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

Consider for example, your BUPA insurance or whatever, that allows you to see a specialist of your choice within a few weeks. Why can you see them within a few weeks? Because other people don't have BUPA, don't want to or can't afford to spend privately, and so they wait much longer to be seen, probably by the same person, on the NHS at no personal cost.

Consider, then, if publicly funded healthcare were to cease to exist altogether. So that that option which has kept people off the private waiting lists, ceases to exist. There are still the same number of specialists, if nothing else changes - if the training bottlenecks and poor incentives remain in place - there will be no additional specialists. If the bottlenecks and incentives change, it still takes 10-15 years plus to train more (and also begs the question why the training bottlenecks and incentives can't just be improved within a publicly funded system).

So either:

A} You continue to pay for private health insurance or upfront for healthcare, but so does everybody else and it no longer gets you seen within a short time frame or gives you access to higher quality than average services. You are all now paying to wait around as long for a similar quality of care that used to be available in a cheaper, publicly funded system.

B) A competitive marketplace develops between insurers / providers, such that you can still be eg seen within a short time frame but you'll have to pay a hell of a lot more for it, seeing as healthcare at no personal cost is no longer part of the marketplace. Receiving high quality care on an urgent timescale becomes the domain of the super rich, and/or ordinary people have to bankrupt themselves to access it. Ordinary people have to limit the healthcare they receive to what is personally affordable.

C) Other people don't compete with you to be seen because they simply can't afford to do so. So maybe your waiting list doesn't increase as much but this is because large sections of society don't access healthcare at all.

D) Public, free at the point of care healthcare does exist in some capacity; but it is limited or means tested and/or delivers a poorer service. So that if you are lower income you can access second tier care, if you are middle or higher income, you can choose to pay a consistently high price in insurance or take on the risk of personal liability for healthcare costs - whilst accessing a higher tier healthcare that isn't much better, and is very possibly worse in terms of a higher proportion of treatments being inaccessible on cost grounds, to the previously existing publicly funded healthcare. And is delivered by the same people.

Or some combination of the above.

Does any of this sound maybe, familiar?

I work in the NHS and I pay to go private for GP appointments now. I can deal with waiting. I can deal with seeing you disappear off somewhere for 10 minutes, because I'm not an idiot and know it's for something useful. I can deal with being told tests will take a while, because I know that's the system. But just as you'd like more empathetic patients and for us not to take our frustrations with the system out on you...clinicians need to be told the same, and GP receptionists in particular. I would rather pay £100 for a private GP appointment now than have to deal with a hideously rude and unhelpful receptionist and then a GP who is either also rude, dismissive, or refuses to properly investigate what I'm there for. And because I too work in the NHS I fully know that everyone is burnt out and it's awful for you too - but this kind of thing is give and take, and in the last few years I personally feel our staff are ruder than ever, lacking compassion, and often doing a half arsed job.

Yes, absolutely. A good friend who is an NHS consultant (in a different medical specialism, nothing to do with gynae/babies) recently had her first baby. She told me that she got noticeably better treatment at antenatal appointments when she turned up straight from her own clinic wearing her badge and NHS lanyard than when she came in her “civvies”.

For patients, medical appointments are anxious time. Sick people are stressed and upset. Sickness is shit. Add missed word onto that. The system is incomprehensible and the clinician is the only person / conduit they have to discuss their thoughts on their care. You see a gp. They wash their hands of it/ have no time/ you get a letter with no information for the hospital then months later attend.

Clinicians, staff and patients all get institutionalised and not in the greatest ways.

Sorry - missed work that should say

Unfortunately there are some stuff in the NHS who are not empathetic or caring. Some staff are lazy. It's hardly surprising that in such a large organisation there are some staff who don't share the values and work ethic of others. And some have limited capability and perform poorly.
But overall it's a poorly designed system that is no longer fit for purpose and so everyone in it is impacted. Health care professionals, admin support, facilities and maintenance, managers and patients.
The strong performers who have support and a good manager will survive, same as patients with support and resources will probably negotiate it better.
Basically the government needs to get a grip of it. Then people like the OP will stay and patients will get a good service.

