"Issues with St Andrews Hospital Out of Hours Service"

About: Adamson Hospital / Accident & Emergency Ninewells Hospital / Accident & Emergency St Andrews Community Hospital

(as the patient),

In June 2014, I became unwell, feeling faint and with palpitations due to high blood pressure and intolerance to medication. I’ve had this before and it required a change of pills and on another occasion I had passed out in the house which resulted in hospital tests. I am an unpaid carer in my 60s, therefore I called out the paramedics who did various checks, on my blood pressure and heartbeat, then recommended I attend the St Andrews Out of Hours Service so as to have a doctor advise me on my medication. The paramedics made an appointment that evening and my son drove me to the hospital, dropped me off and went to park the car. The hospital was about 15 miles from my home.

I entered the main door of the hospital and went to reception but no-one was there and there did not seem to be any signs telling people where to go. There was a member of staff cleaning the stairs so I asked him where I should go and he pointed me towards the Minor Injuries Unit. Another person came in behind me and the cleaner also gave him directions, into another area of the hospital. I wondered why there were no receptionists on duty.

When I entered the Minor Injuries Unit there were about 3 staff behind the desk and about 3 or 4 men sitting on chairs in the foyer, they looked like staff, everyone watching tennis on the TV. I told one of the receptionist staff that I had an appointment at 7. 35pm and they told me to sit down on one of the chairs where the men were sitting. I wasn’t asked to confirm my address or any other details. I sat down, noticed tennis on the TV, and a person sitting opposite me with a badge hanging around their neck asked if I was there to see the doctor. I looked and wondered what it was to do with them but said yes. This person replied that they were the doctor and to follow them. The doctor did not say their name.

We both sat down in a back office and I handed the doctor the sheet that the paramedics had given me. The receptionist staff hadn’t asked for this. The doctor glanced at the sheet and I explained what had happened, telling the doctor about the blood test done by the paramedics, ruling out diabetes, my intolerance to medication. But the doctor said that even though they had done a blood test I might still have diabetes and should see a GP next week. I was worried at hearing this. The doctor then took my blood pressure and said it was very high. That worried me more. I said that one of the readings done by the paramedic was lower, on my right arm which they said was because I had relaxed. The doctor said that could be a sign of a blocked artery. I began to get very worried at hearing this. I have had family members who died of a stroke.

The doctor then took the blood pressure of my right arm with a stethoscope, saying it would get a more accurate reading. I asked the doctor if my blood pressure was OK but I did not hear the response as it was mumbled. I read the doctor’s badge and name as they were sitting close, and repeated the name so I would remember it. Then the doctor told me to make an appointment with my GP next week and I was dismissed with no instructions regarding my medication which was the reason for the paramedics sending me to the hospital. The doctor followed me back through into the foyer and appeared to go back to watching tennis again. There were no other patients around.

I told my son that I was still feeling very unwell, dizzy, dry mouth and was worried about what the doctor had said, regarding a blocked artery and diabetes. My son suggested I could go to Ninewells Hospital, Dundee, for a second opinion and so we drove there, another 13 miles. The receptionist at Ninewells A&E took my details and confirmed them. I was directed to a seating area with a TV screen which no staff were sitting watching. Firstly I saw a staff nurse who took my blood pressure, said it was fine and then I saw a senior registrar. I mentioned who the doctor at St Andrews Hospital saying I might have a blocked artery and diabetes. The Ninewells doctor took my pulse and blood pressure which she said was a bit high but nothing to worry about. This set my mind at rest and I went home, planning to make an appointment with my own GP on the Monday.

The next day, a Saturday, I wrote an Email complaint to NHS Fife Patient Relations, about the way that I was treated at St Andrews Hospital, mentioning the doctor’s name and practice as I had found out this information when searching online. I complained about being told I might have a blocked artery and diabetes, the fact that about 7 members of staff were watching TV at work, that there was no-one on the general reception, and that I had to travel to Ninewells Hospital, Dundee, to get a second opinion and set my mind at rest.

My complaint was handled appropriately and swiftly by the NHS Fife Patient Relations department however I was not satisfied with the responses from either the GP or the Primary Care Emergency Services Manager (PCES), in a letter, from NHS Fife Primary Care Emergency Care. And they would not agree to a meeting with me to discuss my dissatisfaction. The doctor could not “recall” mentioning to me about a blocked artery whereas I remembered it very well, although the doctor did apologise that I had “cause to complain” and was sorry that they did not promptly introduce themselves to me.

The letter said that they were “pleased that the cleaner was able to direct” me to the “appropriate department” but thought I must have “missed the signage for the correct entrance” when coming in to the hospital unwell. As for the staff watching TV, the letter stated that they didn’t expect staff to be “sitting watching television whilst on shift” but if it was on then they were sure I would appreciate that “the staff’s attention my gravitate towards the television”. However the letter did apologise about the “unprofessional first impression” that I experienced on arrival.

The reason as to why I am not happy about the response is that there were apologies offered for the issues that could not be denied because of witnesses but that the interaction between myself and the doctor was their word against mine. This is where the patient is less empowered when it comes to “who said what”. It was the mention of a “blocked artery” that caused me the greatest concern and I thought it an irresponsible thing for a doctor to say without any proof. The fact that the doctor in the complaint response, 4 weeks later, said that they wanted to reassure me that they were at no time concerned that I had any blocked arteries is not reassuring. For I had already been reassured by the Ninewells Hospital doctor’s manner and then at an appointment with my GP in the week following.

On looking back to that night I feel that the St Andrews Hospital staff I came into contact with watching the game seemed more concerned about what was on television than in how a patient might be feeling. It demonstrates how a throwaway remark by a doctor whose mind may still be on a game can have a detrimental effect on a patient who is not feeling well. After all it was out of hours and the staff would be well enough paid except for the cleaner I suppose who in addition to mopping stairs was having to act as a signpost, pointing the way.

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Responses

Response from Louise Ewing, Patient Relations Manager, NHS Fife

picture of Louise Ewing

Dear family carer

Thank you for taking the time to tell us about your experience which has been shared with the Management Team responsible for the Out of Hours Service. I have since received a call to say that they recognise the narrative, having dealt with your complaint. The team are pleased that you chose to go through the complaints process as this provides opportunity for reflection and learning.

Regards

Louise Ewing

Patient Relations Manager

NHS Fife

01592 648153

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