Overall so far I would say that I have received excellent and efficient medical care but I feel that there are some problems with administrative staff and pharmacy staff.
I was referred on an emergency basis to the hepatology department by my GP after becoming jaundiced. I had chosen the Royal Free because the internet contained details of a specialist jaundice clinic at the hospital where all tests could be done on an out-patient basis on the same day. In fact, this facility does not exist, which caused a lot of confusion for my GP and me. After discussion with the Royal Free about this, they tell me they have now removed this page from their web site.
My initial appointments in the hepatology outpatients’ clinic were with a registrar and later with a consultant who were both very good and very thorough. I was offered the opportunity by the registrar to become an in-patient for five days for tests to be carried out but refused this as I have a history of devastating clinical negligence and hideous experiences at two other London NHS hospitals for wholly unrelated issues and am now naturally reluctant to become an in-patient in any hospital unless it is unavoidable. The tests therefore took longer on an out-patient basis than they would have done had I agreed to become an in-patient, and this was entirely my decision.
I had two sets of blood tests, ultrasound, CT and MRI tests. I was mildly concerned that on the second blood sampling, I did not see the person taking the blood tests change his gloves before dealing with me. He may have changed them after the last patient left but I do not know and as a matter of practice, it is better to carry out such necessary hygiene in front of the patient.
I had been sent to the relevant admin person to make an urgent appointment for a CT scan but was only offered an appointment for three weeks’ later. The admin person seemed uninterested, despite the form having been marked “urgent”, so I had to sort this out myself with the registrar, who had been falsely told in the meantime that the problem was that I was insisting on being given the scan that day.
I am dangerously allergic to the contrast used for the MRI scan so have to take a strong regime of prophylactic steroids in the preceding forty-eight hours. These drugs have to be taken at strict intervals counted back from the time of the proposed injection of contrast material and the scan, and I have to be checked afterwards to ensure that I do not go into anaphylactic shock. When I got to the hospital, I noticed that the board said that the MRI scans were running two hours late. I therefore explained to the desk staff that for medical reasons I could not be delayed that long and needed to be brought forward. After waiting an hour, I approached them again, to be told that there were seven patients in front of me and I’d just have to wait my turn. I asked to speak to a doctor as they did not seem to understand that this was a medical issue – I was repeatedly very clear to the desk clerks that I was not complaining about being kept waiting, but that there was a significant medical issue arising from the delay and repeatedly explained clearly what this was.
Initially this request to speak to a doctor was refused and I had to become very assertive and insist on talking to the departmental manager. This too was refused and she would only speak to a desk clerk about what I had said instead of directly to me. I was feeling very unwell and really could have done without all this to-ing and fro-ing and discussion with unhelpful administrative staff. I have no idea why the departmental manager, I think unreasonably, refused to talk directly to me.
After more insistence from me and another half an hour passing, I was seen by the MRI scan consultant. She said that she had only been told that I was complaining about being kept waiting, and after a brief discussion of the medical issues, immediately brought me forward in the queue.
The hepatology consultant I saw several days after the MRI scan had not been told about the scan or given the results. He went to the MRI department to have a discussion with the MRI consultant. The news was not good – I was told at my own prompting that from the size and position of a tumour, I most probably had a cancerous tumour. I had a short discussion with him about this and he arranged for a stent to be fitted to relieve the by now increasingly unpleasant symptoms of a blocked bile duct, and I was told that during this procedure the medics would also take samples for testing and be able to confirm if it were cancer. He also gave me a prescription for three lots of medication that I should take in the meantime.
The person I spoke to in the hospital pharmacy insisted that I could not sit on any of the chairs in the room whilst waiting over half an hour for the prescription to be processed as these were “for travel clinic customers only” – the commercial travel clinic sharing the same facilities – and told me in a bossy manner that I’d “have to go and wait in the café”. The café seats are very uncomfortable, I did not want any refreshments and so I returned to the pharmacy where he became very unpleasant, insisting that I could not sit there and insisting that there was nothing uncomfortable with the café seats. You can imagine that after just finding out that I had suspected cancer, I did not want to deal with such rudeness. I pointed out to him that NHS Trust facilities are paid for out of taxpayers’ money for the benefit of patients not for the commercial interests of people selling travel items, and asked to speak to the pharmacy manager – who immediately said that of course I could sit in one of the three empty seats nearby.
There was a further admin bog-up in that when the appointment was made for the day surgery to fit the stent, I had said that I did not want to stay overnight in the hospital and was told that the doctors would not go ahead with the procedure unless I stayed overnight. When I discussed this with the medical team at the stent fitting, they told me that they had been told that I would not have the stent procedure unless they let me stay in the hospital overnight afterwards. I was quite capable of going home after the procedure and did so.
After the stent was fitted, the samples taken during the procedure confirmed the cancer diagnosis and I was referred on to the oncology consultant for an urgent appointment. The hepatology registrar and hepatology consultant and the hepatology consultant’s secretary had been excellent at communication, regularly phoning me at home to update me with details of my diagnosis, making urgent follow up appointments etc. Once I was passed to oncology, the system collapsed again.
I was told that someone would contact me to make an urgent appointment with the oncology consultant – after hearing nothing for a week, I contacted the hepatology consultant’s secretary and he gave me the number of a member of staff in the oncology department, but told me to get back in touch if I hadn’t been able to sort it out.
By contrast to the hepatology consultant’s secretary’s helpful attitude, I felt that the staff member I spoke to in the oncology department couldn’t care less. This person informed me that they had no trace of me and transferred my call immediately to “referrals”, who didn’t answer the phone. Rather than take up the hepatology consultant’s secretary’s time again, I contacted PALS by email and had an initial response the next day and a day later the PALS representative telephoned me to say someone would call me to make an appointment and the same day someone did, for the following Monday. I’ll do feedback on the oncology services in a few weeks.
So far then, the Royal Free has scored very highly on clinical treatment – I have found the medical staff in the hepatology clinic (and the nurses and admin staff there) efficient, helpful and approachable. Similarly, the staff carrying out the ultrasound, CT scan and MRI scan were pleasant and informative. The medical team who fitted the stent were helpful, pleasant and efficient. Some of the administrative staff, for example the hepatology consultant’s secretary, and the PALS representative, do an excellent job and have a sympathetic and helpful approach.
It is a pity then that some administrative employees of the Royal Free let it down, but it has nonetheless so far been a positive NHS patient experience.