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.
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)”
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.
The doctor might say, ‘I won’t give you any more pain relief until you have a test,’ a kind of pharmacological blackmail.
Sorry, you are inadequately tenacious to change the world. Go to prison. Do not stop at Go. Do not collect…
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.
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.
It is more a chaotic butterfly of cause an effect, a stochastic randomness that nudges the world in a certain direction.
Freud suggested that we can’t imagine our own death.
I’ve tried and I can although it isn’t a comfortable or pleasant.
Not so much, ‘When in doubt, act,’ more, ‘When in doubt, care.’
Incivility from me to you is as bad as my stabbing you with a knife, just less bloody.
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
To me it means ‘oy vey’ and ‘there you go’.
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.
For me, the difference between the two belts and their equivalents in medicine can be described as transactional and transformational care.
One patient recently attempted to resuscitate her (toy) baby when the batteries ran-out.
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’
Sure, some readers will think, ‘Honestly, this isn’t nannyworld, people have some responsibility, they should use their common sense.’
Still recovering from IDLES my daughter tested positive for Covid.
Makes my think of my grandfather and his dilute Dettol baths or his pronunciation of Argos
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.
“whistle”… Rover, where are you? Oh, he must be upstairs on the bed, that old dog.
Death – tradition – Jewishness – family – education – self-consciousness
I brought-up Bob when explaining to my colleagues the meaning of ‘happy accident’ – I was being flippant although the context was not.
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.
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.
My mind has been in a Japanese meta-reality rather than on Wong Lane
‘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.
I read this morning about patients waiting 11 (eleven) hours outside of A&E departments.
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.
Occasionally the nurse in attendance might advise the paramedics or the doctors, ‘He was 100 years old, he was very unwell,’
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.
I popped into Tesco yesterday; there was no pasta on the shelves (no petrol in the pump either).
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).
If you watch the Robin Williams / Oliver Sacks movie/book Awakenings you will see what dopamine can and cannot do to the brain.
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.
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.
If their lack of safety is 10 times greater than your perception of safety, are they safe? Are you?
the back wings
Imagine being able to converse with a cat.
That’s what Nakata can do.
Older people falling is often a bad thing. The Kersh Condition and diagnostic heuristics.
Anyone who has spent much time in hospital will recognise the phenomenon of the invisible patient.
All resonating, taking me back and creating an atmosphere.
Me and my dog and silence.
Silence is sometimes needed to re-charge.
And yet, Freda is gone and I never really said hello.
What became even funnier was the background I occasionally use of a photo I took in the winter of a cob-web.
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.
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.
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”
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.
You can still hold hands if someone is wearing rubber gloves; you can still laugh or smile wearing a face mask.
A basic human right – the right to family life has been bolloxed.
People who don’t know things, asking people who know things to tell other people who don’t know things, things.
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.
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”
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.
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.
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.
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.
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”
Serial processing; switching backwards and forwards from concentrating on Word to Outlook to Chrome uses mental energy;
I have always accepted this concept; it has taught me humility.
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.
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.
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.
‘Will my mum be recorded within the statistics?’
I haven’t been asked that yet.
All we can do in the Time of Covid is to do our best and act in good faith.
We have closed schools which has reduced transmission; we can’t close care homes.
You wouldn’t send someone into the centre of Fukushima wearing a plastic flimsy? Well, the UK has allowed that to happen.
Well, if nothing (but everything) has changed, what is the big deal about DNACPR and ACP; what is new?
This will all soon be over and we can get back to huddling, cuddling or whatever.
How do we cope with Covid when we want to minimise clinical examination?
There is still plenty of bread, flour and beans in the UK.
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.
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’)
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?
Sometimes eight or nine relatives would pack into these airless spaces to spend the last hours and minutes with their mum or dad;
…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.
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.
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.
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)