"Day Surgery at King's College Hospital"

About: King's College Hospital (Denmark Hill) / General surgery

(as the patient),

It started with a shambolic pre-op assessment where the nurse had no knowledge or understanding of my chronic diseases and conditions (which are common), thus was unqualified to answer my questions or address my concerns about whether it was safe for me to have GA. I was told to come back to see someone more qualified (anaesthetist).

I duly took time off work (again). I informed the anaesthetist of my concerns and medical conditions. I commented on the fact the nurse had been out of her depth, to which he responded that she was only accustomed to dealing with “healthy people”. (!)

I informed him I was newly recovered from issues pertaining to a chronic disease, and gave as much information as I could. Despite my higher risk of infection, no antibiotics were offered. Given a number of allergies, I was told I would get intravenous pain relief, but nothing about what pain relief I could take home. Specific questions about the nature of the surgery could not be answered.

I looked at the notes taken down by the nurse and noted my meds were incorrect. I mentioned this, but the details were not corrected. I was told I could drink clear fluids on the day of surgery, something I specifically questioned.

Given my existing lack of confidence in the NHS, I paid to see a private GP to get antibiotics which I commenced prior to surgery, and tried to obtain transdermal pain relief but was unable to. This left me very concerned about the surgery. The nurse had not asked details about vitamins and supplements, but fortunately I knew that some can cause excessive bleeding during surgery, so I stopped taking them.

Day of surgery: I was a nervous wreck (having experienced previous blunders) and had questions I needed answered. I asked a reasonable question about a risk pertaining to surgery – this risk is listed in the booklet I was given at pre assessment so it was a reasonable question. The surgeon became defensive at my questions and even considered calling off surgery.

The anaesthetist (a different one) appeared surprised I was drinking fluids; I explained his colleague had said I could – I got the impression he didn't believe me. I informed him I was taking my own antibiotics because none had been offered. He said that I was to be given them intravenously and that it was not helpful I had started my own. It is unfortunate this information was not communicated at pre assessment.

There was consternation at what pain relief I would be given, despite my full history being declared at pre assessment. It was like they were getting the information for the first time an hour pre surgery.

On my file, my meds were still incorrect. I told the anaesthetist but was not asked for the correct details. My address details were incorrect, the nurse would not allow me to correct the paperwork because ‘it’s not allowed’.

There seemed to be a degree of surprise that I took time to read the small print on the consent form. I specifically stated I did NOT want a pre med, but was wheeled in and given one without my consent. I was powerless to resist – outnumbered and crippled by terror.

Post surgery, I was brought medication to which I am allergic. When I flagged it up, one blamed the other for the mistake. I was so desperate to leave, I left without the surgeon’s discharge letter. I rang the next day to try and get it but was told by ward staff they were too busy to deal with it.

Two days post surgery I started feeling unwell with the same debilitating symptoms that had kept me ill for the year preceding. I immediately recognised the symptoms as relating to one of my chronic diseases that needs careful management.

On day 4 of feeling unwell I rang the number given on the booklet, to be told I should go to A and E. Why bother printing the number on a leaflet if no post op advice can be given? Since I had no desire to lie unattended on a trolley for 5 hours as per previous experience of A&E, I didn't bother.

Instead I obtained the names of the drugs I had been administered. Cursory research indicates that at least 3 of the drugs administered are contra-indicated with 1 of my diseases. Pre-meds are not advised either with my history.

So thanks to the NHS I am now on sick leave again (having spent most of last year on sick leave) which is doing my career no favours. Experience has taught me that no one is ever accountable in the NHS, so all I can really do is post my story here as a warning to others.

Organisation learning to be considered: There is no point having a pre assessment by unqualified staff; neither is there a point having it if you fail to take on board the information given. If contra-indicated drugs are going to be administered anyway, save time and don’t bother with the pre assessment at all!

Doctors would do well to remember that valid patient consent is still a legal requirement.

There is no way of flagging up post op issues with the ward once you are discharged. All patients should be given a follow up appointment so that they can report issues, eg contra indications of GA. That way it can be held on the patient's record. Patients should be given a list of the drugs administered when they are discharged so that they don't have to try and track down the info when they are ill.

Plus points: the nurse who attended to me (apart from not allowing me to correct my personal data) was pleasant and kind. The nurse who did my pre op assessment, although out of her depth, was pleasant. The facilities are a lot better than other hospitals where I have had to sit on a chair both pre and post op, as no beds were available. PALS at Kings is extremely efficient and professional.

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Response from Cathy Varley, PALS Manager, King's College Hospital NHS Foundation Trust

I am very sorry to hear that your experience in Day Surgery was poor from pre assessment through to post operative support. I will of course ensure that the relevant manager for the Service receives your comments.

Alternatively if you contacted PALS we could place your comments in the context of the type of surgery you were having to adequately address the issues within pre assessment and anaesthesia.

We are always keen to act to improve patient services.

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Update posted by Waarheid (the patient)

The response looks like a standard from of words copied and pasted frequently.

If the hospital is keen to learn, it needs be accountable. I have been ill for 6 weeks post surgery due to problems with GA. First the surgeon wrote to my GP to say I would be assessed after surgery. Then the surgeon wrote another letter to my GP later saying again I would be assessed after surgery, but no appointment came through. Then a third letter was written to my GP saying there would be 'no follow up' for me.

What a mess. So I simply rang the department and made an appointment myself. When I saw the surgeon and explained about my bad reaction to GA. I was told it should be taken up with the anaesthetist or my GP. My GP did not know what to do except sign me off work; this issue is beyond the expertise of a GP. I have no access to the anaesthetist, so how can I follow it up? So as usual, no one is accountable and I am left with the problem.

As always, I got more valuable advice online from other patients on a patient advocacy forum where patients are more knowledgeable than most NHS doctors. I ascertained that the drugs are indeed contra-indicated with my diseases, particularly the pre-med to which I did NOT consent.


1) all patients should be seen after surgery. Surgery may have gone fine but there might be issues with GA

2) there needs to be a system in place for issues like this being reported back to the anaesthetist so that a response can be provided and some one is held accountable.

3) communication. Do not send out conflicting letters

4) suggest it is recorded in writing pre-surgery in patient files if the patient does not consent to a pre med, that way there can be no denial later.