Dev Lall

Patient feedback just doesn’t work for everyone

After hanging around in a threatening manner akin to a black cloud for several years, my time to revalidate has eventually arrived. In preparation for my final appraisal, I contacted my appraiser to set a date for our meeting. I was loathe to bring up the topic of patient feedback, having to date kept my head stuck in the sand muttering “How are anaesthetists supposed to do that anyway?”, but I needed to know the state of play.

My appraiser is brand new to me this year: two different appraisers are required within each five year cycle and I’ve been having a chat and a moan with the same one for the last four of them. I had great hopes for this new one though. He is a pathologist and if there was ever a doctor to understand the difficulties of attaining patient feedback, it would be a pathologist for sure. I asked for clarification as to what I should do in terms of patient feedback, feeling confident of some empathy, a shrug, and advice to leave it swept up under the carpet.

No such luck I’m afraid. I was efficiently informed that in order to revalidate I had to submit 25 patient feedback forms and have the results collated and presented in report form by the appraisal administrator. Taking the path of least resistance, I got the questionnaires and got on with it.

The questions only covered non-technical skills and required the patient to grade me on my bedside manner, in 10 different ways. Had I been polite? Introduced myself? Given options for treatment? Involved them as much as they wanted to be when making the plan?(?), shown a true interest in their concerns, allowed them to ask questions, you get the idea – and “no”, I don’t have that long with each patient if theatre is to start on time and we strive for same day admission. But I digress.

The big question really is, how valid are my patients’ opinions?

I was trying to decide when best for them to be given the forms. You see, my skills of this type are only used during a pre-operative consultation. As I do not do a pre-operative clinic, these assessments take place within an hour of so of anaesthetising the patient. I doubt any patient would say anything negative about the doctor about to assume responsibility for their A, B and C.

Post operatively isn’t much better. As they come round from a cocktail of mind-altering drugs, they can, and often do, speak nonsense. Later, they have gone home with strict instructions not to make any serious decisions in the next 24 hours; I consider their feedback on my ability for revalidation a serious decision. So that’s the Day Surgery list out.

If they have returned to the ward they are generally full of morphine compounding their pre-op dementia, so my trauma list not a great option. Emergencies I anaesthetise on call cannot remember me between the ward and the anaesthetic room and I believe their failure to recall me after the operation is a marker of successful anaesthesia (or a dire need for Intensive Care, which may not be). Plus, that’s a technical skill.

This leaves the elective Caesarean Section patients. Pre-operatively they know they will be awake in theatre with me close by, looking after them. I’m sure they would feel too embarrassed to point out any deficiencies they perceived on my part immediately beforehand as I slickly render them numb and ready to meet their new baby in a pain free manner and treat their haemorrhage, nausea, bradycardia and anxiety all while holding their sick bowl and reassuring them everything is fine.

Afterwards they bask in the glow of oxytocin (both endogenous and exogenous, depending on the degree of said haemorrhage) and think everything and everyone is wonderful. Even although they sometimes remember me later on, I’m still do not believe their feedback is meaningful.

In practice, this exercise needs to be done so I will have my forms filled out by a mixture of all these types of patients I meet during my working week.

I hate to sound negative and grumble about the point of it but as we strive to remain up to date, evidence-based and conform to agreed best practices, what IS the point of such patient feedback?

It would be more valid coming from the Auxillary Nurse in Obstetric admissions. Every week she hears me, through the curtains, giving my Caesarean Section/spinal anaesthesia talk plus questions and discussions as required. She could easily testify to the nature of my bedside manner and non technical skills both with the patients and the staff, herself included.

And that’s what she did do, last year, when she filled in my multi-source feedback.

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One Response to “Patient feedback just doesn’t work for everyone”

  1. Malcolm Morrison says:

    Terrific, Caroline! You should send this to the GMC – for their ‘feedback’!

    Speaking as a former (retired, not ‘devalidated!) surgeon, I would have thought that you should get a ‘feedback’ from your surgeons! Do you keep the patients ‘asleep’ and, if needed, ‘relaxed’? Are all your patients ‘blue blooded’ – or can you keep everything in the garden (theatre) ‘rosy’?

    Seriously, of course doctors should ‘keep up to date’ (so NHS Trusts MUST ensure adeqaute study leave); but I fear the present revalidation ‘process’ is seriously flawed. What is needed is a sytem that can ‘prove’ that their ‘knowledge’ is up to date (an on-line exam). Of course it would be a wonderful world if everyone was polite and considerate to others all the time – but both staff and patients are ‘human’ (so have human flaws). Do patients want doctors (and other staff) who are good (efficient) at their jobs? Or do they want them ‘all lovey dovey’ but, not necessarily, efficinet at doing what needs to, be done. I don’t think anyone doubted Sir Lancelot Spratt’s (of Dr in the House fame) ability as a surgeon!

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