AIBU to ask you not to take your frustrations out at the system failures of the NHS on the clinician?

[IncognitoPanda]

It’s been a long week. I loved my job but honestly it’s got so tiring being moaned at about things I cannot control. I want to help you with your problem, that’s why I am here. But the sad truth is that in an over stretched service under immense pressure the limited time I have to help you is not best used with you complaining.
I know how many months you have waited for this appointment, I have your referral letter. I know you’re unhappy about it. I am too, I would much rather have seen you when it first occurred rather than you suffering and worrying until now.
I know how long you’ve sat in the waiting area, I can see your check in time. If we don’t have enough staff we will be delayed in seeing you. I will always apologise if the delay is excessive but please don’t delay me even further by spending ten minutes complaining about it.
I know you’re scared, I really do and I completely empathise. But if I tell you it’s a three month wait for a given test, it’s not because I want you to wait 3 months, it’s because that’s how long the queue is. Getting angry at me doesn’t help, and doesn’t give me any ability to speed up that time frame. I could be evasive and not give any clue as to how long your wait is but that wouldn’t help and would just put more pressure on my administrative colleagues when you are chasing for an appointment that they cannot provide.
I know you may have seen the last patient leave my room ten minutes before I call you through, that’s because I have had to complete their paperwork and take time to read your referral and relevant history. I look rude if I have my back to you to read my screens, so it’s important I take a few minutes to understand why you are here before I invite you through. The systems are so disjointed I may have to view multiple software platforms (all of which are slow to open due to the poor it infrastructure). Even doing this I won’t know your full history so please understand if I ask questions that you may have had to answer before.
I know you may have seen me disappear from clinic for 10 minutes. I can assure you I won’t have been off to the coffee shop. Instead I am probably addressing a critical issue that would further delay the clinic if not remedied.
I know you would like to see the clinician each visit. I get it, as I like to see the progress of patients. However if we all had individual waiting lists, the system would become even more unfair as the wait times would vary between clinician. We do talk, we do leave good notes for each other and you will be looked after. Sadly I cannot promise I will see you myself next time.

It’s the desire to help people that keeps most of us in the profession, it’s certainly not the salary or working conditions. Please believe me that I am just as fed up of the system as you.
YABU - it’s a British right to moan
YANBU- I get it

I don't think there is any point in ranting or being abusive towards staff, and especially not for waiting times. I would hate to be confused or upset about my appointment, or needing extra time taken for any other reason only to be rushed out because others are waiting. I wouldn't like to think of anyone else being in that situation either.

My complaint about the NHS would be that my husband goes to ENT with various ongoing issues that are causing him significant pain and is always dismissed and no scans booked or time spent to find out what the problem is. The other patients won't have to complain about the wait time I guess though.

I've had fantastic treatment from NHS and most staff have been extremely kind, caring and supportive

But I agree with PP that if patients are frightened and in pain, it's unreasonable to expect them to tolerate long waiting lists and delay without expressing frustration. They shouldn't take it out on staff, try not to take it personally, but people do need to feel heard

Lifelong (and I am over retirement age but still working part-time) medical secretary here. OP is telling it how it is. I worked in the NHS for 10 years (in much easier times but finally left to work in private practice when the last straw came - received a memo saying we should share ball point pens, as we were using too many). The description of why the clinician may be absent for 10 mins and needs a short time between patients to complete the notes and order tests for patient just seen and read notes/referral letter for next patient and possibly review their test results before calling them has always been the case (I used to have to attend the clinics and occasionally ward rounds back then to take dictation). If the clinician is a surgeon, they may also be called at any time by members of their team looking after in-patients, who need advice on how to deal with an urgent problem. All the doctors I have worked for in the NHS and many of the private ones are NHS too - NEVER doing private work in their NHS contracted hours, despite popular belief. In fact, I have known many who have done unpaid overtime hours (late into the night) on the NHS side because they care about their patients. In recent years, I have been a patient more often myself and despite the pressures currently in the NHS, I have received courteous, very competent care from the staff looking after me (they literally saved my life on one occasion). I was seen yesterday for a complicated scan, on time, by patient, kind staff who explained everything in detail before carrying out the procedure. It is very heartening to see that clinicians are still staying in the NHS despite the terrible pressures of a failing system and I am very grateful to all the NHS staff for their dedication (when most of us would leave to work elsewhere if our workplace constraints were similar).

OP, I sympathise and would never have a go at the clinician unless….

They seemed totally uncaring, as some of the nurses and doctors did when my son was in acute pain or they showed an arrogance and lack of curiosity, which again I have seen from some doctors all the way to consultant level.

i have also met some wonderful clinicians on the NHS, and always go out of my way to thank them.

