'Patients' know how to behave. They can negotiate the system from car-parking to appointments with practised aplomb. They can memorise their place in a queue with a mere glance at other denizens of a clinic waiting room, and they are on first-name terms not only with the nursing and medical staff, but with the cleaners, the ladies in the League of Friends, and a large proportion of the other patients as well.
'Regulars' on the ward are well acquainted with the mysteries of the ward kitchen, and can magically appear with a plate of fried eggs and toast without even reading the notice on the kitchen door prohibiting patients from entering the inner sanctum.
In the Outpatients Department, their voluminous notes are always at the top of the pile; their test results are always available from the lab reports, and even their X-rays magically appear on the screens before the doctor has even finished his last cup of coffee.
As a medical man thrust into this society, somewhat unexpectedly, I have found myself learning a lot by observation. There are various fundamental rules to the art of being a patient. First of all, attention must be paid to correct attire:- 1.) Slippers are essential. I had not owned a pair of slippers since boarding school. I had some considerable difficulty in a large department store finding some without furry pom-poms on their toes.
2.) Pyjamas are de rigeur. Similarly, I have not possessed a pair of pyjamas since university days. I seemed to remember my goode wyfe prudently saving a pair somewhere "... in case you die in bed..." But these had vanished, so PJs had to be added to the shopping list.
3.) A dressing-gown is a reasonable accessory, though not essential. I purchased a rather classy Paisley satin number... An amber cigarette holder would have completed the ensemble rather well, were it not for the fact that I don't smoke.
Behaviour on the ward is also governed by various unwritten rules, though I note that these are by no means as strict as they were when I was a medical student. There have been many changes:-
1.) Everyone is on first name terms except for Sister and the medical team. Each and every nurse introduces herself - or himself - on the first meeting, so everything seems very 'pally' from the beginning. None of the distant formalities there used to be thirty years ago.
2.) Ward rounds these days are conducted by the registrar rather than the consultant, and start off at a surprisingly early hour, so everyone must be breakfasted, washed and respectable by about 8 o'clock. Consultants tend to appear at random times, accompanied only by one of their juniors, with their 'round' being more of a social call than of great medical import. Many of us will remember the strict formality and hushed silence of the ward round in days of old. Each patient sat up in his immaculate bed; not a crease in blankets or pillows (pillowslips done up with the 'open' end away from the door into the ward...)
3.) There is no longer any evidence of religion playing any part in ward life. The last time I was 'on the wards', the Roman Catholic priest not only came round with his communion kit in a little black brief case, but he also acted as a bookies' runner, occasionally reappearing later in the day with a fist full of notes for a lucky patient. There were also several non-conformists as well as the Church of England service conducted on the ward each Sunday. I seem to remember that Sister said prayers with the nurses too...
On the whole I found that these changes towards greater informality were for the better. Relaxation rather than military-style discipline must be more conducive to convalescence. And in spite of some of the nasty medical conditions on the ward, the atmosphere was always cheery, chatty and happy.
The attire of the medical staff reflected their status and was uniformly observed:
1.) Housemen were the only medical staff who still wore white coats. These were always immaculate and never appeared like those we were used to - second hand at best with tears and frayed edges. Ours always seemed to be stuffed with note-books, pens and pencils as well as stethoscopes, torches and other accessories of our trade. These days it is absolutely essential to wear the stethoscope round the neck in the American fashion; and there is nothing to spoil the cut of the white coat.
Housemen of the female variety also wore white coats but were always very classily clad in a fashionable dress as well. Elegance is obviously not a lost art here...
2.) Registrars wore grey flannels and shirt and tie, but no white coat. I can't remember seeing a stethoscope or any medical accoutrements at all; but then they were always attended by Sister and a trolley laden with all the necessities of diagnosis and treatment.
3.) Anaesthetists always amused me. Universally they wore blazers with brass buttons and looked as though they had stepped straight out of a pre-war M.G. or a vintage Alvis. They appeared very early in the morning to speak to pre-op patients. There seemed to be no distinction in ranks: the same uniform was worn by all. Although no doubt of similar age to other resident staff, they seemed all to be prematurely middle-aged with receding hair-lines...
4.) Consultants could always, in timeless manner, be imagined stepping straight from their Rolls in the centre of the main car park. A three piece suit was usual, and their bearing hasn't changed one bit over the years.
I wonder if others recognise this pattern, or if it is peculiar to the Centre of Excellence in which I found myself for some three weeks. I certainly had plenty of time for observation: there was rarely a dull moment. Humanity from all classes; all manner of men and women - since the ward was 'mixed', though nicely arranged in an L shape; and from the weakest to the strongest. A display of the human spirit at its best.
Dr Alan G. Gray