Medically Fit – 2020

This is a niche subject and one that people will only encounter if they or one of their relatives or friends happens to become a patient in hospital.

Hospital isn’t a hotel.

Some aspects are similar – beds, linen, mealtimes, obliging staff.

The biggest difference relates to checking-out.

 In a hotel, so long as you are out by 11 everything is fine.

In hospital the stay is frequently less definite.

For some conditions it is easy. Cataracts, colonoscopy, hernias and knee replacement. Most people can be reckoned to be in and out either the same day or within a reliable timescale.

Humans when otherwise fit tend to be quite predictable.

In sickness all of this breaks-down.

Pneumonia.

Now, accepting that we are agreed on the definition (which is not always the case), there is an average (length of stay) for an average person; that is, so long as the infection isn’t too bad. Severe pneumonia and you might be in hospital for a week or two, mild and you might get away with a few days in bed at home.

Add age and co-morbidity (all the other things you have wrong with you) and the timescale stretches and distorts.

Those who manage and design hospitals and health services hate this variation. It would be far easier if we were all identical. (‘Widgets’)

I used to know a bottle-maker who thought he could run the NHS like he had his factory.

The determinant for getting home from hospital is usually described as being ‘medically fit’.

Now, this is not a term that I learned at medical school. It wasn’t even something you heard mentioned ten or fifteen years ago, yet, with the spiralling pressure of health and social care and the growth of older people occupying hospital beds it has become a thing.

Essentially, it means, the point at which a person no longer needs to be in a hospital bed and can go home.

I admit the term ‘fit’ can be misleading as the person might still be unwell, might not be fit for work and have several days of antibiotics still to take, yet, within the narrow definition of the hospital, it means that they no longer require oxygen, intravenous medicines of regular checks of temperature and blood pressure.

It says, ‘They are good enough to go it alone.’

Once this has been explained, the use of the term, ‘medically fit’ makes a little more sense.

Again, it breaks-down when you consider older people.

Medically fit might not mean they have recovered enough to walk, dress or feed themselves, just that they don’t have to occupy a hospital bed anymore.

In many situations or circumstances, the only people with the authority to deem an individual, ‘medically fit’ is the doctor. In some disciplines, such as day-case surgery, this can be delegated, yet, for medicine (medical wards – cardiology, care of older people, general medicine, that kind of thing), given that all forms of human health and disease are included it is more complicated.

And this creates a potential power-play with the patient in the middle.

It is equally odd that the sense of medically fit will vary between doctors; given I understand the skills and services that can be available outside of hospital, I have often extended ‘medically fit’ to everyone on the ward. Sometimes a little imagination is required, perhaps the utilisation of different staff or family members or even patients to take-on some of the responsibilities and duties that previously could only have been done by a doctor or nurse.

Check your temperature, blood pressure and oxygen saturations.

In hospital they call this obs.

There is no reason why you have to be a doctor or nurse to do this.

Last week I chatted with a woman in her 80’s who read-off her blood pressure and blood sugar readings, allowing me to alter her medicines over the phone.

In many ways, the concept of hospital is outdated.

So much of what happens can be done in a person’s home; with a little technology, the walls of the institution can fall, and people liberated, to make themselves medically fit, where, in a different time, they might have been considered a typical patient. (i.e. Carry of Matron days of the NHS).

So, dear reader, don’t be perplexed if you hear this term. It is just a representation of the difficulty some people have in understanding when you need to check-out.

Maybe we should call it ‘hospital check-out’, to get away from the nonsense of fitness, when many of the people described are actually quite sick and are often even dying, it is just that their death need not require a bed on a hospital ward.

The health service is staffed by individuals who work with their hearts and souls, in this way, it is a living organism in its own right; yet, it has a non-human part, an onboard computer that must ensure flow, activity and performance, that must meet targets that are not necessarily person-centred, but within the remit of pounds, shillings and pence.

Forgive them for they know not what they do.

When medical fitness is thrown at your aunt or uncle, mum or dad; it is how we reconcile the madness and inefficiency of a struggling system.