Prostate Patient

An Update

2007-03-15T06:39:00.000+09:00

Since recovering from my health challenges following an operation at age 52 to remove cancerous stuff (no I'm not medically knowledgeable) from my prostate, I haven't been keeping this web log up to date. This is because it was never really meant to deal with the health issues. My interest was in recording the service experience as a customer of the medical profession.

And I haven't had much involvement with them lately, certainly not on issues that I'm comfortable talking about.

I got the 6-month all clear. No need for follow up radio or chemotherapy which is just as well because I'm not sure that I'd have agreed to the treatment. My 9 month check up is at the end of March and I've no reason to think it won't be fine. I've taken advice for another prostate recovery patient - same age, same op' 12 months earlier - and gone on Silenium (Usana brand) as a natural assist.

The two issues that males of a certain age want to know about are the bladder and erections. As I said earlier I'd rather talk about customer service! Anyway I will say that the bladder is fine 97% of the time. I'd prefer 100% of the time but this seems to be as good as it will get for me, though I'm diligent with the exercises to improve it or at least make sure it doesn't get worse. As for erections, who'd have believed that you would inject yourself there!!! Not my idea of fun. I'm told they can still happen naturally within 2 years. One year and 3 months to go. I'm hoping.

Health Update

2006-10-10T17:55:00.000+08:00

I've had a few emails from friends and clients that have had a look on this weblog to get an update on my progress.

I haven't put one on recently because if I did I'd be rewriting the September 15th posting, 'Slowly Slowly' almost word for word. I'm happy to say that there have been no setbacks but I continue to follow the 'Slowly, Slowly' path.

Why Some Doctors Get Sued And Others Don't

2006-10-10T16:00:00.000+08:00

If you've read Malcolm Gladwell's book Blink, you'll have heard of this already. If not prepare to be amazed.

"Medical researcher Wendy Levinson recorded hundreds of conversations between doctors and their patients, to find out why some doctors get sued and others don't.

"The answer was three minutes. It turned out the surgeons who had never been sued spent three minutes longer with their patients than those who were sued (18.3 minutes, versus 15 minutes).

"More importantly, they were far more likely to make comments that involved the patient in what was happening, such as "First, I'll examine you, and then we'll talk the problem over". They listened actively and laughed more than the doctors who were sued. The quality of medical information they gave wasn't any better. It was the way they interacted that differed.

"It gets stranger: recordings of doctor-patient conversations were made and the words were removed via computer. All that was left was intonation and inflection - the rise and fall of the voices. Independent judges were asked to rate these doctors for warmth, hostility and dominance, knowing nothing about them but the sound of their voice - not even the words they spoke. They accurately predicted which doctors would be sued and which not."

Jurek's View:

As a patient I can understand that. When you are fragile, you need to feel that you are with someone who cares, someone who takes the time to listen to you, not just someone who is technically excellent. Fortunately, I picked the right type of surgeon.

Now that my health is improving, I'll put on my customer service hat and ask, "What's this got to do with you and your customers?"

Tune in to how you yourself and your team talk to customers and ask yourself, "Is there room for improvement?" Do you take the time to really listen? Is your whole purpose whenever you are with someone, customer, colleague, friend or family, to make them feel better about themselves as a result of being with you? It's a great objective. Give it a go.

I read the extract citing Malcolm Gladwell's best selling book Blink in the ECustomerServiceWorld newsletter. Refer http://www.ecsw.com/.

In Defense Of Receptionists

2006-09-19T10:31:00.000+08:00

I had an email from a friend and client today which said in part "I notice you are having another go at medical receptionists." She was referring to a posting on my weblog on 15th September (see below) about 'A Tale Of Two Ultrasounds'.

Please don't think that. As I said in response to one of the comments at an earlier posting ('Mixed Reception' 5th August), I have found some medical receptionists to be wonderful.

For example, at my busy little doctor's surgery where they are likely to get people coughing and sneezing and feeling generally miserable, they are consistently superb. Full of warmth and care yet still efficient and effective.

Yet at many, while I'm sure they work hard, they lack warmth and empathy and fail to connect with the people who matter, their customers. Maybe, its because they have been led to believe that the people who matter most are their bosses, the specialists or the hospital administrators. And this may be part of the problem. If it is, the bosses are the ones who need to attend the training programs first.

Another cause may be that they understand their function but not their purpose. Theo Gilbert-Jamison, a senior executive at the Ritz-Carlton hotel group, put it well when he said of hotel receptions, "The front-desk's purpose is not to check people in. That's its function. The purpose is to welcome the customer."

So, what this tells us is that while the function of the receptionist may be to manage the appointments process, ensure all records are correct and the doctor/specialist gets the right information and so on, their purpose to help customers (patients) feel better about themselves. They are really health professionals too, looking after the emotional health of the patients they come in contact with.

Below is a link to an interesting article, 'The Teddy Bear Secret', that includes more of Theo Gilbert-Jamison's wisdom...and mine!
http://www.terrifictrading.com/The_Teddy_Bear_Secret.html

Slowly, Slowly

2006-09-15T13:26:00.000+08:00

A month ago I was planning all the things I'd start doing in September. I wasn't over-ambitious, it's just that I seemed to be making steady progress.

Now, I never planned to rush my return to work and other activities. Running my own business, it would be very tempting to do so. But one of my favourite books is 'In Praise Of Slowness' by Carl Honore, and I tend to follow that philosophy. Prior to my operation, I'd put a line through six months and told myself, as well as my colleagues and clients, that if I was back to work earlier than that would be a bonus. I wanted to give my body as much time as it needed to heal.

However, as I came to the end of my first three months recuperation, progress seemed to be good. Thankfully bladder control was heaps better, and I was going out for regular walks and building up on light exercise.

I made a couple of calls to work friends and colleagues to see how they were going. I was astonished at how each time I did this I would feel absolutely exhausted afterwards. I set myself a target of reading up on some work projects and writing an article. It didn't happen. Each time I started I got far too tired. And that's the way it's continued. September has definitely been the month of going slow.

