"Colonoscopy"

I'm sitting here five hours after the abandoned procedure. Abandoned rather bluntly because I wasn't "clean". Really unfair, and I'm now at the back of the queue for another attempt and unsure how the repeat procedure will have a successful outcome. Unfair because I followed the hospital instructions to the letter. 100%. I must be one of the few patients to have read the booklet line by line.

I should have seen this situation coming. The admin worked but with an awkward mix of form letters through the post, sometimes confusingly overwritten, and sometimes through the web portal. Mention of multiple "spreadsheets" in telephone conversations are sure symptoms of an inefficient process with workarounds, underlying problems and unfortunate outcomes. Not to mention the waste to NHS resources.

Issues -

1) I have questions relating to the initial screening test. For clarity I omit them for this story.

2) Interviews and information flows. I had two nurse consultations which were fine in themselves. One on the telephone and the second shortly after attending for the appointment. I also made calls made to the unit to clarify some points. My perception is that a) answers to questions were noted but not considered or acted on. Just ticking boxes. b) answers were not passed on or were not read by the next stage.

For instance, why was I asked at the very last minute if I was on certain medication or had implants. The list of anti coagulant drugs was in any case incomplete. Good thing I know that I'm taking an anti-coagulant and that I recognised that the group of drugs mentioned were in the same class as Rivaroxaban. In fact, the use of Rivaroxaban had been given in both the preceding nurse consultations. Did anyone read the notes?

3) I read the booklet "Welcome to the Endoscopy Unit" line by line. My view is that its not fit for purpose. Staff comments to the effect of "its out of date", "did you really read it", "doesn't matter", "we don't get to see what's sent out". Contradictory? Booklet says to stop taking Rivaroxaban two days before. A hand written note on a letter said three days. A procedure nurse who answered my call for clarification said "do what you like". 

4) I did everything to be your best patient including two trips into Lincoln to establish timings, parking and a place for my wife to wait. I even took the content of the otherwise confusing booklet and formed a spreadsheet of actions, issues and information in chronological order. Yet i'm accused "poor bowel prep". The booklet has sloppy wording in places and didn't cover the one thing I needed to know.

I needed to know how long to wait before questioning the effectiveness of the Citrafleet. I waited ten hours. A nurse saying in retrospect that different medicines work differently for different people doesn't help. Rather, why not try to understand in what circumstances the products work, or not. I was really up front about being "empty but not clean" at the nurse consultation. The appointment could have been abandoned there and then. Even better if there was a formal pathway for that situation. Or, a risk assessment from the initial interview. Generally constipated? On Rivaroxaban? = higher risk. Action - see GP in plenty of time. Action - change timings for the Citrafleet, permissible diet and fluids only period.

Similarly, being told to take a "low fibre diet" next time equally doesn't help. What "low fibre diet". Nothing mentioned in the booklet unless it's the permitted list on page 16?

5) I noticed that there were many occasions when members of staff had to refer to others for answers. What's this a symptom of?

6) I was dumped out of the procedure. I understand why the doctor couldn't continue but the doctor, head nurse (with the blue spectacles) and the screening nurse just left the room leaving the juniors to answer the "why did this happen" and "what happens next", "what don't we know" questions. Just accused and dumped. I couldn't wait to get out of the building. 

I have little confidence that the team will fully reflect on the waste of my appointment. Too many shrugs and "it just happens sometimes" answers. I'm sure the unit is good for maybe 95% of the screening patients that can be sheep dipped. Not so good at helping the others, Needs fresh eyes sometimes, attention to detail. 

"Patient centred, Excellence, Respect, Compassion"? I don't think so. Not my experience.   are a) answers to questions are noted  but not acted upon or significance assessed.