I flashed-forward a decade and imagined them strutting around a hospital wards, missing the point as they seemed to miss it now.
Category Archives: Person Centred Care
Person-centred care and self-love
I, as a doctor might know all about diabetes or asthma, you as the person with the condition know all about you. What you know about you is always far more than I can know about the dry technicalities of disease, even with a lifetime of experience.
R-E-S-P-E-C-T
Whether I call them
Mr Cohen
Or Albert
Mrs Shleperstein
Or Gloria.
Please… Write to me.
It calls for better informed patients, a shift of the power-balance, away from ‘papa-says.’ It is an undoing of paternalism towards equality and inclusion.
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.
Why did granny die? They killed Gran. After Priestley. (A redo, 26/11/22)
The last time Elsie was in hospital was 50 years before when her son was born.
Memories of Mrs. Slocombe & Blind spots in health and care.
This, for mum was a terrible disability as language, conversation and socialising was one of her superpowers. Mum could talk with anyone at any time about anything.
the empty bed & the red dahlia
blink and you will miss it.
Tangled in safety-nets, a healthcare odyssey.
If you don’t agree, or even if you do, if you are in doubt, call an ambulance. I am sure the crew will be pleased to see you.
I just called / pieces of a man
What is left behind when you have gone. Audio legacy.
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.
Mild Cognitive Impairment, dementia, and a happy patient.
For the most, I think I know what I am talking about when I talk about dementia.
Papa
I visited my patient yesterday. He is from Alloa. In the Lowlands of Scotland. A tall, Former miner Now ageing gracefully. His grandson was there And his red-headed great-grand daughter. She sat colouring as I sounded The old man’s chest. ‘Papa, I’ll pop to the chemist.’ Said the grandson. He refers to himself in theContinue reading “Papa”
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.
Elephants, walruses, and forlorn carpenters
Freya probably spent her days swimming between Shetland, Norway, and Holland because of Global Warming; another shitstorm caused by us, people.
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)”
Minimally invasive medicine
They perceive the wonder of human spontaneity, the fragility of hope and fear, the layers of anxiety, of prejudice, hope, joy and deprivation spinning atomic around the patient’s sense of self.
Just say no.
The doctor might say, ‘I won’t give you any more pain relief until you have a test,’ a kind of pharmacological blackmail.
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.
The poop you walk past, Navalny and others on standards in society
It is more a chaotic butterfly of cause an effect, a stochastic randomness that nudges the world in a certain direction.
This is Dying Matters Week.
Freud suggested that we can’t imagine our own death.
I’ve tried and I can although it isn’t a comfortable or pleasant.
Oxygen masks, paranoid androids and helping others
Not so much, ‘When in doubt, act,’ more, ‘When in doubt, care.’
Civility, Incivility and being nice
Incivility from me to you is as bad as my stabbing you with a knife, just less bloody.
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
Analogy
To me it means ‘oy vey’ and ‘there you go’.
Human, all too human.
This is the transparency I encounter when I visit patients at home, in their poorliness or vulnerability, on their death-beds, in their terminal loneliness.
Black-belt medicine
For me, the difference between the two belts and their equivalents in medicine can be described as transactional and transformational care.
The cost of loneliness (Roubles, dollars or robots?)
One patient recently attempted to resuscitate her (toy) baby when the batteries ran-out.
Confusion Screen
In today’s blog Rod tried to explain what he meant when he wanted to say something was to complicated to be summarised by the word ‘screen’
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.
I was an ageist arse
Makes my think of my grandfather and his dilute Dettol baths or his pronunciation of Argos
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.
Have I got dementia?
“whistle”… Rover, where are you? Oh, he must be upstairs on the bed, that old dog.
Boxing day reflection
Death – tradition – Jewishness – family – education – self-consciousness
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.
Indulgence – Sunday morning in Waterstone’s Cafe
I read this morning about patients waiting 11 (eleven) hours outside of A&E departments.
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.
The offer of a natural death.
Occasionally the nurse in attendance might advise the paramedics or the doctors, ‘He was 100 years old, he was very unwell,’
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.
A Grand Unified Theory of Nowt
I popped into Tesco yesterday; there was no pasta on the shelves (no petrol in the pump either).
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.
Two worlds
If their lack of safety is 10 times greater than your perception of safety, are they safe? Are you?
To what extent has Covid damaged medicine?
the back wings
of the
hospital where
nothing
will grow…
Nakata, Aphasia and Sylvia Plath
Imagine being able to converse with a cat.
That’s what Nakata can do.
Every time I stand up I fall over.
Older people falling is often a bad thing. The Kersh Condition and diagnostic heuristics.
What matters.
Anyone who has spent much time in hospital will recognise the phenomenon of the invisible patient.
Muffled sounds, drum beat and dementia
Norwegian Wood
Yesterday
Michelle
Penny Lane
All resonating, taking me back and creating an atmosphere.
Safe in heaven. Thank you Freda.
Me and my dog and silence.
Silence is sometimes needed to re-charge.
And yet, Freda is gone and I never really said hello.
Hey Mr. Blue Sky
What became even funnier was the background I occasionally use of a photo I took in the winter of a cob-web.
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.
The merry-go-round
Interestingly, hospital can be the least-safe place for older people, with home being what most want and with far fewer hazards such as the risk of institutionalisation, over-medicalisation, polypharmacy, falls and a host of other healthcare associated ills.
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”
Covid patients
People say there are more bacteria in our gut than cells in our body; I am not sure how true this is – I don’t think I am ready to say I am faeces.
How do you reduce the risk of Covid over Christmas?
You can still hold hands if someone is wearing rubber gloves; you can still laugh or smile wearing a face mask.
Together, we live in dementia.
A basic human right – the right to family life has been bolloxed.
So, today I was on a Cabinet Office call about care homes.
People who don’t know things, asking people who know things to tell other people who don’t know things, things.
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.
Prisoners
I know that is so very much the essence of care – understanding the language of interaction. How to approach another, how to speak through gesture, to know what to say and what not.
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.
BAME, BME and me
The colour of our skin is various, the shape of our face, head and hair, yet, our eyes, seem a constant.
He has brown eyes doesn’t mean a thing.
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”
Dr Rod’s Odd Blog (almondemotion) 