So I'm certainly glad that I didn't put myself under any pressure with timelines for getting back to work. It is definitely a case of slowly, slowly.

A Tale Of Two Ultrasounds

2006-09-15T12:56:00.000+08:00

This is a tale of two ultrasounds. It marked the beginning of my current health scare eventually resulting in major surgery for prostate cancer. At the time I didn't know if it was serious, but I was concerned, as was my doctor.

With my six year history of close monitoring (six monthly PSA blood tests and two biopsies in the previous six years) anything 'down there' was a concern.

Overnight, one of my testicles had swollen up and was tender, something that had never happened to me before. Could it have something to do with testicular cancer? I didn't know, but I was definitely worried.

So, it was in that state that I arrived at a radiology clinic for the hastily made appointment for an ultrasound. I'd never had an ultrasound before. I knew they were something that pregnant women had. Other than that I was totally ignorant (as I am about many health matters).

To the reception staff of course ultrasounds were nothing new. They were dealing with patients all day, and here I was, another patient to be processed. They didn't know about my apprehension and fears of where all this might lead.

Now that I've set the scene for you, let's go back in time to Wednesday, 7 December 2005.

I walked up to the reception counter where one of the staff was working at her computer screen but was not serving a customer at that time. She made no attempt to welcome me but continued to work on her computer. After what seemed like some time, I stood back to read the signage above the counter and ensure that I was at the right place. The service person noticed this and said, "I won't be a minute. There was no eye contact and she continued looking at her screen.

She then finished what she was doing and said, " How can I help you?"

I handed her my form for an ultrasound and said, "Am I in the right place?"

"Yes", was her one-word answer.

I explained that I already had an appointment for that afternoon, but I also needed to schedule a separate appointment for the following week and had a form for this (my doctor had suggested I get my shoulder checked for a long term problem). She took the form for the first appointment and told me, "We will do this first". She proceeded to process me pleasantly yet anonymously.

Neither she nor her colleague were wearing nametags.

As I sat waiting, I noticed another lady serving at reception ask an elderly ethnic couple something as she took a piece of paper that they handed over. She was looking down at her screen as she took it, not up at then. There was no connection. They had trouble hearing and understanding her.

After a while the radiography assistant called my name, then turned away and walked ahead of me as I went towards her. She stopped at one of the small cubicles, and smiled without eye contact. She said, "Take off your clothes and put on the gown. Knock on the door when you're ready."

On going through to the room, I was left for a while lying on the bed. The stained ceiling looked depressing and there was a stark white globe.

The radiographer, Dr R, introduced himself. He had an excellent manner and communication skills. I'd never had an ultrasound before. I didn't know what to expect and therefore was rather apprehensive. He was reassuring and had a warmth about him. The others could have learnt a lot from this radiographer.

Once finished, the radiographer's assistant told me to use my gown to wipe off the gunk that had been applied to certain parts of my anatomy prior to the ultrasound and gave me a barcoded form to take back to reception.

I handed in the form and a different lady at reception said, "Hi, I'll just see what I can do for you." She then walked away with the form and returned soon after with a Medicare Form that she had printed out. She asked me to sign it, but I wasn't wearing my glasses and I had to ask, "Where?" She then showed me. I handed her the form and she said, "Thank you". That was it, no more. I picked up my bits and pieces and as I left she again said, "Thank you". She did not use my name even though she would have had it on the form and I couldn't set the ball rolling by using her name because she wasn't wearing a name tag.

Does all this matter? I'm sure each staff member was conscientious and hard working. Yet, only the radiographer treated me in a way that made me feel valued and at ease. The others processed me. It doesn't take much to really make a difference for other people.

Lets compare this with my visit the following Monday, this time for a shoulder ultrasound.

All three staff at reception were wearing nametags. Katherine said, "I'll be with you in a minute." She said this with eye contact and maintained eye contact appropriately throughout her time with me.

When it was my turn to go through, the radiographer's assistant called my name. As I walked towards her she made eye contact and said, "My name is Candis." She then walked with me to a cubicle. Not ahead of me, with me.

Dr T was as good as the previous radiologist. When the process was finished, some of the gunky stuff dripped down onto my trousers. Candis gave me paper towels to wipe my shoulder. She mentioned that it was water-based so not to be worried if it got on my clothes. She was wrong about that. I had to get my trousers drycleaned the

next day.

On my way back to reception with my barcoded form, I noticed another receptionist talking pleasantly but to her computer screen rather than the client. I felt like calling out, "You're doing well. Just look at your customer occasionally and make sure you are being heard and understood." The receptionist I dealt with was pleasant, with eye contact, but very quietly spoken. Elderly people may have had trouble hearing her.

Aside from this, the visit was an excellent experience, in total contrast to my experience the previous Friday. And yet it was the same establishment, just different staff.

I've gone into this in some detail, because I'm going to send it to the radiological clinic involved. Hopefully they will use it in a positive way as a learning experience, congratulating those who are doing it well and discussing with others how they can make the total experience a more positive one for their patients. If they do, then the time taken to write this will have been worthwhile.

Lies, Damned Lies and Statistics

2006-08-27T20:11:00.000+08:00

"There are lies, damned lies and statistics". Who was it said that? Its a wonderful quote from long ago. I'd love to know the answer.

The reason for using it here is because of my last posting, 'Prostate Cancer - the Australian Way' (20 August 2006). In it I quote Australian social demographer, Bernard Salt, as saying, "11,191 men died of prostate cancer in Australia in 2001; in the same year 11,791 women died of breast cancer."

Now either I misread the article, the newspaper (The Weekend Australian, 19-20 August) had a misprint or Bernard Salt got his facts wrong. Why am I saying this?

Last Wednesday I read an article in The West Australian newspaper in which the Medical Editor, Cathy O'Leary, is quoted as saying that each year in Australia 11,000 men are diagnosed with prostate cancer and 2,600 die from it.

