Consultants. What makes a good one?

[Cateran]

This question is double-sided. By selecting a consultant's plus points we also think about what does NOT make a "good" consultant, I would guess. I know what are the virtues when it comes to seeing he or she in action. So what are the drawbacks? If any.

[Corin1950]

Hi Cateran

Well in my view, apart from obvious skills like being highly knowledgeable, a good listener and communicator I'd say it's the ability to bring about a positive outcome for the patient usually by using all the written information and test results to improve medication for control of symptoms and prevent further progression and suggest interventions or possible surgical options for those who are further down the line.

Attending an appointment and having a discussion and even being sent for tests isn't particularly effective unless there is some follow up that improves the persons condition. I guess many consultants are far more specialist than others and maybe more effective. I've often wondered how my husband would have got in if he'd been to a hospital like the Royal Brompton which is a specialist centre and has a good reputation for helping those with COPD unlike our local hospital where the consultants are pleasant but variable in their knowledge and expertise.

Hope everyone has a good weekend

Corin

[Cateran in reply to Corin1950]

Well said Corin1950. A genuine quality centre such as the one you refer to is essential and also the amount of expertise of the individual clinician. Bronchiectasis does seem to baffle some GPs in my experience but not the clinic nurses, though then again, it all rather depends on how much BE is lumped under the COPD banner, which is frequently confusing for the lay person. I recommend a support group if there is one available locally, led by bronchiectasis patients who know what it is to have this particular lung problem.

Enjoy your weekend.

Terry.

[SORRELHIPPO in reply to Corin1950]

I agree with Corin1950, I have one caveat about the figures that are published about Consultant Teams. If you have a Team known for working in a "centre of excellence", sometimes their survival rate figures may not be as good as those in a more normal hospital. However this can be because the "centres of excellence" tend to get the most difficult cases sent to them, by the units that end up with better figures.

[Cateran in reply to SORRELHIPPO]

Your last sentence raises an interesting conundrum SORRELHIPPO relating to the concept "Centres of Excellence". Are they excellent because of best practice to an advanced level or because more cases are sent to them because their reputation is high? It rather reminds me of the saying about the definition of a scholar: A scholar is one library's way of making another library.

[katieoxo60]

Hi Cateran, to me a good consultant is one extremely knowledgable in a paticular illness, including maybe experience of none run of the mill symptoms who can talk to a patient with respect for their knowledge about their illness . Nurses involved in certain illness care should also be more aware of the difficulties the patient might encounter along with the consultant. We are not robots and our lifestyles can be impacted greatly by our health problems during flare ups or new illness. i.e I live alone with a house and garden to maintain , shopping to do ect my house has to be adapted to perform daily tasks like washing myself. So when he says can I walk the answer is no because my feet are arthritic and my right leg /knee doesn't work and these things impact on other parts of my body like my back because I do not walk normally , this is what a good consultant should be aware of and show consideration for.

[Cateran in reply to katieoxo60]

Very sensitive katieoxo60 and I share your concern for the personal dimension and centred knowledge necessary for consultant and nurse. I too hobble about with sore feet and balance problems. Our natural concern is not to bother the specialist with what to him/her might amount to be trivial or extraneous information, but at the same time the necessary feedback to the whole patient quality of like is pertinent. I am also worried about my garden and housework, which is becoming too much for me. Rather than palm me off with limited panaceas, the specialist might gain knowledge of the whole person and his or her burden of treatment, often a closed book to the consultant because we let it go unread.

Time to be more proactive I tell myself. Sadly I am not always listening.

[katieoxo60 in reply to Cateran]

Thats the word proactive, we are not alone so things need to change if we are to keep people independent in the community.Not been a bad day today more sunshine good for vitamin D which helps the bones. as the song goes always look on the bright side of life. Not always easy on bad days.

[wheezyof]

The consultant I see at my local hospital is a lovely gentleman. However, if he acted alone I'd ask for a change. He is part of a fantastic team. All of them dedicated, full of knowledge, kind and caring... I can't praise them enough.

The consultant, as I said he's lovely but...

He is reluctant to answer questions, had difficulty diagnosing my illness from a lung scan (one of the team, not a consultant, told him what it was - confirmed by Brompton).

