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.
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.
Well, if nothing (but everything) has changed, what is the big deal about DNACPR and ACP; what is new?
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.
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.
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.
They are in the community, but not in the community in the sense of hospital specialists, rather, they are sitting at their kitchen table struggling with beans on toast, or negotiating the short distance between front and back room
A new class of drugs, originally called ‘novel anticoagulants’ (NOACs) and now, that they aren’t that new, ‘direct oral anticoagulants’ aka ‘DOACs’ have overwhelmed the marketplace
In the hospitals (the hole) we sit and wait.
Eventually, inevitably, the older person will fall-in;
Hard work, when translated into a vision that makes a significant difference is itself transformed, it becomes meaning, its return on investment is not necessarily financial, it is something more profound and longer-lasting.
The message however is usually quite consistent; if you can’t cure me, give me care, comfort, attention, involve my family and those I love, listen to them, consider their wishes.
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?”
This is how I often start, begin the conversation, listen to the story from the perspective of the husband or wife, son or daughter. They tell me about my patient, the deterioration, the frequent acknowledgment that things are getting worse, that they see the future. And, the system, the trying to do itsContinue reading “Tell me what has been happening.”
I want what I want now and I want what I want when I want it and – I want to be able to change my mind as often as I like as my mind is mine, as is my body and no one can tell me what I like or dislike, or want, etc.