A-Z of being a patient

My good friend, Grannymar has been practising her ABC’s on her blog and set her readers a challenge. She said, “Pick not one word for each letter, but three that sit well together”.

I’ve had fun mulling over this task all day. In keeping with the theme of this blog, ‘a patient’s perspective on life‘, I decided to base the alphabet on my summer spent in hospital. Here’s what I came up with…

A-Z of being a patient

A’s for A&E, antibiotics and analgesia.

B is the bacteria, blood pressure and breathing.

C’s for cellulitis, colitis and complications.

D is the diagnosis, doctor and dietician.

E’s for ENT, ECG and ESR.

F is the flare-up, fluids and fasting.

G’s for gargle, gastric and gut.

H is the hospital, hygiene and hypertension.

I’s for investigations, IV’s and injections.

J is the junior doctors, joints (sore) and jelly (and ice-cream).

K’s for kidneys, ketosis and being kind.

L is the light-headed, laughter and longing.

M’s for microbiology, medication and meals.

N is the nurse, needles and nausea.

O’s for osteomyelitis, oxygen and operation (and ouch!).

P is the pulse, PICC line and pain.

Q’s for questions, queasy and quiet.

R is the respiration, rest and results.

S’s for scans (CT), syringes and samples.

T is the temperature, tachycardia and tired.

U’s for ulcer, uncomfortable and unwell.

V is the veins, vision and vital (signs).

W’s for ward, wheelchair and WC.

X is the x-ray, Xysal (antihistamine) and Xanax (for anxiety).

Y’s for yawning, feeling yucky and YES ( in response to) “ready for home”?

Z is the Zoton (antacid), Zestril (ACE inhibitor) and Zimmer frame (not needed yet).

Please Missus, I did my best. Do I pass the test?

Preparation for Surgery

Here’s another excerpt from my little book of Home Nursing.  It details the preparation of the patient for surgery…

“On the day before the operation the nurse should ask the surgeon how he wishes the patient to be prepared. If no specific instructions are given the patient should if possible be kept quiet the previous day: he should take only light food, have a warm bath and an aperient in the evening. On the day of the operation he may, if the operation is not to be performed too early, and with the surgeon’s permission, have a light breakfast of tea, with toast and butter, and, three hours before the operation, a cup of tea or bovril.

His preparation begins with a simple enema first thing in the morning. Then he may have a warm bath or be well sponged down.  The area of the operation must now be sterilized by shaving and then cleansing thoroughly with either soap or spirit soap, which must be washed off with hot water; the skin must again be washed with hot biniodide of mercury solution, and covered with a compress of lint or gauze wrung out of the same solution: or, after drying, the skin may be painted over with mild tincture of iodine, allowed to dry and covered with a dry sterile towel.

Before the operation artificial teeth, hair-pins, jewellery, etc., must be removed, and if the hair is long in a woman it should be plaited in two plaits tied at the ends. The patient must put on warm flannel clothes which can be removed easily, and long woollen stockings.”

Now that’s what you call pre-operative care. These days, patients are admitted to hospital on the day of surgery and the pre-op preparation is left almost entirely to the patient. I can remember once getting it completely wrong and I paid the price.

I had a young baby at the time and instead of resting the day before my surgery, I rushed around putting preparations in place for during my absence. The following moring I insisted on getting myself to the hospital so that my husband could stay at home to look after our baby. Having fasted from the night before, I travelled by train to the hospital and arrived feeling totally parched and exhausted. I had a particularly difficult post-operative recovery from the anaesthetic on that occasion and it taught me a lesson. In today’s world of conveyor belt medicine, it’s really important to rest the day before surgery so as to optimise your powers of recovery. Allow yourself to be pampered!

UPDATE: I’ve just spotted this letter to the Irish Times from a Consultant in Emergency Medicine, which fits in nicely with the ‘ patient care’ theme of this post.

