Tuesday, 9 March 2010

From the horse's mouth

My thanks to reader Hazel who alerted me to this marvellously lucid account on the NHS from today's Telegraph... from an insider.

The hell of finding myself in a hospital bed

My life and career had been blessed. I was appointed a Senior Lecturer in 1987 and a Professor in 1998; in 2002, I was almost at the peak of my career. I had been an adviser to the World Health Organisation twice, I was Sub-Dean for examinations of my primary Royal College and was also an elected Fellow on Council, and had just been appointed to sit on a United Nations committee. My long-term partner had just proposed marriage to me. We had a good year, attending operas and dinners, had travelled widely and enjoyed tennis and sailing together. Then everything changed so very suddenly. I felt a lump in my right breast and at 11.30am on Wednesday November 27 2002 I was told that I had breast cancer: a five-centimetre stage 2 “ductal carcinoma”, which was invasive. I now began my second career – as an NHS patient. Little did I know that my medical CV would soon be almost as long as my academic CV.
My cancer treatment was arduous. I had eight chemotherapy sessions, lasting five months; I then had a partial mastectomy and radical lymph node clearance, and then six weeks of daily radiotherapy. My second and final oncologist advised me to have two “extra chemos”; despite the side effects – septicaemia, continuous nausea, plus vomiting blood because of the pressure on the veins in the throat, undiagnosed restless feet and legs and, naturally, complete hair loss – I agreed. The desire to live and get better was huge.
All this meant that I passed through numerous hands and numerous shifts of staff. Most of the professional staff and particularly the medical teams in the NHS are great: the cancer staff seem particularly caring, as they spend much time talking with, listening to and really caring for their patients.
Since cancer I have been diagnosed as having a “syndrome” – too many dark spots on the skin, which has an association with breast cancer; I have had no fewer than 20 biopsies (thank heaven – none malignant); then I had a total hip replacement (THR); and I also attend various other clinics including the asthma clinic, the lipid clinic (for a blood disorder) and a complementary cancer clinic.
I have, on the whole, been treated very well, especially by the doctors looking after me – and the cynic would say, “Well, of course, she is a doctor”. But I have not always been treated so satisfactorily. I began my cancer treatment with chemotherapy at a London teaching hospital. The side effects were ghastly, the worst of which was the septicaemia. I had to be admitted to hospital in a blue-light ambulance and do not remember two full days: I am lucky to be alive.
Apart from the consultant surgeon, who I thought was really super, the hospital staff were not very kind to me. A junior doctor asked me if I knew “my diagnosis and prognosis” and the oncology consultant appeared off-hand and failed to turn up to an appointment. I subsequently left the hospital, and my GP then transferred me to “my” hospital, where I completed the rest of my treatment and at which I am still an out-patient.
When I felt better in myself and stronger, I wrote to the CEO of the first hospital and received a complete white-wash of a reply. I felt aggrieved, but was too ill to “fight the system”. At my hospital, the doctors and consultants have been fabulous to me, but the same cannot be said for all of the professional groups there.
For instance, nearly all the nurses on the ward when I had the hip replacement a couple of years ago adopted “assumed intimacy”, calling me by my first name when not invited to do so. In fact, one of my visitors asked the nurses where Prof Robertson was – only to be assured that there was no one there by that name on the ward. I was only known as “Mary in bed 10”.
I have always called my adult patients Mr Smith or Mrs Jones; I even ask the youngsters and children what I should call them. This is, I discovered, not always the case in the NHS, particularly in some disciplines. Many a time, while having an X-ray or MRI, I have been called “Mary”. Once, when I did not reply to that, the radiographer asked “Aren’t you Mary?”. “No,” I replied. “To you I am Professor Robertson – I am your patient, not your friend.” Another time in the same department I complained and was told that using first names was their policy – this was despite the fact that the radiographer had not introduced herself, nor was she wearing a name badge.
While some of the nurses are really outstanding (my specialist nurses for breast cancer, lymphoedema and dermatology), others are far from good. Again, when I had my hip replacement, some of the nurses, in particular some Health Care Assistants (HCAs), let me and other patients down. For example, I vomited and was left for half an hour before being cleaned. Once when I used the bed-pan I was left alone and one of my visitors (who is a doctor and physiotherapist) actually took it upon herself to take the bed-pan away. I was left without a wash for two days.
There was also a shortage of nursing staff, which had repercussions for patients. An HCA challenged an 85-year-old woman as to why she could not walk to the lavatory, and everyone could hear her, which was unacceptable. A second HCA told the same 85-year-old – when the patient said she “was bursting and wanted to go to the toilet and would end up wetting her bed” – “That doesn’t matter”.
