The thought process in some hospital departments seems to be that as soon as the patient is no longer on the premises that all the responsibility for what happens next is ‘somebody else’s problem’, writes Fintan Moore
We all know the health service is stretched in every patient-facing area, including our own, but there are times when the patient care following hospital discharge is unreasonably below any acceptable standard. The thought process in some hospital departments seems to be that as soon as the patient is no longer on the premises that all the responsibility for what happens next is ‘somebody else’s problem’. The late, great Douglas Adam in The Hitchhiker’s Guide to the Galaxy described a problem-solving approach called a SEP Field, which was like an invisibility cloak to throw over any difficult issue. The SEP Field didn’t fix the problem – it just made it go away by it becoming something to be solved (or not) by somebody else. Clearly some hospital managers have adopted this as policy.
Joking aside, the experience an elderly patient of mine had at the Easter weekend was appalling. I won’t name the hospital in order to protect the guilty, but every community pharmacist reading this will know which one I’m talking about. The patient had a procedure carried out on the afternoon of Holy Thursday and reached my pharmacy with the discharge prescription by 4.45pm. One of the items was an antibiotic which has been regularly unavailable for months, but no alternative was listed to cover this eventuality. So I tried phoning the day ward, which was theoretically open until five o’clock, except that they had cleared out early for the extra-long weekend from Good Friday until Easter Monday.
Over several calls, the switchboard operator tried the ward that did the procedure – no answer. He tried another person who couldn’t help because the patient wasn’t an inpatient so she said she’d transfer me – no answer. The switchboard guy tried another extension and that person couldn’t do anything either but said she’d transfer me, so I said there was no point in trying the day ward extension but she probably did anyway – no answer.
Then the switchboard guy tried the A&E department – no answer, repeatedly. Then, the next time I called, even the switchboard stopped answering. All I could do at that point was advise the patient to keep trying to ring the A&E department himself over the weekend, which he did without success. So the patient went without any antibiotic cover but, fortunately, all went well.
To add insult to injury, I emailed the Quality Department of the hospital about the lack of patient care, and I never even got an acknowledgement. Remarkably, this hospital doesn’t even seem to use Healthmail, which tells a tale in itself. So I understand that resources are limited and staff are hard to find yada, yada yada, but the simple, cheap, and effective solution to this situation is for the hospital to drag itself into 2024 and set up Healthmail, then have a dedicated Healthmail address for prescription queries from community pharmacists. Doctors in A&E could then deal with these queries at a convenient time rather than being interrupted by phone calls. But that’s probably too simple a solution to be welcome.
Stigmatising terms
I read an interesting article recently about the inadvisability of doctors writing negative comments on patient charts, for example, one doctor wrote ‘I listed several fictitious drug names and the patient said she was taking all of them.’ The author of the piece made the point that such remarks can subsequently lead other doctors and nurses to treat the patient as highly unreliable, and to be less thorough with consultations, with a consequent increased risk of medical misadventure. This is actually borne out by analysis of the charts of patients who suffered a misadventure, and which showed that such patients were twice as likely to have negative comments in their notes as regular patients.
It is easy to see how a comparable phenomenon could exist in pharmacy. We all have heart-sink patients who can be problematic in various ways: Cantankerous, impatient, rude, over-talkative, time-sucking, creepy, generic-phobic, chancers etc, and it is human nature to just want them sorted and out of the place as soon as possible. The risk this creates is that we could fall into the trap of glossing over a genuine problem instead of taking the extra minute to flesh it out. It is a fact of pharmacy service that the people who often most need help can make it difficult to help them.
I understand that resources are limited and staff are hard to find yada, yada yada, but the simple, cheap and effective solution to this situation is for the hospital to drag itself into 2024 and set up Healthmail, then have a dedicated Healthmail address for prescription queries from community pharmacists
Are ya dancing?
An interesting suggestion I came across regarding patients who do not like exercise was to suggest that they join a dance class instead. The activity is aerobically healthy, good for mobility, flexibility, muscle strength, and is good for meeting people. It is also suitable for all ages and levels of ability. A few years ago, a friend of mine who lives down west, got chatting to a visiting European geriatrician who was stunned when he saw set dancing for the first time as he saw its potential to help ward off the physical, mental, and social decline in people as they age. I wonder if set dancing was suddenly imported from a different country as ‘the latest fitness craze’, would we embrace it more seriously? Might be time for a renaissance.
Fintan Moore graduated as a pharmacist in 1990 from TCD and currently runs a pharmacy in Clondalkin. His email address is: greenparkpharmacy @gmail.com.
