politicians contacting doctors on a patient's behalf

sam34

hi folks

i thought i'd see what you guys all think on this issue

in psychiatry, it's something we get a lot

our waiting lists are very short, so we're generally not contacted about getting someone seen quickly

it tends to be about admitting people, often on an involuntary basis

the reason the politician gives is invariably the old chestnut that someone is a "danger to themselves and others"... they seem to think that all they have to do is utter that sentence and the doors will magically open :rolleyes:

they dont seem to realise that you can be a danger to yourself and others for very many reasons, most of which are not related to mental illness.


i've lost count of the number of phonecalls i've had from politicians trying to get someone into hospital, when it is just downright inappropriate for a variety of reasons.

the usual scenario i've come across is this (it has happened me personally at least 4 times that i can recall) :

the parents of a young (or not so young) person are at their wits end because of that person's drug use, and bring them for psychiatric assessment.
the person themselves is not that bothered and doesnt want intervention. key point: the person is not suffering from any mental illness.
person is therefore sent home.
politician then rings up the psych on call, throws around the term "danger to self and others", "out of control" and a few other emotive terms... attempts to put words into doctor's mouth "are you telling me there is no help available blah blah blah".

in these cases, i have taken pains to point out a few things to the politician:

a)they are not the patient's next of kin
b)even if they were next of kin, i couldn't discuss aspects of the patient's care without their express consent
c)people cannot be admitted to psychiatric wards against their will just because they are drug addicts, alcoholics or socially deviant. they are in fact specifically excluded from involuntary admission under the 2006 Mental Health Act


another scenario i've seen in psych is when the politicians write asking for someone to be housed in a specific hostel or group home, without actually having a clue what level of support the person needs, and what level the specific accommodation offers.... they usually ask for a specific place based on location only.

now, i understand that usually the politician has been contacted by the patient's family, and he/she is making the phonecall in an attempt to get brownie points/votes, and they'll turn to the family with fake sympathy and say "i've done all i can", but really i think they should butt out and leave clinical decisions to those qualified to make them.


i think it is very wrong of politicians to attempt to interfere in clinical care.

it really really really gets on my nerves

what do the rest of ye think?

does it happen a lot in other areas?

DrIndy

i have a converse to this. I want politicians getting involved in patient care. A&E in this country is a complete disaster and people need to complete bander the politicians to get involved.

But i do see where you come from sam34

Vorsprung

I knew some politicians did things which were low. That's pretty low.

I'm fairly sure my reply would include the words "****", "go", "yourself", and "medical", "places", "as per need", "allocated".

Maybe not in that order. Maybe add that we could offer a better service if the Government could run one.

sam34

DrIndy wrote: »

i have a converse to this. I want politicians getting involved in patient care. A&E in this country is a complete disaster and people need to complete bander the politicians to get involved.

But i do see where you come from sam34

on a big scale, lobbying for resources etc it's ok.
but i really dont think they should get involved in individual cases, it's totally inappropriate, imo

sam34

i just rememberd another incident...

a local politician (am i allowed name the party but not the individual?) dropped a patient off on the psych ward and told the nurses the guy was "for admission", and if there was a problem with that then the doc on call (me) was to give him a ring, and he left his card.

:eek::eek::eek:

i came along, assessed the guy and found no evidence of any mental illness.... not a shred of it... it wasnt even as if he had a mild illness that wouldnt normally require admission, there was nothing wrong with this guy.

he was homeless, however.

but psychiatric wards are not homeless hostels.

i sent the guy on his way.

i never rang back the politician, as he had really annoyed me and i knew i'd lose my cool on the phone with him

the next day i discussed it with my consultant and i composed a letter to said politician

but my boss wouldnt let me post it...

she said she got me to write it as a cathartic exercise, that i should burn it and forget all about it.... bloody shrinks

tallaght01

I agree with DrIndy.....get them involved. If I could have one of them on the phone lecturing me, while our kids with eczema are waiting 2 years to see a dermatologist/immunologist, I'd fcuking roast him.

Or after I've had to stick another kid on IV fluids because he can't swallow, following another bout of tonsillitis, when his T+As were cancelled a month ago.

