If a MDT is held about a close relative who you advocate for, but you`re not told and left out, is this wrong?
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This is a link from 2018. Under the part ’ Can the MDT meeting refuse to proceed if I bring an advocate along?’ Might provide some information for you.
However, it’s a situation where there are many of them and one of you - so you have will have to really put your foot on it and get your input heard for the person you are advocating for.
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Very good question! When as a consultant psychiatrist I said relatives and other advocates should be invited, the looks I got was like I was from a distant galaxy.
The underlying issue is that nobody (except me) wants longer reviews and searching questions.
I’m working on a full answer to your question. I’ll be back within about 48 hours.
Thanks, I’ll look forward to getting some clarity, this is the first time this has happened, I`ve always been welcomed before, I have been asking a lot of awkward questions, I learnt from a good teacher.
I studied Multi-Disciplinary Team Assessment and issues surrounding this provided (above or below). That’s a brilliant long read. To be honest I could not do better.
I want to approach this from a different angle - and of course I’ll give a couple stories. Story telling is nice depending on the story of course. Some do not like bad stories, I’m led to understand.
The bottom line is that the culture of care has changed - but that does not mean that ‘everybody’ has changed their mindsets. Many of my medical colleagues have told me FTF that they hate advocates - probably a bit less than complaining relatives. They have told me of their feelings - behind closed doors of course - based on ‘strange questions they ask that wastes our time’.
My mindset is of course radically different because I have fought for Radical Transparency, as espoused by the billionaire Ray Dalio - knowing full well that it’ll never fit into a public health services run along Stalinist lines. [Caution: that’s not my opinion - it was the opinion of the BMA which can be found online - but I agree with their opinion.]
Let’s talk openly here (if allowed) - why is it that we must always remain behind closed doors? Word on the block is that some call it the NHSS - national health secret service - and there is ample evidence for that sort of sentiment from massive cover-ups and hounding out of whistleblowers. It’s important at the outset to understand key problems with the macro-culture that few dare to flap their lips about.
Right - that said, care is supposed to be transparent and engaged with patients and their loved ones. I don’t think anyone dares to argue with that. The best decisions are made when relatives and advocates are involved. It’s harder work. So what - I say. But everybody else is like, ‘Hard work - no wayyyy!’ Obviously they’re all burnt out. All they need is a pay packet at the end of the month to secure their food and hols in Tenerife or whereverrr! LOL! You got me going. OMG!
Sidebar: I only discovered 4weeks into a job, that the brother of one of my patients has power of attorney for his sister on my ward. My discovery happened when I called him up to involve him in his sisters care just after 5PM this week. He’s telling me that he has told the hospital and supplied them with copies of the legal proof 3 times. But when I met him in person at a MDT review 2 weeks ago, I wasn’t aware and nobody else acknowledged his status. And today I asked me team an open question: “Is anyone aware of his special status in law?” Nobody knew - and when I told them - nobody demonstrated any familiarity with his status. Straight faces like ‘big deal’. Nobody said ‘OMG! I didn’t know we really need to involve him’. [Expletives withheld] Anways he has been most helpful to his sister’s care on the ward.
Sidebar2: At a ‘certain Special Hospital’ over 20 years ago, we had an advocacy service that was really active and held MDTs to account. Consultants hated them for asking ‘strange questions’ and ‘being difficult’. Fast forward to about 5 years ago, I return to work at said ‘Special Hospital’. It was hard to find an advocate. When on occasions they turned up, they nodded heads took notes and did the bare minimum, asking superficial questions. So I’m like, ‘What the heck is going on here?’ to myself of course. So one day I trapes over to the ‘Advocacy building’ and meet up with there management bods for a discusison. To put it in a nutshell, I’m told that they were contracted after a number of advocacy services were deemed unsuitable. The penny dropped. Basically the Trust went through the motions to find the weakest form of advocacy that just ticks the boxes. I’m not at liberty to go into greater detail.
Could you imagine if I was to become an advocate with my 30-odd years of experience as a psychiatrist? I’d ask such searching questions that I’d have complaints made against me - left, right and centre - with false accusaitons of being ‘aggressive’.
To wrap up: I’m all for advocates and relatives interfacing with MDTs. I wish I could meet up with people who need empowering with what sort of questions to ask - and how not to be fobbed off. Never back down - never be fobbed off. It is wrong - to sideline advocates of any type.
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I appreciate the content. Your blogs consistently provide useful insights, and the thoroughness with linked references is commendable.
I too am finding I am rubbing people up the wrong way, it bothered me a lot then I began to think if I`m touching a raw nerve, I could be doing something right.
The sentence is important, determining the appropriate questions to ask and ensuring that you are not dismissed, as this can easily occur when you are inexperienced.
I believe the term ‘bullying’ is appropriate in this context, as certain meetings evoke a sense of the playground bully.
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I must do an article on bullying on my website. It is an overused term. I’ve been accused of bullying people as well. It was nonsense. Bullying is not the appropriate use of power or control.
I had been bullied for three years by three consecutive trainers in my training years.
I nearly cracked up. I was in email contact with Tim Field a few months before he died (obviously). Not for counselling. He helped me with gaining knowledge. Get his book “Bully in Sight”.
Tim opened my eyes because weirdly enough I did not even know I was being bullied at the time. It’s a long story. Well the short version is that I took action, which then became entertaining. 
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Please do, that applies to everyone who finds themselves in this situation.
I have not read that book yet, but I will now. However, I have read Dr. Duffy’s book, which was also-opening.
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