Language patterns in medicine

wrong-questionIf you have read this far then you know that I have just spent a few days in hospital. As part of that I have been asked a host of questions about my health history and some of them have caused me a little concern, not on grounds of their content but their form. More than once in the last few days I have been asked questions such as:

“Do you know where you are?”

“You don’t have any allergies do you?”

“You are OK with that aren’t you?”

On one occasion I answered the first one with “Yes thank you”!

Now I accept that I am being a bit smart-ass with that answer because it was perfectly obvious that the nurse wanted to test my understanding of where I was by asking me to state where I was at that time. But at its heart it is a closed question.

The other ‘mistakes’ are not so innocent or harmless in my view – they are leading questions, and we all know where leading questions can take us (to the answer we are seeking). It’s easy for someone under stress, such as those waiting for an operation, to answer ‘Yes’ to the leading question without really thinking it through. It would be tragic for someone to receive inappropriate treatment simply because they got the ‘wrong’ answer to a leading question.

There is no room for these potential mistakes and I don’t know whether nurses and doctors get training in such aspects of language use – but they should!

Recovery underway

time to healAfter all the hassle of the last 13 months, ending with a long wait for partly  avoidable reasons on Friday morning I went into theatre at ca 1400 Friday and emerged very groggy but adenoma-less on Friday evening.

I am typing this from my recovery bed in LGI, having spent a wakeful night in a High Dependency Bed because of my moderate sleep apnoea. As always, every single member of staff has been wonderful and although I do have a few constructive comments to offer this is not the post for that. This post is a celebration of the successes of our NHS. I expect to spend Saturday and Sunday in hospital and then, subject to blood tests being OK, go home on Monday when I will have at east 2 weeks ‘doing nothing’ – I gather the word is convalescence.

The effects of a 3 hour anaesthetic wore off overnight and I’m now feeling MUCH better than I had feared I might. The only pain is a flashing headache if I am daft enough to cough; my head does not feel congested (yet, as Suzanne keeps reminding me); my fluids are in balance (so no diabetes insipidus); bloods have so far been fine and so it’s fingers crossed for a Monday release.

I have just been transferred from the HDU bed to a normal ward – shame really as I had a side-room in HDU and share this ward with three other men, none of whom look anything like as healthy as I feel. Thankfully I have a window over Leeds from the 5th(?) floor and it’s bright with summer clouds. IMMEDIATE UPDATE – as I am typing I get moved to a private room. Not as nice a view – unless the sight of the helicopter landing pad turns you on, but quieter.

So what does the future hold? Visit from the Endocrinologist (Monday?) who will apparently prescribe hydrocortisone and something to prevent the Hydrocortisone messing up my stomach, then discharge and a list of other appointments – more bloods, Goldman Test for eyesight, MRI to see how much of the blancmange walnut was left behind…

So pleased that at least the surgery, which was the bit I was most concerned about, is over. So pleased also to see Suzanne (my wife if you don’t already know her) waiting as I came round from surgery and most of today to help keep me sane lying/sitting in this bed. She saved me from myself in week1 and possibly on occasions since and I just know that it has affected her more than she shows. Thank you Suzanne, I love you.

A rocky road to success…

MRI ScannerWhen my surgeon’s secretary rang last week to rearrange my surgery, I just about recall her mentioning a possible need for a further scan. Well, with less than 48 hrs to go before going under the knife, I had heard nothing and assumed that he had decided otherwise.

Imagine my surprise to have a call this afternoon from the booking service for Radiology (who do the MRI scans) saying something along the lines of ‘We have just found this request for a scan and would like to book you in”. Temporarily holding back my frustration I offer immediately this afternoon or Thursday (tomorrow) afternoon. No can do – we have no slots this afternoon and we only offer 0900 appointments. Well my restraint was under severe strain by now, so I explained as politely as I could (I do hope it actually WAS polite) that after rearranging my life three times for surgery that has yet to happen I had scheduled one thing in the morning that I really did not want to move and how hacked off I was with the whole process. Well, for once I did not get the ‘computer says no’ treatment. The nice lady (sorry, I did not get your name) asked if she could go away and see what was possible, maybe even arranging it for the morning of my surgery.

A phone call less than 10 minutes later and i was offered an appointment for 1800 today! Who knows what happened behind the scenes but thank you someone for meeting a patient’s needs, albeit 2nd time round.

What did we not hear?

earsTwo blog posts in one day – something interesting must have happened!

Amidst all the gloating, rage, disappointment about the referendum result, my great friend James Traeger reminded me, by posting this blog, that I am a change leadership professional. So here is a short piece reflecting on the outcome from that perspective.

