Last October I wrote two posts - here and here - about a horrible fall which saw me break my elbow and end up in Ealing Hospital. There, a failure to recognise that I had suffered an open fracture - one where the bone pierces the skin - led to me receiving inadequate care which put me at risk of suffering a dangerous infection. Even when that mistake was rectified I faced unacceptable delays in getting the antibiotics and then the surgery needed.
Such an interesting read. I’m an NHS radiographer, scans/X-rays are my bread and butter. Honestly it doesn’t totally surprise me that the open fracture was missed (although I am shocked that such a thing would happen). This might be a controversial take but in my experience I honestly feel like too much power is given to doctors in some circumstances and us healthcare professionals (radiographers in my example) are overlooked. I have genuinely had an experience where a child came in for elbow X-rays after a fall from a climbing frame, there is also a very obvious wrist deformity but accompanying adult tells me the doctor said the wrist wasn’t broken. I’ve seen enough fractured wrists in my life to know that this kid’s wrist was 100% broken, got the doctor to add on wrist X-rays and lo and behold it was - quite badly. I did a 3 year long degree with work placements before I qualified, we are a very skilled profession and I genuinely think errors like this wouldn’t happen so frequently if we were given more professional autonomy. I’m sorry this happened to you Rory and as much as I want to defend the NHS, it is not a flawless system and reviews like this are so important, thank you for sharing.
Im imaging departments have access to an excellent quality scheme. This should be rolled out to all departments as many imaging departments describe the process of becoming quality assured as improving communications iimmeasurably. The use of reporting radiographers and other training and skills means that the radiologist can concentrate on the most difficult cases.
It was the case in the NHS that a radiologists report was never quality checked blind so although there might be random Checks, the checker knew they were checking the professors work. Maybe this has now changed.
I have enormous sympathy with the staff in the emergency departments, who are really trying to do their best for the patients in their care. However, I have spent a few hours in A&E thinking about how improvements could be made and, yes, communication is absolutely the key - and equipment that isn’t knackered!
Money, and a government that cares are the keys. Let us hope that things will improve.
I worked as an NHS physio until last year. Nearly all of the complaints I heard about were to do with poor communication. It has to be better. I’m pleased that recommendations have been put in place to make improvements in the respective hospitals.
Regarding your inability to straighten your elbow ; the delay in surgery is unlikely to have affected the loss of movement. Elbows are notorious for not regaining the extension. In my experience the more complex the fracture the more unlikely it is that you regain full movement so in your case I would not expect you to regain full movement. Regarding the worsening PD; the impact/stress of the trauma and reduced mobility after are likely to have affected it so no it’s not a coincidence. A friend of mine has had recent multiple trauma and his PD has progressed. But getting out now daily on your dogs walks will help
What a brilliant example of why we should all write to PALS when things go wrong. Actually when they go right too. In my experience of many such issues the reports are always well written and promising change. It is without question the communication hurdles which are actually inexcusable. Technology EPIC in particular should be a help not a hindrance. Lack of training, lack of understanding, lack of user designed shortcuts, leads to heavy duty cumbersome systems. The result woefully inadequate useless dangerous short cuts. It’s not rocket science. It’s basic human behaviours.
I've only been receiving your newsletter for a couple of months but I am sorry to hear about your experience but not surprised. I had my own bad experience of A&E in late January thanks to COVID with delays in decision making, prescribing and receipt of meds. I could also see how either poor or missing processes and systems were making everything worse. It's obvious the NHS cannot continue 'as is' and probably nothing can be off the table when it comes to working out how to make things better both for patients who need it and those who work within it. And yes it needs more of our money but what to use that money on should be based on the needs identified by those who use it and work in it not some expensive analysis by a management consultancy firm engaged by civil servants who may have had little or no experience of the service either as patient or clinician.
Time and again when there is criticism of the NHS there is the caveat that “ it’s not the staff, they’re wonderful “ but it was staff who failed to communicate , staff who failed to give information, staff who failed to recognise the seriousness of the injury not the tooth fairy not Father Christmas.
Thank you for this frank and disturbing account. May it make a difference in planning for a stronger NHS. I know from many other people whose partners have Parkinson's that hospitalisations are often when things fall apart. I hope you continue to improve - progress can be so slow. Wishing you the very best!
My wife is a retired Physiotherapist, who spent the last years of her career working in Occupational Health for an Aerospace company based in the East Midlands. She has lived with PD for 28 years but was able to continue practicing for 8 years post diagnosis due to the support of her employers. On Valentine’s Day she fell on a bent knee and fractured her patella (knee cap). A&E at QMC Nottingham was having a horrendous day but she received excellent care from then on, from the multidisciplinary Fracture clinic team. Although the fracture is healing, the trauma has had a significant impact on her Parkinson’s. The PD team were made aware (through the online systems at QMC) and she was seen promptly by the neurologist and specialist physio. At the heart of the care she has received over the last 10 weeks has to be the excellent communication between all the professionals and admin staff involved, demonstrating an awareness of all her needs.
