Personal View: Hell is the paediatric fracture clinic
Authors: Virginia Davies
Journal: BMJ (2005)

For the first few weeks it was fine. My daughter and I would get to the clinic as it started, get the x ray picture taken, nip back downstairs, pass before the eyes of the orthopod, and get out. All achieved in approximately one hour.

Then it started to go wrong. Booking a fortnight in advance, I asked the receptionist for the earliest possible appointment. I'm sure she told me we'd got a 9 30 am slot, but when the computer generated outpatient appointment letter (complete with mission statement on the back) arrived a week later, my daughter's appointment time was given as 10 30 am. Never mind, I thought, we'll just turn up early and get in and out like we normally do.

So off we set at 8 am to get the bus—parking is expensive and the underground station is miles away. It was all quite exciting really, my 6 year old watching in fascination the antics of the secondary school girls on the bus. We got to the hospital at 9 am and were in the paediatric clinic by five minutes past. Great. The receptionist turned up and, after we queued with the other early birds, we booked in. All the parents and carers, it must be said, had a look of urgent determination on their faces, reminiscent of the people you see at the front of the Harrods' sale queue.


I'm going to experiment with being a delinquent rather than a compliant user


I asked for my daughter's x ray form, and, yes, that was ready. The hospital has an odd system where, despite the fact that they run fracture clinics, they cannot generate x ray forms in advance, allowing you to take your next week's form as you leave. So things were going well. We rushed up to the radiography department, with the clock registering a mere 9 20 am, and were the first to be x rayed at the opening time of 9 30 am. Excellent. We went back down the stairs to paediatric outpatients, handed in the x ray pictures, and sat down to await our in-and-out with the doctor.​doctor.




Figure 1




At 10 20 am I went up to the nurse in charge of the clinic and asked how long it would be until my daughter was seen. Glancing down at the patients' notes fanned out on the trolley, he said, “You've got a 10 30 appointment, so these people will go in first,” indicating a good half dozen or so notes. Knowing full well I would not be seen before 11 am at best, I approached the reception desk to ensure that I got an early appointment for next time. But no, the system would not allow me to book a future appointment before I had had this week's appointment. And thus it was that we entered the cycle of mid-clinic hell.

After we had finally seen the doctor at 11 15, we had to enter a third round of waiting to see the plaster technician. We were told we would need to wait approximately 15 minutes. Fifty minutes later I knocked on his door to ask when we'd be seen. “Next,” I was told.

Once in there, we heard from him (in an incredibly unaggrieved tone, it must be said) about the staff cuts in the paediatric fracture clinic. He was the only technician. He works from 7 am to 7 pm, and from what I saw during my brief spell in the room he would be lucky to grab a coffee, let alone any food to sustain him. It certainly made me wonder about his capacity to keep going under these conditions.

We finally left the clinic at 12 36. I know it was this time, because the hospital has a huge digital clock in the clinic. The clock is over a notice that says, “Patients will not be seen before their appointment time.” “Too bloody right!” I thought to myself

Would things have been better if I had gone at the appointed time of 10 30? I suspect not. We would have waited considerably longer in the radiography department, and the technician would still have been up to his eyeballs with excess work. So I'm trying a new approach next time. I'm going to experiment with being a delinquent rather than a compliant user. I've booked the last appointment in the clinic—11 am—and plan to turn up late. I suppose I should take the technician a snack, to ensure that he doesn't cut off my daughter's arm in a hypoglycaemic lapse of concentration.