"Communication and approach of Surgical medical staff"

I have cancer. Actually I have secondary cancer which has spread to other parts of my body. Life for me is about quality not quantity, for as long as possible. That’s okay, as we all must face our mortality as a guaranteed part of living. Some of us are fortunate to have time to plan and make more of a point of living each day intentionally, finding joy and spending time with the people we love.

Treatment for my primary tumour ended in 2023 after 18 months, and I felt well. After two months, I began to have intermittent pain in my lower back, over my kidney area and lower ribs. I began to use pain relief, hot water bottles or Ice packs. The pain continued to worsen so I sought help from my GP.

Over the next weeks I was scanned, my bloods were checked and cancer was ruled out. My pain continued to increase and I was soon on very high levels of pain medication. By the end of the year, the pain was extreme, even with medication and a decision was made to send me for triage at the Acute Surgical Receiving Unit (ASRU) at Ninewells Hospital. 

Triage in ASRU at Ninewells Hospital, the environment and experience whilst waiting to be seen.

There are 2 waiting areas and patients are moved to the second area as the triage progresses, often requiring to wait long times. Patients are in extreme pain during this process. The seating in the first waiting area is comfortable, however when patients are moved round to the second waiting area, this environment is poor, with no comfortable seating options for patients in extreme pain. There are no nearby toilet facilities.

The surgeons and medics manner with patients.

There was a mix of manner and approach towards me from the surgical medics, however I felt patronised throughout the process. I was admitted to a ward for further tests.

Experience of admission

I was in hospital for 7 days, waiting for scans and investigations. The nursing staff were wonderful at all times despite being in such a busy environment. the consultants changed during the week. The first consultant agreed to request further scans, however the second consultant had a different opinion and unknown to me, cancelled the requested CT scan. There remained an overall theme of patronising, dismissive manner from a variety of medics – even from the junior doctors. The second consultant decided to request an ultrasound of my gallbladder, but that the real reason for my pain was actually constipation, so I was treated for that. The reason for admission was recorded as constipation on my discharge letter. (Constipation is a side effect of all the pain medication I was on).

Aftermath of admission

Within hours of discharge my pain was extreme, so I reinstated to my pre-admission medication. I attended PRI radiology/x-ray department for a repeat CT scan as scheduled in an appointment letter posted to me, only to discover that this was cancelled by the Ninewells consultant and it couldn’t proceed. I was taken to accident and emergency for review. The junior doctor phoned the ASRU, however they were clear that I was not to be sent for further assessment, as I had been treated adequately by them during admission.

In discussion with my GP, I requested a referral for review by the plastic surgeon who had previously completed my reconstruction surgery and this was a pivotal moment in my journey. The subsequent letter from the plastic surgeon was very clear that the original scan had been “misreported” (it was outsourced for reporting to a private company), and the recommendation was for urgent review and repeat scan.

Acute Surgical Receiving Unit (ASRU) triage for the second time

This lead to a second Triage experience in the dreaded ASRU - It was awful, I felt dehumanised, disregarded, patronised, like I was wasting the surgeon’s time. I was examined while lying flat and then they proceeded to stand over me in scrubs and literally talk down to me. The surgeon openly stated that they did not agree with the content of the letter from the plastic surgeon but reluctantly agreed to send me for a repeat CT scan.  I was scanned two days later. A phone call confirmed that something had been found, and this ultimately led to transfer of my care back to oncology.

I have lost valuable time for treatment in my journey. The repeat scan in late February showed extensive cancer spread. Perhaps a scan during hospital would have found this sooner. 

Suggestions for change and improvement within ASRU at Ninewells Hospital:

1. Environment

• Review the environment in the second waiting room and provide comfortable reclining chairs for patients who are waiting lengthy times in extreme pain. 

• Provision of a toilet closer to the waiting areas if possible.

• Support patients with pain relief whilst waiting. 

2. Communication and manner of surgical medical staff

• Regular training of surgical medics regarding their manner and communication style and its impact on patients who are vulnerable but are humans who deserve to be treated with dignity, respect and compassion. 

• Encourage senior surgical staff to understand that they are role models for junior staff and students. 

• Above all – Listen – really listen to you your patients – they are the experts in their health and know their bodies.

NHS Tayside Vision, Values and Aims states:

Our Vision

Everyone has the best care experience possible.

Our Aim

To be the best at getting better.

Our Values

We will:

• Put patients first

• Show compassion, caring and kindness

• Treat everyone with dignity and respect

• Take the time to have good, open communications and be accountable for our actions and behaviours

• Do the best that we can by working as a team to provide excellent treatment and care.

In my experience, the surgical team in the Acute Surgical Receiving Unit struggled to achieve any of these aims.