My time in the NHS began back in August 2007. During medical school, we are made partisans of the GMC's Duties of a doctor. Of its four domains, its' third - communication, partnership and teamwork, highlights the importance of working collaboratively with colleagues to maintain or improve patient care stating that doctors:
• must work collaboratively with colleagues, respecting their skills and contributions.
• must treat colleagues fairly and with respect.
• must be aware of how your behaviour may influence others within and outside the team.
Doctors of course rely on working with other specialists as patient care often necessitates specialist skills. As medical doctors we may for example call upon a surgical colleague if we suspect a patient is suffering from sudden onset bowel obstruction and needs urgent intervention. In addition, if a patient currently being cared for with a chronic illness feels low in mood secondary to their symptomatology, we will no doubt liaise with a psychiatrist in order to effectively assess their mental state. Being aware of our deficits is crucial in providing the very best in patient care. As well as specialists, we also rely heavily on multidisciplinary staff such as nurses to alert us to deteriorating patients' states, pharmacists to ensure accurate drug dosing and physiotherapists to inform us whether patients are physically fit to be safely discharged home following their stay in hospital.
Interestingly however, I have become acutely aware that such multidisciplines often feel the need to obscure our opinion on medical matters in an often non constructive manner delegitimising a clinician's input.
One episode I recall centred on a patient who had been admitted to hospital following vomiting blood. The patient was an alcoholic and there was a concern of bleeding within his digestive tract. As a result he was scheduled for an urgent endoscopy. Our team was informed however that one of the nursing staff had taken it upon himself to speak to the endoscopy department, without direct consultation with ourselves, stating that the patient would not be having his procedure as a result of an abnormal blood result. The abnormal blood result in question, which had already been noted I might add, involved a slightly raised cardiac enzyme which is often raised in cases of cardiac damage but may also be elevated in cases of infection, renal damage or, as in this particular case, a likely gastrointestinal bleed. As a result of its spurious nature, the end result of such non sensical interpretation resulted in a delayed procedure, with the medical team being left to sustain the justified furore by the patient and his family.
On another occasion a patient had been admitted with an episode of chest pain and was being treated as suffering from a heart attack. Medical treatment in such cases involves prescribing drugs that help to thin the blood in addition to medications that help control one's cholesterol and heart rate. Unfortunately the pharmacist on that particular day felt it necessary to be meddlesome and contested our choice of cholesterol lowering medication. We explained that the latest research was for our particular agent but this was not easily digested by her. The patient was quick to take a faux affectionate approach with our team condemning us to subsequently gain a copy of such evidence base and show our reasoning for such prescription.
A third episode saw a patient presenting with left sided weakness who was diagnosed with a stroke following appropriate brain imaging. After medical treatment and rehabilitation she was later geared up for discharge. On the day of discharge she commented that she still felt slightly weak on her left side but was happy to go home. We informed her that if her weakness was still troubling her she was more than welcome to come back to hospital for assessment. A week later she returned and felt her weakness was making it difficult for her to carry out tasks at home. On assessment we concluded that there was no new neurological finding and the patient simply required more rehabilitation from a physiotherapy perspective. The ward physiotherapist made her assessment and again without consultation with the medical team felt the patient had suffered a new stroke. Due to its illusory presentation she informed the patient she would require new brain imaging. Our team was now burdened with distrust and were obliged to perform such a test - the result of which demonstrated no evidence of a new stroke. Yet another example of unnecessary obstructionism.
A final occurrence I would like to share involved a patient with dementia who had been admitted with a urinary tract infection. Following antibiotic treatment the infection had cleared and we were happy for the patient to go home following assessment by the ward occupational therapist. The patient had informed us that being in hospital had made her feel low and she was certainly eager to go home. Part of the occupational therapist's assessment involved determining whether the patient would be suitably placed to function at home by performing normal activities of daily living. Despite scoring highly on almost all domains, the patient was tentatively deemed unsafe for discharge after relinquishing when asked to make a cup of tea (don't worry I know what you are thinking). We spoke to the patient who commented feeling humiliated by being asked to do such a menial task stating that she was not someone who would simply perform on demand. We informed the occupational therapist that her low mood as a result of being sojourned in hospital was most likely the reason for not performing the task in question and if they had communicated with the patient on a personal level her desire for autonomy would have certainly been apparent.
Despite the manifesto underpinning the National Health Service, there are obvious concerns with its functioning, blighted primarily by a lack of resources. As a result NHS workers are left to function in an extirpated environment with less than optimum fodder; limited staffing, bed space and financial constraints hindering the use of latest technologies and treatment. For the NHS to rise above and remain galvanized, workers should avoid autocratic mannerisms and take note of Mattie Stepanek's words: "Unity is strength... when there is teamwork and collaboration, wonderful things can be achieved."