22 June 2008

Red pegs

Patient dignity is climbing up the hospital agenda. Dr Grumble has been concerned about it for a long time. But working on a busy ward without the right infrastructure makes delivering on dignity difficult.

Somebody must be doing a good line in red pegs because in Dr Grumble's hospital vast numbers have suddenly appeared on all the wards. They are a bit like those old fashioned wooden clothes pegs except they are made of bright red plastic. You put them on the curtains around the bed when the patient is not to be disturbed. It's a privacy and dignity thing. The odd thing about NHS curtains is that they never quite meet. There's always a gap of about a foot. Whoever orders them does not seem to realise that when you are ordering curtains they need to be a bit longer than the length of the rail.

But why are we even bothering with curtains? Why don't our patients have individual rooms? Why are the sexes still mixed on open wards - another government broken promise which the hapless Lord Darzi was forced to announce? Why do the staff forget their patients are people? And why do they call these people much older than themselves by their first name (when they never ever call Dr Grumble by his first name). On this last point, they will tell you that the patient has been asked how they would like to be addressed - but they don't ask Dr Grumble. Actually, Dr Grumble likes a bit of this sort of formality on the ward. Titles like 'Dr' and 'Sister' elevate people a little in the eyes of patients and it also says something about what the holders of the title do and what they are qualified to do. Does Dr Grumble need elevating? Perhaps. He can manage without but if staff treat the consultant with a bit of respect perhaps patients will trust him a little more. And that's important. But staff should also be showing the same respect to patients. And that's important. More important.

Incidentally, staff who work with Doc G away from the wards call him by his first name. There's some sense to this. It doesn't matter away from the patients. A few oddballs call Dr Grumble 'sir'. That's a bit over the top but it does no harm. But, in British English anyway, calling somebody 'sir' implies a bit of subservience. We need a word like the French 'monsieur' which doesn't seem to have such connotations. It's good to show respect regardless of rank. For patients it's vital. Left to his own devices Doc G would require patients to be called Mrs Bloggs until they asked otherwise. But Dr Grumble is a curmudgeonly old fart. Nobody is going to listen to him.

As for the red pegs, it's good to make staff think. But they are a cheap solution to an expensive problem: too few single rooms - though there is evidence that single rooms are cost effective. The Americans have figured it all out. They have found that single rooms:

  • Shorten length of stay
  • Shorten convalescence
  • Lessen nosocomial infection
  • Lower readmission rate
  • Reduce non-productive employee time
  • Reduce skilled nursing time/costs
  • Allow better bed management
That's what Lord Darzi should have told his masters.

Dr Grumble is fed up with the lack of dignity on the NHS wards. Dr Grumble is fed up with infections racing around the ward. Dr Grumble is fed up with seeing patients dying on the open ward surrounded by grieving relatives. It's not fair to the dying patient. It's not fair to the grieving relatives. It's not fair to the other patients. Each of these needs their privacy and dignity. Lord Darzi, please listen. This is not fair. It's not right. You need to get these basic things rectified before embarking on ill-thought-out initiatives with a political agenda.

This is not something we can solve with a bag of clothes pegs.


Elaine said...

Curtains, with or without clothes pegs, do not change the fact that the other patients in the room can HEAR everything being said.

I agree with your advocacy of single rooms.

Angus said...

Dr Grumble

The use of titles needs to be considered in terms of appropriateness.

At the Royal Manchester Childrens Hospital staff encourage patients to call them by their first name - they figure that us parents are stressed out enough as it is without the pressure to touch our forelocks every time our 4-year old's leukaemia consultant comes round.

Anonymous said...

And why do they call these people much older than themselves by their first name

quite. Also, why do nurses who've never met me before call me by my first name, GP receptionists who know me, also by my first name, but doctors always address me 'properly'?

(They don't ask, they're just telling you they did.)

(I don't mind, BTW.)

It isn't simply a matter of dignity, it can be dangerous; the generation above mine, say, late seventies on, simply aren't used to being called by their first name and the practice can induce or exacerbate confusion.

BTW. The Rant site is down,I think it's been removed.

Anonymous said...

dr grumble

well said, thanks for saying that


cramerj said...

You will find that hospital staff don't use first name to the rich and /or famous.
the idea that 'sir' is subservient is false. It was handy for keeping over friendly teachers in their place when I was a lad.
And as for first names many are habitually abbreviated in the family. It feels weird to be call William instead of Bill.