blood or something shouldn't it?'

'well we have tried but she isn't passing much water'

'her fluid chart says she is......'

'.........................................ill just go and check her results, see if they've miraculously come through in the last 3 minutes of this awkward conversation demonstrating my incompetence'

..................

'oh yes so she doesn't have a UTI don't worry.'

'well shes still being quite mental and has in fact just referred to me as her 70 year old neighbour'

'probs the codeine innit.'

and that was it. So to some extent i understand what i thought was the arrogance of doctors, which i now see as thoroughness. The idea that at the end of the day the patients well-being is the responsibility of the doctor and so they must check everything themselves and not rely on other people's opinions. This is not an excuse for the obvious elitism that still occurs on the wards, and this is one case and it is very personal to me which is why i care so much about it.

At the end of the day it is not the doctors role to comfort and explain every minute detail of treatment to the family. But from the other side it is difficult to see that your relative is getting the best possible care when no one seems to know what care they are even receiving.

When i worked as a HCA i resented been overlooked by other staff, i felt that my role was one of the most valuable on the team, that it was me that was making the difference in the patients daily lives, but as a medical student i understand that when the shit hits the fan it will be my fault and i cant take any word for gospel, i must be able to justify all my own actions based on my own investigations and not because someone told me that it was like this or that.

confused.com