There is a view that many of those voting for Brexit were essentially casting a protest vote. Protest at austerity, protest at uncontrolled immigration, protest at who knows what… What they are saying is that they have not been heard. As a good change professional (well, I think so anyway!) I need to recognise and be able to work with the difference between hearing someone and that person being heard; the difference between my ears listening to the words and my heart and brain listening for the meaning. I need to seek out and learn from the naysayers and the resistors, for sooner or later their grievances will surface and get in the way of progress. Listen to them properly, explore with them what lies behind their position, for only then can we start to change their minds.

We are also repeatedly told that effective change relies on a positive vision of the future. It is not enough to say what is wrong, we need some idea of what might constitute right. Yet here we are with a campaign about getting Britain out of the EU. Where is the compelling narrative of the future? Where is the roadmap for change? Where are the guiding coalition, the leaders? And where were the leaders who could understand and articulate the interlinked, systemic, nature of the argument (shame it wasn’t dialogue)?

Effective change leaders acknowledge the past, picking out and retaining the good whilst changing the bad. Not here, the baby risks being thrown out with the bathwater.

Finally, and for me this is almost above all else, effective change leaders are honest and humble. They don’t make promises and then change their minds; they don’t pursue their own agenda at the expense of the greater good; they recognise where things have gone  bit dodgy and set about repairing the damage…

Oh, for politicians of any hue who have studied and practised effective change leadership!

All change at Little England

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EU - inoroutWaking up at 0500 my wife whispered in my ear that it looks as if the majority have voted to leave the EU. I can hardly find the words to express the whirl of thoughts and emotions running through my body at a decision that leaves me wondering what our country has come to that we have a majority of voters who believe we can return to greatness by separating ourselves from one of the largest trading and social blocks in the world. I have been disappointed to be on the losing side of general elections, but never as disappointed as this.

The pound is already lower than for 30 years and I hate to think what will happen when the stock exchange opens. The years of instability we now face while trying to disentangle ourselves from the EU and negotiate alternative trade deals around the world. will hardly encourage inward investment (not that the Little Englanders will want that, after all those foreign Johnnies had better get their nose out of our business) and will likely lead to yet more of the bloody awful austerity that was not caused by the EU but by the greedy banking classes. Egocentrism wins.
I am sad that so many people think that closing our borders to people who make a net contribution to the economy is a good thing and just hope that those countries in which so many of our friends and relatives now live are not so small-minded and will allow them to continue living there. Those emigrants relying on incomes based in sterling have just had their incomes cut by 10% overnight, I doubt that they will thank you for that.

Isolationism has never been a good thing.

I’m trying to fight off my anger at this ridiculous decision, not because I am not angry but because it was anger that led to it. Unfortunately that anger got directed at the traditional enemy – ‘the other’ – rather than the real source of it, our own government and banking classes. For the first time in my life I now start to wonder whether there is a way to bypass a democratic decision. Shall we now pull out of TTIP, NATO etc because they cost us money – but recall that the money will not be spent on the NHS or roads it will be spent propping the pound up in order to make trade with our ex-friends affordable to them.

A sad, sad day and one which really makes me wonder about continuing to live in such a self-centred, little-minded country – but of course why would any other Europen country now want me there either?

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Not again!

Staff shortages

Here I am less than 24 hours before surgery and, for the second time, it has been postponed. A very nice and massively apologetic phone call from my surgeon’s secretary advising that they are short of theatre staff and have had to move it to next week, same place same time – and hopefully not the same result!
She was at pains to explain that she had written on my behalf to the Clinical Director explaining what had happened – thank you.

So now I reorganise my life for the third time. I am fed up, my friends will be fed up of me telling them it is going to happen (and that I will be out of action for 2 weeks), my family are fed up (one of whom has now travelled down twice from Cumbria to help with transport and other arrangements.

For the first time in this whole process I am feeling totally pissed off, yet still sanguine(?) about being relatively low priority. Keep calm and carry on.

My story summarised

For those of you who have not the time or inclination to read all of the posts telling my story as I pass through the NHS, this 18 minute video was produced by Leeds Teaching Hospital Trust and shown to a recent internal conference on patient experience. It’s about to be edited down even further to show to the Board. I hope that it raises awareness of the challenges of getting the administration right and triggers the process improvements with which I hope to be associated.


Thank you to the Patient Experience Team for listening to me and helping make this film. If I look a bit grumpy on occasion (as in the still) then that’s because I spent about 90 minutes recalling just the downside of my experience. I want to reiterate that the medical care has, by and large, been wonderful.

The EU debate – worst of two worlds?

