The NHS has a real problem which I would imagine passes most people by........I will not explain that statement immediately, but let you read through and you can decide whether you agree with me.
As I write, I am chock full of antibiotics (more of that later), have acquired a scrap value as I now contain a tiny amount of gold (NB next generation, if the gold price is high at the time of my demise, make sure that you recover it), and eagerly looking forward to the outbreak of democracy in the months following the election.
You may recall that my relationship with the Mid Kent Oncology Unit, which is part of the Maidstone and Tunbridge Wells National Health Service Trust, did not get off to a good start when Well Modulated S**** (WMS) was a little economical with "la verite". I have now met WMS in person and it was not a pleasant experience for either of us.................
Just to continue the prologue a little longer, it is heartening to know that technicians like WMS carry out procedures which were previously the exclusive domain of the medical profession. It is less heartening to know that their training is evidently task focused and does not require any understanding of the theoretical basis for what they do, or the Mental Capacity Act (I will test you on that one later!).
Started as usual: I turned up on time and was told that they were running late. Great receptionist to offered to buy me a cup of coffee if they were less than 10 minutes behind. Her cash was safe, but only just. 10 minutes later than advertised, the junior radiographer I had seen last time appeared and summoned me to the basement. I was shown to an NHS standard room, invited to change into the obligatory hospital gown and asked whether I had brought the antibiotic suppository that had been issued by pharmacy last week. I had it with me, but it is an antibiotic to which I have a severe aversion so refused to hand it over until such time as I received reassurance that it would not be administered without my express permission which I would either give, or not, at the end of the procedure. This was a real problem for him.
Just a note about that particular antibiotic. It is called metronidazole and marketed as Flagyl. It has a serious side effect: it makes you feel sick. Worse, it is guaranteed to make you feel sick if you drink alcohol and the jury is out on the interaction between Flagyl, nicotine vaporizers (e-cigarettes) and one's liver. As a compulsive "vaper" and as someone who enjoys a drink, especially on election night, this was obviously a drug which I did not want to be in the same room as, let alone have it shoved up..........well, you get the idea.
I asked the radiographer what the basis for using this particular drug was and what the comparative outcomes were between single antibiotic use and the polypharmacy (more than one drug) approach they clearly favoured. Some of you may have watched W1A, in which case you will understand the next bit. He took on an expression often worn by the character called Will........ His answer could be summarised as "I have no idea, it is just what our protocol tells us to do". Oh dear.......
Things went a little downhill after that. He conferred with his colleague, WMS, and was sent back to tell me that this is what they do, but that she had summoned a doctor to talk to me. Nice young newly appointed consultant who told me that he had worked at the Marsden Hospital as a junior doctor until recently and they use the same drugs. He had little idea why or what the research was behind this.
I asked one of them (I forget which) why the procedure was carried out rectally instead of through the perineum which has a much lower chance of infection. "Because our protocol is that we would only do that under a general anaesthetic". They really should talk to a 21st century hospital like UCH...........clearly Maidstone is a little behind current practice.
Struck a deal with the doctor: I would decide after the procedure whether I would accept the Flagyl and, if I did not, I would sign a disclaimer. Job done? Not a chance.......
2 minutes later, the young doctor was back to tell me that the technicians refused to carry out the procedure unless I agreed to the Flagyl beforehand. I now had a choice: accept the drug or forego the chance to have radiotherapy and leave the cancer to its work I think this is called blackmail in the real world!
The message from the local NHS is: accept what we do and how we do it, or we will leave you to your fate.
Flagyl or years of suffering ahead............no choice, I accepted the concept of the drug, although not without making my displeasure known.
WMS is clearly not a person who feels that interpersonal skills are necessary, although she tried:
Her "We spoke over the phone"
Me: "I shall gloss over that since you told me that the drugs would be left at reception and they clearly were not"
Her "they were there"
No point in pursuing this one as she was clearly determined to remain in the hole that she had dug for herself.
WMS was competent with needles etc, as a good technician should be. She had clearly done it before, but not with anyone who questioned her.
Before insertion of the Flagyl, I reminded them that they should ask before administering a noxious substance (I had already agreed that I would say yes, but the point needed to me made). It was at this point that WMS raised her voice. Best way to get things done in the NHS: shout at the patient...........................
I had no wish for further confrontation, so merely stated that she was administering a drug without obtaining the consent of the patient and gave in. This clearly went over her head.
Despite the leaflet from the hospital telling me that "....you will need to pass urine before you can leave the department" (a potential whole new argument about deprivation of liberty), the junior discharged his responsibility by advising me and I duly explained that I would not. I think he had had enough............
On reflection, I was probably a bit harsh on technical staff who just follow protocols and the argument should be with those in a position of responsibility, but hindsight is a great thing. The junior has just telephoned me to make sure I am ok and that I have understood my instructions for the next stage on the 26th. I apologised for picking a fight with the wrong people and acknowledged that they were just following orders......(I seem to have heard that phrase somewhere before in a very different context!)
Told a shortened version of the above to a friend when I got home who immediately asked whether it would have happened if I had been a private patient i.e. there was a direct customer / provider relationship. A rhetorical question, but one that others may wish to ponder. Does the NHS have the right to withdraw treatment if a patient makes a judgement with which their protocols do not agree? Should this be the case? Does the current culture of suing public bodies contribute to lack of choice?
We also came up with a new approach to the Flagyl / alcohol problem and a potential solution which I shall test this evening. Given that small amounts of alcohol cause nausea, perhaps this can be avoided by consuming sufficient alcohol to render the nausea insignificant? I will let you know whether it works.
Answers on a postcard please.................
Today's song has nothing to do with the blog post and certainly not WMS, but is here to celibrate the life of Errol Brown.
https://www.youtube.com/watch?v=JIN36NweL6I&list=RDJIN36NweL6I#t=3
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