Feedback Frenzy

My pocket chirrups as I descend the steps from my bank. The text message asks me to rate my recent customer experience. This happens to be one of a hundred or more perfectly routine transactions I’ve made at that bank.   

FreeImages.com/Simon Stratford

Irritated, I delete the text.

At school, there was a girl who was forever checking what people thought of her. Sadly, the answer was ‘not much’, but this didn’t stop her beaming at everyone and trying to decipher their expressions.  When she couldn’t read the emotional temperature, she would ask what we thought. I wince to report that we thought our classmate stupid. Looking back, however, she was well ahead of her time.

These days, Waitrose sends me emails asking how my groceries were. Would I rate and review them?

waitrose-redcurrant-jellyI get similar requests after almost every commercial interaction of the day. If not during it. A text thanks me for travelling with Addison Lee, and invites me to rate the driver. I get this message before I’ve even reached the destination.

Ditto Moonpig, who want to know how everything went with the card I ordered. It’s not even scheduled to be delivered till next week. Stop asking me!

Now an email thanks me for collecting my parcel from the Spar in Chesterton Road, and asks me how I would ‘rate the service in store’.

The bottom line? It was fine. I got my parcel. Had the guy behind the counter not found it, or handed me a damaged parcel or something entirely different like a Mars Bar or a lottery ticket, you can be sure I’d have let someone know, loud and clear.  FreeImages.com/Tony CloughFeedback can certainly be useful. Book reviews, for instance, help guide the author as well as people looking for their next read – though it’s worth noting that the most useful reviews have actual words in them, not just a star rating.

Evaluations from the students I teach can also be valuable, if they help improve the outcome for the next lot.

For feedback to be most useful to others, it pays to ask the right questions. One pension provider invites me to rate my recent dealings with them. A more pertinent point might be whether I was happy with the return on my investment.

Nowadays, detailed feedback from patients is an integral part of a doctor’s appraisal process. It’s a two-page form that demands a certain level of literacy and attention. That makes it difficult for many patients, especially those who’ve just had bad news or been sent to hospital.

Feedback from colleagues is even harder to come by. In smaller practices, family doctors may resort to asking people they haven’t worked with for years, just to make up the numbers.

National Health Service logo

Feedback shouldn’t be just about collecting all the data we can, because we can. To have any value, it needs to be more selective, and to ask the right questions at the right time.

***

If you’ve read a book you enjoyed lately, please think of leaving a review on Amazon or your favourite reading site. It doesn’t have to be long, just your overall impression and anything you’d like the author and prospective readers to know.

Here’s more detailed guidance, should you feel like it: How to write critical book reviews – and why I think you should, by Debbie Young.

bookshelf crop

What Happens When You Become a Doctor

Any day now and it’ll be the Killing Season, so-called. August 1 is the date when a fresh crop of newbie doctors arrives on hospital wards, bursting with enthusiasm and theoretical knowledge but woefully lacking in experience.

Jeremy's scalpel

In fact August is no longer worthy of that macabre tag. The month now begins with a sensible induction process for newly qualified doctors, with proper training in the tasks and procedures they’ll need to do in the coming months. Gone are the days of ‘See one, do one, teach one.’ The Killing Season is well and truly dead. Induction is a recent trend. I will never forget the utter panic on my first day as a doctor as I crept around in squeaky new shoes trying not to look like the rawest recruit. It was a Sunday—was there ever a more stupid day to start work?—and a patient had the misfortune of dying within 45 minutes of my arrival at the hospital. Now don’t jump to conclusions. I hadn’t even seen her before she died.

HP Rapaport Sprague stethoscope, circa 1981

HP Rapaport Sprague stethoscope, circa 1981

Wet behind the ears, I had no idea of the procedure to follow. Even scarier was the realization that I had two whole wards full of people to keep alive as long as possible. I rushed round to say hello to them all and check they were still breathing. At the same time, I said goodbye to many things: sleep, leisurely weekends, sitting on the loo without being bleeped. In short, to normal life. iv nutrition

While a lot has changed since then, including working hours, some things haven’t, as I realized from a recent blog post by Salma Aslam (by which I mean Dr Salma Aslam) Transitional state: med student to doctor It all came back to me. When you graduate from medical school, you may get a number of different reactions. 1 “Well done, but don’t go round thinking you know it all.” Don’t worry, I didn’t. And still don’t. 2 “So what?” That’s what I got from a group of arts students sitting around in the bar. They acted like they couldn’t care less about my news, but they were probably envious. 3 “Can you have a look at my verruca?”

