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The straight road not taken

Phil's patient has had an exhausting journey through the NHS - right back to where he started

Phil's patient has had an exhausting journey through the NHS - right back to where he started

It's currently fashionable to talk about the patient's 'journey' through the NHS. Like most - okay, all - bureaucratic jargon, it's a disingenuous attempt to redefine something simple as something that can be regulated.

Unfortunately, because of the way the NHS now functions (I use that word in its loosest possible sense) our patients do embark upon journeys - not all simple, and not all to the place they'd like to go. An exhausting journey can end with a patient dumped, bemused, back on their doorstep.

I had evidence of this the other day, when three letters about one patient arrived in one post. His journey started when he went for an eye exam. The next week I got a letter asking me to refer him to ophthalmology to get his cataracts looked at.

So far, so good. He got his appointment, it wasn't cancelled, he turned up at the eye infirmary on the correct day and waited his turn. Unfortunately, some confusion in my patient's mind prompted him to turn up nil by mouth since midnight the day before. When he stood up after an hour in a hot waiting room, he fainted flat on the floor.

Letter number one - from the eye infirmary. 'Patient not assessed as collapsed in the waiting room. Came round quickly.' The attending doctor thought he had probably fainted, but I suspect dealing with only eyeballs for a couple of decades had made him a bit cautious. An ambulance was called and the patient was carted off to A&E (in a different hospital, naturally).

Letter number two - from A&E. The diagnosis has now changed to 'unexplained falls'. My patient had his blood pressure measured several times, blood tests, a chest X-ray and an ECG, all normal. The 'falls' remained unexplained (not to me, or indeed my patient, who knew damn well he had fainted - it wasn't the first time), and the A&E doctor referred him to the 'Falls Clinic'. I'm not entirely certain what this is - I suspect it's a bunch of physiotherapists and some rubber wrestling mats.

Letter three - from the Falls Clinic and addressed to me, not the A&E doctor who made the referral. They have assessed my patient over the phone. According to their scoring system, he only scores three points, and they won't see anyone with less than nine. Therefore they regretfully inform me that 'my' referral was inappropriate. Helpfully, they include a copy of their criteria. Unhelpfully, it won't flush.

I've seen my patient since these incidents - he came to find out what was happening about his cataracts. He was bemused. It's obvious he fainted, obvious why, and obvious that a combination therapy of tea and sugar would have cured him, allowing him to get his eyes looked at.

Nobody had mentioned the Falls Clinic referral, not even the clinic's phone assessor who called to ask which floor his bathroom was on and whether he had a dog, before mysteriously telling him to see his GP.

I wonder how many 'patient episodes' were completed here - how many processes were undergone and forms filled in. How many protocols were followed? How many internal invoices are flying around as a result of this exemplary patient journey? What has it all cost? I don't know. I can, however, answer the key question - has he had his cataracts looked at? No.

Dr Phil Peverley is a GP in Sunderland

Phil Peverley

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