@Goatymum one off seizures they don't do anything about....apparently anyone can have 1 seizure. Once it's 2 then they do. That's when my husband was in hospital for a week with aspirate pneumonia.
(He didn't see a neurologist then just started on anti seizure drugs)
Then for us it was another 3 tonic clonic seizures (dislocating both shoulders each time) and daily focal seizures before seeing a neurologist 6 months later.
9 months down the line he's had an EEG but in the meantime another seizure had x2 surgeries on his shoulder because it didn't go back in place...and it's fractured.

I really hope you get seen too quicker!

I work in the NHS. I don't mind patients complaining to me, and I completely understand why they want/need to, but if they took that time to put in a formal complaint, or speak to PALS, or email the chief executive, then it might be more productive. But I also understand why they might not have the time and energy to do so 🤷‍♀️

I've never felt hatred towards a patient, though, and I don't think I've ever known a colleague to, either

@amoobaa

Thank you for such an honest post , I applaud you for calling out what people are not saying .
its almost like patients are not allowed to criticise the “ Marvellous NHS “ as it sinks to completely unacceptable levels of care .

I have seen some truly despicable treatment of family members over the last 18 months and NOTHING excuses it .

One family member was being sent home to die as there was nothing could be done . I got involved, lost my cool , long story short they were then referred to a specialist unit and are doing extremely well .

I would urge all to be very much aware of how many patients are being fobbed off or list in the system and advocate for themselves or others .

In France everyone has medical insurance where they are seen much much quick than people on the nhs.

It also works out cheaper as there is more competition and gives people more of incentive to train to become medical professionals

For those affected by seizures, I recently learned from a seizure-prone relative that Camphor in Tiger Balm and some other 'warming' creams can cause seizures.
Many folks are also sensitive to essential oils which can have neurlogical side-effects.

But this is the point. You've identified that the system works better in France because of there being more clinicians - because they have better incentives and presumably fewer or no perverse training bottlenecks.

Where I disagree with you (if I understand correctly) is that this is a result of the system in France being insurance funded. It is a result of political will. We could achieve the same in a publicly funded system, in my opinion, if the political will existed.

That said, I'm not opposed to a well regulated insurance funded system with safeguards for the most vulnerable. But it wouldn't fix the problems in UK healthcare unless accompanied by the political will and strategy to train and retain more staff.

What we are seeing currently with NHS services that are being privatised (they remain taxpayer funded but are contracted to private enterprise) broadly speaking is that they become more expensive, less effective and less safe. People largely don't understand that this is what is happening to their local NHS services because once privatised they are still using an NHS badge.

For the record France spends a little more on healthcare per capita than we do, their healthcare is not cheaper.

@MadamWho no absolutely not. If they asked me what I do for a living it came up, otherwise I'm a faceless cog in the background. I've watched treatment given to others in the room and am in a what's app group with my patient cohort and my experience is exactly the same as the others.

It's a case of taking the middle ground. The NHS is a shitstorm. It's broken, and we know that.

But, any complaints are best taken up with whoever is actually responsible for what's gone wrong.

It's pointless getting stroppy with the first person in front of you - they are often as powerless as the patient.

‘In France everyone has medical insurance where they are seen much much quick than people on the nhs.

It also works out cheaper as there is more competition and gives people more of incentive to train to become medical professionals’

I used to live in France, and I am in regular contact with friends who are still there ( they are French). Recently they have been saying that there has been a serious decline in the availability of medical appointments, and in the standard of treatment. Of course this is anecdotal, but it is interesting.

When I lived there, the local hospital staff often had a banner up on the roundabout complaining about working hours and pay. I wonder whether healthcare in developed countries is just groaning under the sight of increased expectations, brought about by the continual development of more complex treatments for more complex conditions.