Category Archives: Effectiveness

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.

Pressure ulcers (bedsores) & PCHC

I was recently involved in the care of a patient who developed a pressure ulcer. Behind this seemingly innocuous sentence lurks a whole raft of issues, concerns and aspects of modern healthcare. More surprisingly perhaps, I have spoken with several doctors who believe that pressure ulcers, their care, treatment and avoidance are not a medicalContinue reading “Pressure ulcers (bedsores) & PCHC”

State of frustration

I wanted to begin by discussing my recent practice FB post. I called it >very frustrating situation<. That was the best I could think at the time. What is or has been frustrating? Well, I won’t go on too much about Covid (lie). The vaccine has been rolling out over the past month. And, inContinue reading “State of frustration”

Little hands, absent feet and beautiful people

Of the 147 initial survivors, by the time they were rescued 13 days later only 15 were still alive, the others had been murdered, cannibalised or thrown into the sea.

How long until I die? (Locked down and out in 2020)

Often old men and women will seek human contact, particularly when feeling isolated – and when I reciprocate with my gloved hand (that they don’t appear to notice as being anomalously purple or blue) we are able to make contact, to connect.

this is me, again, and what you and i want or do not want when the ambulance is on the way.

I have become victim to the system bias of considering diagnoses and discharge destinations to be of more importance than the person I am discharging.

Two roads, fever, speculation and biases

Heuristics are the pathways or grooves laid down in our subconscious that make us behave in a certain way; habit. Something works this way, I will do it again, and again and so long as all things are equal, I am ok. If a variable changes and I don’t notice, I can be in trouble.

daydream believer, this can’t be a second-wave; i haven’t had my summer holiday yet.

And, yes, those bureaucrats, the apparatchiks who felt things were returning to normal will be once again on the back-foot and find themselves redundant, scraping the earth with their over-long arms, their Neanderthal gait giving it all away.

A long line of worriers and wear a facemask?

I come from a long line of worriers, which is apposite as the subject of this blog relates to discussions with my brother about Covid. You see, he has been a mask wearer. He also has asthma like me and the combination of worrier, asthma and the time of Covid is a toxic cocktail forContinue reading “A long line of worriers and wear a facemask?”

Thursday morning. Not another blog about advance care planning!

If this narrative has held together, my point is, we can offer just as good, if not better care, treatment and support for particularly older people in their own homes than is available through high-tech medical interventions.

Covid, my brain and the computer interface

Thanks Jane for allowing me to continue today’s blog; that was about the ways in which Covid has forced a change in my behaviour (likely, yours too) which in turn has led to changes in my brain. It is along the lines of the blog I wrote ages ago after reading a Stephen King bookContinue reading “Covid, my brain and the computer interface”

Charles-Bonnet Syndrome and other thoughts about physical and mental illness

Out optic blind-spots continuously adapt to provide us with a seamless sense of reality, only becoming real when we reverse into a wall that we didn’t see.

Self-organisation, the current state of the world and what has worked

Our growth, our evolution has happened unconsciously, at an intuitive, human level – we have been feeling not thinking, reacting not planning, doing what feels right rather than what we are told is right.

Lockdown, solitary confinement and loneliness

Imagine the harm done to those people previously ‘living well’ with dementia who for six weeks have had a dramatic reduction in visitors and day-centre attendances; even the bitter-sweet routine trips to GP surgeries or hospitals have been done away with.