I submitted a complaint after leaving A&E with worse injuries than I went in with. One of the top recommendations was ‘to read a patient’s past medical history’. I was and am truly shocked by this.
Terrifying - and awful for you. From my own experience it’s no coincidence. Even a UTI or other minor infection leaves me feeling underpowered and exhausted. To deal with and recover from such an accident uses more of the body’s resources. The stress and delays deliver a double-whammy. Which means longer taking it easy and ruthlessly pacing yourself.
And to think that 10 years ago we were talking about the importance of 7-day working - as in consultants being scheduled in across a 7 day week rather than 5.
Such a thoughtful response. No one wants to "complain" about the NHS (I know you didn't technically complain) but people who have platforms and voices should articulate these personal experiences or the NHS will never change for the better. There are many patients who do not have a voice or are not listened to by the NHS/relevant bodies in the same manner, which is why it is important to speak up if you can. We all appreciate the NHS but not everything that goes wrong is due to under funding/under staffing - until there are investigations and a genuine concern for what happened and what can be put right there won't be improvements in all our experiences. Thank you Rory.
Another problem is not treating you as a whole person. I understand that all doctors have their specialty but not noticing your arm because they were busy looking at your head, it shouldn’t be like that.
Thank you for sharing this. I do hope your arm continues to improve.. I just wanted to agree there is a need to face problems in the NHS. If you don't define the problem then the solution may miss the mark and be waste of time and money.
I follow your newsletter because my husband has Parkinsons, but in this instance, I have had a similar experience to you. Not with an open fracture, but a misunderstanding of a fracture at diagnosis in A&E. What transpired was a bone that has swivelled around and two other bones broken in my hand. A brilliant hand specialist at Guys called me and operated on a Saturday when the mistake was discovered. My injury was a rare one, so I was medically interesting I believe - but because I had a four-part fracture in my other arm from the same time, the hand injury and misdiagnosis was missed because of the severity and drugs treating the other. Now I wonder whether scans were looked at on mobiles or wrong monitors etc. There are probably thousands of these types of incidents all the time, which doesn't make it better - luckily sepsis/infection was not the threat, but a real chance of disabling my right hand permanently was possible. Thank goodness Guys has such a wonderful specialist working who figured this out eventually and took decisive action.
I think what the investigation is at the heart of how the NHS can go forward. Look at all the processes and pathways not just the serious and critical medical issues, but the non life threatening which probably make up 80%. I expect that won’t take as much money compared to the current approach of black holes.
Such an interesting read. I’m an NHS radiographer, scans/X-rays are my bread and butter. Honestly it doesn’t totally surprise me that the open fracture was missed (although I am shocked that such a thing would happen). This might be a controversial take but in my experience I honestly feel like too much power is given to doctors in some circumstances and us healthcare professionals (radiographers in my example) are overlooked. I have genuinely had an experience where a child came in for elbow X-rays after a fall from a climbing frame, there is also a very obvious wrist deformity but accompanying adult tells me the doctor said the wrist wasn’t broken. I’ve seen enough fractured wrists in my life to know that this kid’s wrist was 100% broken, got the doctor to add on wrist X-rays and lo and behold it was - quite badly. I did a 3 year long degree with work placements before I qualified, we are a very skilled profession and I genuinely think errors like this wouldn’t happen so frequently if we were given more professional autonomy. I’m sorry this happened to you Rory and as much as I want to defend the NHS, it is not a flawless system and reviews like this are so important, thank you for sharing.
Im imaging departments have access to an excellent quality scheme. This should be rolled out to all departments as many imaging departments describe the process of becoming quality assured as improving communications iimmeasurably. The use of reporting radiographers and other training and skills means that the radiologist can concentrate on the most difficult cases.
It was the case in the NHS that a radiologists report was never quality checked blind so although there might be random Checks, the checker knew they were checking the professors work. Maybe this has now changed.
I have enormous sympathy with the staff in the emergency departments, who are really trying to do their best for the patients in their care. However, I have spent a few hours in A&E thinking about how improvements could be made and, yes, communication is absolutely the key - and equipment that isn’t knackered!
Money, and a government that cares are the keys. Let us hope that things will improve.
I worked as an NHS physio until last year. Nearly all of the complaints I heard about were to do with poor communication. It has to be better. I’m pleased that recommendations have been put in place to make improvements in the respective hospitals.
Regarding your inability to straighten your elbow ; the delay in surgery is unlikely to have affected the loss of movement. Elbows are notorious for not regaining the extension. In my experience the more complex the fracture the more unlikely it is that you regain full movement so in your case I would not expect you to regain full movement. Regarding the worsening PD; the impact/stress of the trauma and reduced mobility after are likely to have affected it so no it’s not a coincidence. A friend of mine has had recent multiple trauma and his PD has progressed. But getting out now daily on your dogs walks will help
As I was reading Rory’s post out loud to my wife (retired Physio with PD) she used EXACTLY the same words you used about elbow rehab 👍🏻
What a brilliant example of why we should all write to PALS when things go wrong. Actually when they go right too. In my experience of many such issues the reports are always well written and promising change. It is without question the communication hurdles which are actually inexcusable. Technology EPIC in particular should be a help not a hindrance. Lack of training, lack of understanding, lack of user designed shortcuts, leads to heavy duty cumbersome systems. The result woefully inadequate useless dangerous short cuts. It’s not rocket science. It’s basic human behaviours.
