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.
“whistle”… Rover, where are you? Oh, he must be upstairs on the bed, that old dog.
I brought-up Bob when explaining to my colleagues the meaning of ‘happy accident’ – I was being flippant although the context was not.
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.
If you watch the Robin Williams / Oliver Sacks movie/book Awakenings you will see what dopamine can and cannot do to the brain.
Older people falling is often a bad thing. The Kersh Condition and diagnostic heuristics.
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”
I have always accepted this concept; it has taught me humility.
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?
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.
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.
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!
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.
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”
A physiological determinism was accepted.
Whenever I heard this phrase, sick day rules, it makes me think that someone is celebrating sick days, as in, ‘Rod Rules!’ it isn’t meant to mean that, although I can’t think of an alternative. So, what are these rules? They are in effect advice for people taking different medicines (or who have specific healthContinue reading “Manor Field Surgery Blog Number 15 – Sick Day Rules”
Size doesn’t matter here.
This is not Land Rovers!
Pain is one of the most common reasons for a patient seeking medical advice. It also plays a major role in the progress of all sorts of diseases and conditions, in other words, sometimes the pain is the thing, and at other times it is an outcome of the thing.
If when you stand-up you become light-headed or dizzy, or, even worse, you collapse or lose consciousness, this is something to address.
In the UK we have a fantastic primary prevention service that aims to maintain the health and wellbeing of our population. It is perhaps not as great as Germany or Norway, but it’s pretty good.
In the olden days, over 65 was considered old.
Now, when I meet someone who is 75, I consider them young.
(In health your blood pressure rises when changing position; in disease if it falls, the blood supply to your brain, at times precarious, drops, you feel woozy, light-headed, you fall.)
I gave my annual lecture to the Sheffield University Medical Students on Thursday. It was the hottest day of the year. I have been standing in front of the students for something like 15 years – since I was training to become what I am today, a doctor obsessed with person-centred care, helping older people,Continue reading “Person-centred mainstream?”
Rod’s Blogs, Poems, etc. Table of Contents I search for meaning. 6 ‘Behavioural’ 8 10 Years. 10 10 years. 11 99+. 13 1559 days. 15 A response to Henry. 17 A tale of two times?. 18 Acute. 20 Advance Care Plan, Human Rights & I want what I want 23 alea iacta est 25 AllContinue reading “Blogs, Poems, etc 2017”
This medicine is an old-fashioned anti-depressant, taken in small doses to help pain caused by nerve injury or damage – we call this neuropathic;
Doctor, you know that medicine you gave me last night, to help with my pain, well, it seems to have made my skin itch and I have become all shaky and my mouth, it is very dry and I feel awful, do you think it might be the medicine that has made me feel worse?Continue reading “Doctor”
Dr Rod Kersh’s first blog for us is about Urinary Tract Infections or UTI’s. At Dementia Congress this year, we both heard a presentation about how home carers should respond to issues like UTI’s. It is fair to say that Rod didn’t agree with all that was said, so I asked him to share hisContinue reading “UTIs – myths, facts and what Wellbeing Workers need to do – with Helen Sanderson”
I started writing this, a little chuffed with myself as I thought I had invented a new word. Alas, someone has beaten me to it, although their meaning is slightly different from the one I intend to use here. In the Encyclopaedia of Ageing and Health edited by Kyriakos S Markides*, Polydoctory is defined asContinue reading “The Hazards of Polydoctory”
Our health and social care staff need to gain a better understanding of this condition – how to identify the early signs, how to diagnose and treat.
In most instances it is straightforward, and here is the trick.
Stop, look and listen.
When in doubt, don’t UTI.
It’s funny – well, at least to me, in my world of not so funny things; I was going to start this with, ‘Most people will have heard of de-prescribing…’ Then, I realised I didn’t know what I was talking about. This is groupthink & being a specialist all congealed into one. I’ll start atContinue reading “Funny… De-diagnosing (&de-prescribing)”
In fact, I saw two examples of good practice – one was probably better than the other, but both had a positive outcome of patients; I’ll explain. We have been working for the past couple of years on a ‘pathway’ to guide doctors and nurses in the hospital on how to treat those patients who haveContinue reading “I saw some great practice this week”
For those of you who haven’t read A Confederacy of Dunces, please buy a copy today (ideally from Waterstones)
…the depth of understanding which I possess is incomparable to that of even the most learned academic.
Nevertheless, within the dark underbelly of medicine, where geriatricians live, there are some quite stunning effects often, from stopping and sometimes starting medicines.