Guy Maddern, professor of surgery at the University of Adelaide, begins his regular diary recording the life of a clinical director at St Anywhere. St Anywhere is fictitious, but the events and issues are real:
St Anywhere conducts over 300,000 patient consultations per year and has in excess of 30,000 admissions and employs over 2000 staff. Trainee medical officers, medical students, nursing students and allied health trainees all add to the workforce, working in an often stressful and emotionally demanding environment.
Despite safe working hours, the demands of on call and staff shortages often conspire to prevent adequate breaks from the endless demands of patients and patient care. In such an environment it is hardly surprising that behaviours of staff are not always exemplary. Every few days a letter of complaint requires my urgent attention.
St Anywhere has a patient complaint officer who acts as a point of contact between the aggrieved patient and the staff of the hospital. The array of complaints is staggering. Some are important, relating to poor communication between doctor and patient, nurse and patient, relatives and secretaries. Bad behaviours need to be addressed and acted on. Often it is a lack of time and tolerance on both sides and it is no more significant than a run-in with a parking inspector or a local council planning department.
However, my desk also receives complaints about relatives’ anger at an early discharge of a patient, inability to find a nursing home close to relatives, poor parking, inadequate number of investigations or delay in diagnosis. Sometimes they relate to the added burden an illness places on the family, often it shows little understanding of the difficulty in reaching a satisfactory diagnosis and treatment plan. Serious errors of management need attention and should have already been addressed with the patient and/or family long before a complaint needs to be made.
Complaint departments seem orientated towards the rights and concerns of the patients with apparently less regards to those of the doctor. Abusive aggressive patients are not only arising in emergency departments but also in clinics. Help for clerical, nursing and medical staff is often difficult to mobilise.
Last year one of our surgeons was threatened by a family after a 35-year-old died five days after discharge. Poor care was alleged. The media arrived to find the truth.
On this occasion the Minister of Health, CEO of the Department of Health and hospital all decided the Clinical Director was the ideal individual to face the cameras. A review of the patient record revealed other factors that may have led to the death besides the hospital stay. Off-the-record discussion with the reporter and producer of the show would not dissuade them from running the story, with or without hospital comment.
In the interview I suggested a post mortem should be awaited but scenes of the family crying at the grave side were still included for added effect. The hospital looked guilty, the doctors appeared to be ducking responsibility. The post mortem, when finally reported, exonerated all concerned in the patient’s care but somehow the media had lost interest.
Hospitals are working in a more hostile environment. In 30 years the change has been obvious to anyone involved in treating patients and their families. It is a minority but a difficult and maybe dangerous minority. Support for aggrieved patients is vital but maybe as important, or even more important, is support for staff.
The news doctors give patients is not always good news. Sometimes patients want to blame someone. They are angry and want someone to direct that anger towards. Hospitals have become obsessed with patient rights. Maybe they have forgotten the rights of staff caring for those patients who need protection and support.
Two months ago a hard working surgeon found herself the victim of an abusive clinic consultation. This was followed by calls to her rooms and other hospitals claiming she had told the patient to engage in crime to fund her surgery. Even the media was contacted.
Requests to hospital administration to help deal with this frightening and difficult problem prompted a response “that as the calls had taken place to the doctor’s private rooms and private hospitals the public hospital could not help”. Letters and protest and threats of withdrawal of surgical service by colleagues finally produce an appropriate response of support.