Above and beyond: a story

The NHS relies on its staff going ‘above and beyond’. Compliment letters from patients and relatives often refer to this quality in nurses or doctors; the extra effort, the small acts of care or kindness that are not required, but which make a big difference. At an organisational level, good and safe care often does... 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 →

Asymptote: answering the dreadful question

Working in a specialty that is almost overwhelmed by '2 week wait' referrals (patients who are sent by their GPs with a suspicion of cancer), I am often asked, 'How long?' For some patients, inevitably, are found to have incurable disease. It is the job of me and my colleagues to provide an answer. Frequently,... Continue Reading →

Reputations: the light and the dark

  A recent thread on Twitter brought up a subject that is really spoken about. Elin Roddy kicked it off with a comment that patients admitted to nursing homes should routinely be engaged in conversation about their preferences towards end of life. With habitual frankness, she later commented that there is a danger that those... Continue Reading →

The guiding hand

M.C. Escher - Hand with reflecting sphere   It's a common enough feeling but one that is rarely expressed. This patient did express it - or at least her husband did for her. The patient had undergone multiple investigations and several procedures during three stays in hospital. Her GP had referred her for a review... Continue Reading →

Notes on a judgment

  The judgment given in the case of Janet Tracey’s estate vs Cambridge University Hospital NHS Foundation Trust* contains lessons and warnings for doctors and nurses. There are fundamental implications, and there are subtle insights into how we go about discussing DNACPR decisions. The judge wrote, in conclusion: I would, therefore, grant a declaration against... Continue Reading →

Interactive Ward Ethics 1: Collusion

Welcome to the first interactive medical ethics adventure on the Illusions of Autonomy blog. You will guide an experienced trainee doctor, Nina Charan, through a difficult but not uncommon scenario, and in exploring the consequences of various decisions will experience the risks and pitfalls that are encountered on medical wards. It may end after just... Continue Reading →

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