Category Archives: Effectiveness

Satori in the quicksand, the dimishing returns of a hospital admission

Thus, one doctor might say ‘chest infection’ another ‘bronchitis’ another ‘pneumonia’ and a fourth, ‘chest clear, probable urine infection.’

What is understood. Understood. Standing under. Capisce?

The humans built the tower to reach heaven or God and their punishment to forever live in perplexity, to hover above or alongside the dark matter.

Winter cannibalism, a theory of economics, healthcare, and D:Ream

Healthcare staff working in the late 90’s and early 00’s will be familiar with the airplane analogy. Sometimes a double-decker bus was used. This supposedly equated either (depending on who was talking and their level of cynicism) to the numbers of patients harmed or killed in US and UK hospitals every day. The UK planesContinue reading “Winter cannibalism, a theory of economics, healthcare, and D:Ream”

Dickens speaks to Marx who is in discussion with Harry Leslie Smith. They reach a compromise.

Yes, the NHS and the Tory.

Sure, the Tory has never liked the NHS, it is too leftie, too socialist, democratic, and yet, it is central to UK political debate; it is locked-in to our psyche.

Crisis, alert, no beds!

Many are unaware of the pain and sometimes indignity facing the patients (as Old Adam waits on that stretcher, in hospital gown, bottom or testicle peeking-out, he needs the toilet, ‘Just go in your pad,’ he is told.)

Thirty years ago and counting. 90’s reminiscence.

He has a glass that is so half-full that the Kool-Aid is spilling over the rim.

Anxious Jew Redux, Professor Ian Robertson & Blindboy

Doctors are great at diagnosing or assigning diagnoses. It is something that makes many of them very happy. It provides the doctor with certainty, a finite box in which to insert their patient and to focus treatment – antibiotics, pain killers or anti-depressants. (I am sure there is a dopamine release every time a doctor signs a prescription).

Cognitive dissonance, the NHS, Virtual Wards, and the rest of the shit that is going down

I even recently read in a patient’s notes the following:

‘Called patient for telephone appointment. There was no answer. Patient has not attended the appointment. See again in six months.’

When your batteries are running low, turn down the lights. Permanent pacemakers and other medical follies.

Recently, I received a message that my patient’s battery was running low.

Weight loss junkie (the pitfalls of too much safety)

Family-doctor-dietician and still losing weight; you must be failing the person, not meeting their needs, not creating innovative or adequately tasty food, not supporting mealtimes, not doing your job.

I was taken aback yesterday (Human Factors, Elaine Bromiley & your local medical school)

Yesterday, Friday, I was out and about visiting some of our patients. We have an odd or you might say unusual model of healthcare provision in the surgery, I, as a geriatrician, not a GP don’t see a significant number of the ‘regular’ patients, instead I focus on those who are older or living withContinue reading “I was taken aback yesterday (Human Factors, Elaine Bromiley & your local medical school)”

Photographic evidence. A long, convoluted road.

Sorry, you are inadequately tenacious to change the world. Go to prison. Do not stop at Go. Do not collect…

A dying breed. Knock, knock, It’s the doctor.

What makes a GP special is their knowledge of a patient, their insight over months, years, even decades into a person’s life. The bond that continues after the acute illness has passed, the person recovered, perhaps passed through school, left for college and returned, married then divorced, raised children.

Long distance relationships

It was a toughie. It took me an hour to unravel what was what, which medicines were which, what had been stopped, started, changed, what he could and couldn’t do, what he understood, what the family understood, the plans for further tests and follow-up.

My blood pressure is too high and when I get out of bed in the morning, I almost collapse. What should I do?

  Thanks to Nigel for inspiring this blog. If follows-on from yesterday’s about postural hypotension. I don’t think, in fact, I am almost certain, no patient has ever asked me this specific question, although it is a thing. It is a condition that is tricky to manage and I suspect, one which is becoming moreContinue reading “My blood pressure is too high and when I get out of bed in the morning, I almost collapse. What should I do?”

