Patient Journey For Hernia Repair At Montefiore Hospital

Getting an appointment

  • Getting an appointment with my GP at a time that suited was amazingly (surprisingly) easy and he agreed to refer regarding my USS confirmed hernia.
  • I was keen to have the surgery at the Montefiore but initially received a large amount of NHS based paperwork (number of sheets detailing local referral service but also an appointment at the Nuffield followed one day later by another letter cancelling that appointment!). I didn’t see the letter my GP wrote so suspect it may not have made the Montefiore request clear or that this just reflects that the service at the Montefiore hasn’t been formally set-up as yet
  • On phoning the admin team at the Montefiore they were polite, helpful and speedily arranged an outpatient appointment with Mr Khera
  • The paperwork I received from the Montefiore confirming the appointment time etc was clear and appropriate. I have to see it was far simpler to read than the paperwork received from the NHS which was lengthy and the salient points often lost amongst long, vague paragraphs which I believe many people outside of the health service would struggle to really understand the detail/relevance of. Certainly looking to the future I’d hope the Montefiore could maintain that clear and concise approach to their letters

 

Outpatient appointment

  • The appointment was in the outpatients of the Montefiore so smart, clean surroundings. The staff at the front desk and then the outpatients reception were all polite and efficient as was the nurse who took my weight etc
  • The appointment was if I remember correctly on-time and Mr Khera ran calmly over the problem. I was examined and didn’t feel rushed. He explained the options available clearly and it really felt like this was him discussing and advising but ultimately giving me some choices – so an ideal approach
  • My own (holiday) plans were a sticking point here so it was agreed we would need to review things a few months later
  • Getting that following appointment wasn’t any great trouble but did involve needing to be re-referred by my GP. That wasn’t any great surprise as of course there is a need for appointments to be funded by appropriate referrals but I guess this would be something to think about in the future as I understand people delaying hernia repairs (for example due to certain work commitments) is not uncommon
  • The subsequent appointment with Mr Khera was as friendly & efficient as the first with a second hernia being found!

 

Pre-assessment

  • The pre-assessment took place at a convenient time (I was given a few choices which was great) and the nurse was both friendly and professional
  • There were two things that cropped up during the pre-assessment which it appeared were simply gaps in the protocols rather than her ability
  1. Uncertainty as to whether I needed a Group and Save for a Laparoscopic hernia repair which meant a bit of delay whilst she called the ward – I could see this op wasn’t on the list of various ops (and whether or not a G+S was needed)
  2. The timeframe for the MRSA swabs (or rather the pre-assessment appointment itself) was too tight in so much as if the MRSA result had come back as positive there would have been insufficient time for me to use the appropriate eradication therapy meaning the risk of cancelling the op. Maybe the pre-assessments need to be a bit further away from the op date (it may be mine was unusually close but that wasn’t the impression I got)
  • The paperwork I was given including separate sheets relating to clot risk, having an anaesthetic and the operation itself were clear and appropriate. They had a review date on them which had past which didn’t bother me at all but I guess is the sort of thing someone might pick up on?

 

The Operation/hospital stay

  • The team who I met on arrival from John meeting me downstairs and taking me up to the room followed by staff regarding food then the Nurses were all friendly and professional – really no criticisms.
  • The room itself was comfy and I’d say just the right balance between comfortable but also necessarily clinical/clean
  • The Anaesthetist was approachable, explained things clearly and again I didn’t feel he was rushing
  • Meeting Mr Khera prior to surgery was a reassuring process – although I’d only seen him recently there is something reassuring about seeing the expected surgeon in the building even if just for a second or at the doorway before you’re put off to sleep!
  • The post-op recovery was uncomfortable at times but that wasn’t anyones failing in fact the whole team were timely and helpful in their provision of medication/catheter/assessments including the Anaesthetist and Mr Khera
  • I was due to be a day case but ended up staying overnight. I may simply be a bit pathetic but I’m not convinced I’m totally so – certainly the pain I had from the left sided hernia was a level I’d have happily pottered home with but the combination (and retention) meant I didn’t feel close to doing that. I don’t think basing your decisions of how to run the service around my pain level is necessary but would imagine any double hernia repairs may need to at least be possible overnights in terms of bed provision?
  • The TV and food were both excellent – I know that may sound facile and in fact I think for any NHS patients they should just be glad to be in the building but they were good enough that if I were paying I don’t think I’d have been disappointed (and I expect these are the things people moan or compliment the service on as much as the clinical aspects?!)

 

Follow-up

  • I’m aware that often these days no formal outpatients follow-up is arranged for similar or indeed larger operations. I have to say I found the outpatient appointment helpful and more reassuring than I in some ways expected to. Certainly some form of follow-up/discussion with the Surgeon is I believe very valuable. I know a lot of follow-up is moving to phonecalls these days. I don’t think in my own case I’d have found that as reassuring/helpful as a face to face appointment but I guess if someone had had a unilateral repair and was feeling 100% happy with things they may be happy with just a call in the first instance?
  • Certainly the follow-up outpatient appointment was a more valuable thing than I anticipated – the benefit is perhaps more difficult to measure but is definitely there

Copyright Goldie Khera 2016

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CONSULTANT LAPAROSCOPIC GENERAL & BARIATRIC SURGEON IN BRIGHTON AND SUSSEX