"Lack of person-centred care"

I want to stress, this journey was not all bad. I want to thank so many people. From the pre-assessment teams, to the theatre and ward staff.

I was booked for a partial knee replacement in January. The plan was for this to be done via the GRI site which was then converted to Stobhill.

I attended for the procedure. Was clerked in, check-listed, gowned up and ready. Only to be told at the final hour that there had been an error. The wrong implant had been ordered for the wrong leg. Therefore, the surgery could not go ahead. I was very upset and confused at how such an error could be made. I was sent home with a new date for a few weeks’ time. I took a phone call from the consultant's secretary the following day apologizing profusely for the error, which they stated was all their fault.

I returned a few weeks later, to Stobhill. This time I made it into the operating theatre and was given a general anaesthetic. I was woken up by the recovery nurse to be told that I never got the joint put in,  and the consultant will speak to me later. Completely confused and still groggy from the GA. I was tearful and upset with this information that I had been given on a passing, with no further explanation.

Hours later, the consultant to see me. They explained they assessed the knee with an arthroscope first to check the damage. I was consented for a partial knee replacement. As the joint was so badly damaged they felt a partial knee replacement would not be the best outcome long term. They felt a total knee replacement would be better suited. Unfortunately, as my consent form was for a partial and not a full knee, they were unable to go ahead with that procedure. 

When the reasons were fully explained to me I took this on board and understood the reasoning. I can appreciate that would have not been an easy decision to make at the time.

I was discharged home with the view to have the full knee replacement in approximately 6 weeks, once the swelling had gone down from the arthroscopy.

On the third visit, the surgery finally went ahead at the GRI. Post operatively, the consultant visited me on the ward to say they removed the knee cap as it was badly damaged. Thereon, I committed to the physio rehab plan every day, without fail. I fully understood the long road ahead.

I have to praise both the inpatient and IRH physio teams. They were absolutely fantastic, motivational and supportive about realistic goals.

I am now 4 months post-op. I recently had a follow-up review with the Orthopaedic Nurse Specialist- someone I have never had any input from along the way. This was a telephone review. I expressed some questions over whether a limp is normal at this stage? Is that something I will always have? I also asked about consultant led follow-up-especially given the initial mix up. I also asked was it because the knee cap was removed that it is still so swollen?

Unfortunately their response was of a very dismissive tone. Which included comments of laziness and to think about managing my expectations. 

When I asked about consultant led follow up their response was, the consultant doesn’t see you for follow-up. You were told this at the pre-education meeting (which I attended). We’ve done it this way for years. Whilst I can appreciate that, I do think a follow-up with the consultant would have been appropriate here, especially given the circumstances of what happened in the beginning. 

With regards to the knee cap and swelling, the nurse said that I did in fact have a knee cap and that this had not been removed. Which confused matters even further. The consultant informed me this was removed. I am still unclear whether I have one or not?

I came off the phone-call feeling completely failed. Just another CHI number in the system. Just another call for her to get through on their clinic. With what felt like tick-box questions. Some of which are still unanswered. 

I myself work within the NHS. The lack of compassion and disinterest in the nurse's clinical review was shocking at best. Person-centred care was non-existent here. They gave me a contact number to call if I wanted to make contact – I won’t be using that. Not to be spoken to in that manner again.

Due to the initial errors and this final review, I felt it was important to voice my opinion. Hopefully I can help any other patients who may go through this in future and a lead a positive change. I understand the preparation for such major surgery takes massive amounts of coordination and organisation on both sides of coin with both the professionals and the patient. I also understand mistakes can happen and  I accepted the apology from the consultant's secretary.

From the patient perspective both within work and personal life, commitments/services need planned, juggling childcare responsibilities. Also getting into the mindset to prepare for the rehab that lies ahead. This type of surgery certainly isn’t for the faint hearted. 

What could have been better:

Please order the right implant for the right leg. Whoever this was. Surely this wasn’t a cheap mistake? This delayed my procedure and mentally impacted me with total frustration and disbelief.

The recovery nurse- please think about what you say and how you say it  and at the appropriate time! Compassion goes a long way.

The consent form should include alternative surgery if the need requires it. This could have avoided further delay and a further general anaesthetic.

Please educate your CNS on the principles of clinical assessment, person-centred care and that not every patient is a one size fits pigeon hole.