How others view Diabetes and Diabetics

My diagnosis was very badly handled in 2013, and unfortunately, it doesn't look like things have improved much in the interim.

We have just changed GPs. The old ones used to be fabulous (notwithstanding the diagnostic debacle), but when a particular Gp left and a couple of partners retired it changed - big stylee, and not for the better.

As of now, they have a patient base of 10660 (down from 10662 - we left), and 2 GPs. Yes, there are ancilliary staff, including 2 very good ANPs, but they have gone through several paramedics who would be great if you were under a bus, or such likes, but couldn't (in my case) identify a cyst, giving up after 2 lots of unneeded antibiotics and reference to a GP who guessed about right, without every looking at the offending lump. (resulted in a referral to a hand surgeon)

I have no idea what the new bunch are really like, save for the fact they seem a bit administratively chaotic. For example, Friday I filled out a form to access my Full GP Record, despite having already done it as part of the signing up process, and also having requested it from the online system.

I have just gone through a 2-week pathway with urology. I found blood in my uring a couple of days after completing the swap paperwork, so ANP at the old GP made the referral.

I must say that process went like clockwork. Appointments were made over the phone to ensure they were do-able and in the 2 weeks since, I have had ultrasounds (2 sorts), cystoscopies (including a repeat to check progress), a CT with contrast, various dippy stick tests and antibiotics. Very impressive, including a number of those appointments at the weekends. (Apparently the CT is working 12hrs a day, 7 days a week at present.)

I am now discharged from there, but need a referral to Gynae for something they found along the way (I am the Queen of incidental findings). I'll be curious how long that is forecast to take.

So, I think I agree that large swathes are broken, but some of it works, and when it does, leaves a warm, fuzzy feeling, although the CT contrast dye may have had something to do with that!
 
Sorry should have entered text first doh.
Roland I listened to Giles and am going to buy his book.Very insightful and to me that is the hope for the future in terms of pressing the reset button for all parties so that the way forward can be formulated and decided upon by a willingness to compromise and accept change for the benefit of all concerned.
I do believe people will accept change though many instinctively do not want to but it needs to be explained and debated openly and not forced on the other by one party as that simply divides the two parties and inevitably leads to a bitter acceptance or an ongoing fight.
The need for many parties to be successful and the binary nature of how many people view the world needs imo to be circumvented by the primary need of the greater good and the greater importance of nuance in restoring a better balance in society.
 
Docb said:
I knew my reference to Amazon would get some pushback! OK, the NHS is really, really, big but at the ground level it looks unbelievably disorganised to anybody who has worked in an industry that is well organised.

Starting by getting rid of the stupid things might be a start. A classic example was when I went for a lumbar puncture.....The obviously new doctor doing it spent the first half an hour on his mobile or wandering round the corridors trying to find somebody to tell him what coloured phials the various samples he took went into. When I left he was still trying to work out how to divide up the large sample he took into individual sample tubes. The results came back negative but I have little confidence in the test being done correctly. Why could he not click a button on one of the screens in the room and be presented with the local procedures for taking samples from lumbar punctures? Oh, and why was there a nurse stood in the corner of the room for the hour or so I was there who did not say or do anything even though she probably knew exactly what was wanted. Surely she would have been better employed and much happier if she was doing some "nursing".

Don't get me going on the carers bed or my brothers experience of what he called Stalag Luft 6 in the John Radcliffe hospital in Oxford. Full of stuff that any successful industrial manager would not tolerate.
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I'd be curious to know which month your lumbar puncture experience was, because there are some months (when junior docs and students rotate) I really wouldn't want to be having a really hard time
 
@AndBreathe - can't remember the month but the doctor was Iranian and chatty and seemed very interested in my having worked in the nuclear industry! He struggled to get the sample needle inserted properly and it was painful. OK everybody has to learn by doing but having no clue about local procedures meant his mind was on things other than getting a decent sample without causing me distress.

PS, I had had a lumbar puncture before, that time done by an experienced nurse with a doctor popping in to check on things, and that went very smoothly. Same hospital, same procedure, wildly different experiences.
 
I received my T2 diagnosis in January 2023 and spoke to both my GP and nurse, both of them very up to date on current diabetes treatments and certainly non-judgmental.

I judged myself but no-one medical ever has. I can honestly say, I have not been able to fault my GP surgery since diagnosis. They have offered all the appropriate courses available to me, I never need to chase for my next blood appointments and have always been there if I have any questions.
 
