Tempting fate: the perils of reassurance

Keats as drawn by Benjamin Robert Haydon, and a bird's wing (with pinions)   A patient comes to the clinic with common enough symptoms – say a slight change in bowel habit and a single episode of bleeding. It could be a cough that doesn’t go away, or a lump in the groin, or a pain in... Continue Reading →

Making deals: the problem of the self-discharging patient

There are times when a patient’s dissatisfaction stretches the therapeutic relationship to its limits. Take this example – a man of 32 survives an eight day admission on the intensive care unit, for, say, pneumonia. He is discharged to the ward, but develops a pneumothorax – a collapsed lung. In the middle of the night a... Continue Reading →

Singular histories, common needs: replacing the LCP

Image from Creative Uncut website The Leadership Alliance for the Care of Dying People published its interim report just as I was beginning to wonder what had become of the urgent changes set into motion by Baroness Neuberger's report on the Liverpool Care Pathway. Those of us outside the specialist palliative care community but deeply... Continue Reading →

The patient as riddle

'Speak friend and enter' - riddle on Westgate of Moria (Fellowship of the Ring) Recently a patient said to me, ‘Thank you for taking an interest.’ This compliment reveals a whole world of problems. It says, in ascending order of alarm – Up until now no-one has been interested I’ve been looking for someone to... Continue Reading →

A rare and unpleasant duty: involuntary treatment and the deprivation of liberty

One of the most disturbing and unexpected duties of a doctor in training is that of depriving a person of their liberty. The following secanario describes the emotional and intellectual challenges involved in sedating someone against their will to keep them in hospital. It is worth remembering that the doctors asked to deal with these situations... Continue Reading →

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