plantar warts

Count yourself lucky. It’s much worse to be subjected to the long saga, in multiple episodes, of their entire medical history. This is when you get envious of those jobless arts graduates. 4 “The only thing that works for my migraines/arthritis/autism is kinesiology/homeopathy/acupuncture.” The implication is that allopathic medicine does nothing. Well, I’ll keep an open mind about that, only not so open that my brain falls out.

tablets

5 “You should get a job as a medical adviser on Casualty or something.” Yeah, right. Like nobody else with more experience wants to do it. 6 Perhaps the weirdest reaction was from my mother, who insisted I should now call her Dr Cooper. Why? “Because my daughter is a doctor, it’s like I’m the doctor. You may congratulate me now.” Get used to all of it. It may be a while before you hear the most welcome response of all: Thanks, doc. I feel a lot better.”

medical bag

Easy tweet: What happens when you become a #doctor? http://wp.me/p3uiuG-12N via @DrCarolCooper #medicine

Six Lessons from the Eye Clinic

Today Sanjay takes his mother to her hospital appointment.

He’s a nice young man, a character from my novel One Night at the Jacaranda. Although I made Sanjay up, maybe you know someone like him?

He and his mother walk past a sign warning of the symptoms of Ebola.

Not surprising the font on the sign is massive. This is the eye clinic.

1138666_78954230 medical eye

The morning is a learning curve. They arrive at 9.30am to find there are over 40 patients there already.

Beta, I should have brought chair from home,” says Mrs Shah. Here comes Lesson One: in addition to bringing glasses (including bifocals), appointment letters, and any medication they are taking, in original containers, patients should bring something to sit on.

The only empty seat belongs to a man who’s just gone to the loo, which doesn’t flush, as he explains to all and sundry on returning to waiting-room.

A poster on the wall advises patients that clinic visits can take up to four hours. The notice on a board by the receptionist says the clinic is running 90 minutes late. Sanjay isn’t sure if this time should be added to the four hours, or whether it is already part of it. Nobody knows. Lesson Two: don’t ask stuff. Just accept it may take some time.

They stand in the corridor for a while.  A nurse emerges from somewhere and calls out, “Philip Nutmeg” or something similar. When Mr Nutmeg fails to respond, she says it again, looking meaningfully at Mrs Shah. Sanjay says helpfully, “She’s not Philip Nutmeg.”

The nurse glares at him.

Frame on eye chart

Eventually Sanjay’s mother is summoned into a little room to have her vision tested by another nurse, and to learn Lesson Three: computerised medical records do not necessarily contain any medical records. The entire hospital went computerised two months ago, this nurse says, but there are no clinical data on them. So Mrs Shah gets to recite her entire medical history. She looks over the nurse’s shoulder to make sure she writes everything down.

When they come out again, a cleaner in a hijab is here to deal with the loo. And Philip Nutmeg still hasn’t shown.

Lesson Four: nobody gives old people a seat, not even when they are rubbing their knee and looking around hopefully.  It shocks Sanjay that not one person has stood up for his poor old mother.  He considers ejecting someone forcibly, but then his mum isn’t as old or as poor as some of the others.

In the corridor there are two wheelchairs blocking doorways. In one, a woman with one leg. In the other, a man (or possibly a woman). This person has two legs, but Sanjay is not sure about the face because it’s covered with a blanket.

There’s also an old man pushing out some zeds and a younger man who reeks of alcohol. It is 10.45am.

Sanjay notices a woman with a pinched face and a jute bag bearing the name of a firm of solicitors. The doctors will love that, thinks Sanjay.

One of the doctors appears now to find out what’s wrong with the man with the blanket on his head. He insists there’s nothing wrong, but the light hurts his eyes.

Lesson Five, thinks Sanjay: bring dark glasses to the eye clinic because the lights can become unbearable once you’ve got dilating drops in your eyes. Now the man in the wheelchair is mighty pissed off because the doctor has asked him not to cover his head with the blanket. “It scares us, you see. We think something‘s wrong.”

Sanjay’s not so sure. He reckons you could die in the clinic and not be noticed.

The crowd eventually thins out and they get somewhere to sit.  Sanjay’s stomach is rumbling, and so is his mum’s. Lesson Six: bring something to eat.

989041_50471101 baguette

By the time they’ve been there three and three-quarter hours, Sanjay’s mother has had her visual fields tested and her corneal thickness measured, and her pupils look as wide as a dead cat’s. She’s also gone into the inner sanctum, where the consultant sits at a desk in front of a large cutaway diagram of an eye. This is worrying. Shouldn’t the doctor know what eyes looks like by now?

The medical verdict is not too bad. Mrs Shah’s eye pressure is fine today, and her cataracts don’t need doing yet.