So I had a look on the Prostate Cancer Council of Australia website www.prostate.org.au and there it says:

"Prostate cancer is the most common cancer in Australian men after skin cancer, and the second highest cause of male cancer deaths. Every year in Australia 2,600 men die of prostate cancer - equivalent to the number of women who die from breast cancer annually."

I've written to Bernard Salt, whom I have a lot of respect for, to seek clarification. I suspect that he intended to say 'diagnosed with' rather than 'died of'. Either that or I misread it.

The actual numbers don't take away from my main point in the previous posting. Scroll down and you will see what I mean.

Prostate Cancer - the Australian Way

2006-08-20T11:17:00.000+08:00

I noticed a newspaper article yesterday about men, health care and education. Enough to get any man flicking to the sports pages quick time. Yet I gave it a second look because it was written by one of my favourite columnists, Australian social demographer Bernard Salt. He has the habit of making boring statistics and dry topics meaningful and writes in an amusing way with a wonderful turn of phrase.

Apparently 11,191 men died of prostate cancer in Australia in 2001; in the same year 11,791 women died of breast cancer. Yet I, and many men over 45, will be familiar with the phrase, "prostate cancer is the cancer you die with rather than die of". I've trotted it out in the past, until a few years ago when my specialist almost scared the life out of me (not the best choice of phrase but it seemed the most descriptive of my feelings at the time) with a very different prognosis. And a number of men, shocked that I would opt for surgery at the age of 52, have trotted out the same phrase to me. Why on earth have surgery, with all the sexual risks and implications that go with it, when you can just put it into the background and get on with your life?

Yet us blokes, ignorant of health issues as we are, know that breast cancer can be lethal. We know that early detection followed by action is essential. We know about daffodil day and pink ribbon day and we admire Kylie Minogue for raising the awareness in younger women of the potential risk.

After more than 6 years of regular monitoring you'd think I'd have been more likely than most to notice a campaign to encourage men to firstly go for regular check ups with their doctor and secondly not be squeamish about raising the topic of prostate cancer. Yet it wasn't till I read Bernard Salt's article that I had any idea that the Prostate Cancer Foundation launched a 'Be a Man' awareness campaign in 2005 to encourage men to speak to their doctors about prostate cancer.

I don't think us blokes are going to change much. I can't see us scanning newspapers and magazines for articles on men's health. So, its got to be a word-of-mouth campaign. We've got to be more open and talk about having prostate cancer. Even if that does raise awkward questions.

Income Protection - Have you read the small print?

2006-08-16T09:39:00.000+08:00

Are you self-employed? Have you read the small print on your insurance policy?

I know I'm meant to read all the small print but I never do. So, what was in the small print in my Income Protection policy? It really matters when you are self-employed and won't be able to earn a living for 3 to 6 months.

Having undergone major surgery for prostate cancer I was in that situation. If you are self-employed and haven't thought about your policy recently (you do have one, don't you?) I'd suggest you read on by clicking on http://terrifictrading.com/Income_Protection.html and I'll share the four key points from the small print of my Income Protection policy with you PLUS an extra one they added all by themselves.

Mixed Reception

2006-08-05T14:25:00.000+08:00

Ultrasounds, X-Rays, pathology centres for blood tests - I've had more than a few experiences at reception and beyond in the last few months. And while the technical side of things has been fine, many of the experiences could have been far more pleasant with just a little more care and client focus.

I believe that the purpose of every service experience should be to have the customer feeling better about him or herself as a result of coming into contact with the service provider. If service providers approach each interaction in this way, it will be a far more rewarding experience for them and their customers.

Here is just one of my recent experiences.

3 weeks after my operation, I attended the hospital for an x-ray. The result would have a bearing on whether or not my specialist removed the catheter. So, it was a big day for me.

Gwen dropped me at the main entrance. While she parked the car I shuffled along the corridors to the x-ray section. On arrival at reception I had a real feeling of accomplishment as I'd just walked further than I'd done in three weeks. Yet at reception there was no welcoming smile, no acknowledgement of my achievement. I was a task to be processed. The experience was cold and uncaring....and I was feeling fragile and in need of every positive vibe that was aimed in my direction.

Gwen joined me in the waiting room and remarked on how miserable one of the staff at reception appeared to be. We noticed her colleague also seemed to be going through the motions as she 'processed' an elderly gentleman.

Suddenly, as a lady walked up to reception, we witnessed a dramatic transformation in both staff behind the counter. They smiled and came alive. This is more like it we thought. They are waking up, taking notice and going out of their way to make a positive impression. Then we realised, this lady wasn't a 'patient'. She was a colleague who had just come on shift.

These service providers were ready and willing to be friendly to their favoured colleagues and to purposely deny that warmth and friendship to the people needing it most, the patients.

A couple of minutes later an x-ray technician arrived wearing a big smile and asked me to come with him to the x-ray area. From there the experience improved as the nurse and technician were warm and caring. Such a pity that the staff at reception didn't follow their example.

Professionals and Price Enquiries

2006-07-28T16:58:00.000+08:00

I stand in awe of the skills and responsibilities of medical specialists. And when it's my health or the health of someone I love, I'm prepared to pay the price....as long as I feel I'm getting value.

When I changed specialist to Mr P., my wife Gwen did some checking and got good feedback on other families that had dealt with him. Their feedback backed up the things that he had told us such as:

1. He visits his patients every day in hospital including at the weekend.

2. He gives you his mobile phone number and encourages you to phone at any time if you are concerned.

3. While you are in hospital, he sorts out any problems with nursing staff not following his instructions for patient care and attention. This turned out not to be a concern for me, but I know from this feedback that he is quite firm with nursing staff if the slightest hint of the standard he expects for his patients isn't being met.

4. He is technically excellent and up with the latest techniques.

5. He has a good bedside manner.

Given all of this, I expected his fee to be at the higher end of the scale.