I've only been receiving your newsletter for a couple of months but I am sorry to hear about your experience but not surprised. I had my own bad experience of A&E in late January thanks to COVID with delays in decision making, prescribing and receipt of meds. I could also see how either poor or missing processes and systems were making everything worse. It's obvious the NHS cannot continue 'as is' and probably nothing can be off the table when it comes to working out how to make things better both for patients who need it and those who work within it. And yes it needs more of our money but what to use that money on should be based on the needs identified by those who use it and work in it not some expensive analysis by a management consultancy firm engaged by civil servants who may have had little or no experience of the service either as patient or clinician.
Time and again when there is criticism of the NHS there is the caveat that “ it’s not the staff, they’re wonderful “ but it was staff who failed to communicate , staff who failed to give information, staff who failed to recognise the seriousness of the injury not the tooth fairy not Father Christmas.
Thank you for this frank and disturbing account. May it make a difference in planning for a stronger NHS. I know from many other people whose partners have Parkinson's that hospitalisations are often when things fall apart. I hope you continue to improve - progress can be so slow. Wishing you the very best!
My wife is a retired Physiotherapist, who spent the last years of her career working in Occupational Health for an Aerospace company based in the East Midlands. She has lived with PD for 28 years but was able to continue practicing for 8 years post diagnosis due to the support of her employers. On Valentine’s Day she fell on a bent knee and fractured her patella (knee cap). A&E at QMC Nottingham was having a horrendous day but she received excellent care from then on, from the multidisciplinary Fracture clinic team. Although the fracture is healing, the trauma has had a significant impact on her Parkinson’s. The PD team were made aware (through the online systems at QMC) and she was seen promptly by the neurologist and specialist physio. At the heart of the care she has received over the last 10 weeks has to be the excellent communication between all the professionals and admin staff involved, demonstrating an awareness of all her needs.
Barry, that is great to hear. Really highlights the importance of good communication..
I submitted a complaint after leaving A&E with worse injuries than I went in with. One of the top recommendations was ‘to read a patient’s past medical history’. I was and am truly shocked by this.
Terrifying - and awful for you. From my own experience it’s no coincidence. Even a UTI or other minor infection leaves me feeling underpowered and exhausted. To deal with and recover from such an accident uses more of the body’s resources. The stress and delays deliver a double-whammy. Which means longer taking it easy and ruthlessly pacing yourself.
And to think that 10 years ago we were talking about the importance of 7-day working - as in consultants being scheduled in across a 7 day week rather than 5.
Such a thoughtful response. No one wants to "complain" about the NHS (I know you didn't technically complain) but people who have platforms and voices should articulate these personal experiences or the NHS will never change for the better. There are many patients who do not have a voice or are not listened to by the NHS/relevant bodies in the same manner, which is why it is important to speak up if you can. We all appreciate the NHS but not everything that goes wrong is due to under funding/under staffing - until there are investigations and a genuine concern for what happened and what can be put right there won't be improvements in all our experiences. Thank you Rory.
Another problem is not treating you as a whole person. I understand that all doctors have their specialty but not noticing your arm because they were busy looking at your head, it shouldn’t be like that.
Thank you for sharing this. I do hope your arm continues to improve.. I just wanted to agree there is a need to face problems in the NHS. If you don't define the problem then the solution may miss the mark and be waste of time and money.
I follow your newsletter because my husband has Parkinsons, but in this instance, I have had a similar experience to you. Not with an open fracture, but a misunderstanding of a fracture at diagnosis in A&E. What transpired was a bone that has swivelled around and two other bones broken in my hand. A brilliant hand specialist at Guys called me and operated on a Saturday when the mistake was discovered. My injury was a rare one, so I was medically interesting I believe - but because I had a four-part fracture in my other arm from the same time, the hand injury and misdiagnosis was missed because of the severity and drugs treating the other. Now I wonder whether scans were looked at on mobiles or wrong monitors etc. There are probably thousands of these types of incidents all the time, which doesn't make it better - luckily sepsis/infection was not the threat, but a real chance of disabling my right hand permanently was possible. Thank goodness Guys has such a wonderful specialist working who figured this out eventually and took decisive action.
There were clearly a number of failings concerning Rory's case. A&E departments operate under massive pressure, one of which is to attain government targets. This morning Alistair McLellan provides some further insight which may have contributed to rushed care in Rory's case. https://www.hsj.co.uk/comment/politicians-beware-the-nhs-will-never-again-meet-the-four-hour-aande-target/7037039.article
I think what the investigation is at the heart of how the NHS can go forward. Look at all the processes and pathways not just the serious and critical medical issues, but the non life threatening which probably make up 80%. I expect that won’t take as much money compared to the current approach of black holes.