Unlike a patient leaning on the front desk. There’s only one receptionist left, and this patient is pleading with her to expedite his cataract surgery because it’s very urgent. Unfortunately, the receptionist tells him he’s only on the routine waiting list.

By the time Sanjay and his mother leave, there’s just one man left in the waiting-room. Maybe it’s Philip Nutmeg.

1221586_15421511 nice eye

Just a Little Prick with a Needle

Today’s tests are no biggie. Nothing like the ones Sanjay’s had in the past. Anyway, he’s feeling better than in a long time.

There’s already a queue of blood test patients waiting to be interrogated at reception. You only get a numbered ticket once the bossy boots at the desk finds out if you’re fasting.

NHS

Sanjay gets number 79. The display on the wall says 46. No wonder the place is packed. Pretty soon he’s finished reading the Metro. So he reads people.

The girl next to Sanjay isn’t fasting. She’s shedding sugar from her donut all down her ample front. Fact: nobody who eats donuts ever looks as if they need to eat. And right under the sign that says no eating, drinking or assaulting NHS staff, a man is chomping into a burger. A ketchup sachet lies at his feet.

The plastic chairs are hard. Sanjay wishes he weren’t so skinny. There’s also a bench for urgent patients. The urgent patients look terrible, as if expecting to snuff it while waiting. He was on that bench not long ago, but now he’s been promoted from living dead to living living.

It’s number 67 now. The snoozing woman in the seat next to Sanjay wakes with a start when her walking-stick falls over. Walking-sticks always do. You’d think someone would design a solution.

Some people have brought their entire family, along with their shopping, scattered in carrier bags in and around the chair legs. A toddler with a cold studies Sanjay then removes his finger from his nose and wipes it experimentally on the arm of the chair.

The phlebotomist who finally calls Sanjay isn’t just a phlebotomist. The badge says he’s a cannula technician too. He is about 5’3” and one of his spots is threatening to erupt. He only opens his mouth to ask Sanjay to confirm his name and date of birth. Blood is taken wordlessly. It’s important to make patients feel at ease in today’s patient-centred NHS.

test tubes

Out Sanjay goes, clutching a cotton wool ball to the crook of his elbow.

The imaging department is at the other end of the hospital, down a draughty corridor guaranteed to give you double pneumonia if you don’t have it already.

Nobody’s eating in x-ray. They’re too busy figuring out how to sign in. For chest x-rays it’s straightforward because you can go anytime Tuesday to Friday from 9 to 11am and from 3 till 5pm. He doesn’t like to ask what the hell they do 11-3, not to mention all day Monday.

If you have an appointment, a state-of-the-art machine scans your letter. If you don’t have an appointment, you go to the desk. There’s a third machine that dispenses numbered tickets.   A young man in a moon-boot is waiting patiently while someone tries to fix that one.

Sanjay hangs around the desk while a receptionist makes a hash of explaining a test to the patient in front of him.

Finally Sanjay is told “Take a seat and you’ll be called by your name.” He thanks his lucky stars he’s called Shah, not something like Sivaramalingham. He sits by a wall decorated with enticements to give blood, volunteer for the League of Friends’ shop, give up smoking for good, get help with your alcohol problem, report domestic violence, and donate your organs as soon as you finish with them.

There’s a lot more activity here than in blood-testing. For one thing, there are two calling systems. The staff have the knack of calling out a patient’s name at the exact same time that the automated system calls out numbers. Means nobody can hear either announcement, so patients keep getting up to ask what’s going on, then coming back to their seats, head shaking in disappointment.

One patient has got the system figured out. Now she’s giving out to all and sundry the phone number of the professor’s PA, which is, she reckons, the only way to get your x-ray done and have the results sent to your doctor in the same century.

Only the old man next to Sanjay is immobile. He’s wrapped in so many layers of woolly clothes that he has to sit bolt upright. Probably been wearing them a while, judging from the smell.

Sanjay needs the toilet but it’s out of order. This means a trek halfway round the hospital to find one that works. He could have just asked at the desk for a dozen specimen containers and filled those.

hospital gownFinally it’s his turn for x-ray.  

He is shown into a cubicle and handed a gown. Then he studies the grainy instructions on the wall.

Sanjay tries to tie it as per the picture, but fails. Ah. Two of the tapes are missing.   He goes into his x-ray bare-chested like Putin.

The radiographer tuts.

Two hours for two simple tests. Finally Sanjay breathes a sigh of relief and exits to the fresh air, rushing straight into a crowd of smokers by the revolving doors.

 

Next week it’s the London Book Fair. I look forward to meeting friends old and new, and reading an excerpt from my novel to fellow indie authors. I have yet to choose the passage, but you can bet Sanjay will be in it.