Thursday 15 October 2009

Hospital hierarchies with clogs

You can read the writing

Despite the constraints and the infirmities, I think my observations were keen and I expected to be informed all the prognosis process, the options available the decisions to be made, how they would affect me and a record made of my consideration of the issues.

Whilst the doctors’ notes were in Dutch, I did not see the Anglo-Saxon practice of unreadable scrawls only readable by diviners and members of some special freemason’s organisation with special codes.

The details were clear to read and very legible, the communication simple so that all interested parties never had to seek second opinions of the notes to gain understanding.

So busy for importance

The main professor in charge of my treatment is a leading authority in his field in the Netherlands and that means he is in high demand and difficult to book appointments with, but it was always a pleasure to see him.

In fact, I commiserated with him acknowledging that his high position means he is very important, very relevant and for patients offers some confidence that they are in good hands.

Looking up to the master

I could not help but notice the hierarchies and structures in the hospital, at the out-patient departments; a receptionist to book you in and place your file in the queue, an usher to take you into the doctor’s surgery, there is a possibility that the usher can be the porter and cleaner for the office.

Usually, the doctor is not in the room but has to be summoned, the doctor probably moves from room to room. There is a co-assistant too, an intern or student that understudies the doctor. In some surgeries, the doctor has a backed seat whilst the intern seats on a stool.

We are all introduced and the doctor pulls u your details on the computer and fills in a form catering for your visit. If you are to be closely observed, the doctor first looks then the intern looks and is asked for an opinion before the master explains or expounds depending on what the intern was able to say.

This close mentoring is quite interesting and I think it is in many ways necessary for interns to be involved without necessarily taking any responsibilities. Apart from the ophthalmological department, the decision was never final until the main consultant was first consulted and in some cases visits to observe.

The team and more

After that, the doctor explains in good enough what is to be done, completes the forms and bids your Godspeed.

At the bedside a doctor and an intern usually visits with the ward nurse present to take the bed-pan instructions, you probably would have the same doctor for a maximum of 3 days before a switch and new introductions.

When the professor or chief consultant visits, sometimes, no more than twice a week, it is a retinue with 3 or 4 other doctors who look intently on the master and rarely interject in the conversation except where they are directly asked to comment.

The decisions usually go up to the consultant, the doctors, suggest and discuss then confirm with the consultant.

You have access and hence control

I was glad that the hospital was always forthcoming with information of all my drug options, the regimes available, the possible side effects, how tolerable that would be and what I felt about the situation.

They also always wanted to know if I had questions, if there was more that could be done to help my comfort, ease the pain, and change the options and many other seemingly trivial things.

They always provided detail about the doctors and I could do additional research and ask further questions, I was never in the dark.

Finally, there were quite a good few people in modern clogs; I suppose they are comfortable, clean and easy to manage.

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