I've been lucky to have had 3 consecutive lung function tests with very similar results /FEV 30%. Now I may be wrong but I believe both my lung problems, Bronchiectasis and Bronchiolitis Obliterans are progressive. Add in my age, 67 and I know that in real terms that my results are brilliant. I was a bit put out when my consultant said that as my results were stable we would see no further changes. We have not for the last 3 results, 18 months but I think that 'no further changes' is a bit of an odd promise to make.

He gives no advice about lifestyle, diet, exercise.

I get advice and support from the team that do the lung function tests, my gp and my local Breathe Easy, British Lung Foundation Support Group.

I'm really thankful for all the help I get but no I don't think the consultant is that good. A lovely person but not a good consultant.

[Cateran in reply to wheezyof]

This is a very thoughtful reply wheezyof and frank in its implications for the question I posed. Natural charm does often help to put the patient at ease during the consultation, although you ought to expect this bedside manner to be partnered with sound medical and clinical advice that is best fitted for your personal situation. You don't seem to be getting that from what you report. Your membership of the BLF Support Group as well as this forum, is a bonus. Promises are an open-ended deal if you cannot rely on the follow up. Speaking from my own experience of a consultant and his team I do trust him, from experience, about his advice on medication, as I have had no complaints; also on his prescribed care plan for my particular patient profile and needs.

I am fortunate because my consultant is a world authority on bronchiectasis, which carries its own kudos in terms of his clinical skill, and also approachable and charming to boot, perhaps like your consultant minus the missing ingredient that you describe. I guess that it's the luck of the draw. I happen to know that other faculty physicians and GPs defer to him and respect his advice. I could have been worse off but fortunately I am not.

Make the most of your BLF Support Group, which I expect is patient-led, and keep an eye on this forum, with its myriad of folk in the same boat.

Cheers,

Terry

[momiji in reply to Cateran]

Wow! Cateran,

How lucky are you to have found a world authority consultant on

bronchiectasis.

May I know his name and the hospital he works at?

Right now I have E-coli on the lungs, and the consultant at my local

hospital doesn't know how to treat it.

Thanks a lot

[Cateran in reply to momiji]

As you know momiji the protocols ask that you get your GP to refer you to a consultant. I reside in Scotland in Tayside, so that is the first problem for you, the tyranny of distance and borders. NHS Scotland is quite different and separate from NHS England.

Professor James Chalmers works in Ninewells Hospital, Dundee. he is hosting an Open Evening on October 22 in Ninewells, starting at 6.30pm. The public are invited. I must stress that you cannot expect a consultation out of this were you to turn up but would need the particular referral route I have mentioned.A GP referral is essential.

I hope this answers your query and good luck in your search for satisfaction from the NHS.

[Soul01]

I f you leave a consultation feeling confident, that you’ve been listened to, you’ve had the opportunity to ask questions and have a clear picture of the way forward - that is a good consultation. A smile and a good manner go a long way too!

[Cateran in reply to Soul01]

Yes, Soul01. My consultant always greets me open armed and with a handshake, as if I mattered as a fellow human being, and my symptoms too!

[Soul01 in reply to Cateran]

That is so good to hear. People need to be treated in the context of the lives they live. We are not just a set of test results and scans!!

[SORRELHIPPO]

My regular Consultant is a Gastroenterologist. He is good on explaining the medical stuff, so I can understand, he is not good at discussing "with" me what I want as treatment. I value "quality of life" over "quantity" and have lived the last 10 years in a way I have not wanted to. Exhausted, early retirement and boredom. I had wanted surgery a bit early, which would have allowed me more years at work, but I might be gone by now. His "outcomes" would look bad if I died "early", the fact I would have a better life was beyond his ability to discuss or understand. So I find him a difficult consultant for me, but many would find him very good.

[crashdoll]

Good question.

Whilst medical care is obviously very important, I like to be treated like a person. I like it when they ask what I do for work and what I do in my free time. It helps me talk about how my condition is affecting me and the impact on my life. I find it difficult when I feel I’m just a medical problem to be fixed. I’m lucky my respiratory doctor is open and personable.

I also appreciate a doctor who says they’re going to do something and does it. I totally understand if things change and they can’t, as long as they keep me informed. So, essentially, reliable and a good communicator.