I cant remember why I was given a HbA1c test as it was in February 2013 and was told I was prediabetic with a reading of 58. Was asked to come back three months later for another test and the HbA1c had improved to 50 so was able to go home to continue with my life. Was called back in February 2014 and by then my HbA1c had gone up to 86. Was immediately directed to a nurse who dealt with diabetics and she gave me a quick finger prick and announced that it was quite high at 28. Was immediately prescribed glicazide and given a meter to measure my sugar levels. Was also referred to a dietician who recommended that I should eat smaller potions and I think it was referred to as the eatwell plate or something called that. I dutifully went home and started taking my medicine and everything was well for the next two years until I started feeling unwell and suspected it was diabetes related. It was only then that I decided to educate myself about diabetes and was rather shocked with my ignorance. Fortunately it has all ended well and I ensure I research every medical condition and no longer live in blissful ignorance.
 
Swilko said:
I cant remember why I was given a HbA1c test as it was in February 2013 and was told I was prediabetic with a reading of 58. Was asked to come back three months later for another test and the HbA1c had improved to 50 so was able to go home to continue with my life. Was called back in February 2014 and by then my HbA1c had gone up to 86. Was immediately directed to a nurse who dealt with diabetics and she gave me a quick finger prick and announced that it was quite high at 28. Was immediately prescribed glicazide and given a meter to measure my sugar levels. Was also referred to a dietician who recommended that I should eat smaller potions and I think it was referred to as the eatwell plate or something called that. I dutifully went home and started taking my medicine and everything was well for the next two years until I started feeling unwell and suspected it was diabetes related. It was only then that I decided to educate myself about diabetes and was rather shocked with my ignorance. Fortunately it has all ended well and I ensure I research every medical condition and no longer live in blissful ignorance.
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As you probably realise now that 58mmol/mol was definitely NOT prediabetes but quite a way into the diabetic zone so more action was needed to get you back to normal. Sadly the NHS Eat Well plate on which much of the advice is based is still too high in carbohydrates for many which is why the GP surgery developed the Freshwell program which they found much more successful for their patients. If that low carb approach interests you then have a look at this link. https://lowcarbfreshwell.com/
 
One of the main problems I have found with my experience of working for/with the NHS is there are too many tiers of ‘useless’ management structures each with their own little empires, and God help anybody trying to get those empires to interact with each other. While they exist, each one in effect defines what and how information is distributed down to the lower levels of their organisations. This allows interference of what should be nationally common processes and procedures. Often as not, the senior management of these groups have little or no experience of either working for large corporates or the needs of the Health Service and ultimately, the patient. Believe me I have had to educate senior management in the NHS several times of what their realistic objectives should be.

Sadly until the hierarchy is rationalised and rules enforced nationally to stop or remove ‘Empire Building’ halfwits interfering in common sense policies, the NHS will remain ‘broken’ and enormous amounts of taxpayer money will be wasted with no visible benefits to us, the patients.
 
Docb said:
I knew my reference to Amazon would get some pushback! OK, the NHS is really, really, big but at the ground level it looks unbelievably disorganised to anybody who has worked in an industry that is well organised.
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It looks disorganised simply because it is disorganised.

That may sound unkind from someone who owes his life to great NHS Surgery under extreme conditions. But I've had a lot (too much) Hospital time these last 4.8 years. One County Hospital took 6 weeks to decide they couldn't deal with my Pancreatic Cancer (by which time I was barely able to stand or speak from the blocked bile duct) and referred me to a different Hospital in a different County on a Friday. The following Monday I was seen, a stent needed 5 weeks previously was fitted by the Friday (and within hrs I regained coherence in thought, speech and magically able to walk again); the lead in process for the significant Surgery started. The 1st Hospital had dreadful standards of cleanliness as well as care, the other was impeccable in almost everything they did. Both Hospitals had poor catering and total inability to provide for someone with diabetic nutritional needs: both Hospitals had excellent Catering contracts with monthly updates of the Catering seasonal menu provisions and comprehensive nutrition details; neither Hospital Wards knew they had this data and neither had a system for informing their patients. I found this for the 2nd Hospital from a bored nighttime peruse of ward files and for the 1st (then during a layer stay) I found direct from an Internet search - knowing this contract nutritional detail was likely to exist.

So you might conclude one Trust has got the measure of their business and the other hasn't. But not so. The excellent Hospital has a sister Hospital within that Trust in the same City. This sister Hospital, even after a huge refurbishment project, remains dirty, scruffy and disorganised; it is simply most unappealing when one has to be there. And the medical business feels the same; Cardio outpatients is just an unpleasant experience.

