Tuesday, April 16, 2013

One chance

Today was the start of something new. Another new project from the Portsmouth Diabetes centre. It was the transition clinic for type 1 diabetes patients from the paediatric side to the adult side....and based on feedback from the patients, we had decided to try something...different. 
Gone were the standard clinic set up, gone were the waiting room waits for the parents and kids....awaiting to be transferred to a new team of doctors and nurses. This was going to be different. The parents came along with their kids and the adult and paediatric teams mingled with them in the waiting room. Polite introductions, baby steps for the new folk into the department..metaphorically letting go of their parents to walk into an unknown area...the adult teams split up, some sat with the parents over a coffee, reassured that they would look after their "little ones", some sat with the young teenagers offering an insight into the new gadgets, use of social media, gave them a welcome pack...and you know what? It was..fun. 

Changing the clinic set up based on what our patients had told us..was fun for us as healthcare professionals..perhaps one of the best days I have had recently at work. There was no politics,no Francis report hanging over ones head, no dispute over mortality data, no chest thumping about privatisation...this..simply..was doing what we were supposed to do..look after people who needed some help with the pathology they hadn't brought upon themselves.Yes, this was diabetes, but it wasn't because they were fat, it wasn't because they didn't look after themselves...this was type 1 diabetes.

And while driving back from work, it made me think what sort of a unique position I find myself in. Its a realisation of how incredibly lucky I am..lucky to be in a position to influence a system which could make, perhaps,not all, but even a few people live their lives a bit better. I grew up in Calcutta, lucky to end up in the UK where people sometimes forget what they have. Work in a rural area of Bengal and you will realise what this country offers. Either way, amongst millions of people, a select few get to be a Consultant in their chosen speciality ..and I did. I am paid well..I have an amazing department, surrounded by amazing colleagues, supportive Commissioners...do I have any right to moan? No, I don't. Why waste time doing that when I can spend time trying to negotiate better care for the patients with the payors or set something up based on patient feedback?

Sometimes people forget the opportunity they are handed in life- and I have been given one. The choices are either to sit back, moan, entertain oneself in the false belief that all was well in the past..or work with the system...as for whatever the reason, patients being in charge of their own disease pathology or care is nothing but a distant mirage. We pay tons of lip service but frankly do little. So..as a Consultant...if I don't stand up and fight the corner, who actually does? People say I am always cavalier...I say show me a department which every single day stands up for their patients. People say I speak too highly of our team...I say show me a bunch of nurses who can better the ones I work with. 

One chance.. that's all life gives you...and who knows what's around the corner? The time to change is now, the time to stand up for ones patient is now...not later. Later may never appear.....and I don't want to turn around in 20 years and say "I should have done better". It's not my place to spend time criticising others services..but you know what, if we all simply tried doing the right thing for the patient where we work...I guarantee you the sum total will be amazing. 

In the words of Roosevelt "Far and away the best prize that life has to offer is the chance to work hard at work worth doing". It just maybe worth giving it a try. Because all you have is just one chance to make it happen. As simple as that.


  1. Sounds like a great initiative and just what the kids/adults needed. Well done.

    Love your thoughts about rural India: I defy anyone to go and stay at the homestay in Orchha (Madhya Pradesh, India) we stayed in for only two nights, and for them to come back and complain about anything to do with their UK standards of living. That community barely has enough money for food, let alone clothe itself and it's highly likely that any child getting type 1 will not last long. I've never felt so priviledged (but guilty too) than when I stayed there.

  2. Of course my experience of the paediatric/adult handover was in 1980, a very different time. It was a huge shock to me. I had had type 1 diabetes for 5 years at that point and gone throught the "does he take sugar" and the endless supplies of (laxative) diabetic foods. Then I was referred to the diabetic clinic. My heart sunk with the realisation that I had an "old person's disease". It seemed that the waiting room was entirely pensioners - except for me and my mother.

    Later, at university at Nottingham I was referred to Prof Tattersall's clinic and I soon felt that ther was a team that understood my diabetes. The diabetic clinic was for young adults, people my age (although, oddly so were many of the doctors - QMC being a teaching hospital). Little recognised the benefit of waiting room conversations. It was not an intention of that clinic, but I would talk with other people waiting to see the doctor and this helped me to find out how other people coped.

  3. "this..simply..was doing what we were supposed to do..look after people who needed some help with the pathology they hadn't brought upon themselves.Yes, this was diabetes, but it wasn't because they were fat, it wasn't because they didn't look after themselves...this was type 1 diabetes."

    I am a little surprised that no one has picked up on this paragraph as it stood out to me. Is this how diabetes teams feel about people with T2DM- that they have brought it on themselves because they are fat and not looking after themselves?

    I think this is a great blog post. But hopefully there might be some creative solutions which look at how to help people with T2DM as well.

  4. Hi Anne, this isn't how "diabetes teams" feel about anyone but thats the perception of the public, the media which equates unhealthy lifestyle = diabetes. For type 1, that certainly is not the case and they end up getting sucked into this category.

    As regards type 2, indeed there can be but a lot of it is dependant on will of powers that be to tackle the public health agenda. So far, there seems to be little signs of that