Autonomy and the changing self: commentary on ‘Patient Undone’

  I was immediately drawn to Deborah Bowman’s Radio 4 programme on how her approach to medical ethics changed during her own experience with breast cancer. It was her ‘undoing, personally and professionally’. By this she means that the certainties that had guided her as a professor of medical ethics, as a teacher, were upended... Continue Reading →

After Bawa-Garba: the principle of shared responsibility

  The case had been rekindled in the minds of many this week for two reasons. Firstly, Hadiza Bawa-Garba has been allowed back to work, and secondly, court transcripts have become available. Excerpts from these have been Tweeted to counter several ‘myths’ or received facts such as ‘it was her first day back from maternity... Continue Reading →

The banned list

Does language always reveal underlying attitudes? Do lazy words confirm lazy thinking? These questions were asked when, some time ago, I entered into an ultimately fractious debate with an ED doctor who had 'banned' certain words and phrases in the department where he worked. I reacted to the list, as I thought it was overly... Continue Reading →

In defense of the single-issue consultation

I was struck this week by a sign in a GP surgery (seen on-line) that explicitly encouraged, or instructed, patients to stick to one complaint only. This seems contrary to every holistic instinct, to patient-centred care; perhaps it is inimical to good medicine. Yet it is a tendency I notice in myself, as a hospital... Continue Reading →

Soulful yet soulless: Henry Marsh’s ‘Admissions’

For me, Admissions illustrates a great tension that exists in medicine. The need to feel, to be sensitive, to be humane, versus the need to be impervious to tragedy and move on to the next case. In describing his work in three countries (UK, Nepal, Ukraine), and the many successes and failures inherent in neurosurgery,... Continue Reading →

The limits of kindness: a patient with ‘pseudo’ seizures

Twelve years ago. A hospital at night. 9PM, and the night shift has started. My raggedy handover list contains many jobs; patients to review, “sickies” to keep an eye on, a chest drain to perform. At 9.30PM the bleep goes off - ‘fast’ bleep. Not a full crash call, but I need to rush. The... Continue Reading →

A moment before dying

I have been told all about him, but I barely know him. He was admitted in extremis, but tests quickly confirmed that his disease had progressed too far. He cannot survive. We were not involved. All this - the initial diagnosis, the failed treatment, the progression - happened elsewhere. An ambulance brought him to us... Continue Reading →

An evening in the Dutch Centre: on euthanasia

‘Medicine didn’t work until 1850,’ says Dr Bert Keizer (72), who works in the Dutch Levenseindekliniek (End of Life Clinic). And truly effective, life-prolonging treatments only really developed after the 1950’s. In his opinion, modern doctors commonly ‘misbehave’ when faced with patients who are clearly near the end of life, but for whom there are... Continue Reading →

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