You can usually tell the mood in the department early on, right from the peripheries. When it's busy, patients sit in beds out in the corridor; specialty staff are stuck down in the department; the waiting room heaves and it is standing room only. Tempers flare. And, factually, it is worse for patients.

Sometimes, in this mess, the word “difficult” (or challenging or rude or...) gets brought out. Because some people end up expressing themselves loudly, and that is intimidating. Lots of them express a fear of getting lost in the system. When it is crowded, and it's taken longer than they expect to be seen, a few people have come up to staff to make sure they haven't been forgotten. (They haven't, 99% of the time. It genuinely is a stark matter of supply and demand.)

I think it's the same with children who come in with “behaviour escalation”. They fall between CAMHS and medical services, but neither thinks it's their problem to solve. I suspect this is because neither has particularly good solutions for it. Yet they undeniably are “difficult to manage”, hard to put in a box, sometimes end up hurting themselves.

I think all of them just want to be heard.

Even in a district general hospital, each patient makes up one of 60-120 patients in the department at any time. By my estimate, I spend maybe 20-25 minutes actually seeing and examining patients; the rest of the time is spent in front of a computer, so away from patients, documenting, referring, requesting scans, chasing bloods... All “behind the scenes” work, and from the outside, looks like inaction.

How do we fix this? Can it be fixed? What happened if patients were given a more granular breakdown of progress? How do we even communicate the hundreds of tiny steps needed to decide on disposition? How do we make people feel heard?

#reflections #clinical-communication