All of this was in sharp contrast to the female night staff nurse who virtually manned the ward herself, put up and changed my IV drip for a blood transfusion, gave all of us our night medications, changed my bed-pan and once, when it had spilled over on to the sheets, even made my bed. She greeted every patient when she came on duty with a warm smile. Yes, thank heavens, there are still the real “Florence Nightingales” like her, who actually want to be nurses, but then there are others who appear merely to want a job, and a job in the NHS is secure – it is quite difficult to be fired.
I can see now, as a patient and a doctor, that, in contrast to 30 years ago in the NHS, managers have much more control. Many of my doctors (with me as the patient) and also my colleagues (with me as a doctor) are frustrated, and morale is lower than it used to be. In the days when I started in the NHS, matrons in blue uniforms and starchy white hats ruled the roost, and consultants were held “on high”: everyone worked hard and loved it. People called the professor “Professor”. Now it seems that Professors and doctors are being side-lined: a friend of mine is a senior surgeon and has a midwife as boss and line manager.
There is now no dedicated doctors’ canteen in many hospitals, and complaining about this is not me being elitist – much work used to be done over lunch, obtaining an opinion on a difficult problem. Doctors, in the main, no longer have their own offices either, so many of them have to dictate patients’ letters within hearing of other folk who have nothing to do with the patient.
With all this new management come new rules and conditions, not really made by senior doctors. And then, of course, we also have the European working time rules. When I had my hip operation, the junior doctor (house-man or intern) was rushed off her feet. She was pleasant and, I am sure, competent. But all I saw was her running around like a headless chicken, greeting patients briefly, checking if they had a variety of pains, whether they had had a “pee or poo”, whether they had walked, whether or not they were in pain, whether or not they had had their bloods taken.
“No” was my answer to all: she looked aghast at the last – “Oh, that means that I will have to come and take it”. The rest of the time she seemed to be writing up the drug/medication charts or filling in forms: surely that brought little job satisfaction. I remember as a house-man working endlessly but doing everything and being a proper doctor involved in my patients’ care. I undertook draining of pleural effusions (taking water off the lung), reducing ascities (similar, but taking excess fluid off the abdomen), doing endless lumbar punctures, initiating emergency treatment and so on. We all also made time to talk to and listen to our patients. Even now, I still remember some of my patients’ names from those days, nearly 40 years ago.
A new language has insidiously crept into the medical world. Patients are increasingly called “clients”. I am not a “client” when I am ill – I am a patient and want to be treated by doctors and nurses. I am a customer in a shop and a client in a legal firm. “Breach” and “targets” are also very important new “medical” words. A breach means that a patient misses being allocated an appointment within a specified time, and the target is that specified time (heaven forbid – heads will roll and/or salaries drop).
I have had this happen to me as a patient, illustrating just how crazy it is. My previous GP referred me for a community para-medical appointment: I was offered an appointment within three days (the target) at a centre many miles away – necessitating two bus rides. I declined and asked for one at a clinic within easy walking distance from my home. No – for that appointment and clinic I would have to telephone again next day, or else I would “breach the community practice target”. When I did phone, all appointments were full, and so I was given a place on a waiting list for an appointment within six weeks. I wrote to the manager, pointing out the absurdity, and was given the appointment within three days: but imagine if I could not type and was not articulate – I might still be on the waiting list!
I took early retirement because of my cancer and work one day a week pro bono, so I am not bothered by many of the changes – for example, I almost never go to management meetings. But with the NHS changing so much, many of my academic and NHS colleagues are now taking early retirement, and continuing with academic sessions; that is what doctors love – their work.
Recently, I had the privilege of observing the entire process of deep brain stimulation (DBS; functional neurosurgery – like a “pacemaker” to the brain) for a patient with a movement disorder. The whole day was a pleasure. “Happy hierarchy” ruled and almost all called me and my senior colleague “Prof”. Everyone got on with their jobs and there was a huge esprit de corps.
DBS is probably the most amazing medical development in my 39-year career as a doctor. The day brought out everything that is fabulous about medicine – apart from the fact that in a target-besotted NHS, the operating theatre lacked a pillow for the patient and an appropriate trolley to take her to theatre, so the sister and registrar had to go searching for them.
The NHS is an absolute treasure – my thought is that we should not abuse it. This goes for both staff and patients. NHS staff should act professionally and courteously all of the time and so should patients, by turning up for their appointments (much NHS time and money is lost through missed appointments). All of this makes the NHS, according to some, an inefficient system. Let us at least try to cure that. Long live the weird and wonderful system that is the NHS.
Mary Robertson is Emeritus Professor of Neuropsychiatry and Visiting Professor and Honorary Consultant Neuropsychiatrist at two London teaching hospitals and universities.


