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'Initial NHS contact can affect patients’ opinions of nurses'

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Apparently I have to have a wisdom tooth removed. “It’s facing completely the wrong way,” the dentist said, as if I had somehow arranged for it to grow in the direction of Belgium on purpose. “I’ll refer you to the dental hospital - don’t hold your breath.”

Seven months later I phoned the hospital to see how it was going. “We sent you an appointment in March,” said a man who clearly didn’t like telephones. Or people.

“I didn’t get it,” I said. “Perhaps you sent it to the wrong address?” He duly read out an address that was not mine.

“Was that the address on the referral letter?” I asked.

“It is the address on our records.”

“That’s not what I asked,” I said.

“I’m afraid your referral is no longer active. You failed to attend your appointment.”

“I also failed to take up my place as ruler of the kingdom of Zog,” I said. “Maybe they sent that letter to the wrong address too.”

He didn’t care about Zog, it wasn’t in his catchment area. “You’ll need another referral,” he said. “There’s nothing I can do.”

And of course when you get to the point in any exchange when people are relying on their own powerlessness to get them through the day you know carrying on is pointless. And anyway, he was probably doing his job in exactly the way his job required it being done.

I had waited without actually being on the waiting list. Whatever dissatisfaction I carry with me into my not-yet-established-but-might-happen-one-day-appointment will label me as “difficult” in the eyes of anyone noticing it. The organisation and its administrators can engender irritation, frustration and a mild resentment but, as long as the corporate needs (whoever imagined we would have to care for such things?) are met, it doesn’t matter does it?

Indeed, it doesn’t matter. Not in my case. A wonky wisdom tooth that lent me no wisdom can wait. People like me will always give hospital services the benefit of the doubt, so, so what?

Well I suppose there are two things to notice: talking to rubbish people on the phone is annoying and offers a poor impression of the organisation you are dealing with no matter what, and poor reception skills might impact on the attitudes of patients to clinical staff.

Sometimes my students reflect on patient attitudes, which they say appear set before they arrive - how they are defensive or irritated, looking for fault before anyone has even had the chance to make a mistake. We talk about the modern age of customer-hood and the power of a bad press but many of these patients have already had enough contact with the organisation to form an opinion - a lost referral letter, a rude receptionist, an eyebrow-raise in response to a question, a refusal to acknowledge you are waiting while they file. Such things construct not just opinions but power relations, to which patients can respond both consciously and unconsciously.

Corporations do acknowledge that first impressions are important, yet too often they know the face of the organisation has a dual and contradictory purpose: to be polite and polished but to contain expectation. If the consequence of that creeps through into clinical contact so be it - the nurses will sort it out, they always do.

From GPs’ receptionists to appointment clerks to administrators, too often these people treat patients as enemies to the smooth running of hospitals. It shouldn’t matter but often it does - and it can impact on nursing.

Mark Radcliffe is senior lecturer, and author of Stranger than Kindness. Follow him on twitter @markacradcliffe

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Readers' comments (1)

  • michael stone

    I'm 100% with Mark, re his:

    '“That’s not what I asked,” I said.'

    It is remarkable, how often the answer (assuming you actually get one) 'from the NHS', falls into the 'that isn't an answer, to the question I asked' category.

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