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.
Not so much, ‘When in doubt, act,’ more, ‘When in doubt, care.’
One patient recently attempted to resuscitate her (toy) baby when the batteries ran-out.
The guest that over-stayed its welcome.
The Waltzer that doesn’t stop.
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.
‘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.
For all they care we could go to hell, so long as they can keep going.
It’s a bit shit.
#NHS #scapegoating #primarycare @BMA #justtryingtodoourjob
I read this morning about patients waiting 11 (eleven) hours outside of A&E departments.
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.
‘She’s probably holding something in her mouth,’ I said – since the arrival of pup, she has taken to hoarding all sorts of toys and chews in her mouth.
the back wings
What became even funnier was the background I occasionally use of a photo I took in the winter of a cob-web.
And, yes, those bureaucrats, the apparatchiks who felt things were returning to normal will be once again on the back-foot and find themselves redundant, scraping the earth with their over-long arms, their Neanderthal gait giving it all away.
A drooling, dribbling, stuttering, stumbling, drug-addled bully, we express our love through brutality.
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.
Sometimes eight or nine relatives would pack into these airless spaces to spend the last hours and minutes with their mum or dad;
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)
For today, I hope to keep popping out, spending quality time with patients, understanding what is important to them, their preferences, hopes, fears and aspirations, and supporting them to stay outside acute care.
..when you see society deteriorating, when there is so much potential for improvement, that is surely depressing; when you see vibrant doctors and nurses forced into early retirement because the work has become too much, that is bad; when you know that people have and will die because of cuts, what could be worse?
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.
Maybe we should call it ‘hospital check-out’, to get away from the nonsense of fitness, when many of the people described are actually quite sick and are often even dying, it is just that their death need not require a bed on a hospital ward.
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.
I will not go into more detail about this but suffice it to say, this is congruent with my values and probably my purpose.
You see, nowadays, in order to study medicine, you have to be little short of an academic wunderkind.
In life, there are those who work and act quickly; my mum would say, ‘chick-chak’ which I think is a derivation of Hebrew meaning, ‘promptly, without messing about,’ and, those who tend to dilly-dally.
Just to mention – a normal blood test does not mean that there is nothing seriously wrong – this part is the ‘art’ of the clinician.
Well, most of us – adults that is, have been drinking for many years, and, if you have made it into your 50’s, 60’s or older and are in reasonable health, you are probably close to the sweet spot.
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.
Like baby ants we scuttle around, working away or in retirement, too busy to look up and out.
This tells you how many boxes are ticked – it doesn’t tell you anything else.
And that is the thing.
It doesn’t tell you about quality or whether the interaction led to change or care.
When a surgeon is poised over my broken hip I would like that clinical sterility, that void of softness; yet, for that surgeon to function in a team, with people, peers, they need the kindness, caring and empathy of the group, the ability to be told-off for a silly mistake or mis-perception; ego can’t be allowed in.
…you see your destination and intuitively perceive that the way to arrive at that goal is not straightforward, indeed, you might learn that it is only a stepping-stone towards something else.
…all the way from human genome project, face transplants, over-the-counter Viagra, genomics and gene therapy to long-length of stay, delayed discharges and workforce crises.
All of these add richness to relationship and whilst not essential for me prescribing penicillin are essential to my humanity.
I am not a military guy. Anyone who knows me likely would agree with this statement – in fact, if you have met me, you would almost certainly wonder why a) I have even said it and b) Why ‘Commanders’ is in my title. Well, I’ll try to explain. It was an unusual Bank HolidayContinue reading “Leaders and Commanders”
So, the net investment in more doctors (and nurses and therapists and pharmacists) training is we stand still.
It perhaps has something to do with my internet settings or preferences, I don’t know; you see, I get a number of emails from different national and international health organisations informing me of conferences and award ceremonies taking place in the realm of Quality Improvement. This is the science of doing things better in healthContinue reading “Flow; best left to plumbers.”
Their eyes were dull, tired, their postured stooped; they emanated nothing more than a faint flicker of a need to keep going, to survive today in order to continue the next.
Now, I have long been one to call screen and not answer numbers from Clitheroe and Cambuslang; accepting that these are usually credit robots.
