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.’

Dementia, David Cameron and losing ground

I am no historian. I struggle with details. Dates and times have never been my thing. I am however a reflector. I look at the world around me, absorb its colours and ponder. I was going to say ‘think’ although FEEL is probably more accurate. For once, I will not quote Bruce Lee (Google, ‘almondemotionContinue reading “Dementia, David Cameron and losing ground”

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.

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

In your sleep – (Safe in heaven, dead/)

It is an odd thought – dying in your sleep. Pyjamas, tooth brush, perhaps a few pages of a novel and no more. Your eyes close and at some point, in the night, heart stops. Dead.   This is what it is to be alive. Precarious, a tightrope of existence or not.   The mechanismContinue reading “In your sleep – (Safe in heaven, dead/)”

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?

Stop!  

She survived. She could have died – I never asked the question.

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.

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’

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.

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”

Therapeutic lies and false promises…

I have spent the past few days feeling bad – It is strange, when you discover that something you have been doing, that you had considered ‘right’ is explained to be wrong; it is a little like breaking the law when you don’t know something is illegal … I can’t think of an instance (or,Continue reading “Therapeutic lies and false promises…”

Locked-in, drugs & the 60’s

Here is a question… What do you do when someone you are caring for, refuses your attention? When you, the ‘carer’ – doctor, nurse, therapist, father or son are unable to find a position or a stance that makes sense to the other person, to the extent that you are viewed as a burden, anContinue reading “Locked-in, drugs & the 60’s”

Depression & hospitalisation

Earlier today I watched a TED video by writer Andrew Solomon about his experiences with depression. It is a mesmerizing performance from someone who is both stunningly articulate and strange. Solomon describes his experiences with depression and one of the most significant moments in the piece relates to him discussing the idea that depression isContinue reading “Depression & hospitalisation”

Falling over & knots

I hate it when one of my patients falls over on the ward. Each time this happens, I feel as if I, somehow have personally failed to keep them safe, safe, when they are unwell and at their most vulnerable. It is true, that people falling in hospital is complex, it is equally true thatContinue reading “Falling over & knots”

Dentures, specs & hearing aids

Amongst the piles of lost-and-found that accumulate in wards, care homes, clinics and hospital laundries across the UK, surely the missing dentures, spectacles and hearing aids point to something wrong with the way care is operating. ‘I’m fine, thank you,’ smiles Mary. ‘Do you know where you are?’ No response A little louder, ‘Mary, doContinue reading “Dentures, specs & hearing aids”