Personal views: Outpatients: a ringside view
Authors: Robin Ward
Journal: BMJ (1998)

For six months I have had a ringside seat in outpatient clinics at two London hospitals. The apparently occult nature of my disorder, a paroxysmal cough, weight loss, breathlessness, mild pyrexia, and diarrhoea persisting for 10 months has invoked the multiple application of the alliterative sisters; scans, scopes, smears, and samples, so far without any unambiguous diagnostic conclusion. But I have had a good view from the other end of the speculum. 

Am I a happy outpatient? By and large, yes. Without exception the medical staff, doctors, nurses, radiologists, and technicians have been caring, kind, and efficient. All my lay questions have been answered honestly and thoroughly. Nobody has called me “Pop” (I am 69) or used my first name, which is remarkable nowadays. Every procedure has been as discrete and dignified as possible and has been explained before and during the event. I cannot complain about any stinting of resources, although the diagnostic trail must already have cost thousands of pounds. 

Do I have reservations? Yes, some. These include the much protested problem in some departments of appointment systems which seem to have waiting time built in. Because of “no shows” it may be necessary to overbook and it may be convenient to have every patient on parade at the same time, but why do these consequences of defaults have to be borne by the more conscientious members of society? Incidentally, departmental appointment overload may be measured by the number of pages of a Walter Scott novel read by a waiting outpatient [pSc]; my average over six months is around 30pSc per visit. 

Worse than waiting, however, is the unavailability until the next clinic appointment, which may be weeks ahead, of the results of tests and procedures. Inpatients return to their beds and hear the results during ward rounds a day or two later; we outliers have to wait for our next consultation. Recalls present similar problems; following a gallium scan I was asked to return the following morning; after the new scan there was no one about to explain the significance of the recall. Mildly anxious, I went to the ward to which the clinic is attached and asked the registrar to intercept my report and let me know if all was well. In the event it had been only a question of confirming the movement of matter in the bowel. Without such brass necked brash- ness to pursue an explanation, however, I and no doubt most others, would have worked up a scenario of truly gothic diagnostic horror. 


Would it not be possible for an outpatient to be given the name of a link member of the medical staff from whom a summary result may be obtained long before the next clinic appointment? While I appreciate the problem of an additional diversion of consultants’ valuable time if the news were bad, I feel that some compromise solution could be arranged, perhaps involving an accelerated appointment when necessary but also defusing the patients’ anxieties by telephone when all is well. 


“No one has called me ‘Pop’ or used my first name”



A less serious complaint is that, because of our nomadic existence, we transients encounter a variety of physical discomforts, which ought to be obvious but seem not to have been recognised. For example, a barium meal and follow through may take up to six hours with intermittent examinations on the machine; for outpatients there is nowhere to wait between calls which recur at some 15pSc intervals, except in their 4’ 6” x 3’ 6” changing cubicles with their hard, narrow benches. 

To a lay observer nothing seems to have been seriously deficient or defective. On the contrary, the medical staff with whom I have been in contact have been worthy of an α and α plus for professionalism and what might be broadly called good manners. The use of equipment and laboratory facilities has been unstinted and in absolute terms the discomforts encountered have been trivial. The outpatients’ lot could be improved, however, with, among other things, some better rationale for consultation programming to reduce the queue; the establishment of a link between outpatient and staff to allay anxieties; and the provision of a holding area in which to wait for further tests and examinations and in which to recover. 

Corticosteroid treatment has now been suggested, accompanied by what may be a breakthough—I have been told by letter for the first time of my last C-reactive protein reading and invited to return to the ward if there are any problems. Lines of communication have suddenly opened; has this note been leaked?