  1. Is it me or is the fuss over the use of first names so very trivial?

  2. I think it depends who you are but it is important to some people. When you're very sick and under someone else's care for virtually everything you need, then the relationship becomes extremely important. I can completely understand where the professor is coming from, but if you haven't experienced a long hospital stay you might not understand.

  3. I understand her point entirely. When I go to see a GP, they invariably introduce themselves as "Chris" or "Mark" or whatever. I always ignore that and address them as "Doctor So-and-so". I expect to be treated by a professional. I am not there for a chat with a mate.

  4. Professor is an honoury title. I think her request to be called that stinks of hierarchy. I am a Dr (PhD so earned and entitled to use it, unlike medical doctors on whom it is bestowed as an honour) and do not use it outside of my work.

  5. She may well be a stuck up snob, for all I know. However, it's not for position of doctors or nurses to pass judgement and punish people who they think have airs and graces. If I choose to be called Lord Sutch when I am in hospital then that should be my wish. When I was on one ward there was an old soldier who had reached the rank of major. We patients called his major as it seemed the respectful thing to do. The staff insisted on calling him by his first name. He didn't complain but it didn't seem right somehow.

  6. It is common courtesy to address people in the manner of their choosing.
    Whilst we might be comfortable with someone using our first name it doesn't make it right for everyone.
    My mum is more than happy for folk to call her by her name but it is not the one on her birth certificate! That is her 'Sunday name'!!! My mother in law, on the other hand, gets most annoyed when people address her by anything other than her proper title - Mrs *****.

    It is about respecting other people, something sadly lacking in this country and especially the NHS.

    The hospital I trained in were very clear about this issue. When someone was admitted there was a bit on the form which said - prefer to be called - and that is what we did! We asked what someone wanted to be known as and that is how we adressed them!

    Good manners cost nothing but can make a huge difference to how someone feels, especially in an already stressful situation.

  7. Names should be agreed between two people and be on the same level. I had reason to visit a police station recently. The person I spoke to was Sergeant so-and-so but he addressed me by my Christian name. It grated but I didn't say anything as I wanted to get out of there!

    The nursing home where my Mum-in-law spends her last happy years has a first-name policy for everyone. That works too, especially for dementia patients in my experience.

    Apart from this naming issue, the author raises a number of good points.



  8. name is a matter of respect and the patients choice, there are many elderly folk who feel very uncomfortable being addressed by their first name....but the main point of this article is not just names, but the whole issue of what the \NHS is about - looking after people - not being obsessed by targets to the detriment of everything else...as a nurse, I found that being a patient was a huge advantage - that feeling of dependence on others was very scary. Who do you wnat looking after you - someone ticking boxes or someone who cares about you, your family and your health??? that is what matters most

  9. If respect is not practiced and taught, especially to the young ,it will be lost forever and the old mannerisms will be lost forever to ignorance.

    It cost nothing to be respectful or to have manners,what it does prove is that you were not dragged up, but even if you were the choice to change your mannerisms is yours, it costs nothing.

    Here where I live ignorance is rife ,rudeness breeds and disrespect is a terrible diease amongst the people. They hate it when any one says 'please, sorry and thankyou', they cannot accept the concept of good manners, it is alien to them.

    As for the lady professor, she earned her title by hard work and dedication to her job, she has a right to expect to be called by her chosen title. I always ask anyone who I have been introduced to, what name they want me to call them by , even the ordinary person.