Honestly, I'd say something I'd regret. But I've never been contacted.

sam34

i think we're looking at it from different angles....

i absolutely do not think it is appropriate for a politician to attempt to interfere in an individual's clinical care, and to try and force doctors into a course of action for an individual patient.

however, as elected public representatives, they should be a) aware of the shortfalls in the local service and b)lobbying for further resources etc

but leave the decisions re a patient's care to the professionals please

tallaght01

sam34 wrote: »

i think we're looking at it from different angles....

i absolutely do not think it is appropriate for a politician to attempt to interfere in an individual's clinical care, and to try and force doctors into a course of action for an individual patient.

however, as elected public representatives, they should be a) aware of the shortfalls in the local service and b)lobbying for further resources etc

but leave the decisions re a patient's care to the professionals please

I'm not disputing that....I'm just saying I'd love to have one of them on the other end of a phone trying to complain about his constituent not having a bed!

sam34

you said it's never happened you?
i'm surprised at that tbh, given how frequently it happens in psych
i'd have thought paeds with long waiting lists and the whole "sick kids" heartstring tugging thing, would be a golden opportunity for the politicians

tallaght01

It's fair point actually. Not sure why it's never happened to me.

It may be that switchboard in most hospitals are terrified of sick kids, so they put parents straight through to the on-call registrar all the time.

I'm a bit hard nosed, and i tell the parents to go to their GP or A+E if they want them reassessed, but paeds has a high proportion of quite nice doctors :P and they very often slot the kid intot he next clinic if the parent is worried.

We probably don't have waiting lists like yours either. Plus we are allowed err on the side of caution with admission. Like, in paeds, you don't get roasted by your consultant if you admit a kiddy overnight just to watch them, because you weren't quite sure if there was somehting going on.

So, all in all we're probably a pretty accessible specialty if you're unwell.

Not like you cold hearted psychs :P

sam34

tallaght01 wrote: »

It's fair point actually. Not sure why it's never happened to me.

It may be that switchboard in most hospitals are terrified of sick kids, so they put parents straight through to the on-call registrar all the time.

I'm a bit hard nosed, and i tell the parents to go to their GP or A+E if they want them reassessed, but paeds has a high proportion of quite nice doctors :P and they very often slot the kid intot he next clinic if the parent is worried.

We probably don't have waiting lists like yours either. Plus we are allowed err on the side of caution with admission. Like, in paeds, you don't get roasted by your consultant if you admit a kiddy overnight just to watch them, because you weren't quite sure if there was somehting going on.

So, all in all we're probably a pretty accessible specialty if you're unwell.

Not like you cold hearted psychs :P

ah here now!
waiting lists in psych are very low (with the exception of child psych, but dont get me started on that shower)
our routine out-patient apts are being seen in one month, where i am presently
urgent referrals are seen within 2 to 3 days
and there's always the same day option for emergency cases

i actually think psych are very accessible as a specialty

all someone has to do is mention the word "suicide" and they get a same-day assessment (this is so often abused, by both patients and GPs, its really frustrating)

as i said, it's generally not about routine appointments the politicians tend to ring us, it's trying to orchestrate totally inappropriate admissions.

i always thought surgeons would get a load of this too, looking for people to be bumped up the waiting lists.

RobFowl

sam34 wrote: »

waiting lists in psych are very low (with the exception of child psych, but dont get me started on that shower)

Don't get me started on adolescant psychiatry !! Once cut down a 17 year old from a ceiling (noose had not yet tightened)) and the response I got was "get their parents to watch them until we get a bed (may be 2-3 days)"
To be fair that was in a different juristriction (UK) but in a less severe case the HSE told me " there isn't ant medical services in your area but there are voluntary support groups" :eek:

In resposne to the original question. It is unfair for politicians to expect doc's to liase with them over medical problems. But for them to use their influence to improve access to services and highlight deficiencies is TBH vital.
In the case of the homeless guy I have to say I feel alot of symphathy. Psych like AE is often the last rersort and the "Nuclear option". Vunerable patients often with substance abuse issues more ofen than not have nowhere else to go. Having worked in both and now providing care for similar groups it's hard to give a straight reply.

DrIndy

psychiatric patients are more likely to be homeless but that does not make psychiatric hospitals a home.

Can't the politician get a high support hostel opened instead?

RobFowl

DrIndy wrote: »

psychiatric patients are more likely to be homeless but that does not make psychiatric hospitals a home.

