Endoscopy

I mentioned previously about a conversation I'd had with Phil where he spoke of people saying strange things in his presence, and me countering with the suggestion he could think about these things differently and then might feel differently. An example of just such an event happened whilst I was waiting for my appointment for gastro-intestinal endoscopy.

The appointment was for 8.30 am so Vic dropped me off punctually and I made my way to the department. The paperwork had warned that just because I was asked to get there for 8.30, it didn't mean I'd be seen at that time. I'd been told to eat nothing after my previous evening's meal, and to drink nothing after midnight. The waiting room was already almost full – only a couple of seats spare – as it became apparent that all the patients to be seen that morning had been asked to arrive at 8.30 am. After I sat down, a young woman (early 20's) came and sat next to me. We sat in silence and waited … and waited. There didn't seem to be much happening – occasionally a nurse would come and collect a patient, take them away for a few minutes and then escort them back (after going through the health questionnaire we'd been asked to complete and bring with us).

Eventually the young woman beside me went and spoke to the receptionist, then came and sat down again. After a while she said out loud "You selfish bitch!". Startled, I glanced at her. Momentarily I considered the statement and wondered if I was, indeed, a selfish bitch. It's a possibility I've considered before. Then the Counsellor in my head pointed out that the young lady was probably judging herself harshly because of her earlier action in going to the receptionist (presumably to try and get seen quicker). "I'm sure you're not" I reassured her with a smile, receiving a warm, grateful smile in return. Inwardly I was thankful to the loving spirit which had defused what could have been a painful event for me had I thought differently about it.

Sedation is routinely offered for this gastroscopy procedure, but I'm pleased to say I was able to elect to do without, feeling peaceful and calm despite the long wait. However, I did decide to offer some feedback to the Consultant and sent him a letter which I've posted here in case you wish to read it. In the letter I tried to keep in mind the principles a wise man once taught me regarding communication:

1) Is what I am about to say true?
2) Am I going to say it in such a way that will build up and not tear down? This could relate to a situation or a person. (So often the language we use can be very destructive, and indeed the very way we use it helps create the 'meaning ' of what is going on).
3) If I am speaking about another person who is not present, would I be willing to say it in their presence?

Here is the feedback letter I wrote to the Consultant:


GASTROSCOPY PROCEDURE – 20TH September - FEEDBACK

In these days when everyone is looking for ways to improve the service provided, I hope you will find the following feedback useful.

I received an appointment pack inviting me to come for GI endoscopy on Thursday 20th September. This was very prompt (only a month since my GP requested an appointment).

The information received was very helpful, informative and easy to understand. The paperwork included a proforma to return within 5 days in acceptance of the appointment. There was no return envelope provided. [Comment: On the one hand, I can see this is a good idea in terms of saving hospital money that can be better spent elsewhere – for each patient to fund his/her own return envelope + postage is a minimal outlay – and if it is a policy decision then it would be good to include on the proforma a paragraph to explain this and make it clear that it is the patient's responsibility to provide the envelope. On the other hand, I contrast this with the appointment I received to attend for a barium swallow x-ray in August – where a simple telephone call was all that was required to confirm acceptance of the appointment.]

I arrived at 8.30 am on the 20th as per instructions and was invited to take a seat in an almost full waiting room. I waited there for 3 hours, during which time a nurse went through the health questionnaire with me and labelled me. Then I was brought through to wait in the ward for another 10 minutes or so before you came to collect me and bring me in to the clinic.

Thank you and your staff who made the experience as painless as possible – everyone seemed confident and reassuring, warm, friendly and competent.

The time spent in the waiting room seems excessive. [Comment: You want your patients to be in a relaxed, calm state for the procedure and sitting for 3 hours or more in a room full of potentially anxious people with little to distract them may not be conducive to this. Could you learn from the x-ray department where a timed appointment was given?]

During the procedure, I gave a few loud belches. Each time you said, "I'm sorry, that was my fault". This makes it sound like you've done something wrong, which has caused the belches, but my guess is that the belches are a normal part of the process, and you offer that reassurance in order to put a patient at ease. May I suggest that another form of words, such as "Don't worry – that's normal" would reassure the patient without lodging the idea that you were making mistakes?

As I was being wheeled out of the clinic, you gave me a reassuring wink and it helped me smile and offer a sincere 'thank you'. I do indeed want to reiterate my thanks to you and your staff for all your hard work and for the standard of care provided.