My mind has been in a Japanese meta-reality rather than on Wong Lane
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 didn’t say anything.
I watch the ripples change their size But never leave the stream Of warm impermanence So, wrote David Bowie in 1972. Whenever I think of change these lyrics play in my mind. Let’s take a position on change – it is essential; critical to the survival of our species – we grow, learn, adapt andContinue reading “Change, standing still and evolution”
I hadn’t laughed so much (about me, A and C’s stupidity) since arriving in Rotherham; this is the secret to significant improvements in health.
I have been blogging now for almost three years – thanks to those of you who have stuck with me throughout. For the odd person who has read every blog – hats off to you and cheers. I originally started writing back in 2015, following a period where I felt a little lost, with theContinue reading “What do people think?”
I wonder What is the rule for hospital Inpatient falls. I mean, There must be some Golden Rule That you can Work-out. How many minor falls For every bad fall. Bad being Broken hip, Brain bleed Death. Interesting ratio to calculate. ‘How many patients have fallen in your hospital inContinue reading “Falls (Swiss cheese and serious harm)”
The example being:
89-year-old woman, lives alone, dementia, diabetes, COPD, has fallen, bruised face – best admit.
And this is the thing.
I also wonder, what is the minimum number or, Perhaps, maximum, of, people working In close proximity without eye contact without smile?
They say* That clinical error is like Swiss Cheese; You line-up the holes, twist and turn through happenstance and bad luck and eventually If you are lucky You survive. And, if you’re not, the allergy is missed and the check and the dispense and the doctor and the nurse and the pharmacist are allContinue reading “Swiss Cheese”
everyone (I thought), knew that you write ’10 units of Insulin’ not ’10u’ which can be misread as 100 units, resulting in death or brain-damage
Today, I was asked for the first time, by someone who isn’t my patient, as to whether they should have a colonoscopy. This is, a fibre-optic camera inserted into their large bowel, preceded by powerful laxatives, sometimes accompanied by a hypnotic sedative and followed by, I imagine a smattering of wind. I found the questionContinue reading “Colon”
Last night’s blog got me thinking about some of the over-and-above things we do to our patients during their time in hospital. Dalteparin, is, I wonder an example of this. For those of you unfamiliar with this drug – it is a relatively new class of anticoagulant which can be used to reduce the riskContinue reading “Dalteparin”
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”
Today I gained a further insight into the workings of hierarchy and patient safety. On the ward-round we were discussing a variety of topics; From this, as often happens we talked about one of my recent blogs, in fact, the one about the two old men, who yesterday became one, when Len (not his realContinue reading “You made a mistake, dare I say…”
People might think that surely, within the 21st Century there can’t be that many people out there with these issues – have you read my blog on arses?
It is interesting. If you go back to the Great War and look at the men who returned from the front to be shot for cowardice, or later diagnosed with shell-shock and what we know today as Post-Traumatic Stress Disorder, how society views health and disease, physical and psychological wellbeing, evolves over time. It isContinue reading “Post-traumatic bullying disorder”
I don’t want to analyse the etymology of this phrase, yet, it is something that I have noticed cropping-up over the years. I suspect people say this outside of medicine, but in the context of a doctor taking to a nurse, ‘he’s a bit of an arse,’ tends to suggest the person has behaved inContinue reading “Bit of an arse.”
Once this shift, this change in perspective has occurred, nothing can ever be the same.
We not I.
Us not me.
And here is the connection back to Frankl. A safe workplace is joyful. Safety is achieved through the staff having a sense of control of their own lives and meaning for their efforts.
Eat a healthy diet
Get enough sunlight
Get enough sleep
Spend time with family and friends
What is important and where we must return is the individual starfish.
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.
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?
Snap – your left hip.
She survived. She could have died – I never asked the question.
‘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?’
You are unconscious, the focus for the doctors and nurses is maintaining your physiology with particular attention to your brain and heart.
As modern humans we are the best of the best – most of us are perhaps not as perfect as the Olympians strutting their stuff at Rio, but, pretty damn good.
Nevertheless, within the dark underbelly of medicine, where geriatricians live, there are some quite stunning effects often, from stopping and sometimes starting medicines.
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.
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.