You may be uncomfortable but I AM NOT!

Experienced a rather irritating experience today, let me explain...............
My husband and I (same sex couple and married as far as I am concerned) have recently bought a house, cutting a long story short, Daniel had a negative mowing the lawn experience resulting in acute back pain. Being the nursing professional I am I knew how to manage this without seeking help but my partner's condition deteriorated resulting in a new symptom 'active vomiting'. I was concerned and took him to the walk in centre *oh yes I know not to waste A&E time, it is for emergencies only after all*
After waiting for 2hrs in the waiting room *patiently* we were finally seen by the GP who did routine tests and asked for a sample of urine from Daniel who reported to me " I have only just been before I came in" to which I replied "well squeeze some more out, in my authoritative tone". GP diagnosed him with a urine infection and started him on Nitrofurantoin for 3 days. In my clinical mind I was thinking.. let's see how this one plays out.
Now onto the juicy bit... I contacted my local surgery to register ourselves as new patients (must add that I went there only a week ago to get the forms to be told that "you must book a patient assessment before you can be registered". I took this a caring intervention and said "I will look at our diaries and ring you back with a convenient time".
Anyway, back onto contacting the local surgey.... RING RING... RING RING.... confronted with "Hello surgery".... I reply "is this ********** **** Surgery?"...... "Yes".... "oh I didn't know it was ********** ******* as all I heard was SURGERY".... not a good start the first conversation eh?

I explained that I picked up the registration forms last week and was ringing to make an appointment for my partner and to come and have a patient assessment (added in that unfortunately I had to take my partner to the walk in centre yesterday and he needs a follow up with the GP this week)... this is where it gets climactic....

"What is her name?"  to which I replied "HIS name is Mr bla bla bla"..... phone goes silent...

At this point I would like to state that a normal person with effective communication skills would have replaced the previous phrase with "Can I have your partner's name please" or stated "excuse me for that"        now I am not the biggest complainer but this is common sense.

Now she obviously was uncomfortable with the situation but I kindly explained my relationship status as a matter of course.

I then asked the receptionist to confirm the appointment times back to me for each of us and then experienced a complete reluctance to state my partner's name.

Moral to the story... people might be uncomfortable with conversations relating to relationship structures but this receptionist is an employee of the healthcare service; simple adjustment in thinking and sensitivity for patients situation is needed.

Don't judge me

I have to go back to my  doctor's this week and I suspect that neither of us are looking forward to the experience all that much. We hear a lot about how important it is for health care professionals (HCPs)  to be non-judgmental in their dealing with patients but very little about what happens to the HCP/patient relationship when the patient is doing the judging.

Although I haven't visited my GP very much (not at all in the last 30 years) we have settled into a nice mutually judgmental relationship. He finds me irritating and demanding because I understand health care, know what treatment I need and ask for it repeatedly. I find him patronizing  and unhelpful because he insists on doing tests to find out what is wrong with me rather than just giving me the treatment I want. Neither of us are wrong  - we just understand each others position, disagree with it and try to work round it. This attitude does not necessarily  have a negative effect our relationship, rather it places it upon an equal footing which is often lacking in other HCP/patient interactions.

How informed is informed?

I recently fell into the hands of organized health-care which necessitated a visit to the ultrasound department of my local hospital. In the spirit of ensuring I was informed about my forthcoming visit they sent me a helpful leaflet about drinking water an hour beforehand, how long the investigation would take, what to expect (gel on tummy) etc. NO MENTION AT ALL of the invasive part of the procedure!!!!!
Is this because they think that's the most fun part (*hint* it really really isn't) and want it to be a nice surprise or is it because they think if women know about that bit they won't turn up? Either way my consent was only semi-informed at best, the information I was given seconds before the procedure began was inaccurate ("this won't hurt much") and I am not a happy patient.

The Neutral Zone

The thought occurred to me this week - when did we become an either/or society? We seem to be becoming increasingly polar in our opinions, either Microsoft or Apple, iphone or Blackberry, books or a Kindle. Those are surely unsustainable positions. Why can't we acknowledge that there are elements of both which would work for us at different times. After all, when you buy a Kindle it's not like Amazon send a big skip round to your house and take away your existing book collection is it? 

