As a bronchiectasis patient I sometimes wonder if I am suffering from an identity crisis. I ask myself when I have been to my GP, who has spent most of my ten minutes slot gazing at a screen whilst reducing me, my condition, to a "reading", whatever happened to the personal relationship between a doctor and the patient? The doctor "reads" me, then pushes a PRINT key and I "read" my prescription as I go to my pharmacist. Next patient please.
Obviously this scenario depends on what I have told the GP at the beginning of my consultation, the gravity or otherwise of my condition, whether or not I ask for a referral to a specialist, to a clinic, or I want a physical examination. In other words, a non-routine visit. And how much of this procedure can now be done on line, either as a repeat prescription or a consultation that might be weeks ahead, if you are in luck?
I appreciate that with the current crisis in GP provision nationwide, the person in the surgery room is steadily "vanishing" or being diminished at a further remove thanks to the convenience of heath care technology (HCT) and its all-pervasiveness. The voice behind the screen.
Consider the general hospital should you be admitted. Especially here the case is altered. What used to be envisaged as humanist care, where high touch and low tech meant that nursing the patient was the norm, now the equation is reversed, and high tech and low touch has become more commonplace. Devices such as monitor machines and intravenous tubes proliferate (HCT) whilst the nurse is now a technician "nursing" the machine, rarely the patient.
My point is that my identity as a patient with a lung complaint, such as with bronchiectasis is now more subject to a technological response, be it the GP surgery at one end of the treatment line or be it the hospital sojourn at the other end. Even with inhaled drugs all is a daily reminder of our subjugation to the chemical "fix"of heath care technology. So, what is going on here? I am sorry to have gone on at length but should we be worried?
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A very interesting observation. As a very long term bronch I have seen many changes in my relationship with medics, hospital services and drug delivery. GPs do not engage with us because they know nothing about bronch. This has never changed. Now they are looking at the screen to see what the last letter from the consultant told them to do or failing that the latest guidelines. I keep my personal relationship to the con and her secretary and my nebulised drugs come from the hospital. The last time I trysted my GPs in 2015 they nearly killed me by failing to see that I had pneumonia and an empyema for 6 weeks and after 4 visits. By the time I got myself admitted through A&E to the hospital where I see my con she thought that I was a gonna. The same with my heart conditions. The con tells the GP what to give me and they are very cooperative with that
Recently I have had 2 other levels of personal contact added- much to my surprise. A bronch specialist nurse at the hospital I attend who can liaise with the con very quickly for me and access to a specialist ward at my local hospital which is a new system being rolled out to provide home IV when needed.
Hospital admission ( last in 2015) even on a respiratory ward is a nightmare. Nurses are only trained in copd
They do not understand the bronchs need to empty their lungs in private and refuse to handle any sample pot because they mistakenly think that it will infect them. Perhaps if a robot came to collect them it would get rid of the sense of shame and frustration which this produces.
Well said Littlepom. The impersonal consultation as you demonstrate, is a mixture of uninformed clinical awareness of bronchiectasis and time saving solutions which turn out to be counter intuitive or plainly harmful and bad practice. I am not necessarily prejudging HCT but it has a qualified usefulness in the ward and clinic. It almost as if the remote devices serve the function of separating the human patient from any risk to doctors and nursing staff of medical malpractice and error. Nurses by and large used to make hospitals hospitable, but now the visit to the respiratory ward can be a nerve-racking experience designed to put you off from ever going back! How much does HCT become a barrier nowadays to getting better?
Yes my most recent visit to the GP surgery, the doctor spent the whole time staring at the computer screen looking at 'me' then at symptoms, then a potential therapy, then what the initials stand for, then where these therapies are performed. She could have been playing a computer game or shopping at Amazon for all I know 🙄
Amazon shopping more like! No, that's unfair Hungry but your metaphor sums up the sense of disconnection between the GP and patient which so many come away with. There's a supermarket feel to the transmission belt of processing the consumer (the patient) and the product (the care package) through to the checkout.Minus customer satisfaction.
I don't have what you have, but asthmatic. I am working towards a career in nursing. I would not do that, I'm taught in college that person-centred care is crucial. Technology is used to aid us not take over the care.
If you are not happy speak up about it, they might not even realise what they are doing is making people feel like that. Just say to them how come you are so focused on the technology and not the patient, don't be harsh about it or in a way that is hurtful to them, but just as an observation in general conversation. Worse comes to worse complain.
THEY SHOULDN'T BE JUST LOOKING AT YOU AS A DISEASE, BUT AS AN INDIVIDUAL WHO NEEDS TO BE HEARD AND SPOKEN TO AS AS A HUMAN.
Hope it resolves. I won't do that I promise, if I did, I would want someone to just say 'this isn't a criticism, but...' in a gentle manner in mind, because I am a little on the sensitive side. I don't want to do stuff wrong or hurt someone from my words or actions.
Many of us have tried that. We ended up being labelled as trouble makers. I could fill pages with the way in which ward staff behave which leaves many patients feeling infantalised, powerless, ignored and quite often scared.
Unfortunately the reality of life on the wards is very different to the idealistic hopes of the classroom. I do hope that you manage to hang on to your obviously genuine intentions and who knows - you may make a difference.
Hello, I've been on a community Ward for a placement and a dementia day centre so it's not all classroom based. I've seen how my different topics fit into placement and I've been taught more than enough from placements.