  10. "To you I am Professor Robertson - I am your patient, not your friend" Scary but...cool.

  11. I agree. I'm thinking of using my own version: "To you I am Traction Man - I am your patient, not your friend!"


    If Mr Alhi expects to be called Dr Alhi in his chosen academic environment, surely Professor Robertson should be allowed to expect the same courtesy in her medical domain.

    Familiarity breeds contempt and the patients suffer.

    How sad that Professor Robertson was not given the respect that she had patently earned through a conscientious career and becoming an authority on Tourette Syndrome [TS]. I found this on the Samuel’s Story website [2006, now closed for comments]:

    [A mother whose young son has TS]… we finally got a referral to St Georges, London. That was after we had tried various medications first, mind – about 6 months of trying! We now see Professor Mary Robertson who the leading specialist in TS – a lovely kind caring lady who, when you speak to her, understands!!! That is the all important part – being understood and supported…

  13. Before Feb. 16 I would've been aghast at the behaviour of the nurses/staff. I went to an Ear Nose Throat (ENT) specialist who really attacked me. The only thing he said to me was open and say ahhh, then commenced to grab my tongue and stick something down my throat. I gagged then he pulled that out and stuck something up my nose and when I pulled back he said curtly to "stay still" then pulled it out and did it to the other nostril. It happened so fast and I was stunned that I only said a few times that it hurt.
    This past Monday I went to see him as a followup and told him how I felt being abused and disrespected like that. He looked at me as if he didn't have a clue what I was talking about, that what he did wasn't wrong or unethical. I'm now in disbelief that he sees nothing wrong with his communication and procedural skills. He is one big idiot.
    In response? I'm filing a formal complaint with his ruling body, the College of Physician's & Surgeons of Alberta. I've told everyone I know to avoid him...and especially my family physician (who had referred me to him).
    On the form it asks what I'd like to see come from this. I asked that he take a communication course and be supervised during office visits until he consistently treats patients with respect and clearly understands that what he does is wrong and unethical. And an apology to myself and all his patients that he abused.
    Want to find out what others think of a doctor? http://www.ratemds.com for Canadian,US, UK, AUST etc doctors. For UK & AUST click on looking for doctors in your area link.
    I found out that this dork ambushes routinely. His aide said that he was known for that when I mentioned being ambushed. She also defended his lack of talking as being "busy". I responded that I know many busy doctors who talk to me. What could she say to that?

    Libby in Alberta (who thankfully can stand up and say "No, this isn't right!")

  14. Well done to Libby in Alberta!
    Until more people complain about this sort of treatment then nothing will change! In the UK, patients are not keen on complaining for fear of making situations worse and they are sympathetic to nursing staff who are overworked! However, a complaint MUST be dealt with and enough complaints about a person or a situation must, eventually, lead to a change in practise.

    So, never mind the litigation, that only means less money for treating patients, complain about treatment!

  15. "Now it seems that Professors and doctors are being side-lined: a friend of mine is a senior surgeon and has a midwife as boss and line manager."

    Professor Robertson wants respect for her and her profession but what about a little respect for others? Such as this line manager and midwife? why is she implying that having a boss who is also a midwife degrades a 'senior surgeon'?

  16. Dear XTM

    As always you have sparked a great deal of thought and commentry from all. Respectful approaches to patients is not hard, it is not some unattainable goal. I remember being told as very junior nurse to imagine that allof the patients I was looking after was my mother, father, sister, brother, friend etc, and to think how they would like to be treated and spoken too. Wise words from a wise Mercy sister and exceptional nurse. When you are patient, such as Prof Robertson, particularly, dealing with such an terrible disease as Breast Cancer, you feel so out of control of your normal day to day life, that what seems to be a small thing, such as how you are addressed, becomes so important. As patients, you are a disease or an event, in the eyes of some healthcare workers, when in reality, you are who you are first with that additional burden. Is it really that outrageous to expect to be dealt with by health professionals with respect? I am only human, and I am sure that in my nursing career, I have probably not treated all of my patients as well as I should have, but I do hope that for most of my patients most of the time, I have been respectful and caring and not contributed to their distress.

    Wishing you continued good health XTM,

    Pepsis' Mum