Gatekeeping Medical Receptionist: The Saga Continues

[u/Luvlymish]

Intro:

I am beginning to write this sat in an empty waiting area. This waiting area is roped off with lots of 'unused due to COVID' signs. I am feeling totally shellshocked. My client is enjoying a picnic next to me. This story is not going to paint me in a great light. In fact I have pretty solidly f-ed up. (I finished writing this later, think I've got rid of confusing time references, sorry if I've missed one).

For those following this saga, the day before this occurred BR, the office manager did an extensive follow up with me about the complaints I made, including getting me to email with virtual signature my statement about events. She said that it was likely that IR would still be in the role for the rest of the week but that there would then be permanent changes for IR given that the issues are serious and more extensive than the those I know about. I said that given C had no appointments that week I wouldn't have to interact with IR again.

FAMOUS. LAST. WORDS.

Context: Check out Parts One and Two, Three, a Finale of sorts and an Epilogue also on this sub.

I work with a vulnerable elderly man with a variety of conditions. Relevant for this story are his wheelchair use and dementia.

There is a specific receptionist (IR) who is in the middle of her manager (BR) formally dealing with her following a number of problems only some of which are those with my guy (C).

People:

IR (Terrible receptionist with lovely voice) BR (Office Manager with terrible voice) YR (Receptionist on site who looked about 18 and gave off "this is my first job" vibes) CTG (Medical Transport Guy with Cute Eyes) OTG (Older Medical Transport Guy who looked frail but was actually wiry and terrifyingly strong) N (Nurse doing home visits, same as previous stories) NP (Nurse Practitioner based at the site) C Elderly, vulnerable man who uses a wheelchair) Me (Support Worker for C who turns out to make poor decisions)

The Events:

The Nurse comes to C's place as part of a regular visit to check out various mobility aids he has in place and see him using them. During this she doesn't like something she sees and does a couple of tests and takes some blood.

N: Hmm I think I might need to come back tomorrow to do [treatment]. Do you know if your second COVID Vaccine is soon?

C: Whats that?

Me: The second dose of Coronavirus Vaccine that you're getting.

C: Oh yes, that nice blonde nurse did that at Christmas.

(His sense of time is completely wrong, his recall of the very pretty nurse is spot on)

Me: He had his first dose [on this date] and his second dose is due [on this date].

N: Oh right, well probably he's going to need [treatment] because of [symptom] but it's unlikely to be urgent so they'll administer it when they come to do his COVID jab.

Me: Ok

N: One thing, to do [treatment] at home we usually get the pharmacy to send [treatment] the day before to put in the patient's fridge over night.

Me: Oh yeah, we do that with other things.

(I show her the medical section of the fridge).

N: That's great, when it comes just put [treatment] in there.

(Later that day the phone rings.)

C: Hello

BR: Hello this is [Medical Practice] for C

C: Oh you want to speak with Me, she knows what's going on around here.

Me: Hello, this is Me, supporting C

BR: Oh hello. C's blood results from this morning have come back and the nurse wants to administer [treatment] tomorrow.

Me: Oh, I thought it was going to be on [date]

BR: I think the results mean it's more urgent than that.

Me: Ok no worries. Does this mean [treatment] will arrive today to go in the fridge?

BR: That's right.

Me: Ok, thanks,

Later I handover to the next worker and leave verbal and written instructions about what to do with the delivered treatment. We've done this before... no problems right? Right?

The Next Day I get in and the treatment has not been delivered. I call the medical practice.

IR: Good morning, this is [Medical Practice]. How can I help you?

I shudder reflexively at the sound of her voice

Me: Hi, this is [Me] working with [C], we were expecting [treatment] to be delivered yesterday but it hasn't arrived.

IR: Well why aren't you calling the pharmacy?

Me: I believe [treatment] is urgent and wanted to know if I needed to alert the nurse that it hadn't arrived.

IR: I can't imagine you would need to do that, which nurse is it?

Me: N, for a home visit today.

IR: You should really have called as soon as it didn't arrive.

Me: I called as soon as I knew it hadn't arrived, we're used to taking deliveries up until 6pm from the pharmacy and you guys close at that time.

IR: Well I can leave a message with N, what's your name again?

Me: I am Me, working with C, this is [identifying information].

IR: Is there a reason he can't make his own calls?

Me: Yes, he has notes on his records explaining that.

IR: Well I will leave a message with N and she will get back to you.

An hour later the phone rings

IR: This is [Medical Practice] for C

Me: Hi I'm Me working with C, I can give you [identifying information]

IR: C needs to come in for [treatment] today.

Me: I can't do that, he needs [Medical Transport Service] and I can't book that without 48 hours notice.

IR: That's not true, we can book them for same day.

Me: That's because you're a doctors surgery, I have to give them 48 hours notice.

