Hospital consultant - am I expecting too much?

[Kiltie]

My father has been in hospital for 95 days now.

His consultant offers families the opportunity to meet with him on a Tuesday during the day.

I met with him for the second time today and I'm really not getting a feeling that he's on the ball with respect to my father's care.

As an example, he told us that my dad's pain was much better (I don't think it is). When I asked why they'd then significantly increased his morphine (twice daily MST + request Sevredol) dose last Wednesday, he hadn't been aware.

Now, with what I do for a living, I might have dozens of jobs and projects on the go at the same time. If a client said he wanted a word about one particular job though, I'd make sure I was up to speed with it before the meeting.

I'm really sensing a lack of urgency and a lack of interest and I'm wondering if I should maybe submit a feedback form expressing my dissatisfaction.

I wondered if anyone had any thoughts on this. Perhaps I'm overreacting or expecting too much of the consultant.

[Gargamel]

If recent healthcare results have shown anything, is that families are often better placed to see the effects of care over a period of time.

Don't do a form, go back in there and talk to them again, express your concern. ask them what is their opinion of the best or most likely outcome, and what the care plan is for your father.

If you are still dissatisfied, then speak ask them for a second opinion, or raise it with The hospital management, can doctors become shall we say a little disinterested in some cases over a long period of time, I would say they can.

I hope your old boy recovers well.

[Kiltie]

Thanks, this is a good steer.

The word that jumped out at me was "plan". I don't understand what the plan is and nobody is explaining it to me - or even trying.

I'll discuss it with the rest of the family and suggest, maybe, my brother and I meeting with the consultant next Tuesday and letting him know how we feel.

If that yields nothing then I can think about taking it up with the management as you suggest.

It's difficult that the consultant is really the only source of information we have. The nursing staff on the ward are spread so thinly that they don't appear to have a handle on progress.

Thanks again.

[Wacky Racer]

I would discuss your concerns with the consultant (In a friendly manner) and hope he takes what you say on board.

Then, take it further if necessary.

[jackh707]

Why is your old man in hospital?

I'd say you are pretty lucky personally finding a consultant that can spare the time to talk to families, few have the time.

[blindswelledrat]

Ive noticed similar with my mother who has been in a stroke ward for a couple of months.
Everything they do is reactive and the ward seems like nothing other than a care home.

The contrast between the care and service my mother has had compared with my daughter who has been ill is absolutely unbelievable.
THe elderly seem to be just a job for the nurses to manage and a consultant to rush around checking their pulses periodically.
In contrast I have had calls from consultants from home at the weekends about my daughter.

[Hoofy]

Is your dad elderly and on his way out? Or is it just a fixable issue?

Let me put it this way, Dignitas doesn't operate in this country but there's a way round it. Tell your nurse you're in a lot of pain, even if you're not, they'll keep ramping up the diamorphine. Boom! Headshot!

It wasn't the cancer that killed my dad but the nurses. However, I say this in a grateful way as he was suffering with his cancer symptoms (I don't just mean pain). I think that was their "plan" all along.

[HughS47]

It's not unusual for a consultant (is he an MFE consultant - from earlier posts on this?) to not be fully 100% up to date with current changes, often as the SPR will run the day to day and the consultant will do rounds once or twice a week to trouble shoot. This could be excused as an oversight for not knowing why someone inceased his pain meds - most likely that the poor FY1 or SHO did it, without informing anyone, in response to nurses informing them that your dad was in pain. This would often not get passed back up the chain to the top.

What is tricky and something that the consultant is unlikely to ever discuss candidly is that if your dad is really crumbling, with each fixable problem or new introduction of medications raising other issues, it might be that they are out of options. A 95 day stay strikes me as possibly just that. It would be impossible to offer any insight into a complicated medical case with co-morbidities on an internet forum, but to answer your original OP question - the answer yes, they may have lost interest but no, it isn't unreasonable for the consultant to be not 100% fully up to date with all the minor changes in his case.

Have you had 'the talk' yet with any of his medical team?

[Silent1]

Hoofy said:

Is your dad elderly and on his way out? Or is it just a fixable issue?

Let me put it this way, Dignitas doesn't operate in this country but there's a way round it. Tell your nurse you're in a lot of pain, even if you're not, they'll keep ramping up the diamorphine. Boom! Headshot!

It wasn't the cancer that killed my dad but the nurses. However, I say this in a grateful way as he was suffering with his cancer symptoms (I don't just mean pain). I think that was their "plan" all along.

It's called the doctrine of double effect and R v Adams [1957] was pretty important with regard to it in the uk

[Hoofy]

Silent1 said:

It's called the doctrine of double effect and R v Adams [1957] was pretty important with regard to it in the uk

Thanks for that. I won't show it to my mum or my sister as they suspected the hospice were speeding up his death and weren't very happy about it!

[Kiltie]

HughS47 said:

It's not unusual for a consultant (is he an MFE consultant - from earlier posts on this?) to not be fully 100% up to date with current changes, often as the SPR will run the day to day and the consultant will do rounds once or twice a week to trouble shoot. This could be excused as an oversight for not knowing why someone inceased his pain meds - most likely that the poor FY1 or SHO did it, without informing anyone, in response to nurses informing them that your dad was in pain. This would often not get passed back up the chain to the top.

What is tricky and something that the consultant is unlikely to ever discuss candidly is that if your dad is really crumbling, with each fixable problem or new introduction of medications raising other issues, it might be that they are out of options. A 95 day stay strikes me as possibly just that. It would be impossible to offer any insight into a complicated medical case with co-morbidities on an internet forum, but to answer your original OP question - the answer yes, they may have lost interest but no, it isn't unreasonable for the consultant to be not 100% fully up to date with all the minor changes in his case.

Have you had 'the talk' yet with any of his medical team?

Thanks for this reply. It's been really useful in allowing me to get things into perspective a bit.

I agree, absolutely impossible for anyone here to offer insight in to the case.

Yes, my father is in a unit for the elderly (he'll be 87 next month).

The problem has been one of pain in his pelvis and thighs. The only thing they've really found is an L1 compression fracture. They're now thinking all the pain is referred.

Interesting that you say the consultant may be reluctant to talk candidly if my father is really "crumbling".

I accept this may be the case but I really do need to know.

I've actually mentioned this to the consultant before. I've told him that however this pans out, I need to be satisfied that the burden of care isn't going to fall on my mother.

Regarding speaking to his medical team, the difficulty I have is that I'm generally only ever at the hospital in the evenings when there's nobody around.

Anyway, some good news is that my mother was present at the consultant's ward rounds on the day after the meeting I described in the OP. He was a different man - informed and proactive.

I'm thinking that we maybe just need to keep up a regular dialogue with him such that my father's case has a more constant profile.

I've talked to my brother about this today. He was previously reluctant to do this but it's sounding like he's now prepared to take week-about turn in speaking to the consultant which is good.

Anyway, thanks again to everyone who replied here.

[Mobile Chicane]

Hate to say it, but my experience of elderly + NHS is that you need to be very physically present, and in their faces.

If the staff get the slightest whiff that no-one else gives a toss about the patient, neither will they.