And I've been in my local hospital wards enough (many many times) to know what mine are like from a patients point of view
The truth is each trust, each hospital, each department and staff member does things differently but they shouldn't be forgetting about the crucial elements to the job such as person centred care which is supposed to be at the forefront of everything we do
Sorry to hear what people are going through. Just keep in mind the constant pressure they are under which may be causing their standards to decline due to this. Just bare with them x I wouldn't be here without the NHS being here to pick us up when ill 😷 and not ask for a bill beforehand! (I couldn't live in America with the idea if paying thousands for just a hospital appt let alone anything else).
Don't mean this to sound mean apologies if it does
Take care all of you, every single one of you is amazing, brave, determined people and more of those personality traits x
I don’t think that you sound mean at all. Unfortunately, over 66 years of having bronchiectasis, giving birth in a first class maternity hospital and (luckily) a few admissions for other things, my experience has been as I described.
There is so much wrong with the financial and organisational administration of the NHS that it is bound to cause pressure.
We do not get our treatment with no payment. We pay for it through our taxes and I do think that many should be made to think before they abuse the system. My daughter’s best friend is a paramedic and nowhere is this abuse more obvious than in the amount of 999 calls which could be dealt with by a sticking plaster.
As you qualify and go to work on the wards please don’t become one of the cabal of nursing staff who gather around the nurses’ station, gossiping and shuffling paper whilst patients who need help are ignored and those who are brave enough to venture up there to attempt to get help for them are met with a row of stony stares.
Sorry, these are the facts and not only my experiences. You are very brave to want to do this job and I really do hope that you have a fulfilling career.x
That's why I always see the senior partner at our practice, who looks at me and gets the full story and then tells me how it is: if it's something to worry about or not. Other patients don't seem to appreciate his straight talking, but I don't mind. He also took 20 mins with a patient before me once, which I was quite content about because I knew that patient would have needed the time, and he would give me the same time if I need it.
Your post is from the heart Erin and the sentiments expressed humane and caring. It is good that you are in college training to become a nurse because you will be in the front line of health care when you graduate. The human touch that you advocate is ideally suited to the conditions that you are experiencing in your practicals because you are working with HCT every time that you enter the ward, to some degree or another.
My observations about technology in care are that it is all-pervasive and at times almost unconsciously used as an aid to nursing, from the temperature and pulse rate devices which are used for each patient innumerable times a day, as well as bloods, and with your attention to the monitoring routines that you experience and apply in your care. My point about the use of HCT is that nursing, with all the best intentions which you have for your individual patient, is now dispensable. You cannot do your modern tasks at the bedside without technology, despite your human and humane intentions. From the hugely expensive intensive care units to the minor and time saving functions in the general ward, your nursing is compromised by the reliance upon machines and hand-held devices. Your human touch which is so valuable to you as you seem to be saying, your high touch, is lowered and weakened ,mostly by the low touch of modern medical technology.
Please do not think that I am demeaning your feelings and care, Erin. I am a lung patient who has a great deal to be thankful for high touch nursing, from an earlier age when I contracted tuberculosis back in the 1960s, and constant nursing did not proceed with the technology which we experience today. It is because of this caring that I am here today writing this reply (paradoxically the care then coupled with a daily dose of the wonder drug of streptomycin). I have nothing but praise for your chosen career Erin. I hope that your sentiments are respected as they deserve to be in this age of HCT.
I understand why you would feel that way. I spent years with no single gp understanding what was wrong with me or why I kept getting ill. It was being admitted to hospital that finally set things rolling for a while before coming to a halt for several years when I changed surgeries. I am thankful that I changed again and have found a surgery that does go out of their way to work out what is wrong and works well with consultants, specialists etc. Since joining them I have gained a respiratory physio (she is amazing), a speech and language therapist and have and continue to have tests and things that were never considered before. My resp. Physio is currently getting me moved from my old consultant to a more local one who is based at Derriford. Apparently they have a great deal of equipment there that may pinpoint what is going on with my asthma and my bronch along with my breathing disorder and a host of other things.
I feel that if the combination of personal interaction and the use of technology are balanced correctly, the care we receive will be top notch but it is difficult to get that balance right. It’s taken years for this to happen and I sincerely hope you and everyone else also receives the right level and balance of care.
Hello ladytelita and you are quite right to search for a fusion of the necessary condition of HCT combined with nursing that values human contact. But is it a sufficient condition? I think that the way things are developing with modern technology then you might be right to talk about physiotherapy where the patient becomes the technician managing her treatment . Possibly the physiotherapist takes more and more the intermediary function between HCT and the nurse in order to empower the patient in a recombination of self-as-medical-technology. We are constantly encouraged to manage our own condition by medical and NHS gurus. We thus become instrumental and also a medical device, so that we can see the human body as a form of technology , of hominism or knowledge gained from the body.
I do not want to make this thinking mystical or weird but I am looking for a suitable paradigm for nursing and HCT co-existing, acceptable. The machine metaphor of the body as robotic may work here. if I am right, and HCT is more becoming the norm rather than the exception, then it makes sense to search for new ways of encountering the changes that are taking place in medicine. So how do we retain the human when confronted by the non-human devices and caring in the modern hospital? Can we come up with an answer?
Yes Littlepom, physios are high touch practitioners and humanise health care, without too much need or resort to automation in the hospital or their place of practice. Long may it last but I have to say that machines can compete with physios in other ways, such as with the semi-automated devices of the gymnasium and health clubs where you pay your subscription and move through a whole transmission belt of treadmills, rowing, cycling gizmos etc. It is a kind of do-it-yourself approach which does away with the physio to some greater or lesser extent. Hospitals are not exactly health spas but the body interacts with machines much more than we realise, and frequently to our benefit.
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