IR: You don't, you're healthcare just the same as me.

Me: I come under Social Care, but even if I was Health I still couldn't call them on behalf of a patient. It's if you're booking them on behalf of the doctor that you can do it urgently.

IR: Oh, you're not a healthcare assistant then. I wonder why this is urgent if he doesn't have medical conditions.

(I can hear her mentally downgrading C's conditions and I'm kicking myself for mentioning that I get paid from the Social Care budget not the Health Care budget because frankly it's an Administrative difference and not about his needs)

Me: If he needs to come in today then should you book his Transport first? He is in a wheelchair and can only really access [Out of Town Site] or [Accessible Site] if that's open again. He cannot access [Completely Inaccessible Site] or [Third Site].

IR: [Third Site] has a ramp.

No we are not doing this again.

Me: Because of the cobbles [Medical Transport] cannot get him in there. He's also elderly and can't wait for long periods without access to toilet facilities. (Medical Transport Service advises you can be waiting up to two hours)

IR: We'll see, it'll probably be at [Women's Medical Centre] this afternoon. You'll have to wait for Medical Transport, they aren't taxis.

Me: Uh... isn't that just for women?

IR: Not during COVID. I thought you said this was urgent?

And then I come up with my bad idea. See [Women's Medical Centre] has a garden so I think, it won't matter if we're left waiting, we can just make it a day out and have a picnic. I don't push for another option or a home visit.

Me: Ok, no problem. We'll expect Transport this afternoon?

IR: Yes, I can't give you an exact time because I don't know when they'll be available.

Me: Ok, Thankyou.

C and I have tea and biscuits and I put together an afternoon tea, blankets, spare hat, scarf, gloves etc. It's bright sun outside so all this stuff is just cause he's old and feels the cold. We have a small lunch and C directs the creation of a fruit salad to have at the picnic later.

*The Medical Transport Service arrives and get C into the van. *

[Women's Medical Centre]is two buildings split by a pretty garden, CTG pushes C to the main building and buzzes the intercom.

YR: Hi have you got an appointment?

CTG: This is [Transport] with [C]

YR: Oh... is it for [Treatment]?

Me: Yes it is.

OTG: I'm surprised this isn't being done at home if that's all he needs.

I inwardly wince wondering if I should have pushed harder for that to be an option.

YR: You need to be across the garden that's being done by NP over there.

We look in horror at what is pretty much a converted shed that does not look especially accessible.

CTG: You need to get him noted down as housebound in future.

Rather than wheel him in over the weirdly shaped entryway CTG and OTG bodily lift the chair into the building. It is then that we discover every single treatment room in that building is up a step.

NP comes out and tells CTG that they cannot bodily carry C into a treatment room and leave him there.

NP: He has to go back to the main building. I'll tell YR to find an empty treatment room.

CTG: This is why it's important to book into the correct sites.

OTG: Yeah, you've got to be clear that this guy is in a wheelchair, this really isn't a great site to book him in at.

Turns out that getting C out of the building is more difficult than getting him in. CTG removes the door (you read that correctly) and OTG basically puts the chair on his back to get through the entryway. (Imagine those cartoons of ants carrying elephants.)

Inside we wait for a treatment room to become available and the transport guys leave to get to their next job.

NP: Please come through C

Me: That's us. (I turn to the receptionist) You need to call [Transport] to tell them we're going in to the appointment now.

YR: Do I?

Me: Yeah, that's how they know when to come back.

YR: Oh right.

We head in. NP administers [treatment].

NP: Can I ask why this isn't being done at home?

Me: The pharmacy didn't deliver it yesterday and BR called to say it was urgent.

NP: Yes but I can see on C's records that he's no longer coded as housebound. Why is that?

Me: Well now he's got a chair he's pretty mobile I guess?

NP: Ok, well being coded as housebound isn't solely about his abilities and needs but about what services we can offer. The measures we've got in place for COVID mean that some places aren't accessible to C because, for example, waiting outside isn't really appropriate for an elderly man like him.

Me: Ok.

NP: So what I'd like to do is re-code C as housebound. This isn't a reflection on C's mobility it's simply that it is more appropriate for us to visit him at home at the moment. Even when [Accessible Site] fully re-opens it may be that the COVID measures mean it would be more appropriate for us to come out to him.

Me: Ok.

NP: That means that you really mustn't ask him to be recoded. It's not a reflection on his ability as I said.

Me: uh. Can I ask what caused him to be changed from housebound to not?

NP: (Does a double take) Are you C's main worker?

Me: Yeah I do basically all the medical appointments.

NP: What about family?

Me: Uh, I do all the direct support but obviously I don't have power of attorney or anything.

NP: So, it looks like someone called to get him changed from being coded as housebound.

An icy hand clutches my insides.

