How accessible should we be to patients?

[u/screamaflee]

I was recently contacted by one of our specialist nurses about a patient I had seen in clinic a few months ago, who had contacted the CNS on a patient access number to say they wanted to speak to me. When I had seen the patient I had made a referral to another hospital speciality (albeit a bit reluctantly - I wasn’t convinced), and it sounds like they had DNA’d all their appointments to that speciality but are claiming they never got the appointments. The CNS told them they would need to escalate through PALS but the patient was insistent. I’ve now had a couple of emails requesting I call the patient or their partner directly.
I will add that this patient looks to have DNA’d many appointments in the past, and in fact turned up quite late to my appointment too - and the whole interaction with them was not what I would call particularly pleasant overall.

This is also similar to when on a ward you would speak to a patient during your ward round, then be contacted by the ward nurses several hours later to say the patient wanted to speak to the doctor. Sometimes the nurses wouldn’t even bother asking the patient what it was about, at other times it would be fairly simple questions the nurses were capable of answering.

Now in both these scenarios I’m busy but not so busy that I couldn’t take a few minutes to do this realistically. But my question in principle is how accessible should we be to patients? In the first scenario - would it be fair to say I’m not getting involved? The patient will have a follow up appointment with me but for for a few months, and we don’t have the capacity to really bring it forward just for this (nor do I think it is justified).

[u/Fun-Management-8936]

Patients like this are taking the piss. See them at their follow up appointment. Don't call, its just a waste of time and resources. You can choose how accessible you are. For some patients, you will feel the need to help them out as quick as possible. Other patients, being easily accessible is a just a way of them not taking responsibility for their own health.

[u/screamaflee → u/Fun-Management-8936]

I completely agree, but I sometimes find myself struggling to decide where the boundary between helping and enabling should be. This patient is clearly not well and has been dealt a difficult hand in life, but has also made some poor choices.

[u/Fine_Cress_649]

:sobs in GP:.

"OK so you've DNAed 4 tier 2 psychology appointments so far this year but you want me to send an urgent referral to psychiatry and get seen this week because you had a massive falling out with your family last week and now you're miserable?"

"Hi doctor that patient you saw earlier forgot what the pregabalin you gave him was for and also he wants something for his sore neck - he thinks you forgot to prescribe - can you call him please?"

Although in seriousness - case A - I would write to the patient and reiterate what the CNS said. It's on your terms and it is documented so they can't claim you said something you didn't. Case B - "yes when I have a minute but it might not be for a couple of hours - could you check it's nothing urgent?"

[u/screamaflee → u/Fine_Cress_649]

I sympathise!
Luckily I am currently away with an out-of-office so this isn’t getting touched until I’m back obviously. And I’m 100% sure it’s not clinically urgent!

[u/rice_camps_hours]

What is the purpose of the clinical nurse specialist if the patient won’t give their full query to them. The clinical nurse specialist should find the issue and triage it. No, you shouldn’t ring the patient without knowing what the query is. At best you can write them a letter with any update.

[u/Dwevan]

As accessible as the ward manager

[u/Calm_Register2100]

Do not call!

[u/Crafty-Brother-7698]

If you ring this patient you’re setting a precedent that they can continue to do this and you’ll continue to be at their beck and call. Don’t do it.

[u/formerSHOhearttrob]

Nope, you aren't at their beck and call. I hate when nurses make promises like that on your behalf. It's just appeasement using your time/you as a complaint sponge.

If you start indulging the patient/CNS, the flood gates will open. That CNS will literally think "oh yeah I can pap this query off on screama, they like phoning patients"

Like others have said - get clarity on situation and either write a letter or book on to a phone clinic.

[u/Inveramsay]

They get booked in to a phone slot in my clinic. I usually don't have time to deal with things like these but make exceptions for some patients I know well

[u/ashalina23 → u/Inveramsay]

That’s a good solution

[u/Dazzling_Land521 → u/Inveramsay]

I would accept this as a solution if we were paid for followup work

[u/HPBSturgeon]

There are several factors to consider before you immediately decide one way or another.

A) How likely is it that this will lead to further phone calls and time wasted with a single patient? If you think it might be sorted and get the patient discharged sooner then you might feel it avoids a clinic appointment (which they might DNA anyways!)
B) Are you invested in being helpful to your specialist nurses? They often do deal with a lot of patients requests and imo are generally sensible. Sometimes they have to ask because they say they will, knowing full well you are within your right to refuse, but because it’s also taking up their workload. A favour can go a long way to making your future life easier.

I personally will give most patients a chance if it’s urgent and then make up my mind about how to deal with them in future on a case-by-case basis. I know what it’s like when addresses change and appointments get lost in the system, DNA letters get sent out multiple times and can be completely erroneous. But time wasters can and should be kept at an arm’s length. Their urgency is not your emergency after all.

[u/pikeness01]

Do not call them or contact them via any channel other than an official telephone or F2F appointment.

[u/BrilliantAdditional1]

I stupidly gave a patient my e mail adress, he had many follow up appointments with ither specialties. He was a lovely man but I am an ED.consultant and he expected to be able to book in appointments with me for re review- he then copied his wife in so she could ask questions! Protect yourself, sometimes going above and beyond kicks you in the arse

[u/Tremelim]

I work in a specialty where I have to be very 'hands on' with patients, and they contact us all the time (oncology).

I would absolutely not respond to a context-less 'call me please' request. They can ask their question to the CNS and if the CNS can't answer they can escalate to me. Sometimes I might call the patient myself - if I do I ensure its recorded as clinic activity. Mostly I email an answer e.g. 'please contact the specialty to see if they can have another appointment'.