"Hospital inpatient - lack of information"

My husband has suffered from type II diabetes and essential hypertension for over 10 years. He has a high level of medical monitoring and ongoing support, both from his GP practice and from the Diabetes clinic as an outpatient, including regular checks and treatment visits with the Podiatry Department.

He has also had several emergency admissions to our local DGH, and while there has been no suggestion that his treatment has ever been inadequate, or inappropriate, there have certainly been some recurring themes that I suspect are not only typical of the experience of many patients admitted to acute hospitals, but appear to be almost endemic to the system.

I present rather more detail about one of these admissions as an illustration of the kinds of problems of patient communication that he has repeatedly complained about:

He presented at A&E mid morning on a Monday in late July a couple of years ago, with cellulitis of one leg from below the knee, accompanied by large serum filled skin blisters, which had developed after he had been gardening one afternoon a couple of days earlier.

After initial assessment in A&E, followed by admission to the Medical Assessment ward, he was initially admitted to a surgical short stay ward ( because there were no spare beds in a medical ward at the time) and transferred the next day to a medical ward.

Over the next few days, numerous swabs were taken of the lesions on his leg, and numerous blood and urine samples, by various nurses and the phlebotomist, and by the podiatrist who came to visit him on the ward rather than at his usual outpatient appointment.

He was sufficiently alert and compos mentis to ask various people about what the results might be of these various tests, including at some point:

- the consultant in general medicine who had admitted him,

- the diabetic consultant whose care he was technically already under for monitoring in the community,

- the consultant chest physician who had previously seen him for investigations into breathlessness,

- the consultant dermatologist who was called in to look at the skin lesions,

- their various registrars,

- and the nursing staff who were caring for him in the ward.

He reported that the universal response was ‘I don’t know the results of your tests, because I didn’t request them and therefore do not have the results. You will have to ask my colleague/the consultant/someone else…. ’

When he was duly discharged a week later, after antibiotic therapy with a variety of drugs, and discussion about whether he was going to need surgery, including potentially a below the knee amputation, not unnaturally he was rather wondering what exactly had happened, whether it was likely to recur, and what the prognosis might be for the future.

There had been various informal comments, largely from nursing staff, about what might have been going on, and technically many of the tests were intended by someone to throw light on the matter. But he didn’t know what the results were, or what interpretation anyone had placed upon them.

He reported to me that the most useful comment was:

‘You are technically a patient of your GP, so even though your GP did not refer you to this hospital, a discharge letter of some sort will be sent back to your GP practice by someone in due course. So if you want an overall summary of what has happened here, it is probably easiest to contact your GP in a couple of weeks to see if the discharge letter says what happened. ’

That is what he did, because while he was in hospital it did not seem to be anyone’s role to take an overall overview of his case, or tell him at any point what was going on. I visited him every day, but he could not tell me what was happening because no one had told him.

He has had four or five unscheduled admissions to hospital since, and has by now been an in-patient of nearly every general medical and surgical ward in the DGH, with the exception of HDU, ITU or the renal unit.

Sadly, both he and I can report that the situation seems to always be the same – even though all the staff are performing appropriately, if the patient asks what is happening in relation to their own treatment, it can be remarkably difficult to get a useful or coherent response.

All of which suggests that not only is it not surprising that on this occasion very significant errors or omissions of patient care took place without my husband or our relatives being aware of it, it is in fact perhaps surprising they do not happen more often.

It is also unsurprising that many members of the public have a very high index of suspicion about the quality of their own care or that of their relatives as a result.