hospital

Two roads, fever, speculation and biases

Heuristics are the pathways or grooves laid down in our subconscious that make us behave in a certain way; habit. Something works this way, I will do it again, and again and so long as all things are equal, I am ok. If a variable changes and I don’t notice, I can be in trouble.

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.

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.

To stop, or not: that is the question.

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

Teepee, tepee, tipi (Tzipi)

Camerado, I give you my hand!
I give you my love more precious than money,
I give you myself before preaching or law;
Will you give me yourself? will you come travel with me?
Shall we stick by each other as long as we live?

‘But, why do I have to go?’

‘Three days,’ the patient replied, ‘No one told me, I didn’t know what was happening.’

Discharge

This is when we can behave in ways that are counter to our usual preferences; the quiet guy shouts, the woman obsessed with detail makes rash and sweeping assessments, the emotional soul becomes a tyrant.

To send home or not?

It is funny however when people consider the fevered hospital atmosphere where cries of ‘discharge!’ often ring-out on Monday afternoon as the system like the mind of the poor doctor or nurse is sludging-up, a fat-ball of actions and risk mitigation.

Today there was a thing about falls.

Old man. In his nineties, he fell. He fell again after arriving in hospital. What to do with him? He wants to go home; we risk and capacity assess. Determine what is right, good or not and let things happen. We tried to get him home. I can tell you something; he’ll fall again. WeContinue reading “Today there was a thing about falls.”

Housebound

I struck upon this last night after reading the section in Hilary Cottam’s book, ‘Radical Help’ (See below). It is interesting, how people acquire certain statuses – handicapped, disabled, impaired; the same applies to housebound. This is a term we use to describe – I imagine (I haven’t consulted the dictionary), a person who isContinue reading “Housebound”

Troponinitis

Troponin, this Millennial test, investigation of the iPhone generation is, despite its reputation not all that.

Small is beautiful

ure, there are workforce and financial hurdles, but, the most valuable resources are people, and, by, supporting and nurturing their emotional, intellectual and experiential capital things happen.

Some thoughts on being medically fit

The system is not coping now, how will it manage tomorrow?

Medically fit – today and tomorrow (3)

You hear this term all the time nowadays, at least, if you work in an NHS hospital, are an inpatient or carer or relative of someone who is occupying a hospital bed. Most often… Are they medically fit? When will they be medically fit? If they are medically fit, have you done the take-home medicines?Continue reading “Medically fit – today and tomorrow (3)”

(299 792 458) The Speed of Light

Yesterday I received a letter from a GP. How many of you (patients, that is), realise that within our health and care system, on which at times your life, or the life of your family depends, and, despite 21st century technology that can take us to Mars and back, doctors are writing each other letters.Continue reading “(299 792 458) The Speed of Light”

Disaster avoided (2)

His autonomy was not violated. We reached a conclusion that avoided any crossing of boundaries between care and carer.

Why I’ve been so upset (& dumplings)

Who have slipped from, Jean in the corner, retired postmistress from Fife, to bed 12;

10 years

I have spent so long recently crying over our beloved system, this was more like a time to celebrate.

Dog

The constraints of modernity are a strange perversion.

Night at the hospital

There is an assumption that when the lights go down and the night-staff appear on the scene that things become quiet and still – a little like a scene from Bambi.

Person-centred

Could you Facetime your doctor when you are on holiday in Greece rather than having to wade through the complexities of health insurance (yes, Brexiters) and a foreign health system?

Just what are we doing?

Snap – your left hip.

1328 and some

‘Did my dad die because someone didn’t follow policy, didn’t pay attention or, was the outcome inevitable?’ ‘Might my mum have survived the operation if she had a different surgeon or she was at a different hospital?’

Unnatural selection

You are unconscious, the focus for the doctors and nurses is maintaining your physiology with particular attention to your brain and heart.

Medicines, etc.

Nevertheless, within the dark underbelly of medicine, where geriatricians live, there are some quite stunning effects often, from stopping and sometimes starting medicines.

1328

They aren’t diseases or malfunctioning organs, they aren’t flow or machinations of the system; they are universes unto themselves and those who love them.

