The Revolving Door: the Endless Carousel of Opinions

Every new shift, every new doctor, arrives carrying it. A fresh opinion. A new theory. A different plan. Nearly every single day. And with it, the unspoken assumption that this time, someone has finally understood. For patients and carers who live with long term illness or disability, hospital admissions are rarely a single event. They are episodes in a much longer story – one that stretches back years and forward indefinitely. Yet, hospitals often treat them as stand-alone puzzles, to be solved quickly, or to be left unresolved, tossed aside as you would a cross word that gets the better of you.

This is where the revolving door begins.

A New Doctor, A New Story

One of the strangest experiences in hospital is watching a life by reinterpreted every 12 hours.

Morning ward round (if there is one):

“This looks behavioural”

Afternoon review (that you normally push for as you’ve been sat there endless hours):

“Possibly anxiety related”

Evening SHO:

“Could be gastro related”

The next day:

“I’m doctor……………could you just explain to me what’s been going on” and you feel something inside you sink. Because you already did. Yesterday, and the day before that, and the day before that. “Yes, I know” they say, “I’m sorry about that”. But the apology does not give you energy back. It does not return sleep you lost. It does not erase the fact that nothing has moved forward. So, you explain again, and again and again.

Each clinician speaks with authority. Each contradicts the last. What’s rarely acknowledged is that the patient hasn’t changed – only the lens through which they are being viewed.

For people with complex needs, especially those who are disabled, non-verbal, or reliant on carers, this constant reframing is exhausting and dangerous. Symptoms are filtered through assumptions. Distress is labelled. Long-standing patterns are ignored in favour of neat explanations that fit within familiar categories.  And carers – who hold years of lived knowledge – who are their voice, who, hold their relative’s chronology in detail in their head – are often treated as inconvenient narrators rather than essential witnesses.  Each retelling means reliving fear and repeating trauma. A system that relies on constant re-explanation is not neutral, it privileges stamina over truth. And for those with disabilities and their carers, it is not just frustrating, it is dangerous.

Medication as motion, not progress

When certainty is lacking, medication often becomes movement.

Something must be done, something must be changed, something must show action. So drugs are added, removed, swapped, increased, decreased – sometimes within days, sometimes within hours. A sedative for agitation. A painkiller without a clear pain assessment. A steroid without a full review of side effects (or whether needed). A mood stabiliser for symptoms no one has properly investigated. Each prescription comes with reassurance. Each has been described as temporary. Each is framed as a step forward. But over time, what builds is not clarity – it is confusion. Side effects mimic symptoms. Withdrawal is mistaken for deterioration. New behaviours are blamed on the underlying condition rather than the chemical storm now taking place. And when things inevitably don’t improve, the conclusion is rarely, “we may have caused harm”. It is more often: “the condition is complex”.

Waiting for the Doctor Lottery

Each morning brings quiet dread. Which doctor will it be today? Will this one listen – or dismiss? Will they read the notes – or ask me to start again? Will they see my daughter – or a diagnosis? Will they see me – or a problem? It’s not just care that’s inconsistent, it is attitude and willingness to engage. And you learn, quickly, how much hinges on that first interaction. How the entire day, sometimes the entire admission, will “sit” depending on who walks through the door.  They don’t see the battles – the complaints, the investigations, the letters, the safeguarding referrals, the trauma that still flares when alarms sound or voices harden. They don’t know how many times I have watched deterioration that could have been prevented.  So, when I push back, it is not hostility, it is memory.

When Opinions Become Power

Medical opinions are not neutral. They carry weight, legal, social and emotional. “Difficult to engage”, “Anxious parent”, “Behavioural”, “Safeguarding concerns raised”.

Once written, these labels harden. Future clinicians read them before meeting the person (probably about the only thing many do read). The narrative arrives first; the human follow second. And challenging those narratives is incredibly hard – especially when you are tired, frightened, unwell, or reliant on the very system you are questioning. For carers, this creates an impossible tension: speak up and risk being seen as obstructive or stay quiet and watch harm unfold.

The Human cost of the revolving door

What the revolving door of opinions and medications erodes most is trust. Patients become wary. Carers become hypervigilant, everyone becomes defensive. Hospital admissions stop feeling like places of care and start feeling like places of negotiation – where you must constantly explain, justify, correct and protect. And when discharge finally comes, it often arrives without resolution. Medications are left “to be reviewed”. Questions remain unanswered. Responsibility shifts back to families, the overwhelmed GP and community teams. Until the next admission and the door spins again.

You’ve Always Got the Hospital

You’re told you always have the safety net of the hospital. It is offered as reassurance, as a fallback. But what happens when the safety net does more harm than good? When admission causes regression rather than recovery. When protocols are ignored. When distress is created, not erased. When medication is used to manage systems rather than symptoms. For some of us, hospital is not a place of safety – it is a place of risk. A place where vigilance has to double to prevent harm. Where history is erased and yet the phrase is still used "you’ve always got the safety net of the hospital", as if the damage done there does not count, as if trauma does not accumulate, as if families don’t leave carrying more than they arrived with. A system described as a safety net cannot be credibly described as such when its use results in avoidable harm.

What Needs to Change

This is not about blaming individual doctors. Many are thoughtful, kind and genuinely trying to help with broken systems. But continuity matters. Listening matters. Curiosity matters. Real progress comes not from constant change, but from: respecting history, valuing carers as partners, being honest about uncertainty, investigating before medicating and understanding that distress is communication. Until healthcare learns to step off the carousel, too many patients and carers will remain dizzy – spinning between opinions, carrying the consequences long after the ward lights go out