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.

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”

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.

Covid, pants and barriers to communication

I met an old man last week, his pants were poking out of his pyjama bottoms.   They were the same as mine M&S blue stars;   I was going to tell him and everyone else in the room about our shared underwear but, the facemask and the goggles, gown and gloves Got in theContinue reading “Covid, pants and barriers to communication”

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.

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.

Infection then and now, the Great Influenza and Covid… lessons from the past, reflections on the present.

You wouldn’t send someone into the centre of Fukushima wearing a plastic flimsy? Well, the UK has allowed that to happen.

Do Not Attempt (Cardio-Pulmonary Resuscitation) and Advance Care Plans in the time of Covid

Well, if nothing (but everything) has changed, what is the big deal about DNACPR and ACP; what is new?

Covid – My blog is calling (Week one, through a doctor/dad/outsider’s lens)

Fear of doing the wrong thing is a fundamental of quality improvement. If you are afraid to act because people might call you out or think you stupid, you won’t do anything, and the quality won’t improve. It won’t necessarily deteriorate either, yet, in times of radical change, that is worse.

Broken sleep & Coronavirus (Bruce Lee, the philosophy of time and space and this week)

Getting rid of the routine allows people to focus on what is important. (Bruce Lee said this in the 60’s – ‘Hack away the un-essential’)

This is black-belt medicine (areas of uncertainty in health and social care)

Ever been breathless at three in the morning? Do you have any strategies to sort yourself out, particularly when to begin you have a bad chest?

Why an ECHO focusing on human rights in relation to dementia and frailty?

…designed for maximum efficiency of staff and outcomes, not necessarily for the comfort or dignity of patients – we erect a thin curtain between beds and pretend it is sound-proof, for example.

Metrodome Part 2 – agitation in Alzheimer’s disease. (Words and the complex nature of a problem)

You will note this is the opposite of ‘There is no bus to Upton, you are 93, you have dementia, you are in hospital’ approach, which is likely only to worsen the anxiety.

Too negative, too positive, or should I just be quiet? (thoughts on the experiences of people living with dementia in the UK)

Ensure independence, autonomy and the right care and support for people living with dementia (and, yes, older people in general) and the NHS will be fine.

Catch-22, doctors, leaders and the NHS (healthcare, military and other absurdities)

What struck me was the similarity between bad leadership as described in the 256th US Army Air Squadron and… you guessed it, the NHS.

(Admittedly there are no bombing runs in most UK hospitals)

Doctor, my husband will see you now. Home visits, and why we should fight for them.

For today, I hope to keep popping out, spending quality time with patients, understanding what is important to them, their preferences, hopes, fears and aspirations, and supporting them to stay outside acute care.

GPs ending home visits – what the heck?!

Many are the result of an acute deterioration in the health of an older person, who, terrified of being admitted to hospital calls their GP. Many patients do not want to be admitted; they want to stay at home and recover.

Why I have been depressed for the past nine years (and how to save the NHS)

..when you see society deteriorating, when there is so much potential for improvement, that is surely depressing; when you see vibrant doctors and nurses forced into early retirement because the work has become too much, that is bad; when you know that people have and will die because of cuts, what could be worse?

Hospital

You see, The Plan says that more will be invested into community care, yet, the cumbersome nature of the NHS, again, the upside-down system of health and social care has resulted in lots or organisation and reorganisation but little transformational thought, little concept of how we can do things differently.

Manor Field Blog Number 19 COPD

It is never good to start something with an obscure medical acronym; ‘Chronic Obstructive Pulmonary Disease’ is however a bit of a mouthful and I suspect for many, even those who have the condition it doesn’t explain much more.

Medically Fit – 2020

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.

Anticoagulation and possible head injuries in care home residents

Consequently, significant numbers of very frail and older people are transferred to local Emergency Departments following either trivial head injuries or when a head injury is only suspected but not witnessed.

General Practitioner and General Physician

A patient with a headache is more likely to receive paracetamol from a GP, a CT scan from a General Physician and an MRI from the specialist.

Who is more effective?

My Job

Mostly, my approach is to consider that we, that is the community services (those outside the acute hospital) can and do support a far broader range of patients than people realise and, when working well together, can care for a significant proportion of the people who otherwise arrive at the door of A&E.

In the darkness we wait.

I have a patient Who cannot read or write.   I have not yet Determined the reasons why; Whether circumstance situation or something else.   Nevertheless, He struggles with many activities that you or I would find Straightforward.   When I was explaining to him the other day About the dosing of Paracetamol, I realisedContinue reading “In the darkness we wait.”

London to Glasgow (cardiologists and frailty)

First, I wanted to mention Neprilysin (and its inhibitor) as it seems to me to be such a cunning piece of high-tech science it should reach this blog. Then I’ll get to the cardiologists!

G. falls over and possibly bangs his head

He was treated with antibiotics and returned to the care home 48 hours later. During his stay he fell twice on the ward; there was an incident with a member of staff which led to him receiving intramuscular Lorazepam.

Influenza

This morning I had a brief discussion with one of our patients; she is on the cusp of her 65th birthday. And, for those involved in the administration of the flu vaccine, this is a thing. Under 65s get one vaccine and overs another. Why would this be? At first, my assumption was that asContinue reading “Influenza”

Doctoring, fast and slow.

In life, there are those who work and act quickly; my mum would say, ‘chick-chak’ which I think is a derivation of Hebrew meaning, ‘promptly, without messing about,’ and, those who tend to dilly-dally.