"It often feels to me like a power game with medical secretaries and receptionists"

(as the patient),

I'm a former Medical Secretary and Electronic Office Skills Tutor and I did my training in the early 1970's. In those days Medical Secretaries had to study anatomy and physiology, human biology, medical terminology, medical shorthand, medical office skills, social studies and the background of the NHS. I was taught to be scrupulous in my attention to detail when taking dictation and to check the notes made by doctors in the patient's case notes whilst I was typing my letters - this was to ensure that if doctor said 'amputate the person's left leg' that he did, in fact mean the left leg and not the right. We had to be as competent as the doctor with regard to medical terminology - we didn't just have to know the words, we also had to understand their meaning, and the same went for anatomy and physiology. That was to ensure accuracy at all times as we all know what happens in the game of Chinese Whispers.

We were also taught to be courteous at all times, especially to patients as, after all, the NHS is actually all about their welfare and it's not supposed to be a power game of 'us versus them'. But I have to say, in my experience where Secretaries and Receptionists have been concerned, it often feels to me like a power game and there seem to be a lot of receptionists and secretaries with a defensive attitude bordering on the hostile. We all know doctors are busy people, but then so are other members of the public and workforce. Doctors are not flying around their locality these days like they were in the past. It’s my understanding that they have 10 minute appointments well spaced out, they have support teams based in their surgeries, they have out of hours doctors and locums - so come on, let's not be silly about having to fend off patients left, right and centre. In my opinion, it feels like Receptionists would sometimes have us think patients are beating down doctors doors, malingering or wasting time, or indeed stupid. Actually some patients have had a good education themselves and they are simply trying to get an appointment or give a message most of the time and would appreciate being listened to by the Receptionist or Secretary.

Over the years I've had some horrendous greetings from GP Receptionists - the most memorable one was "Hmmmph! Do you REALLY need to see Doctor, he's very busy at the moment." I was, in fact, suffering from chest pains at the time, which was later diagnosed by a locum GP as angina and I was referred to a cardiac specialist.

I recently telephoned my GP surgery to cancel an appointment and to make an enquiry, as I was an inpatient in a local hospital at the time. I was met with an abrupt greeting from whoever it was who answered the phone and I immediately felt from their tone that they wouldn't have time to listen to the message I was about to give them. I began to tell them that I was an inpatient at a certain hospital and therefore, couldn't attend my appointment with my GP. Easy enough. The tone of my voice was obviously telling this person that I wasn't finished, that I had something else to enquire about but their tone and manner was hurried and I felt dismissive and rude and I kept having to say 'Just a minute ...' because I felt they were about to put the phone down. They tried to end the conversation several times before I'd finished what I was saying and before I'd had the chance to ask about a referral which was supposed to have been sent off by my GP. When I asked about the referral to Dermatology, I was absolutely confident that this person hadn't a clue what Dermatology was, never mind say it!!! They then asked me when I'd be out of Broadgreen Hospital - I wasn't in Broadgreen Hospital - I'd told them I was in Whiston. The whole message would only have taken me 2 minutes to give had they listened in the first place, instead of being more concerned with ending the conversation and rushing me off the line. When I asked for their name, their response was "What d'you want my name for?"

I was also a Medical Secretary myself at a local hospital, and I was astonished at the number of Secretaries who did not seem to understand medical terminology at all. I felt there was also very much an atmosphere of 'oh no, not ANOTHER patient wanting to know something', when the telephone rang.

I actually felt that I was remonstrated for spending time on the phone answering relevant questions from a patient because I had targets to meet - by the very person who would regularly disappear from her desk for hours leaving me to answer her phone calls and deal with her queries as well as my own.

My point was - if we didn't disappear for hours, we would all have time to meet targets and answer the phone to patients instead of transferring their calls round the hospital in a never-ending circle. That's an unacceptable practice.

I wonder if some medical secretaries and receptionists are untrained and therefore cheaper to employ than trained personnel? I also wonder if those who are trained and experienced, are overworked and underpaid and don't have the time to speak civilly to patients? And if so, then isn't it time that Trusts provided some kind of Patient Query Service totally separate from the Secretarial duties? At least then patients like me wouldn't feel like a nuisance or overlooked. A patient should never feel that they have to begin their telephone call with "I'm sorry to be a nuisance ..." should they?

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Response from Stacy Smith, PALS Officer, NHS Knowsley

Dear Grace3

Thank you for your comments. The Patient Advice and Liaison Service (PALS) provides support, information and signposting to other services.

You will find that there is a PALS Service at hospitals and Primary Care Trusts (which covers GP Services). Please let us know if you would like the contact number for PALS and the particular area/services you would find most useful and we could put you in touch with the PALS Team in your area.

Many Thanks


NHS Knowsley

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