Wow

What so many clinicians forget is that there are real life people, with real life lives, behind all of our consultations. Consultations impact far more deeply, wider, and for longer than they do on the clinician (“next please”)…

But even this level of understanding looks like genius compared with the trite sound-bites of the politicians. An NHS with time to care. What a crock of shite. It takes hours and hours with a patient (as we have) to get to see and hear insights like yours. I could never have this with everyone – it is just not doable. It has been built over years of communications and understanding. It transcends the normal doctor patient interaction, but gives so much insight into what it is like to be on the receiving end of treatments especially surgery. Thank goodness you are representing the patient on the NHS England board.

You were advised to have a Boari flap. That is all there is to it – following the prior operation that did not go so well…

Meanwhile, but not meant in any sort of mitigation / defence or even an explanation of your predicament, consider the extraordinary job that it is to be a surgeon. What an unbelievable responsibility to make a decision, take the unswerving trust and faith of another person, and operate on them in the hope that things will be better, but knowing that in an unfortunate few, they may not or get worse… How, when we understand the deeper consequences of our failures to help, can we ever pick up tools and do the same for another patient seeking our advice. It is not like medicine where we can say this pill did not work; let’s try another one. We know it is our own work that has let the patient down.

We are told to reflect and have appraisal, but, as you say, there are evil people out there pretending to be nurses or doctors, or even real ones that prey on children, who don’t get weeded out by these laborious processes until it is already way too late.

The system is crazy. The people who care, care too much and could not cope with knowing too much about the negative implications of some of their decisions, actions or omissions.

The problem with a politically run NHS is it does not have the guts to admit that it simply cannot live up to its promises. And it just keeps making more and more.

The patient is not like a car going in for a service (why did you get the carburettor changed; you needed a new exhaust)… You can’t simply get a new one if the engine is too difficult to fix. The system is slow, too complicated, lies about being patient centred (3 days notice – nice – who books a holiday with 3 days notice? Or a show? Or even a dinner out with friends?) and demands too much of both the staff and, more importantly, the patient. It needs both to fight to get things done. Both are ready for the challenge in a proper doctor patient partnership, but neither needs the false promise that it is easy, quick and certainly not guaranteed. Or some nurse you’ve never met asking you to justify someone else’s decision that can’t be changed anyway. It all sounds rather horrendous to me.

I will send 10 MSU forms and keep my bit as simple, reliable and helpful as I possibly can. In the meanwhile, I hope you have a decent sleep as a better remedy even than neuro modulation courses, and will look out for replies at 0600 or thereabouts as we both tackle the next day at the front line of healthcare (provider and seeker and real life receiver)

J