So todays story to get my goat-In the University teaching hospital (Trust A) in which I work I am treating someone with pancreatic cancer with chemotherapy. They live near hospital B at which I run a peripheral clinic although I do not normally treat pancreatic cancer there for historical reasons. My patient asks if instead of travelling on a 70 mile round trip every week they could possibly see me at Hospital B and have their treatment there. So the same patient sees the same doctor and receives the same treatment in a more convenient setting. Simple? A no brainer, I thought.
Oh no. So far I have had emails from the following: Lead clinician of Trust A, Head of commissioning at Trust A (several), Clinical service manager at trust A, Head of Drug and Therapeutics at PCT, secretary to D and T commitee at Trust B, lead cancer nurse at Trust B and cancer services manager at trust B. The problem? I have no idea, but this fairly simple decision is not only taken out of my hands and sent-who knows where? but has involved a significant amount of time for me, as well as at least 7 colleagues Yes 7. seven! seven! seven!
Manwhile the patient continues to wend his way up and down the motorway. Am I alone in thinking this is unsustainable?
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4 comments:
It is a wretched state of affairs. It is patently ludicrous that your willingness to accommodate a patient is being over-ruled by a guideline that can not be set in stone.
What makes it worse is that the other participants in this wrangle must also know what a waste of time it is for all of you.
Why don't you know what the problem is? You haven't read any of the emails?
Something to do with the money following the patient, maybe? After all, chemo is not cheap. Is this not just an inevitable (if probably exaggerated in this case) side-effect of making people responsible for budgets? And as a conservative, you presumably approve of making people responsible for budgets if it leads to better control over levels of taxation?
Hi potentilla
Of course I have read the emails. The point is that there is no problem-the treatment was approved (unsurprisingly) in the end. But it took up 7 peoples time and effort to ask the details of what was proposed and to say they would have to check with X or Y or Z or all 3.
As you say the money is supposed to follow the patient and the patient is receiving treatment anyway, the money should not have been an issue. But it is, or at least the beaurocracy is
This is for a relatively straightforward matter. If it is something which involves (heaven forbid) clinical judgement instead of following standard protocols that a trained postman could apply then the process takes a huge amount of time rather than the hour or two that it has taken to sort this issue out. This is time that I could and should be spending seeing other patients, or on research, not on justifying every decision I make to someone often faceless and usually less well qualified than myself to make the decision.
I absolutely agree with making people responsible for budgets-I just think that the people doing the spending should have some idea of what their budget is and some latitude to spend the budget as they see fit, within reason.
One of the major probems historically has been that hospital doctors have abrogated their responsibility for management functions including budgets etc. This is our [doctors'] fault but needs to be corrected.
I don't blame any of the people invoved in this, all of whom were doing their best to be helpful. My point is that the lack of trust in professionals' judgement spawns a controlling beaurocracy which is hugely expensive and inefficient
But do you, personally, HAVE a budget? If you do/did, you should certainly be aware od what it is and have some latitude in spending it. Is it not the case that the cost of your time and the chemo comes out of a budget for which someone else is responsible?
Sorry, I am not trying to labour a point here, I can just imagine how it feeld from your end, but also imagine how it feels from the side of some of the people involved at trust A and B in these times of financial strain (A making sure that the trust is really going to lose the work before losing the money, B vice versa).
I'm glad all the people involved were trying to be helpful, anyhow, not telling you you couldn't do it. Budegtary control does come with some management/admin overhead, though; SOME of the emails at least must have been in pursuit of making sure that, administratively, the money DID follow the patient.
One of the major probems historically has been that hospital doctors have abrogated their responsibility for management functions including budgets etc. This is our [doctors'] fault but needs to be corrected. Definitely! But management of process is more complicated than you might think, if you have not previously attempted it. (I speak as someone who used to be a director of operations in the City, a milieu not renowned for tolerating excess bureacracy).
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