Can't the politician get a high support hostel opened instead?

Yes but if there arn't any available then what ?
I just feel in a crisis it's reasonable for people to use all tools available even if they are not the most appropriate.

JuliusCaesar

sam34 wrote: »

i think we're looking at it from different angles....

i absolutely do not think it is appropriate for a politician to attempt to interfere in an individual's clinical care, and to try and force doctors into a course of action for an individual patient.

however, as elected public representatives, they should be a) aware of the shortfalls in the local service and b)lobbying for further resources etc

but leave the decisions re a patient's care to the professionals please

Totally agree.

However, what we have in Ireland is parochialism and clientism. So the voters seem to have a magical faith in the weight of a TD's opinion/letter/pull. So TDs spend an awful lot of time writing letters to the Housing Dept asking that so-and-so be bumped up the list. These letters make not a bit of difference as the person and their circumstances have been assessed and given whatever number of points they are due.

And this is the failing of Irish politics, bigtime - too much clientelism and no attention to policy. (Aprat from Harney's 3 tier health system policy, but that's a rant for another day)

ChewChew

I deal with politicians on a very regular basis in my department. I'm in Bed Management so I manage all the elective waiting lists. No so much fun at the minute. Anyways. . . I have no problem dealing with these guys because unfortunately the reasoning behind our ridiculously long waiting lists for surgical admission does not change.

If we have overcrowding in A&E we have no choice but open our dayward to inpatients resulting in the following days theatre list being slashed. So then the patients who are canceled then have to wait a few more weeks because the next few weeks lists are already booked.

but for people who are just actively sitting, waiting on the list often think that by contacting their local politician will help them move up the list. It's like they are on the same wave lenght as private patients. I'm afriad it just does not work that way.

Patients need to be educated more about the public health service. I dont mean this in a petty way but there is nothing we can do about our hospitals. if anything, they are going to get worse! So people have to expect to wait a few months on a waiting list.

If I could bring in 100 patients a day I would, but lack of beds, staff shortages, winter vomiting bugs, consultant conferences and many other issues stand in my way. I hate making a call at 3pm and telling a patient to discontinue taking their preparation because their colonoscopy isn't going to go ahead tomorrow due to overcrowding. but what can I do?

Politicians cant help. Yeah fair enough we definitley would look into the individuals case, but thats about it. What can we do when we dont have the resources to manage it to the expectations a patient deserves?

sam34

RobFowl wrote: »

In the case of the homeless guy I have to say I feel alot of symphathy. Psych like AE is often the last rersort and the "Nuclear option". Vunerable patients often with substance abuse issues more ofen than not have nowhere else to go. Having worked in both and now providing care for similar groups it's hard to give a straight reply.

DrIndy wrote: »

psychiatric patients are more likely to be homeless but that does not make psychiatric hospitals a home.

Can't the politician get a high support hostel opened instead?

RobFowl wrote: »

Yes but if there arn't any available then what ?
I just feel in a crisis it's reasonable for people to use all tools available even if they are not the most appropriate.

i see what you're saying rob, but i dont think psych wards should become places of shelter for those who simply require shelter, not psychiatric treatment.

it takes up beds and leads to a shortage of beds when you do need them for those who are seriously mentally ill.

i've worked in one acute unit which was continually full and operated a waiting list for acute admissions - for political reasons in that hospital, psych patients were not "allowed" wait in a&e for admission, so we were in a situation where we had to send seriously ill people home and tell them we'd ring them in a few days when we had a bed. it was at best, unsatisfactory, and at worst, fatal for some. that unit would have collapsed altogether if we were accepting social admissions.

sam34

RobFowl wrote: »

Don't get me started on adolescant psychiatry !! Once cut down a 17 year old rom a ceiling (noose had not yet tightened)) and the response I got was "get them parents to watch them until we get a bed (may be 2-3 days)"
To be fair that was in a different juristriction (UK) but in a less severe case the HSE told me " there isn't ant medical services in your area but there are voluntary support groups" :eek:

child and adolescent psychiatrists and the "service" they provide really make my blood boil!

it's mandatory for us to do 6 months C&A, and i hated every minute of it, for various reasons.

but what really bugged me was their work ethic and attitude towards the waiting lists.

