Disappearing doctors: the limits of medical debate on Twitter

My adoption of Twitter coincided with the Liverpool Care Pathway (LCP) controversy. Naturally, I 'joined the conversation'. The compact exchanges that followed forced me to examine and re-evaluate my views. The links to press stories (in newspapers I would not normally read) and blogs helped me appreciate how broad the spectrum of opinion is. The... Continue Reading →

Not For this and Not For that: emphasising the positive in care for the elderly

It is a sad truth that we sometimes spend as much time deciding what not to do when treating elderly patients as we do determining what options are appropriate. The early part of each admission is straightforward enough – we take a history, perform an examination, form a list of possible diagnoses and initiate treatment... Continue Reading →

Derailed: how the LCP controversy has changed family discussions

The Liverpool Care Pathway (LCP) debate has brought the public's attention to the possibility that patients are being deprived of life, their death hastened, when medical teams decide that their time has come. The elements of the pathway that were intended to reduce the burden of treatment, such as not inserting new intravenous lines or... Continue Reading →

When paternalism = bravery: a ‘slow code’ dilemma

What are doctors supposed to do if a patient’s relatives fail to agree with a Do Not Resuscitate order, even when the doctor knows that such resuscitation would be completely futile? One solution to this, described in literature coming out of the United States, is the ‘slow code’. This is when a deliberately ineffectual resuscitation attempt is... Continue Reading →

Fatal error: a doctor deals with the harm she did

Junior doctors make mistakes, and how they deal with those mistakes is of crucial importance. In this dialogue I explore the psychological reaction and coping mechanisms of a Foundation Year doctor who has made a drug error, contributing to the death of a patient. She speaks with her registrar, who has been though a similar... Continue Reading →

Meaning it: acting, (in)sincerity and compassion on the wards

A consultant and her junior sit opposite the daughter of a dying patient. They have entered the relatives’ room following an assessment of the patient on the ward round. The elderly lady is clearly succumbing to pneumonia, and the consultant wants to explain why continued efforts to ventilate non-invasively through a mask and monitor intensely... Continue Reading →

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