UnlikeEU - inorout,I suspect, many others, I will be voting in the EU referendum. Moreover, I have a predisposition to vote to stay in based as much on my own biases and prejudices as any hard data. Therein lies the biggest challenge that some of us face. I would like to be able to decide on a rational basis, upon indisputable facts about the various issues at play in what could be a defining decision on the future of our nation. But it’s a political arena and it’s hard to know what’s fact and what’s propaganda. It’s increasingly irritating that the debate (I would rather it was dialogue) is revolving around competing fears of what will happen if we stay/leave.

It is, of course, all speculation for nobody can actually know the consequences of the decision – especially when the consequences rest in the hands of politicians and bureaucrats of dozens of other countries around the world, to say nothing of the multinationals and bankers.

Where to go for this elusive ‘objective truth’? Well, accepting that there is no such thing leaves a hole which can only be filled with whatever sources are available. Newspapers? Each has their own agenda. Broadcast media? Some certainly seem to have an agenda, but what about the good old BBC which is required to be balanced? Well balance seems to consist of allowing equal airtime for opposing views and an attempt to provide independent analysis, but to me they are primarily a vehicle for lobbyists to air their views and I’m getting less and less interested in hearing what Dave or Boris want to tell me, especially when the tone of the debate gets more and more aerated.

So perhaps we can turn to that treasure trove of knowledge the internet? Same story here, what is ‘truth’ and what is propaganda? What about friends – either the real ones or those who simply carry that label on Facebook? Well one who meets both of those descriptions, and whose intellect I have long been impressed with, started posting some apparently objective analysis. But how do I decide it is objective? Academic references and seemingly independent research institutions and think-tanks are subsequently picked apart by others. How do I know they are independent? I don’t, they just somehow seem to be unconnected with the usual sources, but I know no more about their funders that the next man.

I guess where I am going is that, apart from the philosophical position, there is no ‘objective truth. All that exists is a series of more or less biased positions and/or data promoted by individuals some of whom clearly have personal agendas.

How then, do I decide which way to vote? Some (Boris’ camp?) seem to believe that we (the country, or perhaps big business) would be better off freed from the strictures of the EU bureaucracy who they suggest inhibit our ability to make our own decisions about how to live or whether it is OK to sell undersized bananas. One might argue (I do) that they believe in the power of free markets. Others (Cameron?) might want out because they recognise the looming United States of Europe and want to continue believing in a Great Britain that died with the Empire a generation ago. It does seem to me that the long-term vision of the founders of the EU was either hidden from the country when we first voted ‘In’ or our politicians missed it at the time.

Where are the ‘big beasts’ speaking on behalf of the concept of a united Europe? One that is not a United States but which shares enough values and beliefs to keep us from attacking each other for another 50 years; one that values solidarity and communality; one that enables free trade across one of the biggest trading blocks in the world; that facilitates free movement of people across borders that are but temporary artefacts created by politicians?

So in the end I guess I will vote based partly on my preference for the latter philosophy and partly on a belief that the uncertainty caused by exit will be more detrimental than the current dysfunction. For the system certainly needs change and maybe a narrow margin of stayers might give Dave et al a renewed mandate for tougher renegotiation of the way the institutions work.

Discuss. Please.

Reflections on Hay

Hay on WyeIt was warming up for The Festival here, the annual pilgrimage for a quarter of a million (or so my landlady tells me) literary, arty, philosophical types to the Kingdom of Hay. For so it was declared by Richard Booth, the instigator of the global fame of this book-centric town and its ‘largest arts festival in the world’. Over the next week or so the population of around 5000 will be swamped by incomers and I hope they have fat wallets, for this pretty town deserves it. With its river, derelict but hopefully being rebuilt castle, a cheese hall, more pubs than you can shake a stick at, even more restaurants, cobbled streets, high-class delis and knickknack shops it has a lot going for it. People on early morning walks even say hello to you.

I think the closest I can get to a one word description is ‘genteel’, although in a positive life affirming way. It feel safe, happy and comfortable in its skin.

I’m in Wales but the local accents don’t give it away – or perhaps I have yet to meet a true local, for this is certainly the sort of place likely to fill with a well-off middle-class eco-warriors. Throw a stone across the river with a strong arm and it would land in England. I know this because I read it in a guidebook.

Did I mention books? Since Richard Booth’s first bookshop – and by the way his original is beautiful, airy and well-organised and with a cafe that encourages encourages you to stay even longer – over 30 more followed. It takes very little research to recognise that way over 1 million second-hand books are offer in this small town. You name it and you can buy it here. From publishers’ overstocks to antiquarians (aren’t they just old books?) and even a whole shop devoted to books about railways. This is book porn without the porn books, although it would not surprise me to find a little corner somewhere selling early- or high-class porn as well. As for me, I headed to the cookery sections and found everything from the ubiquitous Jamie through Anton Edelman to vintage professional kitchen guidance tomes. A mere £12.50 released three into my possession and not only will they occupy a few hours happy reading but two of them (Picnics by Claudia Roden and Creative Cuisine by the aforementioned Edelman) will even prove useful in my own culinary adventures.