Hospital at home, virtual wards and turning care in the community on its head

The doctor calling the ambulance rationalises their actions, ‘I don’t know what will happen to their chest (NB not ‘Albert’, but his chest – a lapse into pathology and medical-speak

The cost of loneliness (Roubles, dollars or robots?)

One patient recently attempted to resuscitate her (toy) baby when the batteries ran-out.

Safety netting – to net or not?

Sure, some readers will think, ‘Honestly, this isn’t nannyworld, people have some responsibility, they should use their common sense.’

The week that was and was not!

Still recovering from IDLES my daughter tested positive for Covid.

Innovation, oranges and the impossibility of happiness (Monday imaginings)

…the shape of hills, the movement of water, muscles and the eye, the mechanism of the woodpecker’s tongue, the development of the foetus, creation, innovation, perspective and momentum.

Should I or he or she or they stay at home or go into care?

Locked in a room, when you are 90 and if you have dementia and significant physical and cognitive impairment is horrible. It is cruel and harmful. It is what our older folk have to do, whilst we, the rest are out and about, living it up.

Bob Ross, Happy and Unhappy accidents (healthcare and filler-TV)

I brought-up Bob when explaining to my colleagues the meaning of ‘happy accident’ – I was being flippant although the context was not.

Three days, 15 points and just starting to recover from the British Geriatric Society Autumn Conference

For the most, this was people showing-off their successes, how many older people they had saved from peril (mostly keeping them out of hospital), how many standard deviations from the mean their intervention had generated and so on.

Broken hearts, or why telephone consultations are less than 35% effective (homage to Heathcote)

Although doctors are being battered over the head for not enough F2F appointments, in reality, telephone reviews are much harder than seeing a person in the surgery.

Take away, facial expression, eye contact and body-language and it is far more difficult to know or understand what is going-on.

Thinking mindful – geriatrician asks his followers to ‘get high’

My mind has been in a Japanese meta-reality rather than on Wong Lane

It’s worse than it’s ever been. Just kidding… Not.

‘When will I receive my Covid booster?’ Asks patient Annie, 98, unable to leave her house for the past three years.

‘We are working-our way round,’ Says the doctor.

Caveat emptor – learner beware.

That doctors and nurses aren’t working hard enough, that the poor are poor from choice, and, that good things come to those who deserve it or who were born lucky.

I am long and thin by the end of the summer… Who am I?

You know the game. A cryptic clue and an unexpected answer. It came to me this evening, when I was discussing my role with colleagues. I am a hospital trained doctor who works in the community and helps older people, although sometimes young ones too. Who am I? I am a geriatrician. Although I hateContinue reading “I am long and thin by the end of the summer… Who am I?”

Manor Field Surgery Blog 10 Dizziness (three-part series) 

The most significant, particularly for older people (the definition of older is anyone who is older than you) when the effects of ageing can impair balance, coordination, and reflexes. 

Shady Towers, Social Care, Nora and Whitey on the Moon.

The PM announced a rise in NI tax this week. I understand this is to offset some of the damage they have done to the NHS over the past decade. Fantastic. (And yes, Whitey is still on the moon).

To stop or not? (Jerzy Kosinski, Oliver Sacks & other ideas)

If you watch the Robin Williams / Oliver Sacks movie/book Awakenings you will see what dopamine can and cannot do to the brain.

You get what you pay for. (this is not a happy one)

No, not the climate, not the uncollected bins, the zero hours, no, not the Shitty White Men travelling on purpose-built spaceships that fly over the filth and poverty of a world falling apart, all of it together.

If I told you I’m good, you would probably say I’m boasting & Teamworking

We want to be associated with the best – the best team, country, organisation.

Others don’t really care.

Some see the whole of the moon.

Others Brigadoon.

Function versus behaviour

Nothing works with Florence, distraction, diversion, joking, cajoling, all the old tropes fail. You have to accept that Florence isn’t eating and leave her alone.