My medical record…

I still haven’t accepted the standard of not writing clinic or outpatient letters to patients, or at the very least copying them into the correspondence.

e.g. Dear Mr J,

Thank you for attending my clinic this afternoon. It was a pleasure to meet you and…

Here is an example:

Dear Dr Mulberry

I saw your patient, Mr K in my clinic this morning. He attended with his wife Morag and daughter.

Mr K described a three-week history of non-specific dizziness.

He has a history of asthma, diabetes and hypertension.

You can imagine the rest.

It would end,

Yours sincerely,

Dr Z(ygmunt)

Consultant…

This is all formulaic and a little like the heuristics I have described before. The short-cuts that allow productivity but detract from effectiveness. Don’t think, feel. Or, don’t even feel, just treadmill.

There is a problem.

It is called type 1 and 2 thinking.

It is about modes of cognition.

Mindfulness versus unconsciousness (Consciousnessless?).

Doing what is right and doing what gets you from A to B.

Most of us, when conditions are optimal will opt for doing what is right. Driving at 60mph, eating wholemeal, switching the TV off at the wall. Yet, how often are we here?

The NHS is a good example.

Take, an intensive care unit with 10 beds (sorry to pick on the Intensivists) – an 11^th patient arrives in A&E, critically ill, requiring support for airway, heart and kidneys.

You cannot accommodate more. You need to find an ITU bed someplace else.

That’s it. Finite. (Zero sum). There might be difficulty leading up to the transfer, which, in itself can be fraught, but tomorrow things settle-down.

This is not the situation when more is added to more and units and facilities are created to accommodate extra and, as with last winter, even corridors outside A&E departments act as temporary holding bays and the nurses rostered to care for eight are responsible for 16 and the number keeps growing.

You cannot meaningfully do what is right all the time, every time. If you do, nothing will happen; you rely on fast-thinking, shortcuts, diverts and make-dos.

Auto-pilot.

Unconscious performance allows you to get the job done. You cannot be mindful amidst chaos.

Going back to my clinic letter; better to be mindful?

Better to consider that the only way to ensure you have the correct information is to involve the patient and their family in the correspondence, to not act in loco parentis, but in collaboration. Equals.

This is OK when the weather is calm. Take that clinic and double the demand; increase the numbers two, three times and the system starts to break-down.

Mindfulness and person-centred care have been a feature of this blog since its inception.

See here if you don’t believe me 🙂

Doing what is right, in the moment, for people not patients, stripping away the pretence; ripping a page out of the Catcher in the Rye. There is a time and a place for everything; there just is not necessarily the space or the capacity.

What do you do when there is ample time, adequate capacity and still people take the shortcut? That, I do not know.

All I can demonstrate is my sense of the way.

Mindfully engaging with a patient and their family is talking slowly. It is listening. It is sensing and hearing, intuiting what is not said and not considered, it is accommodating the in-between – rate of breathing, level of engagement, scent, movement, pause.

Person-centred is not using widget after widget for different shapes and sizes; it is made-to-measure, you flex and stretch to the dimensions of the challenge.

It is openness.

Honesty.

Vulnerability.

In the beginning was the word and the Word was God.

You can’t have that form of obfuscation when interacting one on one with humanity.

You have to strip away; cleanse; make do and mend.

Homo sapiens; we think.

We are more than thinkers; we are listeners; tinkerers.

If we listen, we are.