We recently had an appointment with an consultant orthopaedic surgeon to discuss my son's longstanding (not sure if that pun is intended or not!) foot pain. At least that is what I thought it was for.
He did indeed take a comprehensive series of x-rays, the first Ram has had in his life (he is now 17) which showed no structural abnormality.
The consultant was good in that he showed us the x-rays, explained where all the bones were and said that as there was nothing there that could be causing pain, it is likely that his pain is caused by fat pad atrophy. That bit makes sense, because Ram has so much pain in his feet when he puts pressure on them, it makes sense that the fat pads on his feet are no longer right.
But that was not quite how it came out in the consultant's letter. You have to bare in mind that this letter is sent to our GP who originally referred us, not to us. I have no idea if the consultant even realises that I get a copy of all correspondence. So it is important that the letter reflect what happened in the appointment.
First off the actual wording of the letter is “Diagnosis: Pain in both feet, probably due to fat pad atrophy secondary to long standing disuse.” Then he goes on to say, “The history is somewhat unusual in that his parents report that from a very young age (around the age of 3) he appeared to not like walking and therefore took to putting him in a buggy out of doors.” Nope. We didn't even own a buggy! Living in the countryside with no pavements there wasn't much use for one. Once Ram grew out of the backpack he had no choice but to walk everywhere. We didn't start using a buggy until he was 8, and even then Ram was very active swimming, climbing, trampolining and tricycling after that. It was only when he hit puberty that the fatigue set in and he slowly lost all his fitness.
But secondly, and perhaps more bizarrely, he said, “He is currently understood by his parents to be on the autistic spectrum disorder. In clinic today I found him to be articulate and did not obviously fall on the autistic spectrum disorder although I will admit that I am not expert in such matters.”
Hmmmm...we were not seeking an opinion on whether or not our son is on the Autistic Spectrum and if we were, we wouldn't have gone to an orthopaedic surgeon! By his own admission he is not an expert, so why even mention it when it wasn't on the agenda.
Oh. Agenda? But there wasn't one! At least not a written one. I suspect there is possibly a hidden one, perhaps our GP made some comment in his referral letter that lead the consultant to think that the parents have made up all this stuff about their son. Or maybe the GP just mentioned it as a way of warning the consultant that this young man will show up wearing a strange hat and have a stim that involves spinning the cord of his hoodie.
And the report? Serious inaccuracies which have already be distributed to the GP and physiotherapist. How does this leave us as parents feeling? We feel that we have not been listened to, that the judgements were made before we even got to the appointment or at the very least within the first few minutes, and that we are not partners in our son's health matters.
So how can this be avoided? I got to thinking about various business meetings that I have been involved with. There seems to be two types, those that have someone taking the minutes; they are typed up, distributed for comment, then officially agreed at or before the next meeting. The other type is where the minutes are prepared as the meeting happens, being agreed on the spot.
If I had produced minutes that were that wrong, or if I was charing a meeting that strayed from the agenda, I wouldn't last as a chair for very long. So why should consultants get away with it?
Maybe it is time for appointments with consultants to become more like business meetings where there is an agenda, where people's contributions are valued, where minutes are agreed before they are distributed, and where people feel listened to.
As for our situation just now, our consultant will have a two page letter hitting his desk next week copied in to our GP and physio, telling him just what he got wrong in his letter, explaining a little more about ASD, and containing some of the history that he didn't bother to take in the appointment. Maybe next time he will be more careful and treat the parents of his patients more like business partners and less like bystanders.
