I’ve been chatting with a local diabetes group about the rate of Did Not Attend’s at our local clinic and what could be done to reduce the rates of missed appointments. So have you ever been a “DNA” and, if so, why?
Don’t worry, the names of those that confess to missing appointments will be passed to the Diabetes Police.
I’ll face the wrath of the Diabetes Police first – I’ve only missed one appointment in recent memory. It was for eye-screening. They used to do eye-screening at the same time as my six-monthly check up but changed it so it was done on a different day. This meant instead of getting everything diabetic sorted in one trip, I also needed to travel to the hospital clinic for a five minute photograph of my eyes.
Frankly I couldn’t be arsed travelling that far in the middle of the working day for a five minute appointment. This was especially so as I also go to my local optometrist, who does a *far* more thorough job of looking at my eyes than the hospital.
I’ve missed two over twenty odd years that I’m aware of.
Once with my diabetic nurse I was an hour late (due to people in london not realizing you ride in the tube not under it) & they still managed to squeeze me in at the end.
The second was the annual eye test, they’d given a weeks notice for the appointment, during three weeks I wasn’t in the country. (I received the appointment letter & a snotty letter about missing it when I came back & sent an equally snotty letter back!)
OK, I’m going to either stand on my own here or be speaking as one of the silent many.
I’ve missed a handful of consultant and GP nurse appointments over the years. There’s no excuse that is worthy of the time and money I wasted but I did it because at the time I was afraid of the results and the response. Consultant appointments usually involved me sitting there whilst I was told how my control ‘really wasn’t good enough’ and if it didn’t improve I would die or go blind or lose a limb or all of the above. I’d read enough Balance articles to know that that was happening anyway so why did I need to go to be talked down to?
The nurse was a little different as I truly didn’t believe she had enough knowledge or understanding to interpret the results I was producing even though I wasn’t really doing enough to fix them myself. And every appointment I did go to ended with being told to come back in three months for another blood test and if I hadn’t improved enough I would be referred back to the hospital. As a scared young man threats like that didn’t help to encourage me to engage with my local healthcare teams.
Now, obviously I’ve turned the corner but I’m not sure what could have been done in the system to get me to engage sooner. DNA isn’t big and it certainly isn’t clever but I think it’s wrong to assume and stereotype the people who fit into that category.
The topic, maybe intentionally, relates well to the other thread on contracts for pump users. And I agree to a point. If you’re not willing to engage then why should you gain the benefit of the latest technology that others cannot have? This doesn’t mean I agree with broad brush measurements such as the hugely flawed HbA1c but if you’re not willing to even meet and discuss then, erm, tough.
Oops, that went on a bit. All you lifetime-of-perfect-control people can now return to this thread again.
I did a DNA which was the hospital’s fault !
On a ward, due to admittance with DKA while pregnant (well actually in a private room as there was no bed available on a ward, so didn’t get to see many nurses – after reading the other thread about hospital disasters I view this as having been a blessing) my diabetic clinic appointment was the following morning. Come lunchtime, when I realised and mentioned it to the nurse who had brought me a torture tray -I mean something vaguely resembling food – I was popped into an ambulance and driven round the hospital grounds to see the consultant who had waited after clinic hours to see me.
The mobile phone text system my hospitals use is great at giving you a reminder for appointments. I don’t know if it is countrywide or not. I get a text 14 days, 7 days and the day before all hospital appointments telling me which location and the time of the appointment and also giving ways to change appointment by letter, phone, text, smoke signals. Its a lot easier than rummaging around for appointment letters.
I get an automated phone message a few days before my hospital appointments to remind me about them. I don’t think I’ve ever not turned up for an appointment, but I have cancelled a fair few – normally the ones I don’t see any benefit in, like meeting with the GP to talk about diabetes when I see a consultant as well.
I get a text message 7 days before my appointment. (Which is great, but I think maybe a day before one would be more useful.)
I dont think I’ve ever done a DNA, but like @Alison I’ve cancelled loads of ones that were made for me. Like GP clinics. (And spent a fair bit of time on the phone to receptionists telling them I didnt need a replacement appointment, I didnt need an appointment at all, I attend a hospital clinic that my GP referred me to so I dont need one etc etc etc.)