The Thursday market was due the morning after I arrived. Advertisers as from 0800 onwards I guess I should have expected that it might not have been up and running as early as a French equivalent would be but nonetheless it, and a smaller flea market the following day, added colour to the already interesting streets. Some of the flea market vendors even had sufficient bravado to have a few second-hand books on offer. I resisted the temptation to buy one of Nigella’s early oeuvres.

So, lasting impressions. Pretty place in a gorgeous setting, amazingly friendly and helpful locals (one, when I asked directions, even came down from his ladder and went inside his house to get me a free town guide before giving precise and detailed directions to my dinner venue), shops and activities that will surely keep everyone occupied. What’s not to like? I will be back.

Connecting the dots – or not!

Connecting the dotsFrom the very beginning of my (ongoing) journey, I have felt that nobody was ‘connecting the dots’. I mentioned in earlier posts the feeling that I was being seen as a sequence/collection of symptoms rather than a whole entity presenting with a single syndrome. Well, recent experiences reinforce that feeling.

Loyal readers will recall that my operation, originally scheduled for 8th April was postponed (for very understandable and acceptable reasons) and has now been rescheduled for 24th June. On the day, and during a conversation with ‘my’ surgeon (actually one of them as I understand there may be as many as three finally involved!) we agreed the new date and he said “I will dictate a letter this afternoon confirming the date”. So the letter arrived on 25th (?) April. It was a helpful and informative letter, but with header details of ‘Dictated 08 Apr  … Typed 21 Apr’. Does it really take nearly 2 weeks to get a letter typed up?!

Anyway, it didn’t actually matter – at least in terms of the medical process – although I had been left wondering for over a week about whether or not the situation might have changed.

Next, in early May, I get a letter inviting me to an Endocrinology Outpatient appointment on 28th June. If you are observant you may have noticed that this is only four days after the surgery, for which I expect to be in hospital for at least three days! Puzzled, I rang the Referral and Booking Service Cluster 5 as suggested. After the usual security clearance and explaining my puzzlement that I was being invited for an outpatients appointment on a day when I might conceivably actually be an inpatient, I was informed that this was an appointment that should have happened last December, being a routine follow-up 3-4 months after my initial appointment. Yes, you read it right, it should have happened 15 weeks ago! I hope the recording of the phone call shows that I was polite!

Clearly the booker (or whatever her job title is) was not going to be able to resolve the puzzle and credit to her for giving me the phone number of Dr Murray’s Secretary and transferring me there and then. I explained that I had been referred for surgery that had yet to happen and wondered if this was a post-surgery appointment. I remain unclear about what had actually happened, suffice it to say that she volunteered to cancel this appointment and send another out. All that after a 2-minute wait while I hear her very clearly explaining how to do something unrelated to my call to a colleague in her office.

So yet again we appear to have disconnected dots – the Endocrinology Team not being aware of, or not acting on, the information that my surgery had yet to happen. And what happened to the appointment that should have been arranged for December?

It’s got to the stage that first I laugh at it and then I get on sorting things out myself – I am left wondering what someone less stress-resilient and less organisationally-aware would do.

On a more positive note, I went along to spend an hour or so in front of the cameras for the Patient Experience Team last week. Having contacted them and offered my experience as both a patient and change leadership wallah, they have been working away seeking opportunities to use my experience to reinforce the case for and help them improve their administrative systems, most especially appointments. I am delighted to be able to help in any way I can, I suspect that others might have found this journey much more traumatic than I and I reinforced my key message that the admin processes are as important as the medical processes in the overall care of patients. After all, the letter is for many people their first contact with the hospital and it is the ongoing route through which long-term patients are kept informed of appointments etc. Organisations who rely on good customer service, and the NHS must surely be one of those:

  • have  easy and transparent ways for customers to contact them,
  • they respond quickly to any changes in either the patient’s or the organisation’s situation,
  • they explain very clearly what the customer can expect,
  • they find out what the customer wants and do their best to meet those wants,
  • they constantly check how their customers are.

Some way to go here, but to hear that they will be looking at Kaizen/Lean/Toyota methodologies (and that I will be involved) is reassuring and a future partnership with Virginia Mason Medical Center in Seattle, who have radically improved their systems using these methodologies is encouraging. The journey will be challenging, tough and rewarding and I look forward to being part of it.