Did not attend

At Dr Grumble's hospital if a patient misses an outpatient appointment a standard letter is sent to the 'culprit'. The letter has been written by a manager or more likely a committee of managers. It is signed by the consultant. It is curt. It is somewhat accusatory. It is dismissive. And it takes no account of the many things that can go wrong to prevent a patient getting to their appointment. There is the assumption that it is never the fault of the hospital. Often it is. Whoever composed the letter can never have worked in an outpatient clinic.

Where Dr Grumble works patients frequently change address. Frequently letters arrive from GPs drawing attention to a patient's change of address. Dr Grumble reads these letters. He then puts an enormous arrow next to the sentence referring to the address change. If he has the right coloured pen to hand he does this in red. The appointment then gets sent to the old address. It is exasperating.

Some years back failed attendees at Dr Grumble's clinic were so high that he suspected something was wrong. There was. Somebody somewhere in the bowels of the hospital was pressing a button to send out appointment letters but nothing was happening. The button was being pressed but sometimes no letter came out. It took them a year to realise. It really is exasperating.

Of course things will go wrong. The odd computer glitch will happen. But some of our problems are created at the highest level and are completely beyond the Grumble control. When things go wrong, patients write to the consultant. Naively they think the consultant is in charge and can actually do something. Sadly they are not in charge. And quite often they can't so anything.

Last week Dr Grumble had the following letter. Dr Grumble has the original letter scanned in. But he's not going to let you see it. A breach of confidentiality could ruin Dr Grumble. So the letter pasted in below is paraphrased and typed.

Dear Mr (sic) Grumble

........I wish to inform you that I would not just miss an appointment. I telephoned to cancel my appointment 11 days before and asked to rebook it for September. I was told that I must rebook nearer the time..........

Mr A Grieve

Some time ago when we had all these targets introduced Dr Grumble pointed out to a senior manager that some patients might not want to be treated as quickly as possible. The manager seemed incredulous. Dr Grumble was also incredulous. He was incredulous at the manager's difficulty with this concept. The manager seemed to think that we all deal with life and death issues. Dr Grumble does deal with life and death issues. But not always. Some things can wait. These things have often been there for some time already. What matters to the patient is getting them fixed at a convenient time which is not necessarily instantly.

Where is patient choice in all of this? Where is, to use the words of our prime minister, 'putting the patient at the centre'?