But I do think too many think of the patient as a charity recipient rather than as someone who has paid for their care (through their taxes).

It works both ways.

Unfortunately, in any person-facing job you get complaints, entitled people and people who are under stress. In a medical setting most people are under stress, in pain, scared etc. So while there is no excuse for rudeness to staff, let alone abuse, the prevailing culture in the NHS which seems to be ‘it’s not my fault and you should be grateful for whatever care you may get’ is not helpful. In any job there are issues
caused by management decisions as well as circumstances and it is not helpful to shrug and say ‘not my fault’ when someone gets poor service or care.

I am always polite and pleasant and I tend to get very good service everywhere I go. I don’t sweat the small stuff when it comes to appointments etc and try to work with the system. I know
the staff are generally doing their best under huge pressures. I can’t fault my GP surgery for example, yet I’m sure there will be some patients who think they are rude, late, etc etc

It’s incredibly distressing, however, when you are treated as a nuisance - despite having followed every instruction - because of internal problems. No, perhaps not the fault of the nurse at the desk, but certainly not my fault either. I will happily go private where possible but sometimes it isn’t possible. I had a horrible experience with staff when I had a simple broken bone. I don’t expect rudeness in other settings and certainly not when I’m not only in pain but also have done absolutely everything I was told to as well as being polite and considerate. Tutting, eye-rolling etc isn’t acceptable in retail, for example, but we are expected to put up with it from NHS staff.

I think the NHS has gone to absolute shite and there are loads of people working for it that are completely disinterested and just going for the paycheck.

Don't lose your empathy OP, we desperately, desperately need people like you.

You might find that people don't actually know where to voice their annoyance and that's why they're telling you - maybe redirecting them would help?

I think the claim that NHS staff couldn’t cope in the real world is one of the most ridiculous statements I’ve ever read. If they don’t see and deal with the real world in all its glory I’m struggling to think who does.

Full marks for my GP surgery- brilliant. Also great that I’ve had bowel cancer screening and am about to get my 50s health check. For podiatry I admit I go private as I’ll be waiting too long and I’m in denplan - so I know how lucky I am. But all the staff I’ve seen recently have been very professional.

As the OP says, complaints need to go to other people. You’re reducing your own consultation time if you spend half of it complaining.

As a pp said you are definitely in the very tiny minority. I can absolutely understand why patients might be a bit shitty.

I've never, ever, been to the GP or consultant in the last 10 years where they have bothered to read my notes or history. So I waste time going over the same thing only to get a huffy "well what do you think it is?" Or "what do you want me to do" I don't know, expert, that's why I've come to you 🙄

Well this is a perfect example of the problem with NHS mentality. You dare to voice a criticism, you must be a troll. 😂

You haven’t bothered on a message board to use perfect spelling and grammar. You’re ignorant I don’t need to listen.

God I hate dealing with the NHS. The system maybe shit, but the staff certainly don’t help.

I don't work in acute in-patient work so my experience of staff colleagues is probably different to some on here (and I have met a fair few hospital counterparts who do have a bit of a martyr ego on them), but my colleagues of all the different disciplines within my area team are a really dedicated bunch.

However, to preserve themselves they HAVE put lines in the sand and most won't sneak in an extra visit or take an extra onto caseload because they've learnt from bitter experience of burning out that the referrals will keep on coming and the system will keep on taking the unpaid overtime. I respect that they've learnt that and they're strong enough and confident enough to have those boundaries because at the moment the system will just take and take and take it out of you.

As for the comment about assaults and staff not wanting prosecutions forced on people and accepting that people in pain and fear respond in some inappropriate ways - definitely. I was assaulted relatively recently by a patient - had to report it just so we have accurate logs on how often it's happened and colleagues were ready to jump in and take over care, or backing me if I wanted to take it higher or refuse to see this patient - but it was a reaction out of fear, extreme anxiety and I could have read the situation better in terms of how they responded (it was a first appointment and their non-verbal signals were very very subtle). Went away, thought through it all, reflected on how I'd handled it and went back again to approach things differently - and I would say everyone I work with would have done exactly the same.

The IT is shit, the communication between different elements of the NHS does not fucking work and that takes up so much unnecessary fucking time - as an example, our trust has a different structure to email addresses than many - still with exactly the same IT security etc, but we have a seemingly weekly dialogue with one of the other local trusts about "can I send you this file" - and it's utterly bollocks. We also are on a different IT system to GPs and acute trusts - so we spend bloody hours on hold to GP phone lines (I rejoice when I find one that has a number to press for healthcare professionals rather than sitting in the 9324 person long queue) to chase up information we should have access to if only the IT worked together, and we can't access paediatric records for those transitioning into adult services - again hours and hours of paperwork and information chasing that goes on there. It is absolutely the biggest source of frustration in my life - shit NHS IT along with the glacially slow speed NHS recruitment runs at to get people into post.