We had the important appointment with him at which I confirmed that surgery was my preferred option and that I agreed that it should be as soon as possible. Gwen then asked the question, "How much will it cost?"

Now, I should point out here that Gwen really just wanted to know what to expect so that she could calculate the gap between our private health insurance cover and the total bill. This was not a prelude to her trying to knock down the price.

Let me pause to clarify that. Gwen is a Londoner and I reckon wheeling and dealing is in their genes. She loves a bargain. I'm sure she would have tried to knock him down on price BUT she was under strict instructions from me NOT to bargain. I'd shared with her one of my two favourite quotes about discounting, from Tom O'Toole of the famous Beechworth Bakery:

"If they ask for a 20% discount, I ask which 20% of the ingredients do they want taken out. I can take out 20% of the ingredients but it doesn't taste real good!"

And I'd stressed, "I don't want 20% less anaesthetic. I dont want him to rush to get the job done in 20% less time. So, promise me, no price haggling!"

Our otherwise calm and confident specialist clearly hadn't heard my other favourite discounting quote, from English sales trainer Richard Denny:

"Never apologise for your prices. Your product knowledge and the service you give demonstrate that your prices are fair."

As soon as Gwen said the words, "How much will it cost?" he became quite nervous, almost stammering as he started to justify the price.

He explained that he was at the lower end of the price scale for urologists. He even went on to detail some of his overheads. I particularly remember him saying that he paid over $3,000 per month in professional indemnity insurance - and I'd thought my professional indemnity insurance as a trainer and consultant was high!

So, there was no need for the nervous justification of his price, which was around about $1,500 less than I'd anticipated. And looking back on the professional and caring way he's handled everything to do with the surgery and post-operative care, he would have been worth every penny of the higher fee.

I wrote an article about 'Dealing With Price Shoppers Over The Phone' a few months ago which is at my website. Its one Mr P. could learn from. Go to the Free Articles section at http://www.terrifictrading.com/ if you would like to read it.

The Epidural Machine

2006-07-23T16:38:00.000+08:00

My first few days in hospital involved far less pain that I anticipated, which was wonderful (see Pain Control for Wimps posting 16 July).

Whenever I felt any pain my specialist, or was it anaesthetist, had instructed the nursing staff to check the level of drugs flowing through the epidural machine. This was then increased or decreased as required. If the bag was getting low and they hadn't noticed, I would call the nurse and it would soon be sorted....during the day.

At night sometimes it was a bit different. A couple of the nurses seemed to have real problems with checking and changing the bag, or whatever it is they do, on the epidural machine.

One night I went through a stage of feeling a considerable amount of discomfort, which seemed to suggest that the drugs weren't flowing through the epidural machine properly. I called the night nurse. She was a lovely friendly person, but for some reason hadn't seemed terribly confident with the epidural machine. She fiddled around with it in the same way that I would with a video recorder or a piece of technical equipment that I couldn't get to work properly. In other words, it seemed as if she didn't have a clue!

After much fiddling and tutting, she called another nurse to help. She wasn't much better, but between the two of them, they eventually got things working and I became more comfortable and went off to sleep again.

The following night I had a similar episode. I think it was as a result of the bag being almost empty. I asked the nurse what the problem was with the epidural machine. She rolled her eyes and said, "The staff don't like it. It doesn't make our life any easier, and it doesn't do much for the patients either."

Nothing could have been further from the truth. What we had here was a machine that worked superbly and kept me comfortable, in spite of the major surgery that I'd been through. To me it was like a miracle as long as it was working properly. And the only thing that stopped it from working properly was the occasional nurse who didn't seem confident or competent to handle it.

The following day, I had a visit from my anaesthetist and mentioned to him that the nurses didn't seem to have any problem with the equipment during the day but they did at night. He said to me that this wasn't unusual at my hospital because the night nurses didn't deal with some of the equipment quite as much they tended to be less confident with it.

I hope he realised that this lack of confidence also affects the confidence of patients like me, which in turn affects the level of pain we feel. Pain is a psychological thing as well as physical. Feeling anxious raises the level of pain.

It's really important in any customer situation that service providers are encouraged to build up their confidence as well as their competence. Then they can pass this confidence and feeling of well-being onto the customer, in this case their patients.

It's also important that they realise that their negative comments and expressions can cause a loss of confidence in them as service providers and as ambassadors of their organisation.

Pain Control For Wimps

2006-07-16T11:55:00.000+08:00

My radical proctectomy operation is the first time that I've had major surgery so I didn't know what to expect with pain control. Prior to the operation when the anaesthetist went through the options (see the 29th April 'What does a patient want to know?' posting for more on that!) he stressed that the best way to control pain was to take something to ward it off before it happened rather than wait until feeling the pain.

This is the opposite to what I'm used to. Normally, I never take medication, for example for a headache, unless it is really bad....and for me that's a rare occurrence.

The anaesthetist explained that after surgery its far better to control pain using a preventative approach. So, I got used to this new approach and it certainly worked well. I felt very little pain most of the time during my seven days in hospital and for the first week or so at home was given various levels of pain relief pills to take.

Then I had a follow up appointment with my specialist, Mr P. He started by whipping out the catheter (Youchhhhhh!) and then sat me down before going through a few other things. Fortunately my wife Gwen was there to take in what he was saying because I was still getting over the shock of where he had just put a needle.

He finished by asking if we had any other questions. "Just one", I said and proceeded to ask for his advice on further pain control, particularly as I only had a week's supply of the main prescription pain relief pills. "Will I still be needing them after that", I asked. "Or should I be down to the occasional Panadol or Panedeine Forte by then?"

"Jurek, if you still feel you need the prescription pain relief in a week's time, just phone me up....and I'll tell you you're a wimp!"

The psychology of this is probably to make sure that patients don't get addicted to prescription drugs. It worked!

The Rubber Gloves Treatment (Part Two)

2006-07-10T10:27:00.000+08:00

In my earlier posting on this topic (9th June) I explained that my total education of internal examinations of the prostate was provided by Billy Connolly. A cartoon sent in response by a friend illustrates the first examination experience fairly well. Click here for enlightenment!

