The case for innovation up close and personal


In the same week that my colleague drew my attention to the new book ‘ The patient will see you now‘, I became part of John’s story. I quote from the book:

Doctors are still labeling patients as difficult. Patients are typically unable to see, let alone keep or contribute to their office visit notes about their condition and their body that they paid for, Frequently they have to consult multiple doctors for the same condition. It may take weeks to get an appointment. The time with the doctor is quite limited, typically less than ten minutes, and much of that is without eye contact because the doctor is pecking away at a keyboard.

John (75) was born and lives in Dublin. He has the generosity of spirit that made Ireland what it is. A working man all of his life he lives to walk to the shops on Saturday morning. Two years ago he had a bilateral knee replacement. In the past six months he has become severely disabled with back and hip pain. He now walks with crutches and spends most of the day in a chair. His aging wife has to help him put on his socks, a friend ferries them to the shops in his taxi once a week. He is in constant and relentless pain. He attends a pain clinic and visits his general practitioner on foot, a hour long walk on his crutches every week. His aging prostate requires him to be within a short dash of a toilet. He finds life a struggle each and every day. He needs a hip replacement.

He was offered a review appointment at a Dublin teaching hospital. The appointment last Thursday was for 2.30pm. Not wanting to keep the doctor waiting he turned up on time and patiently waited in a chair until 6pm when he was finally called in. The senior house officer who saw him was ‘multitasking’, fielding calls from the wards. The patient’s records were strewn on the floor at his feet.

After a cursory examination he advised John that he would have to be ‘worse’ before they could do anything. John politely thanked him for his concern but asked to see the consultant. The consultant offered to refer him to a pain clinic but added that it would take months to get an appointment. John pointed out that, as their records would show, he was already attending a pain clinic and the specialist there told him nothing more could be done and that he needed a new hip. The consultant was unfazed by this news and said he would ‘write to the pain clinic’. They watched him struggle out of the chair and leave the room.

Not one to make a fuss, ever, John took a taxi home. By the time he got home he needed to ‘go straight to bed.

John’s story is typical of the many Irish people who daily endure a third world healthcare system. Ireland’s tax payers, men and women like John forked out for the training of tens of  thousands of doctors who form the backbone of healthcare organisations the world over. But John gave me more. He is grandfather in our family. It pains us deeply to hear that healthcare in that country is now for those with private insurance or those who are prepared to voice their displeasure. Surely it can’t be beyond the pale to organise an outpatient clinic where people are treated with dignity even if, it seems, nothing can be done for them? How do specialists determine who merits the rationed healthcare resources now on offer? John was advised to be very polite to secretaries who have power and influence over their boss’s schedules . The need for reform is compelling. It may not be obvious in ‘official’ data because the whole unpalatable truth is only apparent to those who have not. It doesn’t require research to know that something is very wrong, it simply requires an interest in the experience of those who need healthcare the most.

Picture by Julie Keryesz

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