I do the job because I love it, I love my client base and colleagues and I've been incredibly lucky to get to build relationships with some amazing patients, families and carers - no hero-complex - I'm a selfish bugger who's found a job I like doing (I never actually thought I'd go into working in the NHS when I started out).

It's okay for anyone to be assertive re their job boundaries or indeed medical needs.

Assault and abuse are common in the NHS; I think quite a lot is inappropriately placed on front line staff and not seen by management. A&E needs better security to ensure its not letting in criminals, time wasters and nor is it a family day out.

A drunk tank outside each hospital staffed with the biggest male paramedics you can get imo would also be a very good idea.

Unfortunately sexual assault of female doctors, nurses and paramedics is common. And that should be prosecuted more than it is.

I just posted this to show that the reality of dealing with the general public is tougher than many think. Some people are entitled to the point of being abusive.

Complain to hospital management; the clinicians are the people least able to affect the speed of service unless you want negligence

Not my experience at all. My mum is preparing for surgery in a couple of weeks. She is terrified, takes that out as anger, gets fixated on inconsequential things and comes across as aggressive. She writes pages of notes and takes them to appointments and demands things that she only has to calmly ask for, she tries to score points about minor process issues that she thinls prove shes been badly treated. She is, frankly, a bit of a nightmare patient.

And yet the 2 surgeons, surgical nurse team, GP and anesthetist have all been calm, patient and understanding. They have talked her down from her ledge of her own making at every appointment.

Completely agree OP. Such a shame there's so much hatred for NHS staff amongst people, as you can see on this thread. Would love to take them on my ward for the day to see everything I and my staff do. Miss meals to ensure patients have theirs etc. They wouldn't last the whole 13 hour shift.

YANBU. OP I work for the NHS too and it's soul destroying. I agree with everything you say.

I have been an NHS consultant for over 20 years. There are good and bad staff. You do tend to remember the rubbish ones.

It is incredibly hard to get rid of difficult staff members. They tend to move sideways into other roles and threaten litigation and it is all but impossible to get rid of them. Well, it is possible, but the trust does not want to spend the time and money on legal cases.

over the years, I have seen increased rudeness by staff towards colleagues and other patients. I always tell my trainees that there is no excuse for such rudeness. However, badly behaved others are, do not stoop to their level. I have never taken out my irritation on patients or colleagues and have no regrets.

I will always apologise if I am late, although I am very rarely late. I call patients and their relatives back within 24 hours of them leaving a message for me. And I always listen with kindness however I might be feeling inside. There is no excuse to treat people with disrespect. And I always do the paperwork, referrals etc that I say I will. Patients need doctors they can rely on.

Luckily, I have met a lot of decent colleagues too. Who are understanding and go the extra mile for patients.

however, the system is struggling. Many staff have left and those of us remaining Seeing patients are increasingly burdened by the increasing number of referrals. It is very difficult to get onward care from other services. We are also affected by cuts to social services, poor housing and lack of support generally for people in the community.

Yes, having more staff and better IT resource would make a huge difference but nobody wants to pay for it. I did have some thoughts this week of what other job could I do. However, I love my clinical job and seeing patients and I cannot imagine finding another job which would give me that human contact, intellectual challenge, and emotional reward.

I urge people to complain if they have experienced poor service and rudeness. You do not have to put up with it and we should highlight poor practice.

What's your specific experience to back up these accusations?

Oh yes right. Nurses don't go on their phones on the ward. Drs do for BNF etc

I’m inclined to agree with you. I have a lot of interaction with the NHS. Staff do their best for me and some of the care is excellent but the whole system is clunky and obtuse. I can deal with any amount of waiting time if I have some idea of how long we are looking at. I’d like to be informed if the wait for an x-ray is half an hour or one and a half hours so I can go to the toilet without worrying about being missed being called. I had a scan recently and the staff just pulled a screen across the area so you couldn’t ask anything but I had no idea how long the wait would be. Same with the blood tests. Appalling lack of accountability to patients seems to be the norm. My local hospital PALS department won’t even take complaints. They say you have to write to the chief executive. So what are they there for then? A complaint can be you turned up for your appointment but you weren’t seen to a major fuck up of medical treatments but they don’t want to know and you have to write to the CE for the former? It’s barriers everywhere. Rude reception staff, inexplicable waits in out patients, inability to talk to your doctors by email or another other modern means of communication. As a patient I find it utterly frustrating and, OP, if your patients have been sitting waiting for your for ages in outpatients and they’ve waiting 9 months for that very appointment you should hardly be surprised they are pissed off. Perhaps the NHS needs to learn to communicate effectively which would benefit everyone but we, as patients, don’t have any power to ask for change. Doctors, however, do and should advocate for their patients.