“And the Minister should focus on the universal need for a familiar smiling face. Let us have carers who have the time to care and the moral support of a loved one in our hour of need. Health economists may have factored these basics out in their many dubious prescriptions, but Mother Nature has not”.

Patient Empowerment

The public, armed with useful non-jargon information, is rightly demanding a say in how healthcare is organised and delivered. Historically the patient has been expected to follow blindly the doctor’s advice with little input or participation in his/her treatment. The ability of patients to act as consumers and therefore participate in their own treatment has been severely hampered by medical secrecy and arrogance. The patient, on the whole, was not seen as having the training or intellect to understand complex medical issues and was therefore treated as a passenger and not a participant in their treatment. This lack of participation by the patient was caused in large part by a lack of appropriate information on which to make informed decisions.

The almost universal access to the internet has turned a bright light into what had been relatively dark corners. Patients, armed with useful non-jargon information, are becoming consumers of healthcare. They are insisting on doctors being measured, the publishing of meaningful outcome data, and access to healthcare based on their needs and not services based around what the health workers want.

Patients need to have a platform from which to make informed decisions and demand that they are participants and not passengers in their treatment. They can begin to measure around data points that are meaningful to them the quality of the treatment they receive and, most importantly, begin to shape the health service from a patient’s and not an employee perspective.

In France, (where the health system frequently ranks at the top of the World Health Organisation’s best providers) 40 per cent of health provision is supplied by the private sector. The French enjoy choice, clean hospitals and friendly staff, not to mention some of the highest quality outcomes in the world. France has embraced an agnostic system where providers are chosen and survive based on ability and quality of outcomes and not idealism.

For too long, patients have been allowed to suffer while high-level discussions take place around the politics of health.  France and others have proven that the discussion must centre around the patient and their needs. Most importantly, the patient must be at the centre of that debate and not be kept on its periphery.

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The above is the opinion of Ken Anderson, former commercial director general, Department of Health, UK. He is singing my song. The best and the most efficient health systems in other countries are based on universal provision where the money follows the patient. With further health cuts promised in the present economic downturn, we have never been more in need of new leadership and a new direction for our health service.

Source: Irish Times online.

Mutiny in the Ranks

The Irish Nurses Organisation (INO) is escalating it’s campaign against the proposed spending cuts in the health service. It has launched a new website Stop Health Cutbacks to monitor the level of cutbacks proposed by the Health Service Executive (HSE). Hospital staff and members of the public are invited to post comments online on what their experience of cutbacks has been and to air their views on how the services could be improved. All material will be validated before publishing and patient confidentiality will be protected at all times. Liam Doran, General Secretary (INO), has stressed that the overriding aim of this initiative is to demonstrate in detail where the system is failing patients.

The non-consultant hospitals doctors (NCHD) are also up in arms with the latest decision by the HSE, to cut their overtime and allowances.

Six junior doctors have begun a High Court challenge, along with the Irish Medical Organisation (IMO), against the HSE. The IMO and the doctors claim that the HSE’s proposals are a breach of contract. They further claim that the proposed changes are impractical and will damage the functioning of the various departments in the hospitals where they work.

Next month’s emergency budget will radically affect healthcare in this country and it will be patients who bare the brunt of the further cutbacks. It is essential that everyone plays their part to ensure the highest possible standards of patient care in the difficult times ahead. Make your views known before it is too late.

Save our Health Service

A letter to the editor of the Irish Times, caught my attention the other day as it’s topic was the health service. I was very pleased to find that it’s content confirmed my views about the abuse of out-patient clinic appointments in our public hospitals. The contributor proposed some ideas to solve this problem, measures which would also help to reduce waiting lists and raise funds for hospital services.

The letter was headed “DNA and Hospital Waiting Lists”

“Madam, – Sheila Gorman (February 19th) notes that last year St James’ Hospital had almost 25,000 “DNAs”. As she explains, a “DNA” is someone who did not attend the hospital for their appointment. They did not call to cancel or postpone and so the hospital’s time was lost.

