Paul Fenton pleads for less bureaucracy and more communication

Everyone does it. How many times have you looked at one of the doctors you're being taught by and thought, "I wouldn't want them to be treating me"? You have teaching with your house officer and find yourself picking holes afterwards in what they've told you. "They could hardly put the cannula in themselves!" "I'm better at interpreting a chest x ray than that!" "I feel sorry for the patients!"

I was talking to my grandmother about the long and protracted illness of my grandfather. Going in and out of different hospitals. No one having much clue about what was going on. None capable of communicating properly with the others. I could see it happening all too easily - the piles of notes on the registrar's desk waiting for a discharge summary - how many of those patients would be in hospital again by the time it was written? The rushed trips to another casualty, to be seen by another few doctors and have to give the same story over and over again. Undergoing the same degrading examinations. In the end it took an abortive operation to tell them what was obvious - he had inoperable cancer. "We're very sorry but there's nothing that we can do." Did it take four different consultants in three different hospitals months to work that out? Why did I find myself making excuses for them - it was a complicated situation, there were lots of things going on at once? They should have found out - we had guessed long ago. Would it have made a difference if he'd been sent to just one hospital, if people had actually talked to each other? He wouldn't have lived any longer - does that mean that it didn't matter?

We've seen the frustration in patients' eyes as they finally get to be seen by a tired and hurried doctor after a six hour wait on the uncomfortable plastic seats in accident and emergency. But we shrug it off - that's the way it is for everyone, we can't do anything about it. We forget so easily that it's not just when you're seen, it's how you're treated. My grandmother accepted the bureaucracy, the waits, the different hospitals, and the different doctors - that's just the way the system is. What made her angry - what made them both angry - was the way they were treated. What she complained about wasn't the time it took to make a diagnosis or the number of tests he had to undergo, it was when doctors and nurses were inconsiderate, when they didn't explain things, when they didn't treat them with any respect.

She started talking about a particular doctor they'd seen late at night in one casualty department. It surprised us both when, without thinking, I filled in the gap in the name she had been hesitating over. It had been my old house officer. The one who none of us really liked. The one who, to us, had always seemed very much less than ideal - the practical skills weren't as fluid as we expected, the knowledge wasn't as comprehensive as we thought it should be. We found ourselves saying, "I feel sorry for the patients." But this was the one my grandmother remembered by name, the one who took the time to apologise for the wait, to be interested in them as people, to ask them what they wanted, and to explain what was known and what was unknown. The one who recognised them when they came in again. The one who, out of all the people who'd seen them over the months, stood out for treating them with dignity and respect. Did this speed up the diagnosis? Probably not. Did it make any difference? It made all the difference in the world.

When I think of my grandfather's illness I feel sad that he fell through the gaps in the NHS. That bureaucracy prolonged the uncertainty and the pain. But I feel a deeper sadness that there have to be doctors who stand out for treating someone with dignity and respect. It's something we should all do. We can make excuses for waiting times and bureaucracy, but can we for people?