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”
I was recently involved in the care of a patient who developed a pressure ulcer. Behind this seemingly innocuous sentence lurks a whole raft of issues, concerns and aspects of modern healthcare. More surprisingly perhaps, I have spoken with several doctors who believe that pressure ulcers, their care, treatment and avoidance are not a medicalContinue reading “Pressure ulcers (bedsores) & PCHC”
Relative: Doctor, I believe my mum is dying, I want us to stop the antibiotics/fluids/oxygen/etc.
Doctor: No, I feel we should continue, there might be some improvement (aka other blandishment/platitude).
Now, here is the question.
How many of us are happy?
I have been reading Amos Oz’s book ‘Dear Zealots’ – it is a collection of essays reflecting the place of zealots in our world – the challenge in our relationships with them, their effect upon us and society, with some thoughts for the future, written last year by Israel’s greatest living novelist. In the bookContinue reading “Humanism/PCC/Amos and archeology”
I now request that we pull on another string of person-centredness.
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?”
How many older people enter hospital and never leave? Are never aware that the paramedics who carry them from their living-room floor will never bring them back; their secrets, mementos, curios, stashed-away in corners only to be discovered by relatives when clearing-out the house after they have moved-on or died.
Boab hands me my phone and is longer shouting, he is calm the rest of the day and the next.
Is this what we want? One overall winner with everyone else losing?
I went back to Doncaster yesterday, to take part in the Person-Centred Care training day we have been running for the past year. On this occasion, I attended as a guest speaker, which was a novelty. I also took with me some colleagues from Rotherham, so that they could get a feel for the workContinue reading “Silly hats, uniforms.”
It is like squeezing in to too small shoes. It can be done, it is awkward and, you can get about, but you look odd and you will soon get blisters.
I had another interesting discussion with a colleague today. She had heard about my plans to move hospitals and she wished me good luck. ‘I thought about leaving, but as I only have a few years left I am going to stick it out. I understand you have much longer… Go for it.’ This wasn’tContinue reading “Not many years left”
OK. It is Dementia Awareness Week 2017. Now, until Sunday the 21st. If you want to see what was going-on last year, look here. Today, we released to the world, via You Tube, our most recent film, focusing on Person-Centred Care and Dementia. Just because you have dementia doesn’t mean you stop being you. DementiaContinue reading “Dementia”
In fact, I saw two examples of good practice – one was probably better than the other, but both had a positive outcome of patients; I’ll explain. We have been working for the past couple of years on a ‘pathway’ to guide doctors and nurses in the hospital on how to treat those patients who haveContinue reading “I saw some great practice this week”
Now… I was ear-wigging this morning. I know it is a bad habit, but sometimes you just can’t help yourself. I had been called to see a patient on the surgical ward – an old woman & when I say ‘old’ (rather than ‘older’) – I am justified this time; she was 100. I wasContinue reading “Obese appendix”
All these little bits, these fragments of who we are, where we have been and what we have done contribute to our whole
Today, I am in Gouda, Holland. Tomorrow I am talking at a Microsystems conference in the local Green-Heart hospital. I don’t have much of an idea what it will be like, who will be there or even what I will talk about. Sure, I have a PowerPoint ready; as to whether this is what theContinue reading “Teal, Gouda & Buurtzorg”
The constraints of modernity are a strange perversion.
Let us lift our love-ones out of the morass of 21st Century care.
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.
Simplicity is the ultimate sophistication.
‘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.
Nevertheless, within the dark underbelly of medicine, where geriatricians live, there are some quite stunning effects often, from stopping and sometimes starting medicines.
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.
What could be better – working within science and the metaphysical, the harmonious synchronicity of mindful being and state-of-the-art clinical science?
In other words, intravenous saline although a fundamental part of modern medicine is nowhere near as good as a cup of tea.
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.
if you choose to follow this path in life, without basing your actions on, I guess, vocation, you are in trouble
Slow down, be mindful, respect your elders, respect your knees & don’t mess too much with your hair!
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.
How to change the system?
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.
And so, back to the junior doctors –
They came from across South Yorkshire and it was inspiring to be in a room with so many bright, young people
Our actions at times border on the holy, and we cannot allow the profane to defile the sanctity of the experience.
And so, to my colleagues, the team of Mallard, I say, here we are – we are something special, we are the exception to the exception that allows magical things to happen.
Balance is the essence of nature; winter and summer, hot and cold, dead or alive, we constantly fluctuate between these extremes.
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
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.
To a box, the world is the world, is the world.
There has been a silent revolution happening…
An old man living alone, is that the problem? Is the problem that it is a problem?
I have recently been asked to show what I do, to demonstrate, I guess, how much value I am for the money spent on me.
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.
Call the therapists, the carers, the teams who are out there
to keep me
Alan Paton wrote Cry the Beloved Country, I sometimes cry for the beloved, the forsaken who don’t fit into our systematic boxes.
We can look at quantity of life – something we have very little influence over, or, we can address, quality – an area we can influence tremendously.
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.
I can’t imagine what modern medicine would be like without these colourful pieces of plastic.
You don’t have ‘x’ – this can be good news for some, for others it doesn’t really help… Let me explain. If a person feels ill or has a specific symptom – (the easier ones tend to be breathlessness, chest pain or cough), there are a fairly standard set of tests or investigations whichContinue reading “You don’t have ‘x’”
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”
I guess, after the months that I have been writing about older people, memory and emotion, I should spend some time describing what, in my eyes, is Alzheimer’s disease – bearing in mind that this is my interpretation, rather than say the view you might get from another doctor, whether geriatrician, psychiatrist or neurologist. ThereContinue reading “Alzheimer’s – what is it?”
So, I have a problem with the elderly; what do I do when I have James, a 95 year old man, with coal tattoos crisscrossing his knees from years down the pit, as he coughs and lies in bed worrying about his wife who is at home, struggling to cope herself.
How can we change a 98 year old with pneumonia into a person, how can we sketch, add layers of detail that establish the place of this person in the clinical stratosphere? How can I convey their humanity?
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.
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.
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…”
The Verve released this song in 1997 in their album ‘Urban Hymns’. I was living in Dundee at the time and can remember walking down Perth Road singing this as I met my friend Phil who has walking in the opposite direction, singing the same song to himself. It is funny that so manyContinue reading “The drugs don’t work they just make you worse”