@seasiderdave – that’s an interesting point about having no confidence in what the nurse / doctor would talk to you about. It’s pretty similar to Annette and Alison cancelling appointments because they’re pointless I guess.
It’s also another demonstration that the “threat” method of dealing with patients doesn’t really work. You can see why doctor’s do it though…
Following on from the comments of @alison and @annette above re cancelling *unneccesary* appointments, part of the reason for my own lack of DNAs is that for about 30 years I avoided hospital diabetic clinics!
From diagnosis at age 10 to leaving home at 18 I was subject to the tedium and humiliation of my local hospital’s diabetic clinic.
However since then until about 18 months ago I had happily and effectively been taken care of by a succession of GPs who saw little point in referring me to a diabetic clinic since I seemed to know what I was doing and could ask sensible questions and often provide my own answers ( @seasiderdave – this definitely does not equate to a “lifetime of perfect control” )
However, my increasingly complex medical history (unrelated to the diabetes) had by then grown so convoluted that my GP had to admit that I needed more specialist help and referred me to the hospital endocrinologist (i.e. diabetic clinic).
The half dozen appointments I have had since then have been useful but apart from the first one have barely considered my diabetes.
The point I am getting to is that to reduce the number of DNAs that concerns your local group @tim, it seems obvious that either the outcome of each appointment needs to be valued by the patient (who should otherwise cancel it as Alison and Annette have done) or the appointment needs to be in a context that can provide that value (as with my GPs). The experience of @seasiderdave indicates how a lack of “value” can encourage DNAs. If I wasn’t getting value from my visits to the diabetes clinic in respect of my other issues, I don’t think I would continue to go just to get a HbA1c that I can get just as easily from my GP.
But isn’t that exactly the answer to the question raised by @tim ? In order to minimise the number of DNAs the HCPs need to address the individual needs of us, the bloody awkward patients, and not treat us as items on a ticklist.
I know that http://guidance.nice.org.uk/CG15/Guidance/Adults refers to a “patient centered” approach but if you can keep that in mind while reading the rest of it, you are a better diabetic than I am!
So if it is just your job and not your life, is it any wonder that HCPs sometimes (often?) default to a ticklist approach and don’t quite manage the heights of patient centered-ness that we would wish?
@furrypaul I think I see your point – sometimes an appointment may have medical benefit even if the patient doesn’t see it – but I’d argue that if this is the case, part of the role of the clinician is to help the patient to see the the benefit of the appointment ie what did we learn from this? What’s changed as a result?
Personally, my GP diabetes appointments fall into the category of delivering a benefit to the clinician (it gets their notes up to date and enables them to get paid for providing diabetes care) but delivers no noticable benefit to me (I knew the results anyway and am more competent to decide what actions to take than my GP is).
@nigho its an absolute right of anyone to choose who provides their healthcare, my body is not the place to provide training to incompetent doctors…
In my case after several problems with my hospital resulting in repeated hospitalisation , I wrote to the hospital to tell them their appointments were no longer needed & I would instead see my doctor to take care of me.
Again in my case my hba1c fell by 10 points & I stopped having weekly hypos which needed to be treated by ambulance, as I’m older & wiser now I would these days put a complaint in to the bma but back then I for a while put up with ‘treating’ the rising hba1c & horrendous htpos with ‘lets increase your insulin even further, the monthly meetings were pointless to me because the doc wasn’t listening & after being rushed to hospital my gp would look at what he’d done & go ‘why’
I’m now back under hospital care but under a different PCT as there’s no way I’d go back where I was!
More generally, my intention was to say a DNA is failure to attend an appointment without notifying the healthcare provider, frankly if someone chooses not to see a doctor for their diabetes I’d advise against it but its their choice as an adult.
@alison is right a doctor should explain why a meeting is useful to them, but not all do or are capable of that. I’m sure most of us see both a hospital & our GP or a nurse at our GP – at least 50% of those meetings must be pointless & dealt with better by effective sharing of health records.
My new hospital always writes to my GP with a summary of meetings & test results, cc’ing myself , yet my GP under their new management don’t do the same with the hospital. Infact i’ve had proper arguments with them & needed to use threats of the data protection act to get them to release MY test results to me to share with the hospital!
This I suspect is a problem of protecting payments of diabetes care & weirdly may make me go full circle & write to my GP telling them I will no longer attend.