Do You Hate Water Features?

2006-07-10T08:05:00.000+08:00

Have you noticed in the last couple of years how garden centres seem to have almost as much space taken up with displaying water features as they do displaying plants? It seems to be the trendy thing to do these days.

Well, I reckon there will be more than your average number of males reading this, so it seems the perfect time to find out something that's had me wondering?

Am I the only person in the world who hates water features?

It's nothing to do with aesthetics; it's the effect that the bloody things have on me! I know they are meant to bring a feeling of peace and tranquillity but they certainly don't to me. They just have the effect of sending me in search of the nearest loo....urgently.

I'm not referring to my post-op problems here. This has been the effect they've had on me for at least 5 or 6 years. A bit like Pavlov's experiment with his dog, the moment I see and here the trickling water on a fountain or some other fancy water feature, I am desperately in need of a pee!

So, help me out here. I'm dying to know:

- Do you like water features?
- Would you have one in your garden?
- If you do have one in your garden, would you like to rip it out?

Go on, click at the bottom with your answers YES or NO. You can remain anonymous but it would be interesting to know your age group e.g. under 40, over 50, over the hill and whether you are male or female.

Name badges - it's selfish not to wear them

2006-07-02T13:04:00.000+08:00

Hospital staff are at an advantage. They can check your name before talking to you. It will be on their records, on the door or at the end of the bed. And when they use your name it’s really lovely.

“Hi Jurek, you're looking different to the last time I saw you.” When a nurse coming on shift said this to me it made me feel special and feel better in myself. In other words, it was a caring, healing way of addressing me and it was personal. I wasn’t ‘the prostate patient’, I was a person.

What then makes a patient feel even better about him or herself, is if they can respond using the nurse’s name. The same applies in a restaurant, reception area or any other service situation.

In the hospital I was in, most staff didn’t have badges pinned on. Instead, they had easy to read large nametags hanging on a cord around their necks. A bit like you often see for delegates at conferences and seminars these days.

Sometimes the nametags had turned the wrong way round. The name needs to be imprinted on both sides of the nametag to overcome this. They hadn’t taken that little design flaw into account at this hospital (and rarely do at conferences either). If the patient can’t read the nametag it defeats its purpose!

Some staff must have found the nametags irritating (I noticed it tended to be those with a fuller figure!) because they actually tucked their name badge into their shirt pocket, meaning that there was no way any patient would be able to see it, again totally overcoming the purpose of the name badge.

When I couldn't identify someone's name that had dealt with me before, it didn't feel as good when I was talking to them. And if our purpose is to make someone feel better about themselves as a result of being with us, then we have to take this into account.

By the way, in my other life I’ve written an article about the benefits of name badges and how to get staff to wear them. Click on ‘Name Badges’ to read or print out a copy.

What's in a name?

2006-06-30T18:05:00.000+08:00

With the one or two minor exceptions that I've mentioned in some of these postings, I found the hospital staff to be wonderful, caring people. And when I needed help or reassurance, they were willing to take time out from their busy schedule to meet my needs.

In large part, this was because they were professional and out to do the best they could for their patients. However, I reckon it was also because I made a point of using their names.

As you know from my last posting (Walking The Corridors – 25 June), I kept a pocket notebook and pen beside my bed. Whenever a nurse introduced herself, I would jot down her name so that I didn’t forget. I could then use it whenever I made a comment or request.

Using a staff member’s name really does make a difference to the relationship. In fact, it's one of the points that Patricia Cameron-Hill and Dr Shayne Yates make in their wonderful book, ‘Doctor, I feel funny - How to take the stress out of being in hospital, for patients and visitors’. This is a must read for anyone going into hospital and for the close family members who will be visiting them. It’s also hilarious. Click here to read a review. It’s the perfect present for anyone prior to going into hospital or for their partner. Click here to order a copy.

Walking The Corridors

2006-06-25T20:16:00.000+08:00

While in hospital there were two tools that I kept close to me at all times. My little pocket notebook and pen and also my dictaphone. This meant that whenever I had an observation or thought it could be recorded. And if I wasn't up to writing anything down, as soon as the nurses or other staff were out of earshot, I could say it into my dictaphone. As a result, I gathered quite a few patient observations while in hospital and I'd like to share a few of these with you.

On day four or five the various tubes stuck into the front and back of me were removed. It was great to have the opportunity to be up and about with my tubes out and fascinating to see what went on outside my room. All the sounds that I'd been hearing now had more meaning.

Walking round the two corridors in my ward and the ward next to mine, I noticed something happening (or failing to happen) on both the morning and the afternoon shift. At reception and in the corridor as I shuffled along, I would be met with eye contact and a smile by any member of staff who previously had been in contact with me. If they didn't know me...blank.

Actually, looking back, that's true of the nursing staff and doctors but not of the support staff. On every occasion I was met with eye contact and a smile by support staff as they went about their work.

Doing the rounds ever so slowly in a true softshoe shuffle on my first walk by myself, I had three different nursing staff blank me out. One actually had to swerve to avoid me as she rushed round a corner, yet there was still no acknowledgement.

Then in the lounge waiting area situated outside the lifts I noticed there were some plaques up on the wall; the sort that organisations put their mission statement and other grand corporate statements on. One of them had wonderful words. Here's what it said:

Every encounter is an opportunity

Every interaction with patients at any stage in their journey provides

us with an opportunity to exceed their expectations.

· Every encounter.

· Every moment.

· Every person.

· Every day.

Now, I don't know if this was one of those typical things that senior management put together at one of their corporate love-ins or whether or not the staff were actively involved in coming up with these wonderful words. Either way, quite a number of people weren't living them on a daily basis - which is sad not just for their customers, the patients, but also for themselves. Sad because living these words would help them to feel better about themselves and certainly help their patients and colleagues feel better about themselves too.

