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Cabin fever
  1. C O’Mahony
  1. Department of Genitourinary Medicine, Countess of Chester Hospital, Chester CH2 1UL, UK; colm.omahonycoch.nhs.uk

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    Figure1

    EASTGATE CLOCK, CHESTER

    I thought I’d seen it all before, but this just takes the biscuit. This is the worst clinic premises I have ever seen. It appears to be a green Portacabin in the middle of a car park. When I tentatively opened the door, directly into the 6 ft by 6 ft waiting room, a gust of rain and wind whipped through the flimsy building. Eurocamp has bigger mobile homes than this building, meant to cater for a catchment population of almost ¼ million.

    My heart went out to the hard working, sympathetic staff, who actually use this place, and I can only admire the dedication and fortitude that gives them the courage to actually come in every day and cope with the indignity of working in such an inadequate structure.

    Strange, isn’t it, how Portacabins seem to be considered good enough for managing patients with sexually transmitted infections (STIs)? Can you imagine a newly appointed cardiologist, orthopaedic surgeon, or a consultant in any of the glamorous specialties being shown around their new outpatient department, which consisted of a thrown together temporary structure in the middle of a completely jam packed hospital car park? It’s all part of the old attitude that the acquisition of STIs is self inflicted and patients with such problems should be grateful that they are seen anywhere, so therefore anything will do. The extraordinary thing is that many of our own patients who actually have an STI share this attitude themselves, so they feel worthless, guilty and ashamed, and appear to be glad to be seen anywhere, even if it is a dilapidated Portacabin. This attitude is reflected in the incredible difficulty involved in getting any of our patients to complain about anything! It therefore falls to us as consultants in the specialty to do the complaining for them, and inevitably we get tarnished with the brush of whinging consultants only interested in empire building, the golf course, and private practice. Well, if that’s the case, we have been singularly unsuccessful at all three. The numbers of Portacabins dotted around the country are a testimony to our failed attempts to get buildings that help reduce the distress, embarrassment, and indignity that many of our patients feel. As for the golf course, there have been several failed attempts to get a GUM golf society established over the past 15 years by the few stalwarts who actually possess a set of clubs. I went to one “day out” once, and if it hadn’t been for the friendly microbiologists and other hangers-on that turned up, the day could not have happened at all. As for private practice—now there’s a laugh. Let’s be honest here and admit that in every specialty it’s waiting lists that generate private practice. Yet, here we are, the only specialty in medicine striving King Canute-like for open access clinics.

    Now I had tried to park in the car park near that clinic, but couldn’t find a space and ended up accidentally in the car park of the annexed private wing of the same trust. I therefore went through the private section and the striking contrast only induced melancholy and despair. The difference between the two environments could not have been more stark. All it takes to create a decent environment is a proper building, a bit of imaginative lighting, carpets, and furniture that haven’t come from some clearout or old people’s home.

    Individuals who have been unlucky enough to acquire an STI or even the worry of one should not have their shame and embarrassment compounded by a health service that considers a Portacabin to be a modern outpatient department. Well, it isn’t!

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