In my own area of Pembroke-Rathmines, St Vincent’s Hospital had 26,878 “DNAs” last year.

Assuming similar figures for hospitals across the country, waiting lists could be cut dramatically by appealing to those who have made medical appointments which they no longer require to cancel their appointment. This would also help to ensure that those most in need of medical attention get it sooner.

In the UK, NHS dentists request a £20 deposit from patients booking an appointment. This is later refunded or discounted from the bill. If the patient does not attend,and fails to cancel in time, the dentist keeps the £20. A similar scheme for our hospitals would either reduce waiting lists by hundreds of thousands or raise millions of euro to provide better services.

Could this be a simple way to improve our own health service for medics and patients alike?”

Source: The Irish Times online.

There are probably lots of reasons why so many public patients do not attend for hospital appointments but I would say prime amongst them, is a lack of respect for our inefficient health service. I’m all for making our present health service more efficient but only if it results in improved patient care. The sooner we get a system of universal health insurance in place, the better.

For anyone interested, world-famous cancer specialist, Professor John Crown will address a Public Meeting in Blanchardstown tomorrow evening. The meeting, hosted by Deputy Joan Burton of the Labour Party, will deal with issues relating to the future of Connolly Hospital, Blanchardstown and will facilitate questions by members of the public.

Where? St. Brigid’s Community Centre, Blanchardstown
When? Thursday 5th March 2009 at 8pm

Prof. Crown will address the meeting on the importance of introducing universal health insurance to put an end to our 2-tier health system.

Thank God

A man suffered a heart attack and had open heart surgery. He was awakened from the surgery to find himself in the care of nuns at the hospital.  As he was recovering, a nun asked about how he was going to pay for his care.  He was asked if he had health insurance.

He replied in a raspy voice, “No health insurance”.

Then he was asked if he had money in the bank.

“No money in the bank”.

Finally, “Do you have a relative who could help you?”

He said, “I have only a spinster sister who is a nun”.

The nun got a little perturbed and announced “Nuns are not spinsters! Nuns are married to God”.

The patient replied, “Well then, send the bill to my brother-in-law”.

Who Makes The Best Patient?

Five surgeons are discussing who makes the best patient to operate on.

The first surgeon says, “I like to see accountants on my operating table, because when you open them up everything inside is numbered.”

The second responds, “Yeah, but you should try electricians! Everything inside them is colour coded.”

The third surgeon says, “No, I really think librarians are the best; everything inside them is in alphabetical order.”

The fourth surgeon chimes in: “You know, I like construction workers…those guys always understand when you have a few parts left over at the end, and when the job takes longer than you said it would.”

But the fifth surgeon shuts them all up when he observes: “You’re all wrong. Politicians are definitely the easiest to operate on. They have no guts, no heart, and no spine, and their head and rear end are interchangeable.”

And Steph says: “Hang on a minute, I’m not an ‘expert by experience’ patient for nothing you know.  After years of consulting surgeons, I can see through them all so they must be the easiest to operate on!

Technology Therapy

Did you realise that patients in Ireland are set to get technical? The Nintendo Wii, the home video game console, is now being used as part of a new innovative programme to help patients recover from strokes. Patients are having fun while enjoying a form of therapy that helps them to build balance, coordination and endurance.

Therapists at the Stroke Rehabilitation Unit in Baggot Street Community Hospital have begun using the Nintendo Wii game console with their patients to compliment regular therapy. Potential benefits for this group of patients include increased hand function, balance, reaction times and processing skills. It’s proving very popular amongst the patients because it’s interactive and there’s a competitive element involved.

Many nursing homes in the US are already using Wii technology as a form of therapy and recreation. A lot of older people have limited mobility and the Wii provides entertainment as well as physical rehabilitation. It also helps pensioners remember activities that they used to enjoy a lot when they were functioning in their community.

