Mindless medicine

Recently, I was taken aback by the approach of one of the doctors at work.

She is a bright young thing; smiley, enthusiastic; positive.

The scene was an older patient arriving on the ward before any of the doctors had the opportunity to ‘clerk’ them – this means, take a history, conduct an examination, review investigation results and make a treatment plan.

It’s not that complicated, but, as with everything in healthcare, prone to error or at the very least misinterpretation.

I decided, rather than wait for one of the junior doctors to see the man, I would take what information we had and work-out what was wrong and how to help.

I did my thing.

Just as I had finished, the young doctor approached, clerking document completed, review, complete with diagnosis and treatment plan; all before she had even seen the patient.

It was an awkward moment for both of us;

The doctor had copied the earlier assessment by the doctors in A&E, diagnosed pneumonia and started intravenous fluids and antibiotics.

This was a little different to my assessment – the old man having fallen because of his Parkinson’s disease, frailty and medicine complications with a plan to stop some treatments, conduct more measurements and speak with his wife.

The former was mindless medicine;

I am not saying that the doctor was mindless, rather, she was practicing medicine in a mindless manner.

This is different to being either stupid or uncaring, it is slotting into a comfortable thought-bypass and engaging in treatment and care as a bystander or observer rather than an active participant; it is taking the middle-road without considering whether there is either a shortcut or more scenic route.

The thing is, and I tried hard not to make her feel bad, this kind of practice is rife within health and social care.

It is auto-pilot practice.

It is documenting clinical observations that are the same as those taken an hour before, because, well, the patient looks OK, or writing, ‘too confused to tell me anything,’ when encountering a delirious patient rather than taking the time to phone the relatives or enquire from care home staff.

It is writing, ‘patient refused physio today, will try tomorrow,’ without actually challenging why the patient has refused – too much pain (sort the pain), don’t understand (try harder to explain), fearful (reassure).

‘Pressure areas intact’ when there is actually a large pressure sore underneath the dressing.

All of this is in part individual failure, it is mostly however system error.

It is the way we teach people to blindly follow protocols, pathways and guidance; it is what makes the nurse challenge my wearing a watch but miss all the dirt on the floor or the nurses not washing their hands; it is, to quote Master Lee, staring at the finger and missing the heavenly glory.

How do we fix/reverse this process?

It is easy.

Teaching, training, role-modelling.

Sometimes shortcuts are reasonable – in the midst of winter when the walls are caving-in, perhaps being focused and relying proportionately more on test results than patient assessment is conceivable, but, on a sunny summer’s day, when England is still in the World Cup?

No.

It is a reversion to person-centred care.

It is why the majority of staff working in health and social care made the first steps along the career ladder.

To help, to care, to share in human joy and tragedy; to participate, to ameliorate; support the lives of others. To take our rewards in the satisfaction that we have made a difference.

My suggestion for everyone –

Stop.

Take a breath.

Look at what you are doing.

Ask yourself, is this what I would want for me, my mum, my grandfather, baby-sister?

Moving a patient from ward to ward, discombobulated at two in the morning is sometimes justified; is it the right thing to do? Are there alternatives?

Taking shortcuts is part of everyday life in the NHS – this shouldn’t become standard practice.

Sometimes, slowing-down saves time – for the patient at least.

Treating a patient with medicine they don’t need for a condition they don’t have is not just illogical, it is wrong. It defies the first principle of all care – primum non-nocere; first, do no harm.

When the system is forcing people through pressure, hierarchy, coercion or mindlessness to behave in this way, we need to stop and re-evaluate.

It might take the doctor two seconds to prescribe the antibiotics – what effect does this have on the patient, the nurse administering the drug, the technician re-siting the cannula when it falls out, the security guard called-in at two in the morning to watch the agitated patient because they are delirious because of too frequent observations or blood tests?

One degree of separation can lead you down a crazy path. This is the reason for care, diligence and treating each patient as if they are both the first and the last; each is the potential beginning and end of their life, and, yours.

Tread carefully;

Don’t freeze.

Keep moving forward, but, take care.

Here be dragons.