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Groote Schuur Hospital's unsatisfactory service: Part 3

This is a follow-up to my previous post (here) wherein I related my attempts to obtain treatment for a serious condition at Groote Schuur Hospital (GSH).

I attended the hospital's outpatient clinic on April 25 on the appointed day after obtaining an earlier appointment due to its urgency – they originally gave me one for July 10.  At 7am I registered at main reception, and was the seventh patient at the clinic. The receptionist showed the practitioner my referral letter and X-rays, which they had seen the previous week, which indicated a serious condition.

But due to the receptionist (a different one) previously not recording my appointment in their diary (the outpatient department has a dual booking system, a diary at clinics and computerised calendar at the outpatient appointments desk, neither talking to each other) when I made it the previous week and the practitioner allegedly been "fully booked", I was not seen and instead given an appointment for April 30. I was annoyed.

GSH clinics work on a first-come, first-serve basis and I was the seventh patient there. My appointment had been made with and confirmed at the central appointment office. I was turned away despite having a medical emergency after first going there the previous week and been given a future appointment. This lapse was at the clinic's end, not my fault.  Legally and medically they're not not permitted to turn patients away although it reportedly happens often which the Western Cape Health Department (WCHD) always denies. The same thing happened to me in 2001 with a disastrous medical outcome. Then, GSH denied responsibility and blamed me.

I returned the following week, on April 30. The clinic was busier than before. This time, though, the same practitioner saw me and confirmed my worsening condition,  a deepening infection. (Although it was diagnosed in April, the symptoms had been present since January, and I suspect, longer.)

He presented two options – surgical intervention or the recommended conservative, less drastic alternative to hopefully drain and halt/mitigate the infection. But he said Groote Schuur doesn't perform the latter. That's odd as it's a specialist hospital.

He gave me a referral letter to Tygerberg Clinic. He said it was urgent and I must get it done as soon as possible or there will be severe local and overall medical consequences. He would send them my records (he never did).

The following day, May 1, was a public holiday. The day after, Thursday, I contacted Tygerberg's department head, Dr CS, by phone and email pleading for a fast-track appointment. Courteous and concerned, she told me they would do what they could but two weeks was the earliest possible, even pushing me to the head of the queue of 800 patients who needed procedures in her department alone. She differed in another way from GSH medical staff in that she readily communicated with me.

However, she strongly recommended – insisted, really – I get private medical treatment. Although she gave me the names of three clinics, neither were specialists which my primary practitioner and GSH said I needed. And when they heard I'd been referred from GSH, referred me to specialists anyway. But one I called was booked for the following three weeks and another, in Sea Point, charged three times medical aid rates which I couldn't afford.

Public holidays that week and the following including the general election shortened the week. Increasingly desperate, I searched on the Internet for private specialists and made calls.  But I couldn't find anyone. When I told her, Dr CS insisted there were "fifty" doctors in the city who could do the job. And it wasn't even a true speciality except for practitioners requiring a post-graduate diploma and experience. To me, that indicated it was. However, she confirmed a rough appointment for 10 to 14 days time. I was confused by her mixed signals.

By the end of that week – May 4 – my condition worsened. I went to my GP who put me on antibiotics. I told him about my difficulty getting an appointment at Tygerberg or private. He said that anyway, procedures must wait until the course of antibiotics was complete.

Over the following five days I felt ill, and although the medication alleviated my symptoms a little, I was worried about the underlying damage that was being done. Upset and angry, I emailed the head of the WCHD Dr Beth Engelbrecht relating the failures of GSH from the time I first presented there with the problem, copying the Health Professions Council and Health Ombudsman.

She replied she understood my "frustration", and "it is unfortunate the original referral did not allow you to enter the system at the right end, our Tygerberg academic partners ... It is clear we need to promote the referral pathway to private and state clinicians.  I truly regret your series of negative experiences." However, she never addressed the failures at GSH outpatients.

I replied thanking her for her email. "I'm not sure how to interpret 'referral pathways'. Do you mean [my GP] and I ought to have referred directly to Tygerberg? I live in in GSH's 'drainage area'.  We know how picky the [health] department is about that, turning non-emergency patients away who may violate that inviolable rule. Unless you've changed policy, in which case why haven't you informed practitioners and users? Or are you saying I and patients may attend whichever facility they wish?"

"It's obvious the confusion and errors are within the department and in this case GSH and not, as I suspect you're implying, outside practitioners and patients. As I've said before, you need to get your house in order, which the department and its political masters appear incapable of doing, preferring self-congratulatory bromides, spin and photo-ops rather than doing the work.  Pathways are part of it, but a red herring that obscures the true nature of the failure which I summarised as staff indifference, carelessness and absence of a patient-centred attitude I've detected among GSH staff."

"As other instances, there are systemic failures within the hospital's patient management system. The test of system integrity is not that it passes 99% of the time, but the 1% failure. Politicians and bureaucrats concentrate and boast about the 99% and overlook the other because it's flattering to them."

I noted she hadn't asked how I was doing medically (not good) and her reply "concentrates on bureaucratic minutiae, but compassion is absent and even professional interest as a doctor. It's telling you don't say how you will help me get the medical attention I need given my present condition is in big part your department's failure. This lack of compassion and interest in citizens' welfare is not a side the DA, and for that matter, ANC government show."

I noted that Dr CS displayed the qualities GSH and WCHD lack and she should be asked to give the department workshops on the patient-centred approach.

It might seem churlish to reject Engelbrecht's "regret".  But, as usual, she did not acknowledge and/or accept responsibility. She prefaced her note by passing blame to "original referral pathways", i.e. not the hospital or department.  This is their modus operandi.

Later that week Dr CS called with a confirmed appointment for May 13. I suspect it was because of my emails to Engelbrecht (I told her I did so).

The examination confirmed infection had spread since it was diagnosed in April (I advised Engelbrecht). CS and the nice, competent doctor who performed the procedure were concerned. But after confirming with a consultant, they agreed the correct, conservative option, which GSH's doctor suggested, was the best for now. At least he got something right (he appeared competent if brusque); my GP thought they should have gone the extreme route to get it right away.

The first procedure went well but a follow-up visit on June 3 showed partial improvement and healing in a key, sensitive area, but not in another part. The upside is this bought time and localised strength if later more drastic intervention is needed.  A second procedure was performed, but if there's no complete improvement at the next visit later this month, the extreme option will be all that's left.

It's difficult to say how much GSH's delays exacerbated the outcome. It's possible even if I had had immediate treatment it would be little different. However, with infections and other serious  conditions, delays always work against the patient.

Footnote: I am an outpatient at another GSH clinic. There the medical treatment is thorough and competent. But the problem too, which is systemic hospital-wide, is lackadaisical administration and nursing staff and a dismissive, indifferent, don't-bother-me-I'm-busy attitude that is its and the WCHD's downfall.  Recently when I made an appointment to collect results, the receptionist told me patients are not called with an appointment – the clinic's way – and patients don't call either waiting for the call, so end up not getting an appointment.

That was an unusual admission for them, i.e. admitting fault. I wondered if it had anything to do with my complaint in April about the same thing that happened to me last year. Coincidentally, a patient I spoke to earlier that morning told me it had happened to him too.

But having identified the problem, it's anyone's guess why they're not doing anything about it.

Minor updates 25/06/2019.

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