Words are just words until we choose to live them.

Absolutely No Bladder Control!

2006-06-24T16:59:00.000+08:00

It's now over a week since I had my catheter taken out. I had imagined that after a day or so I'd be taking longer walks and having Gwen take me out to coffee shops by the river and by the ocean, both of which are close to our home in Perth.

The reality is considerably different.

My specialist had given me exercises to do to help with bladder control. He said that some people show a marked improvement within seven to ten days. But for others it can take four to six weeks or longer to get a reasonable degree of control.

Now, women tend to be more used to facing up to these challenges than men. As a result of operations relating to childbirth, prolapse, hysterectomy and the like they often have problems with their waterworks. At the health club I frequent, it's not unusual to see ladies suddenly dash out of their aerobics or pump class. I presume to make an emergency trip to the loo.

This means that they talk to one another about this stuff. Blokes don't, which means that I don't have anyone to compare war stories with....which means that I feel a bit anxious, inadequate and irritable.

It's been eight days now, and I still have virtually no control. Most of the time when I stand up and walk around it leads to a virtual waterfall! Of course, I'm wearing the equivalent of adult nappies, but it's still extremely offputting.

As a result, I do a minimal amount of walking, and today will only be my second outing to a coffee shop close by. Meanwhile, I keep practising my exercises. Hold one, two, three. Hold one, two, three!

Medical Update

2006-06-17T08:23:00.000+08:00

I saw my specialist, Mr P, yesterday, two weeks and four days after the operation. He confirmed that the cancer appears to be contained within the prostate, which he removed. Always a slight possibility that some microscopic nasties have snuck through but things are looking good. This means no radiotherapy or chemotherapy required (sigh of relief!).

Got my catherter out too which isn't something I would want to happen every day. For the benefit of the males reading this, I won't go into detail....it would make your eyes water.

Should start getting easier now...once I learn how to control my bladder!

Don't Mind Me

2006-06-14T11:18:00.000+08:00

You know what it's like when you're standing in line at a supermarket and the operator is carrying on a conversation with their colleague in the next aisle; all the time processing your goods accurately and efficiently. Even though they are getting the job done, it doesn't make you feel good, does it?

To some extent we can make allowances for this, because they are typically only 16 years old, have never had explained to them that this is inappropriate behaviour and often their managers are poor role models.

I was shocked though to experience this behaviour from two mature nurses during my recent stay in hospital. I found the nurses to be friendly, helpful and professional in the way they operate with one exception. On the morning shift, on two or three occasions, I had the situation where the nurses were checking the various tubes sticking into me or doing some other regular tasks, while carrying on a conversation with one another as if I wasn't there - about studies, children, their own ailments and things going on at the hospital.

How do you think that made me feel?

Insignificant!

You see, they were oblivious to the fact that they weren’t really ‘being there’ for me. They were doing their jobs, taking good care of Jurek Leon the patient, yet ignoring Jurek Leon the person.

They were like many of us are when driving our car on a regular journey - functionally there, driving safely (hopefully) but not fully focussed.

They were missing out on what I call ‘the essence of service’: To make someone feel better about him or herself as a result of being in contact with us.

In my other life I’ve written a two-page article on this. If you'd like to read it click on The Essence Of Service.

Are You Listening?

2006-06-13T16:04:00.000+08:00

Listening skills are vital in any customer service role. And that's certainly the case for the medical profession. While I was in hospital, I had a classic example of a senior nurse actively listening and yet doing it in an unpleasant way.

It's a mistake that experienced service providers often make. Before sharing with you what happened to me with the senior nurse, let me first explain what I mean by active listening.

We live in a busy world these days, and as a result, many people aren't particularly good at listening. They hear what the other person has to say, let them know that they've heard with comments like 'Uhu', 'I see' and the like, but they often don't confirm understanding.

Is what we think they've said, what the other person thinks they've told us?

There are two key steps to active listening -

Attend to what the other person is saying. In other words, pay attention.
Confirm understanding. In other words, paraphrase what the other person has said and feed this back to them in the form of a closed question. That way we can check whether or not what they think they've told us is what we think we've heard.

For example, " So, you're fine when you're on your back, but as soon as you lie on your side you feel the pain. Is that right?"

Where some experienced service providers get it wrong is that they correct rather than confirm understanding. Here's what happened to me in hospital on the Wednesday after my operation:

Nurse: " Is this Day Two for you?"

Patient: "Well, I had my operation on Monday, so it's my third day."

Nurse: "Yes, it's Day Two."

I stand corrected!

It's not a very nice feeling being corrected, especially when you're feeling a bit fragile. So, how could she have handled this more diplomatically? How about something like this?

Nurse: "Your third day? Good. Just in case anyone else asked you, we start counting from the day after your operation, so in hospital terms, this is Day Two."

Confirming understanding is a wonderful speech habit to have. The English language is just made for misunderstandings, so it really does pay to check. And most of the time, active listening demonstrates to people that you are listening and that they are important. You are taking the time to really listen to them. Where this falls down, is when officious people like the nurse in my example correct rather than confirm understanding.

First Impressions

Interestingly, my first impressions with this nurse hadn't been that great. When she first came into my room at the beginning of her shift, she was chewing. That seemed to me to be rather unprofessional.

I had this nurse on a couple of occasions. Technically, she seemed to be most competent. But I didn't take to her nearly as much as many of the other nurses. First impressions tell us a lot.

The Rubber Gloves Treatment

2006-06-09T16:06:00.000+08:00

Since letting it be known that I have prostate cancer, I've been amazed and concerned by the number of males over 50 who have confided in me that they havent had a full medical check-up in years, including a check of their prostate.

The main reason for this appears to be that they are too embarrassed or too squeamish to allow themselves to be subjected to the rubber gloves treatment.

There is no doubt that we males are a squeamish lot. Women are often subjected to embarrassing and at times degrading medical examinations. Men don't have to go through this nearly as often. That's no excuse though. There is nothing macho about avoiding something that needs to happen.