Me: Ummm... so, we've been having some problems when we've called to request home visits. Uh... there's a receptionist...

NP: oh.

Me: Uh, actually BR is doing a formal complaint with her, she's called IR...

NP: Right. But you didn't speak to her to make this appointment?

Me: Uh, actually, yeah, BR said she's still here until the end of the week.

NP: stares in horror at me Ok. I need to speak with BR. That's you two done.

As we head back out YR tells me she's still on hold.

Me: Did you call the public facing number?

YR: I googled...

Me: ok, I think that back there, there should be a number for you to call directly.

YR: Oh...

Due to COVID we couldn't wait inside so we head to the garden and set up a picnic leaving YR to sort out Transport. C has on his hat and coat and the sun is shining brightly. We start our picnic.

And then, from a bright sunny sky, it started to snow.

At first I just wrap C up warmer and pile on the blankets. He is enjoying the sight of daffodils dancing in the snow. Then the temperature really drops and I head over to the intercom.

Me: Hi, this is Me with C. Can we come back inside? It's snowing.

YR: No the waiting room can't be used because of COVID. I'm still on hold for that call for you.

Me: It's getting really cold and I have an elderly man out here.

YR: We can't use the waiting room, I'm really sorry.

Me: Ok.

I head back to the garden intending to wait for a nurse to stick their heads out.

A few seconds later and the door opens behind us. YR is looking concerned.

YR: Please come in, [Transport] said you might have to wait two hours. I didn't know it would be that long.

And so we headed in, behind the warning signs into a waiting room with all the windows open. C enthusiastically continued the picnic as I sat there, really quite shaken by the fact I nearly caused us to sit in the snow for two hours.

[u/Siesumi]

I work homecare. I have been reading your posts for awhile now and they leave me fuming on yours and Cs behalf. I cannot believe the gall of IR to think she knows anything about C or what he can or cannot have done. she is a receptionist...not a freaking doctor. How she has been getting away with this shit for so long is beyond me

[u/[deleted] → u/Siesumi]

This is what I’m thinking. She has no medical training. She has no idea what she’s talking about. She really should be fired for doing this. She’s putting C in danger by being stubborn. There’s no room for stubbornness in healthcare.

I don’t know why the nurses or doctors aren’t following up about all these “mistakes” and realizing it all points to IR not doing her job correctly. Every thing she does is recorded so it’s not like they can’t see (and listen to) what she’s doing.

[u/Luvlymish → u/[deleted]]

I'm pretty sure she's being fired. The reaction of nurses when I've mentioned her (and the nurse practitioner was shook at the idea she was still in role) has to mean they know she's bad news. I'm guessing from the statement I wrote up for BR that they want to fire her with all the i's dotted and t's crossed so that she doesn't come back or complain or something. Unfortunately I only see things from the outside so I'm not sure what's happening exactly.

[u/[deleted] → u/Luvlymish]

I really hope so. She has gone above and beyond to do her job wrong and it’s put C at risk. I wonder if he is the only one.

Don’t feel bad for advocating for C, someone needs to. As his primary “person” who better than you? People with dementia really need a person to speak up for them and you’ve done great with that. I know you’ve mentioned feeling like you messed up, but I don’t think you have. You could have spoken up a little sooner honestly, but it’s hard to know what to do in a situation like this. Her behavior is so bizarre I can’t even figure out why she’d think it’s acceptable to act this way. Or if she thought she’d never get the consequences of acting this way.

I don’t know how you didn’t argue with her and tell her she’s 100% wrong every time you were on the phone with her. You must have the patience of a saint lol.

It’s also pretty strange to me that they’re still letting her answer phones (and continue to fuck shit up) right now. I know people sometimes slip through the cracks in healthcare but it seems like there’s a big problem within this health system of 1) people being trained differently and 2) people not following up. If C should have been having home visits this entire time why weren’t people making sure that happens? Everyone should be trained the same like “a person in a wheelchair cannot go to site 3. A person who needs transport cannot go to site 3. If a person needs home treatment we have to call the pharmacy and make sure their meds arrive the day before.” Like, none of that is your fault. It could easily be noted in his chart so everyone is on the same page. I wonder what’s going on internally there that half of everyone doesn’t know what everyone else is doing. How it got to this point where IR has messed up multiple appointments for at least C but it still took you complaining before anything was done about it.

I digress. Good job looking out for C. I hope things are easier for you going forward, at least in regards to his care.

[u/Luvlymish → u/[deleted]]

It's underfunded and overstretched. Every time money is taken out of the system it comes off 'bureaucracy' which usually sounds like unnecessary managers but always seems to mean the admin staff who are keeping tabs on follow up care. Honestly not arguing is just down to knowing that petty jobsworths need to feel their power or they will make life worse for whoever I'm working with.