With such disparity in a single Trust one can't help feeling that bringing different places to a common standard will become the standard of the lowest denominator. Anyway we'll have to wait, hope and see.

Conversely today I had to go for my 6 monthly Oncology CT scan. On a Sunday, quietly busy at an in-city Business Park, with a newish building given over to the NHS and a chunk of the Car Park given to mobile radiography trailers. All seemed to be staffed and run by Alliance Medical Services and that sub-contract felt very efficient: I was seen on time, kept well informed and finished in c.10 mins. Normally I am obliged to receive a Contrast dye, which has always made me very ill later that day. My last 2 scans, after pleasantly but robustly requesting "no dye" were successful, but that success and my allergy has never appeared on my medical notes. Today I simply asked, explained my allergic reaction and had the scan without any dye. The Alliance Team looked up my previous results, confirmed they had all been successful scans and confirmed no annotation about no dye for the last 2 scans. As I left the radiographer advised me that he had made such a note about today and future scan teams should clearly see that note. Outcome: scan took <4 minutes without the dye malarkey and the Patient (me) left happy. The NHS could do a lot worse than look for other outsourcing opportunities, within NHS infrastructure.

@Wendal; great points. I just remember that the Blair Brown Alliance brought about an amazing clean start to their era and then promises slid out of sight, taxation became all dominating (contrary to the promises) and the bickering started. The lessons of history do have purpose, but are only usually referred to too late in the day.

@Plumeraider, more than once members of this Forum have remarked on a perception of Specialists working in their own small silos; oblivious to the wider effects of their Specialist diagnoses or treatments on the wider needs of patients, particularly those with multiple co-morbidities.

I feel pretty fortunate in that my Oncologist seems to be sure he has the lead for my overall health co-ordination and my Endocrinologist gives me a strong perception that their Department understands my co-morbidity contradictions and will do all that is necessary to keep those in sight. I have on my part tried to keep the important problems within a single Trust (in another County) if only to help each Department see all my medical notes. Ironically, despite Integrated Care Systems going live in mid '22 my GP in Berks sees the correspondence from Oxford but can't add these to my patient records and Oxford simply can't see my GP Notes from Berks today or Bucks previously. It's all a mess!

Anyway, enough on all of this from me.
 
Proud to be erratic said:
Relating the NHS declared Geographical Granularity:
Ambulance Trusts,​
Care Trusts,​
Clinical Commissioning Groups,​
Hospital and Community Health Services,​
Hospital Trusts,​
Mental Health Trusts,​
NHS Trusts,​
Region​
​
to this NHS National problem:
Insufficient detection and diagnosis​
Low patient awareness and understanding​
Incomplete knowledge amongst healthcare professionals​
​
will be fascinating to see how that is achieved.
At all​
Never mind visibly and promptly enough for demoralised Staff and / or Patients.​
At what cost?​
​
Glad this is not MY problem to solve. Interesting listening to Giles Brandreth this morning on BBC1, who talked in his normal light and yet insightful manner about accepting and embracing change and maintaining a positive outlook for increased personal longevity [about the change of Gov't not to do with the NHS].
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The problem was Atrial Fibrilation but the description applies equally well to Diabetes, Type 2 in particular.

Believe me! A well organised, single concerted action could address the three issues related to diabetes (insufficient detection and diagnosis, low patient awareness and understanding, incomplete knowledge amongst healthcare professionals) and get results.

It would be far more effective than expecting tens of thousands of HCPs to get up to speed and work things out for themselves. They do not have time for that.

An up to date, easy to read document, agreed by experts, GPs and DNs, and patients would be a huge step forward. It would provide a common basis for HCPs and patients to set targets and agree what to do next.

The scope of the 'insufficient detection and diagnosis' work package would probably have extend to fatty liver as well as diabetes.
 
Plumeraider said:
One of the main problems I have found with my experience of working for/with the NHS is there are too many tiers of ‘useless’ management structures each with their own little empires, and God help anybody trying to get those empires to interact with each other.
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It's not just the NHS.
Every company I've worked for has had a layer upon layer of middle managers, many of them useless, most of them a hindrance.
 
@harbottle how big are the companies you have worked for?
I try to work for smaller companies without many layers of management. I wouldn't say that's perfect because it means there's less people toske the decisions so they become bottlenecks. But I rarely see layers upon layers of middle management. In fact, I am not sure what is "middle management".
 