I have to say the thing that has struck me about the NHS in the last year or so is how antagonistic and difficult the majority of staff are nowadays. I don’t know if it is because they are ground down because of having to deal with it day in day out but in the main I have found the staff uncaring, obstinate and lazy.

We think it's burn out and have had such poor care it nearly led to a preventable death but the whole set of systems and communication is dire and falling apart it's clearly as frustrating for staff as patients and many services do complain of being short staffed.

Though district nurses not reading notes so turning up again and again with any supplies needed and needing to be watched so they actually follow basic hygiene procedures is just poor practise.

I've worked in non-clinical roles in a variety of NHS settings over the last 20 years. Not at the coal face but understanding the pressures. Never needed treatment until this year when I have been:
Seen promptly
Referred quickly
Tested quickly
Diagnosed quickly
Treated extensively, by competent and personable clinicians

I hear that I'm lucky but surely it proves that it can be done? What makes my local trust so different from others?

I've experienced delays in outpatient waiting rooms certainly, but that's a fair trade off I can cope with for knowing that when I see the clinician, I won't be rushed, they will be thorough and if I have questions they will answer them. On treatment days it's been a well-oiled machine.

Maybe in some places it is down to management failings? For me, it's still a great system and I know that if we lived in the USA, my treatment needs would have bankrupted us. So, I'll continue to campaign and vote to keep the imperfect system we have, and hope that others will do the same before it's too late.

@Haydenn
Hard to imagine what’s more ‘real world’ than the NHS….?

I’ve had a lot of NHS contact in the last year or so, and several emergency attendances at A& E. I’ve been hugely impressed by all the people treating me. For one evolving issue, I’ve had contact with at least 20 specialist nurses, radiographers, consultants, junior doctors, pharmacists…not counting the admin staff.

All were professional, pleasant, did their job competently, guided me through a pretty serious new diagnosis. A kind nurse told me when I could take an hour’s break from the waiting room because the ultrasound person wouldn’t be on site until later. I came out of a consultant appointment feeling really happy because he’d been so kind.

Yes, one nurse in one part of A&E was a very little bit short with me, on one occasion. It was one of the hottest days of the heatwave last year, and they were rammed with people in a windowless, boiling hot space. She was actually asking if I was alright. These things happen, I put it down to the conditions.

‘They waft around, doing bugger all’

Never, EVER seen that.

Thank you for your examples. I really feel for you as a clinician and everything you say is utterly valid. I don't know how you continue to do it, and I am very grateful that you do. But the patient experience is valid too.

Here are some examples of my experiences I observed when being in hospital with my elderly patients.

Nurse spent 20 mins angrily clearing us out of where we were sitting waiting so she could use the area for treatment then called the patient for treatment and it was us - complete waste of time, and completely unnecessary.
Over 5 days I had to repeatedly tell nurses that my Dad was no longer on one of his medications, it was never removed or recorded and I had to prevent them giving it to him every single time.
Old people crying out for help or to go to the toilet and being shouted at by staff and told angrily to wait. One wet herself and the nurse was so fuming I thought she was going to hit her.
Staff so burnout that they literally did not care about their jobs or patients and in fact resented them immensely.
A complete lack of honesty from staff, passing the jobs on to the next clinician on the next shift the whole time.
Appointments being cancelled and changed without telling the actual patient - we turned up for chemo appointments to be told they had been moved to that morning (no-one told us)
Promises to ring with test results or appointment never, ever followed through
Nurses saying they would find something out and come straight back and then just never ever coming back and in fact going off shift (which is fine but just let us know)
Complete lack of the most basic organisation - beds being put against cupboards then having to be moved to get in the cupboard, basic equipment being stored on different wards so it took 45 minutes to get a syringe, dirty plates and dinner things left on top of emergency medical equipment for hours, toilet next to Dads bed not cleaned for 72 hours with someone's soiled gown on the floor (for 3 days!)

I could go on. Yes it is utter carnage and you don't realise how bad it is until you see it yourself. Yes I feel for the staff and was always polite and respectful. But it tested our patience to the extreme. I was actually clinically diagnosed with PTSD because of some of the things I witnessed. I expect staff will be experiencing that ten fold. The system is broken and it is heartbreaking.

As a very old NHS worker I am so glad I worked when I did! I wonder whether I could cope now, I hope so but a big thankyou for all you are doing.Some people are so self centred now take care!

Grateful to you and your colleagues, OP.