It means, I am your doctor, I am here to help, I will do whatever I can to support, and, with this the clinical contract – first, I will do no harm, second, this is confidential and, third, well, If I don’t know, I’ll find someone who does.
The pull of this is so strong it overwhelms our logic.
And so, we compete.
Compete for nurses, doctors and so on.
Scare resources don’t go a long way in a finite economy.
Give a man a McDonalds and he’ll eat it; give him a thousand and he’ll develop metabolic syndrome.
Would a tiger if given the option have chosen its stripes? Surely;
(When was the last time anyone checked the dirt level of an NHS keyboard)(Oops, should have said that – the snap response there is sometimes keyboard-condom rather than ‘clean the thing’ the former making touch-typing a nightmare)(when you do get to type, rather than write, which is a mixed-methods form of data collection, common in the health service).
I wrote a few months ago about one of the NHS terms that cause me feelings of anxiety – DToC, in other words, the acronym used to describe people who are deemed by the ‘system’ to be ‘delayed transfers of care’ – this being, people, mostly older, often frail, frequently living with dementia who areContinue reading “Super-stranded”
I’d never really considered healthcare as a competitive sport.
…this of course doesn’t mean that you won’t be the sucker to die on the tablet, you are just less likely.
(lots of references!)
In the past when I have written about Mr Hunt I have struggled to use his name, generally preferring the abbreviation ‘JH’ or just that man. As if, by not naming him he is less real, more likely to be the product of a too-vivid nightmare. But, alas, he is real. This leads me toContinue reading “Being Jeremy Hunt”
The system is not coping now, how will it manage tomorrow?
No, everyone can’t find the meaning of life in work, but so many of us find no meaning at all – the existential treadmill drawing us along.
The government is screwing the NHS through mismanagement at every level and this is left as the elephant in the room. Think of a grey animal. Yes, think of a struggling system.
Sure, we know that unnecessary hospitalisation is bad, but what about inappropriate institutionalisation?
Remember, I am not English…
But… Dr Who – he’s international; the guy with the blue police-box, alien time-lord?
This was a recruitment poster from WWI – designed to create a feeling of guilt in young men, chivvying them to volunteer, head-off to Flanders, Ypres or somewhere on the Western Front and, likely die. At least they wouldn’t have to face their children… ‘I stayed at home, because I didn’t want to participate inContinue reading “Daddy, what did you do?”
You take a cup, smash it, pollute the river and offer constant interruptions and the result is not tranquillity or effectiveness, it is, a mess.
I haven’t had a chance to thank everyone for the incredible send-off I received on Thursday. It was overwhelming and humbling. Such a group of amazing people – thank you and Namaste.
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)”
You can’t lie in the same hospital bed for more than the average length of stay which in your case, for your disease, disorder or condition is 3.76 days.
Most readers of my blog will not have heard of this term. I suspect most of those working inside the NHS don’t know of its existence either… DToC – Delayed Transfer of Care. This is how groups of mostly older people are categorised once they are deemed medically fit – (another NHS neologism which tooContinue reading “DToC”
I thought it an odd way for someone to explain, ‘This is how we do it,’ but, there you go – within a short few years that person had become a victim of the system themselves.
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”
Who have slipped from, Jean in the corner, retired postmistress from Fife, to bed 12;
Thank you, Wendy for the comment to yesterday’s blog. You mentioned the close-shave in my awakening to the values. And, you are one hundred per cent correct. If the values are at odds, you can’t go anywhere. It is ironic, for within the NHS, values are so pivotal to everything that happens – the goodContinue reading “Values”
I spent a few hours in York yesterday. I travelled up to present some of the work we have done in Doncaster in relation to Quality Improvement, dementia and delirium (signing, dancing, dog-visits – that sort of thing). Recently, I have been talking about the perpetual Narnia which the government has foisted on the NHS;Continue reading “York – somewhere else;”
…where, through an over reliance on targets, process and objectification, people became dehumanised, and where, with the current extreme pressures within the system, fixating on waiting times, bed-occupancy and length of stay, we risk falling into a similar trope.
I have spent so long recently crying over our beloved system, this was more like a time to celebrate.
It is not GP access that is the problem.
Pressure pushing down on me
pressing down on you
Quality Improvement is, fun.