For the last two and a half months, since the New Year, the call screen in our surgery has not been working. This means that rather than pressing a key on my keyboard when I am ready for the next patient, and their name appearing on the screen in the waiting room, I have to go and fetch them myself. There are clearly some irritations to this. My consulting room is nearly at the end of the corridor, and I lose time walking up and down. My usual practice is to use the thirty seconds or so while patients walk to my room to scan through their records, I can’t do that at the moment. Other than that, however, I struggle to say why this has been a problem. In fact I would like to suggest that the screen breaking down has brought about unexpected benefits.
Firstly, there must be some health benefits for me and the other clinicians being forced out of our chairs and made to walk up and down the corridor after every patient? I think I counted an extra 100 steps per patient. That adds up over the course of the day. Better for fitness, weight loss, back pains, general mobility, must be a win-win?
Secondly, I see my colleagues more. Ok, it might only be to smile and say hello as we pass in the corridor, but otherwise you can spend an entire surgery not seeing anyone other than patients. Just passing in the corridor reminds you that you are part of a team, and I have had several conversations in the corridor over the past weeks (sometimes resulting in me forgetting the name of the patient I am meant to be calling through!)
Finally, I think patients like it, and that it improves my relationship with them. Anything that does that has the potential to improve outcomes. I think patients like it because it is a more personal service. I will sometimes engage in a bit of small talk during the walk to the consultation room, chatting about the weather usually (very British!) and starting to make the connection that is required between that most intimate of professional relationships – the relationship between an individual and their doctor.
For me, these are all positives. The role-modelling of physical activity to our patients, the increased feeling of connectedness with my colleagues and the ability to improve the service my patients experience.
I have recently been reading a book that I would recommend to you all. “If Disney ran your hospital. 9 1/2 things you would do differently” by Fred Lee. Look it up and see if you can get a copy. Chapter six had a big impact on me. “If Disney ran your hospital you would…Change the concept of work from service to theatre.” As Lee says “For both Disney and hospitals, it is more accurate to describe their business as providing a transforming dramatic experience than delivering a service.” It’s not often that someone hits me with something that really changes my thinking on something. This was one of those occasions. It gave me cause to stop and re-evaluate. Can we change our perspective from one that has us delivering a service, to one where we are creating an experience? That is where, I believe, time spent on small talk, connections and things not immediately thought to be part of ‘what we do’ comes in. You are unlikely to be taught this in medical school. In fact, the opposite is more likely, with the overwhelming emphasis being on clinical skills (not inappropriately, but it would be nice if at least some time was spent on these ‘softer’ aspects. In fact, a phrase which has recently stuck with me from a day conference is ‘the soft stuff is the hard stuff’ – I’ll leave that with you to think about!)
There are clearly many ways in which we can create a positive experience that people will remember. I recently remember being able to hear my GP colleague in the next room laughing long and loudly with their patient. As their consultation ended and they left I clearly heard the patient and whoever they were with talking in the corridor, “She’s a really nice doctor isn’t she?” An experience had been created. (Well done Dr Washbrook!). I think GPs do this really well, and have many opportunities to do so. Seeing patients over and over again, along with their families provides a unique platform to connect and make a difference. As independent, self employed contractors to the NHS we can also choose to do things without asking for permission, whether it be ringing a patient up out of the blue or dropping by for an unannounced home visit. These interventions really make a difference and mean a great deal to people. In his book, Lee makes the point that it is the unexpected experience that has the most impact.
Whatever your role, I would encourage you to think about what you could do to create these positive experiences that people will remember. I would also strongly suggest that this isn’t just ‘icing on the cake’ stuff, it really matters. A doctor who cannot make these connections, regardless of how good they might be clinically, will struggle. Ask any patient. Ask your friends and family for their experiences and you will see what I mean.
There has been learning for me therefore in our call system going down. I actually quite like it. I wonder what other things are out their to be learned when something goes wrong. In the meantime I am going to continue to call my patients, even when the call screen is fixed, and will strive to create those positive experiences which are so important.
PS. It is now end July and the call screen has been fixed for just over a week. I continue to collect my patients personally. Everyone else has gone back to using the call screen…
Dr Jonathan is a GP at Swanlow Surgery in Winsford, Cheshire, and Chair of NHS Vale Royal Clinical Commissioning Group.
Follow Jonathan on Twitter @DrJonGriffiths