13 February 2009

Responsibility & Telephones & Lazyness, Oh My!

I am unsure whether it is a total lack of insight or just plain laziness which is the doctrine of state sector hospital employees. My concerns are with those occupying the other very important positions in health care delivery who avoid responsibility. A telephone is the wicked accomplice to those in question.

Here ensues three stories to illustrate my point.

Switchboard Operator & Nurses

I receive a call from a very flustered colleague. She has her hands full with a patient who has complicated intra-operatively and needs an urgent ICU bed. She is working in another hospital nearby, which only has a high care facility without ventilators. So she has been trying to arrange for a bed in the hospital where I am on call. She is calling from her personal cellphone to mine. Apparently, she can't get through to our ICU or find out who the doctor on duty is because switchboard is not answering the phone.
"Not a problem", I reassure her. "Just sit tight, I'll get this sorted out from my side"

This shouldn't be a problem since I have the advantage of the internal short dial for ICU & will arrange the bed on her behalf.

4121 - engaged
4122 - rings, rings, rings
4123 - engaged
4122 again - engaged
(the nurses are making private phone calls)

9 - rings, rings, rings
(switchboard operator still sleeping/on tea/away)

After retrying for 10 minutes or so I finally get through to ICU.
I tell the sister I am trying to urgently arrange for a bed et cetera. She abruptly tells me to phone the doctor on 4137 & puts the phone down in my ear.

4137 - rings, rings, rings

Phone back to ICU. Engaged or ringing again. Persist & finally get through. I tell the sister the doctor is unavailable on 4133. I ask her who the doctor on call is, but she doesn't know!
"Ask one of the others, please"
"We don't know, we are the new shift." (so much for handover rounds, which was 2 hours ago mind you)
"Please could you look on the roster for me, Sister."
"Where is the roster?"
"I don't know, I don't work there - you do"
"Find out from switchboard" and she puts the phone down in my ear again before I can tell her nobody is answering at switchboard.

By now I am breaking out in a sweat from fury. I am about to sprint to ICU in person to wring a few necks & vent my frustrations. Lucky for them, I have a case on table.

We eventually solved the problem by phoning a random ICU doctor & asked who was on call. All was sorted out in 2 minutes.

This is the reason why I pay for a business cellular phone contract, privately. Many of my calls are for the state, which gives me no phone allowance and pays me peanuts in thanks.

Laboratory Technicians

We had a patient on table the other day - very ill, very urgent. I was unwilling this time (with the patient's best interests at heart) to blindly start the procedure in good faith that the blood results would be available "soon".
We knew the specimens were at the laboratory because an Intern had kindly made the two kilometre round trip to deliver them in person (you see, the messengers don't respond to sentences containing the word "urgently").
Problems :

  1. nobody answers the phone at the laboratory - it just rings & rings & rings
  2. when it rings too much, it is irritating to the lab tech's, so they take it off the hook
  3. then the phone stays engaged
  4. there is no computer system for us to personally check results
  5. it is far to run to the laboratory each time
  6. smoke signals would contravene certain laws (besides, they would be too stupid to understand it, or be too busy sleeping to notice)
So we had no choice. I left the patient under the care of my intern. The surgeon & I climbed into the car & drove to the laboratory.

The techies didn't even notice us standing at the counter. Music was blaring. One was sleeping in the laboratory & two were having an animated conversation in the corner near the phone which was ringing because I had dialed it on my cellphone.

We were only noticed after my earsplitting whistle. I thought the two of us standing there, in theatre attire, would perhaps draw at least an apology for the inconvenience caused or mild embarrassment at such poor service rendering. In fact, they didn't even flinch when I asked them if they weren't going to answer the phone whilst waving my cell in the air.

Blood Bank Technician
I'll spare you the details. We called for 4 packed cells, 6 fresh frozen plasmas & 1 mega unit of platelets.
The blood bank technician felt our order was overkill and only dispensed 1 unit of packed cells and a message via the porter that we can ask for the remainder as we need it.
After struggling with the phones and eventually, much explaining to the insightless but frugal-due-to-low-blood-stocks tech, the rest of the products finally arrived just as the sisters were preparing the corpse for the mortuary.
I KNOW she would have made it, but we missed the window of opportunity.
And the struggle continues because blood bank doesn't have to break the news to families, therefore no culture of responsibility.

I wish I could enlighten those who hide behind the telephone :
You may enjoy the anonymity and use it as a scapegoat for sloth and ducking responsibility....
You may enjoy ignoring the phone because you know it brings more work...
You may enjoy removing the phone off the hook because your sleep is then uninterrupted...
How corny, but what if that phone call is your life hanging in the balance?
People die everyday because of phones, lack of responsibility & lazyness.


