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Protocols must not stop us from being open with patients


I took my mum to the opticians yesterday. I sensed it was time when she mistook the cat for a slipper. Anyway the optician was a very nice man who took a lot of time explaining what he was doing before moving on to offering an overview of cataract surgery.

I sat quietly while he explained that these days cataract surgery was a quick and painless procedure, “a bit like having your hair done”. I knew there was about as much chance of my mum choosing to go to a hospital as there was of Gordon Brown and David Cameron agreeing to replace the scheduled election debate with a breakdancing competition.

When he finished talking and could tell she remained unconvinced (she had him by the ear and was twisting quite hard), he said: “Well, what you could do is go down to the eye clinic, spend some time in the waiting room, maybe ask some of the people there what they thought and perhaps have a chat with a nurse or someone?” And I thought, “What a lovely idea” and then “How removed from reality is this man?”

‘Can you imagine running a clinic that dealt with a lot of cataracts and finding a couple of non-patients wandering around asking everyone questions?’

It wasn’t actually an outrageous suggestion in the context it was made. If you are an anxious older person uncertain about a possible intervention, why not go and see for yourself what it might be like? But if you imagine that happening from a nursing point of view it stops being reasonable and becomes quite absurd.

Can you imagine running a clinic that dealt with a lot of cataracts and finding a couple of non-patients wandering around asking everyone questions?

When they see you they may stroll over and say, “Hello, sorry to bother you but I was wondering about getting my cataracts done and the optician told me to pop in and ask you what it might be like. Do you have any biscuits?”

You may be the kindest nurse in the world but I’m prepared to bet that you would not consider this normal or part of your job. You may find a way to be polite or ask, “Have you been referred to us?” Or you may think, “I can’t have non-patients wandering around here asking questions.”

You may be annoyed, surprised or a bit irritated with the optician who clearly doesn’t quite understand the way your clinic works. Or the way the hospital works. Basically, the way the “system” works.

This is because we are bound by our protocols and the customs and habits they construct, aren’t we? And anything that happens outside of that set of expectations can feel like an assault of sorts, an assault on our time, on our professional roles and on our boundaries. Perhaps that is the only way we can survive, given the pressures and expectations of our workplaces.

But is it only me who thinks this is a bit sad, that we cannot be flexible, responsive and open to simple expressions of need or curiosity? That we maybe struggle when we step outside of our protocols and our “systems”? Or that we are so set in our procedures that we may be lost without them?


Readers' comments (2)

  • There are many problems with protocols. Following a protocol may not neccessarily be in the best interests of a patient. Then what do you do, follow the protocol or use your initiative and experience to do what is right?
    We prefer to use the term guidline rather than protocol. Protocals serve to restrict practice and become outdated very quickly. Guidelines allow flexiblity.

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  • Personally I believe health promotion and advice is an integral part of my profession. It may not always be possible to sit down with biscuits, but I do try.

    The problem with guidelines and protocols in this profession, is that the second we step outside of them - even if in our patients best interests - then chances are we'll be witch hunted out of our hard earned careers.

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