This begs the question as to why Irish nursing homes are failing to make proper use of technology? It’s makes utter sense to encourage older people to use technology as a form of therapy. Let’s face it, anything’s got to be better than staring into space all day long!

Bowel Cancer Screening

Bowel cancer is the second most common cause of cancer death in Ireland. More than 50 per cent of patients in Ireland are diagnosed with Stage 3 or 4 bowel cancer, which is the most advanced stage. Bowel cancer screening aims to detect bowel cancer at an early stage (in people with no symptoms), when treatment is more likely to be effective.  If caught early enough, the chances of a successful outcome are greatly increased. Regular screening has been shown to reduce the risk of dying from bowel cancer by 16 per cent and yet Ireland continues to have no bowel screening programme in place.

People need not be embarrassed about bowel cancer screening.  They are not required to take a stool sample to their doctor nor do they have to undergo a physical examination. They are instead sent a simple FOBT (faecal occult blood test) kit in the post along with step-by-step instructions for completing the test in the privacy of their own home. This involves collecting a small sample from two separate bowel motions and, using a specially designed prepaid envelope, returning the kit to the laboratory for analysis. The test does not diagnose bowel cancer but gives an indication as to whether further investigations are required.

The European Commission has advised that all countries should give consideration to the introduction of faecal occult blood screening for colorectal cancer in men and women between the ages of 50 and 74. Almost 60% of Irish cases of colorectal cancer occur in this age group. International randomised controlled trials have clearly demonstrated that faecal occult blood testing reduces mortality for colorectal cancer. The NHS Bowel Cancer Screening Programme has already been rolled out in the UK following a successful pilot scheme and it’s due to be extended to Northern Ireland next year.

Ireland is still dragging it’s feet! The HSE states that “a number of issues need to be addressed prior to this service being implemented”. In January 2007, it funded a 3-year study to ascertain “the optimal tools and framework to be used in an Irish screening service“.  In other words, it’s kicking for touch as our poorly resourced public health service cannot currently cope with the numbers of symptomatic patients presenting for investigation. The waiting time for a colonoscopy appointment in the public system, can be six months or more – a deadly wait for some.

Bowel cancer is preventable, treatable and beatable.  The prognosis for patients with colorectal cancer is closely related to the stage of the disease at the time of diagnosis. A national bowel screening programme in Ireland would lead to fewer patients presenting with advanced bowel cancer.  The HSE chooses to ignore this fact and continues to prioritise health expenditure over people’s lives. In recent days, Mary Harney has been warning of severe cutbacks in healthcare spending. News has begun to filter through that the HSE plans to save €500 million on healthcare spending in 2009.  The prognosis for Irish healthcare, is not looking good.

Further information on the FOBT can be found here (with thanks to Baino, an Aussie blogger).

UPDATE: Just spotted this article about an innovative bowel cancer screening programme taking place at Tallaght Hospital in Dublin. The programme began about four months ago and is attempting to screen 10,000 people aged 50-74 in the Tallaght area, over a period of 18 months. Tallaght hospital is the first in Ireland to offer this service.  Let’s hope it’s not the last.

FURTHER UPDATE: Health cutbacks of almost €1 billion forecast.

JUST PUBLISHED: The HSE’s National Service Plan for 2009.

Isn’t it Ironic?

The Irish Patient’s Association recently carried out a survey to assess the level of information provided to patients and visitors by hospital websites.  The result was astonishing. The survey found that out of the 49 public hospitals across the State, 31 hospitals did not even own a website!

The hospital websites were assessed according to the information provided to the public.  The survey looked for details on car parking, internet facilities, TV and/or radio, canteen, public phones, vending machines and banking facilities.  Of the 18 hospitals that did have their own website, at least half were found to provide poor information.

I don’t know about you but when I’m going somewhere new, I always check it out online first. It seems more than a little ironic to me that in an era where we have high tech medicine available in our hospitals, many hospitals don’t even own a website? Surely the HSE intends to correct this deficit?