The consensus seems to be that unless there is a particular problem that arises, there is no need to ask the doctor for the rubber gloves treatment until you reach the age of 50. In my case, as a result of what showed up in blood tests, I was only 44 or 45. And yes, I was squeamish. It wasn't an examination that I would have volunteered myself for.

You see, prior to that time, my only knowledge of prostate examinations was as a result of a skit I'd seen live on stage from Billy Connolly. In it, he commented, 'Once you get to 50 doctors take an unhealthy interest in you arse.' Then he went on to describe in graphic detail, as only Billy Connolly can, the rubber gloves treatment. I can assure you it's not the ideal image to have in mind for your first prostate examination.

Since then I've had numerous prostate examinations and am just relieved that they help identify a potential problem before it gets serious.So, if you are over 45, go and get a full medical examination - including the rubber gloves treatment!

One day at a time

2006-06-05T17:17:00.000+08:00

One of the things that I've learnt from my spell in hospital, is to take one day at a time.

I know that's a hackneyed phrase but it certainly is the truth when you're recovering from an operation, and it may well be something that I take into other aspects of my life from now on.

Now that I'm out of hospital following my radical prostatectomy operation, there are two key goals to focus on:

To get the results to see if they found any other cancerous nasties.
To have my catheter removed.

My specialist tells me that the catheter needs to stay in for a total of two weeks and four days from the time of the operation. That's 10 days time. He will be removing the catheter himself at his rooms, and that's also the time when he wants to discuss with me my full report following the operation.

Today is a public holiday here in Perth, Western Australia, so I know that the earliest he will have the results back from the lab is Tuesday, probably Wednesday. So, I said to him, "I'm quite anxious to hear the results. Can't you phone me when you get them, especially if it's good news?"He pointed out that while he could, it would be best to discuss the results face-to-face.

In his view the phone wasn't a good medium for this. He said, even in a worst-case scenario, no action could be taken prior to our appointment to remove the catheter. And even in a best-case scenario, we would need to discuss what this really meant. Either way, it was better to do it face-to-face.

Normally, that's the point at which I would have attempted to find out if my assertion skills had fully recovered from the anaesthetic. But what he said made sense, very convenient for him being a busy medical specialist, but it did make sense.

I explained this to my wife Gwen the following day. She like me was anxious to hear the results and patience is not Gwens greatest virtue. But I pointed out to her that I've already waited five weeks since the biopsy, and it was more important to concentrate on the healing process one day at a time than to get the results. However, I understand how tough it is for the partners in these situations so I said to Gwen, if she found this too difficult I was quite comfortable with her phoning up our specialist to discuss it.

Gwen said that was OK. She understood that the most important thing right now was the healing process and agreed that we could wait and deal with other things at the appropriate time.

I think weve both learnt something important about taking things one day at a time.

Alive and Healing

2006-06-05T13:10:00.000+08:00

I am truly in awe of the wonderful job done by the medical specialists, doctors, nurses and support staff in hospitals.

Eight days ago I was chopped open and parts of my stomach moved out the way so that they could get into other parts for the fairly extensive surgery. That afternoon I woke up in hospital with tubes seemingly sticking into and out of me everywhere. And yet I felt no pain. I was even able to have a brief chat with nurses and with my wife, much to her surprise and mine. And day-by-day with their constant care and attention to detail I progressed and after seven days headed home.

And here I am exactly one week after the operation, sitting in front of a computer screen preparing this information. Not that I'm energetic enough to bang away on the keyboards for long, because I'm using Dragon NaturallySpeaking. But that's something I can tell you about another day.

Too Much Information!

2006-05-28T15:18:00.000+08:00

I'd been asked a number of times by my specialist and the nurse who arranged my pre-admission check through, "Do you have any other questions?" My standard answer, "No."

But I did have one and last week plucked about the courage to ask my doctor. You see I had a reasonable idea of what a catheter is but thought they can't really insert it right up there on a bloke can they, can they?....Yes, they can!

My doctor proceeded to draw me a detailed diagram of what it would be like. I wish I hadn't asked!

I've just had a friend from New Zealand email me and advise "...the better your knowledge then you can engage with your professional at a higher level and get a better and sometimes quicker result." I'm sure it works well in accountancy and law, Deane but not with the medical profession. Not for me anyway.

That ones definately a case of 'too much information!'

I had no idea

2006-05-28T07:37:00.000+08:00

It's now five weeks since my specialist, Mr P, broke the news to my wife Gwen and myself that I had prostate cancer. Given the amount of it that was discovered there seemed to be no alternative to surgery.

My specialist arranged for his receptionist to make the necessary bookings. She proceeded to make a phone call to someone telling them that I was having 'a radical'. A radical? I don't think I've been described as a radical for over 20 years.

Since then, things haven't gone quite as I'd planned. I'd many things to organise to ensure that my business continued with as little disruption as possible to our clients. And I decided that it would be good to keep myself busy by scheduling quite a few training courses with clients that I could run in the intervening period. That would take my mind off the operation and everything that might follow. Seemed like a good idea at the time.

I had no idea just what would be required of me medically in the intervening period. I had to give a pint of blood 3 times one week apart. This is so they could use my blood in the operation. Good idea but I just didn't expect it.

I did wonder if it meant that my specialist was a bit like Doc Martin in the UK TV series. In other words, he was unable to stand the sight of blind and maybe figured if he could remove it all from my veins prior to the op he was less likely to faint at the operating table. Just to help him out, I've been doing my best to fill my veins with Chardonnay rather than Shiraz. Anything I can do to help the surgeon!

Of course, the thing about having a pint of blood removed from you each week is that it does slow you down. A bit of a challenge with the work schedule I'd committed myself to.