Bongi said...

your posts are comforting to me. i'm not the only one being driven mad by these things. everything in this post is familiar to me. i think i sould have written the exact same post but i would have said the anaesthetist and i went to the lab (rather than the surgeon and i went to the lab, because, well, you are a gas monkey... and...well....i'm a...nevermind)

i always walk to the ward myself. firstly to calm down, but secondly the frustration of phoning is too much for me.

the tech and blood bank.


Anne said...

oh my word... i can relate to every single scenario. another favourite non phone answerer is the western cape metro ambulances: need to transfer a patient urgently to your tertiary hospital at around 7pm (shift change time?) be prepared to waste at least 15 mins waiting for some idiot to answer the phone. meanwhile watch in wonder while all the nursing staff disappear for 'handover'/tea while leaving your intern alone with your potentially unstable patient.

Vetnurse said...

OMG if we behaved like that in the veterinary world there would be hell to pay.

As for handovers well even if part or all is missed there is other staff that were on it. And if all else fails just look on the computer for the details or the handover sheet.

And as for a telephone ringing and not getting answered, there had better be a damm good reason for it.

Anonymous said...

It's ER, only better. Great blog. Keep it up.

Dr Guinevere said...

Like your other commentors said, I can so relate! The lack of responsibility is mind-boggling. You know, in frustration at switch not answering my calls, I walked down to their office one day. Mind, this was mid-morning. All three switchboard operators were lazily stretched out, feet on desks and the switch board sound was on mute. So while all the pretty red lights from waiting calls were flashing on the control panel, patients were suffering because health care professionals were being directly blocked from performing their duties, communication with other doctors or the wards. As you say, it is the culture of responsibility which is seriously lacking in our set-up.

I had a patient bleeding out in theatre, needing blood as a matter of urgency, obviously. This particular night happened to be one of three nights this year where it actually rained in my neck of the woods. Our blood bank is located directly across the road from the hospital, so yes, one would get wet walking there if you didn't use a raincoat / umbrella or plastic bag held over your head. Do you know what the porter said to me when I phoned him to bring the blood for my rapidly exsanguinating patient? He said no, he's not going, its raining. So, I see this as an opportunity to boost his self pride and remind him of how important his job is in saving this patient's life. I tell him that the blood, which its his job to fetch, is the only thing that will save this patient's life. I make it even clearer: without the blood, this man will die! Don't think the porter was at all touched by the important role he performs in the health care system or by the fact that someone could die directly as a consequence of his dereliction of duty. Oh, no! His response to me, "I'm not going, its raining."

Anonymous said...

I resigned from a certain Joburg hospital nine months ago. Every third/ fourth day they persistantly phone me like im supposed to be on call and leave rude messages. (up to 50 times a day)

I answered the phone the first few hundred timess and phoned switchboard a couple of dozen times to take my name off the phone list but then i gave up. I often wonder how many patients die while they are "waiting for the doctor we called an hour ago" - the one who doesnt work there anymore.

Anonymous said...

Late to the party by a few years but that's how us (Government)paramedics roll. In a sick way it's such a relief to read your blog, knowing I'm not alone in wanting to strangle the nurse who insists I must go through triage and open a file first....while I'm standing there with an intubated 900gr neonate, running three inotropes, etco2 from hell and a ventilator that is O2 driven...been with the tiny rat 4hrs as the Dr who accepted the patient has evaporated into thin air and no one wants to take over. The temptation to pull the weapon I know conceal carry (being assaulted and almost raped while on duty), becomes tempting...imagining complete nurse pandemonium as I remove one from the herd is satisfying... At least I get attention as I just connect my vent to the hospital O2 supply...suddenly 4 nurses arrive to scream and tell me how I'm not allowed to use "their" O2. Eventually we get attended to but first screamed at "for taking so long"...showing paper work and proof of time we received the call is futile. I hand over, I stress the BP and etco2 that are horrific and that we're running inotropes...all they want is the sats. Get my paperwork signed, while opening the file knuckle draging nurse informs me that little rat died, so now I must take it back. My turn to look at her and ignore her...you killed it, you deal with it.

Anonymous said...

It is 8 years later and things have only gotten worse. Nurses have a total disregard for their work and I see patients dying on a regular basis due to their incompetence. Oh, and don't even try to report it - you will be treated as the enemy. The Nursing Council and its complaints procedure is a complete joke. Reported a few cases -
nothing gets done. I dont see how things are going to improve and I feel sorry for medical students who still need to go through Internship and Community Service