What sparked this off in me was attending a meeting of Healthcare Professionals for Assisted Dying (HPAD) at the Dignity in Dying offices in London.  It was a good meeting, focusing upon how HPAD could inform the healthcare profession's debate around assisted dying and also support doctors and nurses in practical ways...and it changed my mind for me. Not in terms of being a whole hearted supporter of choice at the end of life but in terms of what we should be expecting from the Royal Colleges in terms of their guidance to practitioners. I admit that when the Royal College of Nursing adopted it's neutral stance towards assisted dying in July 2009, I was a little disappointed that they hadn't gone the whole way and come out in clear support. However Professor Ray Tallis made the point that neutrality is the obvious and most desirable outcome. Why? Because it's the only outcome that complete acknowledges the autonomy of the individual. This is not an issue to be controlled by healthcare professionals who set themselves up as gatekeepers, it's an issue that that cements the partnership between the patients and their health carers/providers. We need neutrality in order to encourage our professional organisations to provide support for healthcare professionals who both do and do not support this contentious question and we need neutrality to enable us to direct patients to the best sources of advice, whatever those sources may be. This is not about either good palliative care OR assisted dying, it is, what it has always been, about informed choice.

Finally, I was a little depressed to note that only 66 of HPADs 380 members are nurses. This despite the fact that nurses would argue that they spend more time with patients than doctors, they act as patient advocates and that some polls suggest that nurses are more open to a change in the law around assisted dying. Nurses care about this question so I would hope that more of them will join HPAD and make sure their voices are heard.

Virtual loss, real grief

Like a number of people I have a lot of on-line friends, more if I'm honest than I have in the off-line world. And this week I lost one. One of my tweeps (that's what I call my  friends on the micro-blogging site Twitter)  has died after a long health struggle that he bravely kept to himself. This was a person I had never met in the off line world, didn't know what he looked like or what his off line name was. I know he was tolerant and kind and quirky, I know we shared a love of opera, shoes (he was a self-declared transvestite), take away food and  most importantly a sense of humour. @daminicustard was always ready with a virtual hug when I posted a sad thought or a witty quip, we recommended each other to our own followers and I like to think we made each other laugh. It's hard to think that I'll never get another *mwah*  for giving him a #ff recommendation or making him smile.

So don't tell me that relationships in the virtual world are some how less authentic or meaningful than those in the off line world. If they were the grief I'm feeling at the moment would be much less painful and much less real. As health care professionals this may be an area of loss we have not even begun to think about addressing but it is an area of care we cannot ignore for much longer. Social media has made communication both more immediate and more intimate and working out how to support individuals who have lost people they never really had in the 'real' world is possibly one of the next big challenges in nursing care.

So, goodbye @daminicustard, I'm sad you never knew how special you were, it was a privilege to be one of your Twitter friends and I hope, wherever you are now, you are finally happy.

When did playing outside become a disease?

I couldn't believe when, watching TV the other night I saw an advert for Oralyte for healthy kids. For those who have not come across this before, it marketed in the UK as Dioralyte and is a drinkable  salts and glucose mixture used to help rehydrate patients who have severe intestinal problems and had nifty little animations demonstrating how salts ad electrolytes are lost through sweat and how easily they are replaced by Oralyte. This advert was encouraging mothers to feed this stuff to their children who "become dehydrated when playing outside. I'm sorry....what??????????

In a society which seem sdetermined to prevent children from playing In streets parks and gardens, walking to school and generally rushing around on bikes this seems the final step to far. Kids who are playing outside require (I'm told from my friends with kids) frequent feeding and watering and if this is done the there is no need to seeking medical treatment.

It  seems to me that this is a cynical attempt to frighten parents into buying a treatment for their kids that is unnecessary and redundant. Whilst electrolyte replacement compounds have been used to treat severe diarrhoea in children there is no evidence that in ordinary thirst it is any more effective than ordinary water or fruit juices especialy in healhty individuals.
This does 2 things, firstly it exploits parents by implying that the old way to look after their children in the summer is to make them drink electrolyte supplements and secondly it emphasise a more important trend in today's society to find medical ways of treating ordinary life experiences. Is this how we want our children to grow up - frightened to play in case they dehydrate?

Feet of clay?

The first professional idol I had was a ward sister called Angela Knight. I worked on her ward at the start of my third year of training and she was the first person that I looked at and thought " When I'm a ward sister I want to be like her!" Fortunately my placement was only for 10 weeks so I left the ward with my awe intact. Since that innocent time I have been sadly disappointed in my ( very few) idols since. Finding an individual I held in great regard operated, on closer inspection, in a cloud of glamour with little substance behind the show, meeting a key nurse theorist who changed the way we think about nursing and finding them to be inarticulate and shy was a massive disappointment. It shouldn't detract from the esteem in which I hold their work but somehow....

And maybe that is the way to ensure that your professional idols maintain their mystique, appreciate them from a far and never, never get to know them!