And then there were the medical appointments, the additional visits for blood tests and the appointment with my anaesthetist. He sat me down and proceeded to go into the most amazing detail about the two forms of anaesthetic he could use (far more information than I wanted to know). Then he asked which option I wanted to use. Me? I thought he was the specialist, he was the one who'd studied this stuff for five years and practiced it for 30. And he couldn't decide which to use! It's a worry. Now, I'm sure this is because of threats of litigation these days but who was I to choose? My answer, which ever takes away the most pain for the longest period.

Ah well, tomorrows the day. And the main task left on my 'To Do' list is to respond to the amazing numbers of emails people have sent me. I'm only up to the 10th May so I'd better get on with it because I really do want everyone to know how much I've appreciated their kind thoughts...and some of the humour has been great. I'll sign off with a Mark Twain quote sent to me by Paul Wennagel from Esperance:

'Be careful about reading health books. You may die of a misprint.'

Why Change Specialist?

2006-05-04T20:18:00.000+08:00

My previous specialist, unlike his secretary, was a nice fellow with lots of experience and a good reputation. This time though, when it was clear that I needed to be referred to a specialist once again, I asked my doctor to refer me to someone different. Why?

There were four reasons for this.

I’d been given my two previous biopsies under a local anaesthetic. No choice. That’s just the way the specialist decided to do it. This wasn't much fun. Like many blokes, I don't have a terribly high pain threshold, especially when I’m lying there having something done to me. I took this up with him after the second biopsy, and he acted surprised. Made out it wasn't a big deal. Made me feel a bit of a wimp. Gwen, who was with me, then asked him if he'd had it done under local. He hadn't been through it himself. I decided that there was no way in the world that I would again have a biopsy under a local. So I either had to confront him on this or go to someone else.
I knew that if he found cancer he would want me to have surgery. He told me before that this was his recommended option. If that happened, I would have insisted on a second opinion. So it seemed to make sense to get a second opinion first by going to someone else.
After the second biopsy because of what had been said, I was sure cancer would be found. I’d spent weeks working on myself to try and be brave and so had Gwen. From the time of the biopsy it took me almost 3 weeks to get an appointment with him. There was no contact prior to the appointment, so I assumed the worst. When we got in to see him, with a gracious smile on his face, he informed us that the biopsy had come up clear, as if he was doing us a big favour. Surely he could have shown some empathy for what we were going through. Surely he could have got his receptionist to phone us with the good news as soon as the results were available. Why didn't he? Was he afraid that we would then cancel the appointment and he was lose money for this? We would still have needed a more detailed analysis. I think he'd just been doing what he was doing for too long and had lost the ability to have empathy for his customer.
The fourth, and the prime reason, I made the change to another specialist was because of his secretary/PA, the bitch from hell. As a customer service consultant, I do a bit of work with medical specialists and notice that quite a few of them employ strong minded, assertive PAs. I can understand this. A lot of them need to be organised, need someone to shield them at times from the demands of their patients, and often need someone to handle the money side of things, because the specialists are too embarrassed doing this with patients themselves. But that doesn't mean they should be able to lord it over their patients, regarding themselves as in charge and their customers as second-class citizens who should do exactly as they say. When I was waiting in the reception area, on a number of occasions, I noticed how she treated people, particularly over the phone. It was not nice. I hate giving my money to people who treat their customers in that way. So, I made sure they didn’t get any more money from me.

What does a patient want to know?

2006-04-29T11:14:00.000+08:00

We are all different. Some of us want to know the detail, every little bit of it, while others just want to know what the result will be. When it comes to health, my wife Gwen like many women wants to have a proper understanding of everything that is going on. Personally, I just want a general overview. The less I know the better I feel.

At the time of my second biopsy a few years ago, my then specialist made it clear that he felt I needed to know all the ins and outs of things because he felt it was fairly likely that I did have prostate cancer. I went on the internet and downloaded heaps of information; well-meaning friends passed on articles and Gwen looked out and put in front of me the things she thought I should know about. The whole thing frightened the living shit out of me!

It reminds me of buying a car. Some people, particularly blokes, love cars. To me they are a means of comfortable transport from Point A to Point B. All I'm concerned about is that the control panel is not as complicated as the cockpit of a 747 aircraft; there is a suitable side compartment for my street directory and somewhere to store my CDs. Yet the car salespeople insist on showing me under the bonnet. I believe there is an engine under there. That much, I'm willing to trust them on. And if I turn on the motor and do a test drive I can tell if it's working. Why on earth do I need to see under the bonnet? I don't need to know that much!

Totally Prostate

2006-04-21T16:10:00.000+08:00

Friday 21 April was the day I got the news. My wife Gwen was with me when I went to see my new specialist, Mr P, to get the results of a biopsy I'd had 10 days earlier.

This had been my third biopsy in six years. So, while I was anxious, I certainly wasn't in the state that I been the last time round three years before. I'd covered most of the angles, been through the fears, and was better prepared to accept the results.

For some time now my blood test results, low in reliability as these appear to be, continued to be worrisome. More recently they had got a lot worse. Add to that the fact that the lump that I had in my prostate was concerning both my doctor and my specialist and it seemed more than likely that this time round they would find some cancerous cells. Still, I thought I was pretty well prepared.

What I wasn't prepared for was the extent of the cancer that they did find. This time round, I had 12 samples taken, whereas my previous specialist on two occasions had taken six samples each time. Mr P was clearly of the view that this wasn't an extensive enough sample and told me that the 12-part test would give 95% accuracy.

Six of the 12 samples showed up as cancerous, with four of these showing fairly long tumours.

Up until now my chief concern had been to ensure that I didn't end up as impotent because of any treatment to remove the cancerous tumours from my prostate. Suddenly, that wasn't such a big deal. Now all my questions and concerns for the specialist were about whether or not the cancer could be contained within the prostate. Whether or not it had perhaps already extended beyond the prostate loomed large as my greatest fear.

We left the specialist and headed for my favourite coffee shop in Leederville, Cafe Villa. I wondered what conversations were going on at the tables round about us. It looked to me like they were mostly informal business meetings, the ones I would normally visit Cafe Villa for. This time my one was different.