it is nothing short of disgraceful, and i think they are an embarrassment.

quite how they go home and sleep souldly at night is beyond me.

sam34

ChewChew wrote: »

but for people who are just actively sitting, waiting on the list often think that by contacting their local politician will help them move up the list. It's like they are on the same wave lenght as private patients. I'm afriad it just does not work that way.
QUOTE]

i find it funny (but also a bit sad) that people think a phonecall or letter from a politician will be the answer. and it's wrong of a poliotician to mislead them, in the quest for votes, but thats another thread!

it's like the old "joe duffy" threat - people think you will magically do whatever they want if they threaten you with joe duffy. :rolleyes:

i get great pleasure in replying "you are perfectly entitled to contact joe duffy, if thats what you want to do, then go right ahead. however, that doesnt change the issue here which is...." .

they are so totally gobsmacked when they realise i'm not capitulating and begging them not to "talk to joe", it totally takes the wind out of their sails.

i've never given into these threats and i've never made it onto the airwaves...yet

tallaght01

sam34 wrote: »

child and adolescent psychiatrists and the "service" they provide really make my blood boil!


quite how they go home and sleep souldly at night is beyond me.

Usually because general paediatrics ends up admitting them "for social reasons" because no-one else can be arsed. :mad:

sam34

tallaght01 wrote: »

Usually because general paediatrics ends up admitting them "for social reasons" because no-one else can be arsed. :mad:

i know, thats not a satisfactory solution at all.
the people worst served though, are the 16 to 18 year olds... too old for paeds, too young for admission to adult psych wards (strictly speaking) and unwanted by medical wards for many reasons

JuliusCaesar

sam34 wrote: »

it's like the old "joe duffy" threat - people think you will magically do whatever they want if they threaten you with joe duffy. :rolleyes:

I often tell people to write to their TD saying 'there's not enough services/beds/hospices' etc on the grounds that we (frontline/clinical staff) are doing the best we can with limited resources - which are about to get even worse........... Will the politicians ever listen though?

sam34

there was an sho once where i worked who had a great response when people in a&e complained about how long they were waiting.... she gave them the local TD's address and phone no and told them to get on to them.
not sure it worked, but in the short term it deflected hassle from her!

DrIndy

sam34 wrote: »

there was an sho once where i worked who had a great response when people in a&e complained about how long they were waiting.... she gave them the local TD's address and phone no and told them to get on to them.
not sure it worked, but in the short term it deflected hassle from her!

i should do that. but i'm actually too busy - might hang up a poster.

ChewChew

sam34 wrote: »

ChewChew wrote: »

but for people who are just actively sitting, waiting on the list often think that by contacting their local politician will help them move up the list. It's like they are on the same wave lenght as private patients. I'm afriad it just does not work that way.
QUOTE]

i find it funny (but also a bit sad) that people think a phonecall or letter from a politician will be the answer. and it's wrong of a poliotician to mislead them, in the quest for votes, but thats another thread!

it's like the old "joe duffy" threat - people think you will magically do whatever they want if they threaten you with joe duffy. :rolleyes:

i get great pleasure in replying "you are perfectly entitled to contact joe duffy, if thats what you want to do, then go right ahead. however, that doesnt change the issue here which is...." .

they are so totally gobsmacked when they realise i'm not capitulating and begging them not to "talk to joe", it totally takes the wind out of their sails.

i've never given into these threats and i've never made it onto the airwaves...yet

It is sad because the politicians have barely any recognition of whats going on because his/her lovely secretary is typing up a letter that gets read and put into a confidential waste bit to be shredded.

Politicians cant do anything from a point of view of bumping someone up the list. the can be proactive but that something they have to actually WANT to do which I dont feel they actually do because they know how crap the health service is at the moment with funding etc.

Our dayward was shut down for 10 weeks from August last year as a cost saving exercise. So naturally I had alot of irate patients on screaming and shouting at me. next thing I got a phone can from the ministers office enquiring as to why I wouldn't give a patient who contacted them an appointment!!!! She didn't even know that the ward was closed. for ten weeks. So if our minister is so 'out of touch' how the hell can a patient believe that a politician can do magic.

Fionnanc

Just wait til you get the letter on the Sinn Fein letterhead, asking someone's surgery to be brought forward. And no it wasn't for trigger finger release