Isomers, CRP and diet

The concept of a ‘reassurance scan’ is particularly treacherous, for often, odd abnormalities are discovered – with such frequency in medicine that they even have their own name… ‘Incidentalomas’

Gut microbiome, antibiotics and older people

We, the homeostatic organisms that have evolved over the past four billion years, exist in a state of serenity when well, but things can be thrown out of kilter by disease.

More than one path

What could be better – working within science and the metaphysical, the harmonious synchronicity of mindful being and state-of-the-art clinical science?

Teacups

In other words, intravenous saline although a fundamental part of modern medicine is nowhere near as good as a cup of tea.

The Interceptors

The point, as is often the case, is my aversion to patients. Or rather, the existential construct that relates to the ‘patient state’ = they who suffer; with the principal goal of my life being to obviate suffering, my objective is to really stop people turning into patients.

And that is the role of the interceptors.

Let’s talk

We humans are so incredibly expert at communication that we often forget about its importance, a little like breathing – which in a similar vein, is only an issue when you can’t.

Dementia awareness week #DAW2016

Slow down, be mindful, respect your elders, respect your knees & don’t mess too much with your hair!

Medically fit

So long as you are still able to participate, join-in with the conversation, your perception of self is just as valid as that of the doctor or nurse.

Continuity (ii)

I try my best to ensure the continuity of care, of relationships, particularly on my ward, which is critical as so many of the patients themselves are lost – being lost within a system which is itself lost, must be terrifying.

How far can you walk into a forest?

If you take away our air, our water and our food, we will not survive, that is the situation being foisted on doctors and everyone else in the health service.

Puberty, the NHS and Laloux

Here we have it, a system that needs to be changed, a system that is changing and a process that is threatening to kill that system – you might think of puberty with anabolic steroids or platform boots – wobbly, unsafe and unsightly.

Visiting time, or, what is 21st Century Medicine?

Our actions at times border on the holy, and we cannot allow the profane to defile the sanctity of the experience.

How the tree grew, Or… the unintended consequences of improvement and change;

The tree, like the people who work on the ward and who receive our care are part of the art, part of the creation, the magic that is our team.

Today I had a go at being a patient…

I didn’t have to remove my shoes, thanks to new trainers.

Innocence and experience – sorry, I don’t know

Unless I am 100% sure that it is the left kidney, surely I should ask before I remove the wrong one, or prescribe the wrong medicine or convey the wrong information.

I don’t like pathways

To a box, the world is the world, is the world.

Team – the next step

There has been a silent revolution happening…

Followers, leaders and into battle

Why should you follow them?

Habit, hospital & older people

Habits are our liberation, they are also a limitation

Sliding in, struggling out

An old man living alone, is that the problem? Is the problem that it is a problem?

Catheters, old men & dementia

As time marches on, with each passing decade, more men will develop these symptoms, until, in their 80’s and 90’s, they are almost universal.

Prisoners and systematic boxes

Alan Paton wrote Cry the Beloved Country, I sometimes cry for the beloved, the forsaken who don’t fit into our systematic boxes.

Planning ahead…

I’m sorry if this sounds a little dark, and that, is probably part of the reason most people don’t want to go-here.

Cannulas and Cannulae

I can’t imagine what modern medicine would be like without these colourful pieces of plastic.

Patients in pyjamas

Patients in pyjamas – it might sound a little flippant, but I think this is something that is very important. I cannot comment on the behaviours of other patients outside of the UK – we, in Britain, approach hospital attire in a special way; pyjamas. I don’t know when pyjamas began in hospital – whether backContinue reading “Patients in pyjamas”

Some more thoughts on urine infections…

It is likely that a doctor, a nurse or carer admitting, ‘something is wrong, I don’t know what,’ is better than heading off down a therapeutic blind alley.

Reducing restrictive interventions

Take a moment to think of those nurses, healthcare assistants, therapists and domestics who daily see beyond the fear and the worry of an old person, to the human being who is hiding in the shadows, obscured by layers of disease, for they are what keep us human.