Being approachable

Milk and Two Sugar, over at Tea at Ten, got me thinking on a comment she made.

It got me thinking about how approachable Consultants are. Or aren't.

I think of myself as approachable, because patients and families are frequently seeking me out, "Just to tell me blah," which was worrying them and on their mind, or "I've not told anyone else, doctor, but . . . " then opening up. All doctors experience this, it was very common in General Practice, too.

Since I joined this Trust none of my patients have sought a second opinion or change of Consultant. Every other sector have had folk wishing to change Consultants and, for whatever reasons, have asked to change to me. I'm no better a clinician than my colleagues, it's got to be something about how people work (not the work that's done).

I cover a wider geographical area than I should, by mistake, which I won't bore you with. Patients live in areas between our hospital and 3 other hospitals. Patients on the borders have choices of where they wish to go, with our PCT paying us to see patients out of our area, recognising in our contract that 6% of activity should be out of area referrals. Locally, our service is well regarded. Patients outside my catchment area know of me and our team, through this rather fluid boundary. Oddly, the Medical Director and service manager at the neighbouring hospital met with me in March and the amount of patients they saw from my patch within their hospital in the last financial year was 0%. Patients have moved home from neighbouring Trusts to be in our catchment area. Clinical care isn't particularly better in my corner than it is in the university teaching hospital they're moving from. People have said they've moved so they can get good care. People do this with GPs often, too, not letting them know of change of addresses or being coy with details so they can see "their doctor" still. Lord Darzi should heed this. It matters. Still, for folk to be so enthusiastic to have care from my team reflects, I think, the approachability and compassionate care provided (rather than us doing anything miraculous, clinically).

We're signed up to 360 degree appraisal. This means I give a list of secretaries, clerical support staff, domestics, physios, OTs, nurses, social workers, Consultant Colleagues, GPs, junior doctors and managers who I work with over 4 hospitals, in-patients and community, from which random folk are anonymously sampled and give feedback on me. My secretary also generates a lengthy list of consecutive patients seen, from which a random sample are anonymously sampled with questionnaires about me. Their results are mailed back to the Royal College of Psychiatrists (so it's independent) to crunch the numbers and give feedback. They give feedback as graphs, showing the average range, top and bottom of the range, where you rate yourself and where staff and patients rate you. Feedback was embarrasingly positive, with scores at the top of the reference range, and some well above it. This can't be, I know I'm no better than most colleagues and certainly am not the best in the country! It has to be about perception of those staff and patients scoring me, of which I reckon approachability's key.

This really can be encapsulated in a conversation I recently had with a senior nurse. It's been busy in our team. I'd been working particularly long hours, which happens from time to time, but there'd been a run of this. She'd been working a couple extra hours a day too, doing far more work than she should. She'd mentioned that I was doing too much work, laughingly chiding me, "I don't like seeing you busy, it's not normal!"
We joke that she does all my work for me, because she does so much. And there's truth there, she does a stunning job that eases my workload big time.

We had a patient referred. It was a patient I'd seen before, a few years ago, with vascular dementia. Strokes had caused widespread damage, particularly affecting word finding and judgement. After a few months of assessment and advice, the patient was picked up by social services and day care and Alzheimer's Society input and was discharged with an open appointment, since there was nothing further at that point that our service could usefully do. She'd been seen by both me (for assessment and diagnosis) and the nurse (for advice/psychoeducation, coordinating social service and other care, and carer support). They were re-referred because the patient's dementia had progressed and the family wanted advice on what the referrals letter suggested amounted to wandering, a reversed sleep/wake pattern and respite care.

The nurse wanted to take the referral, since she knew I was busy and there wasn't any medical work to do, she could pick this re-referral up and discuss it with me. I wanted to take the referral, since I knew she was busy, I'd seen the patient already so could pick it up and easily see them again.

I don't think she finds me unapproachable and difficult to talk with. She jokes I do no work and she does it all, but everyone knows that everyone in our team all pull their weight. It was with kindness that she took the referral, flounced off (she's good at flouncing) telling me, "Oooh, stop being an idiot and fuck off back to your office and go pretend to do some work!"

I love this team.