My last entry on here was a description of my visit to an OP department a week or so back. It was a visit that left me feeling profoundly depressed, I just didn’t know why. Looking back I now realise that I feel like after virtually every OP visit I make. Just why has been niggling at me until I watched the blobs and squares video and had some more thinking time.
All the outpatient departments that I have visited are places where the process feels more important than the blobby contex bit. Everyone knows how the appt is going to go, you stand in a queue to check in, then you’re told to sit somewhere, you are called through and sit again, get weighed (clinic dependant), other tests are done, then you sit again – perhaps moved into a different waiting area, you’re surrounded by signs warning of disease, uncomfortble seats, surrounded by uncertainty about who you are going to see, which door are you going to go through. You watch staff in nurses uniforms rush around carrying notes, calling people in, you may even hear details of consultations as doors open and close. You wait and then eventually you are called in, seen, a quick consultation and then you are out with a slip of paper and told to check in with the receptionist on the way out so your paperwork can be completed and further appointments issued.
I was upset about the last OP appt because from the very start of it, I was told ‘we don’t have a referral letter for you’ . Their process had broken down but my context was still there so that became my problem. The uncertainty of whether I would then be seen was added to my context – scar & lump on my face, ill from another infection somewhere else, have come 12-13 miles in a taxi for the appointment. There was a huge disconnect between the process and my context and it could have been that the process could have overridden everything and they could have refused to see me if they couldn’t have got hold of the referral letter because atm it is the process in OP that is seen (or so it feels to me at least) as all important.
Essentially patients (or the blobs) can’t change their context – the reason that they are coming to OP is because there is a, or has been, a problem with their health. So really the process has to change. But how? I would say that it needs to become invisible, in the background – so that everyone – staff and patients- can focus on the context of the appointment – the health of the patient rather than making sure the process runs properly.
– Ensure information sharing is as efficient as possible. The NHS spine contains details of tests and medication that the pt is on, so why do they have to be the ones to bring it in again? Why does information like name, address, dr have to be given every time a pt checks in to an OP clinic? Why can’t pts just check in using a simple machine? (& Surely repeat appts could be arranged within the consultation – rather than have to queue up again to be interrogated and sighed over by the ‘dragon’ at the front desk.)
– On check in pts could be allocated a seating area, an approximate time of being seen plus given information about who is going to see them. (I often wonder how the pts get parcelled out in clinics – luck of the draw?) This may allow them to go for a drink, (or heaven forbid a smoke) lessen congestion in waiting areas etc.
– In my (brief) time as a midwife one of the best bits for me was going down from the ward and doing the AN clinic for the Ward consultant – does that ever happen in general OP? A lot of my OP apps have been simple review clinics, surely there are is a role for nurses to be doing some of this work.