Just a little something about Amazon - they have incredibly strict procedures and only really want staff who are prepared to work, but as long as you are that, you'll do more than OK. You have to be prepared to jump through the hoops they deliberately have within their staff systems, to weed out the useless and jump in the way they require you to jump. In a supervisory role, staff will try and make friends with you in the mistaken belief they'll be able to 'get away with stuff' and you'll turn a blind eye. Ooops, no you won't, not if you wish to retain your own job. One of our granddaughters is a supervisor at an Amazon warehouse, on permanent nights. She can get staff discount but only on items actually sold and shipped by Amazon - if it happens to be a branded item merely stocked and shipped to you by A for which the customer actually pays the manufacturer - no discount. Standard discount on 99.9% of goods is 10%. Don't expect more.

Immovable object.
 
helli said:
@harbottle how big are the companies you have worked for?
I try to work for smaller companies without many layers of management. I wouldn't say that's perfect because it means there's less people toske the decisions so they become bottlenecks. But I rarely see layers upon layers of middle management. In fact, I am not sure what is "middle management".
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First job was with GEC, huge corporation, then a stint with a Japanese company that employed over 100,000 peoplec worldwide. Current company was a small firm taken over by by corporation. More managers than technical staff now.

GEC has layer upon layer of managers. Usually bumbling around in a crisis emitting slogans while coming close to getting garrotted. I once told them to make themselves useful and order in some pizza.
 
Can't say there are unnecessary managers in my bit nhs, and we are well treated compared to other employers in my sector. I must admit a chortle at the idea of amazon being a model to look up to, after the way the amazon drivers are happy to leave a parcel out at the mercy of the rain, theives, molluscs etc
 
Tdm said:
Can't say there are unnecessary managers in my bit nhs, and we are well treated compared to other employers in my sector. I must admit a chortle at the idea of amazon being a model to look up to, after the way the amazon drivers are happy to leave a parcel out at the mercy of the rain, theives, molluscs etc
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And the way Amazon treat their warehouse workers!
 
@trophywench - Yes, Amazons management style is not for all and certainly not for me, but that is not what I was alluding to.

One of the most important things in Amazon are the vans. Without the vans the whole business model collapses. I reckon that Amazon will know this and by some means or other (some of the means possibly reprehensible) will be very efficient at dealing with breakdowns and accidents to keep them on the road.

Stalag Luft 6 at the John Radcliffe Hospital is the Emergency Surgical Assessment Unit. It is situated on the sixth floor. The scanning equipment it is reliant on is on the ground floor/basement. It follows that amongst the most important things in the building are the six lifts used to move anything and everybody between the floors. Just like Amazons vans. When my brother finished up there very poorly and in considerable pain, emergency scans were ordered. Eventually he is got into a wheelchair (they did not have any beds but that is another story) and wheeled off. Two of the six lifts were out of order - one had been so for months. Not only was there a queue for the remaining lifts, there were members of staff on each floor organising the queues. Took 40 minutes to get to the ground floor.....and there was the prospect of another 40 minute wait on the way back.

The NHS solution to the problem, organise queues and assign staff to keeping it all orderly with little or no thought for the patient who just has to suffer with the inconvenience. The "Amazon" solution, and indeed the modern industry solution, would be to move heaven and earth to get the lifts fixed. No way would they have valuable staff members wasting their time permanently organising queues whilst hacking off their customers (the patients).

It is a question of attitude when it comes to doing simple things (like moving patients about) well.

And @Tdm some bits of the NHS are exemplary. It is the very different experiences between various parts of it that are frustrating and no doubt contribute to answering the question posed by the OP.
 
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One aspect of what @Docb says is poor identification of (operational) problems and solutions, coupled with lack of decision makers/making.
 
Recently we heard that chaps having prostate cancer operated on using the Davinci robot at our hospital were now told to report to the Day Opthalmology Surgery ward at our hospital. ????? we said.

The theatres are on the same floor as that ward. The Urology ward however is several floors above, so the blokes go up there and do all the necessary checks, then have to plod down the stairs or catch the lift - both well away from either ward down and now from 2 per day they can usually do 6 !
 
trophywench said:
Recently we heard that chaps having prostate cancer operated on using the Davinci robot at our hospital were now told to report to the Day Opthalmology Surgery ward at our hospital. ????? we said.

The theatres are on the same floor as that ward. The Urology ward however is several floors above, so the blokes go up there and do all the necessary checks, then have to plod down the stairs or catch the lift - both well away from either ward down and now from 2 per day they can usually do 6 !
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When my OH was at Cov hospital for a gastro issue the ward he was in was signed as gynaecology which we though rather funny.
 
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