Scarlett McNally: Valuing a patient’s name by using a number instead
BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p391 (Published 22 February 2023) Cite this as: BMJ 2023;380:p391
- Scarlett McNally, professor
- scarlettmcnally{at}cantab.net
Follow Scarlett on Twitter @scarlettmcnally
Many aspects of being both a surgeon and a patient can feel surreal. Once, when sitting incognito in a busy waiting room, I thought I’d heard my name and dutifully followed the nurse into the treatment area. It turns out that “Janet” can sound like “Scarlett.” Luckily, there’s always a second check before chemotherapy, but the nurse and I were well into the pre-treatment discussion before the error became apparent.
Hundreds of “never events,” such as surgery being carried out on the wrong person or at the wrong site, still occur in healthcare despite monitoring.1 The Healthcare Safety Investigation Branch, for example, reported how worryingly easy it was for a patient to undergo a gynaecological procedure intended for another patient by mistake.2
The holes in the “Swiss cheese” model show us how medical mishaps can occur despite multiple checks, especially when healthcare workers are rushed or fatigued.3 Another rare but preventable risk is confusing patients who share the same name, such as the case of a patient receiving a bronchoscopy intended for a namesake patient.4 The newly revised National Safety Standards for Invasive Procedures (NatSSIPs 2) suggest using simple checklists in outpatient departments to avoid mistakes.5
I’d argue that one simple solution could help. We should invite people into the consultation room by a number—for example, the last four digits of their NHS number. Importantly, this must be followed up with the question, “Please can you confirm your name?” as an additional check to prevent mistaken identity.
There are multiple reasons for introducing this, including patient safety, confidentiality, and awareness of cultural sensitivities around pronunciation of names.
Safety and privacy
Patients may be prepared to be called by a number if they realise that it’s in the interests of their safety. An NHS number or hospital number could be used in a similar way to other industries: for decades shops have used announcements such as, “Order number 6789 to collection point A.” Electronic display boards could help make this easier, especially for people with disabilities. Some hospitals and GPs have screens advising, “Joe Bloggs to room 2.” Others don’t, because they fear it risks breaking confidentiality. But they may be more likely to use a monitor that stated numbers, not names.
When collecting prescriptions you’re usually asked to state the “first line of your address” out loud in public—awkwardly announcing your home address to strangers, as though drug safety should trump personal privacy. Perhaps an alternative would be for pharmacies to ask people to verify the last four digits of their NHS number and then ask their name for confirmation. Initially, some people may struggle with learning their number or having it available, but using it consistently across the NHS could overcome this.
Healthcare is a balance between individualising and standardising processes. Instinctively, it feels politre to personalise an interaction with a name, yet we often guess at pronunciation. As a clinician, I’m always grateful when another staff member calls the patient in, so that the consultation doesn’t start with me apologising for poor pronunciation. Using a number for verification means that the patient is the first to speak their name in an interaction—giving an opportunity to clarify pronunciation, abbreviations, preferred names, or nicknames to ensure that the name used is the one the patient prefers. This could be particularly valuable to people with uncommon names, those whose name doesn’t match their official record, or patients with international heritage whose names are regularly mispronounced.
Covid-19 showed that clinicians can lead huge change rapidly. The change to a numbered system could be brought in by any organisation, any outpatient department, or any clinician in charge of a clinic. It needs two steps. First, the receptionist welcomes the patient and advises them to “listen out for number 1-2-3-4” or to look for it on the board. Second, the clinician calls out a number and then follows with, “Hello, please can you confirm your full name?”
No nationwide decree is needed. We could change this from the ground up.
Footnotes
Competing interests: Scarlett McNally is deputy director of the Centre for Perioperative Care (www.cpoc.org.uk). The centre pays her NHS trust 1 PA (one half day a week) for her time.
Provenance and peer review: commissioned, not externally peer reviewed.