Thursday, 22 August 2013

NHS No Hope Service

As an individual, I have had two life threatening illnesses. I was grateful at the time for the wonderful treatment I was given. But that was over 50 years ago, a time when the NHS was not managed by bean counters. When treatment was as a result of a diagnosis and not cost.  
However, the experience I want to tell you about is much more recent. I had to stop and ask myself, is it me?
I had to pay a visit to consult with the doctor a few months ago. I have this small hard lump the size of a pea on my forearm. He had a look and pronounced it to be a small fatty lump. Being a new age bloke and now heeding all the advice about checking yourself out for lumps and bumps from time to time. I pushed my GP for a check up with a specialist at the hospital. 

I have had one similar sort of lump in the past on the same arm. Which was checked out in a previous visit to the local hospital. A small biopsy was done and the fatty lump proved to be nothing to worry about. Some two weeks later, I had a surgical procedure done to remove the lump. That was some ten years ago. From visiting the doctor to the end of the whole procedure was a matter of a few weeks.
This time, after consulting with my GP we decided to do exactly the same process as before. So he made arrangements for me to go for a consultation at the local hospital. The appointment was booked on-line at the surgery and the earliest opportunity was some six weeks into the future. Then two weeks before the consultation was due to take place. A letter arrived from the hospital cancelling the appointment and asking me to get in touch with my GP again. I did so and my GP was as mystified about the cancellation as I was. The doctor went on the computer system and booked yet another appointment. The consultation was again about six weeks into the future. The next day a further letter arrived from the hospital with a new appointment on a completely different date, but thankfully it was only five weeks into the future.

When I attended, I expected to have the usual examination and another biopsy to be arranged. But not this time. The doctor conducted a preliminary examination and I was then sent directly down to the Xray department to get an ultrasound examination done. There had been some doubt if there was only one or if there was the possibility of two lumps. Now, I'm not sure what the difference would be in diagnosis between one or two lumps. However, I expected to get an ultra sound check on demand almost the same process as an X ray which is certainly done that way. I then expected on my return from the ultrasound scan to go back to the dermatology department for a biopsy appointment to be made.

On arrival, in the X Ray department, I handed over my letter from the doctor who had requested the ultrasound check. The receptionist without reading the letter tossed it into a pile on her desk and said that the waiting time for an ultrasound check is currently six to eight weeks. I asked if an actual appointment could be made for me now. I was wanting to arrange a short holiday for ourselves. But the receptionist said she was unable to do so and reaffirmed again the waiting period. So two weeks later, still nothing received from the hospital. Nothing confirming any date for an outpatients appointment. However, because things have progressed. I am now very aware that its not just one lump - But like sugar in my tea its two lumps, if you please.

I decided to ring the hospital dermatology department and explained that there was no longer any question about one lump. Because now, in the intervening period of time it was now definitely two lumps. I made them aware that there was a six to eight week waiting period for an ultrasound scan.  So the lady said I will dig out your file and ask one of the doctors to take a look and give some advice. Later she rang me back and the doctor had said he still wanted the ultra sound check to be done. So there I was, waiting for an appointment to be made and knowing that after the ultrasound has been done. I will have to wait several weeks more for a further appointment to be made in the dermatology department.

Maybe I am expecting more from the NHS than I actually should. Maybe the warnings about checking yourself out are a bit over the top and making people over sensitised to lumps and bumps that appear under the skin. Or maybe in the last ten years the inner workings of the NHS have undergone significant changes for the worse. Changes where each department now works in isolation to another. Therefore it is going to be a slow process not based on a priority that is based on a diagnosis of need. But based on the departments workload, with no notion of priority or need. A service that is now conducted on a first come first served basis.

No one actually knows, the prognosis. Neither my GP, the specialist or the hospital. No one knows what the next step in my treatment will  be. That can only be decided by establishing the provenance of my fast growing pair of lumps. That can't be done until the results of a biopsy have been ascertained. The biopsy will only be done once I have had a further appointment with the dermatology department. That will not happen until the results of my ultrasound are known. That can't happen until I get an appointment for an ultra sound scan. 

Well the weeks went by, I had the ultrasound done. The specialist doing the ultrasound was unable to explain in words that I could understand the results of the scan. It was not the technical stuff, it was his basic grasp of english. I could not understand what he was saying at all. I left it a couple of weeks and contacted the dermatology department again. They had not had the results back from the ultrasound scan. So could not give me an appointment. the lady consulted the booking system and said there were no free slots for the next ten weeks. So I made an appointment to see my GP. He rang up the ultrasound specialist. Like me he had problems with the language and also gave up. So he went on line and pulled up the results. Just what the dermatology department could have done.

It was nothing to worry about at all. Yet all the appointments for each treatment had to be made by me. The service is unable to pass information and create appointments between departments in the same hospital.

The prognosis:- its a kind of inflammation of the ligament and muscle sheth and will clear up itself in the next few months. In the last few days the swelling has started to recede. Now lets suppose it had been something more serious and urgent follow up treatment would have been needed.... scary stuff! 

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