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 →

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 →

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 →

Batteries are low: the work of engaging in DNACPR discussions

During a talk I gave to an audience of palliative care specialists two weeks ago (St Barnabas Hospice, Worthing, thank you for having me), I wondered how they found the energy to engage patients in discussions about dying all day, every day. The comment was undoubtedly naïve, because that’s not what they do, and the... Continue Reading →

Curators of compassion

Mechanical medic, by Ben Mauro (concept art for the film Elysium)     “When I was hospitalized for multiple cancer surgeries, it was my #nurses who provided the compassion many of my doctors lacked.” – a Tweet I saw this week.   Why is this? Do doctors not care?   The question was brought into... Continue Reading →

Bed X – an explanation, not an excuse

Earlier this month Dr Kate Granger closed the NHS Confederation annual conference with a powerful speech. In it she described being referred to by a nurse as 'Bed 7'. These two syllables seem to embody uncompassionate care. 'Bed' represents all that is awful about hospitalisation, apart from the illness itself. It represents horizontality, frailty, powerlessness... Continue Reading →

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