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 →

The unknown quantity

What determines if and when patients ‘turn the corner’? I have never understood. In my world of acute-on-chronic disease, where patients suffer sudden and life threatening reverses, there are numerous stories of unexpected turnarounds. Our efforts to prognosticate accurately have led to many scoring systems, all of which have been ‘validated’, but when applied to... Continue Reading →

‘I wouldn’t want it but…’ – commentary on an important paper

  This study, published by the open access journal PLOS1 last week, approaches but does not solve two important questions: Why do doctors provide intensive treatment at the end of life when they would never accept it themselves? And how can they propose such treatments when evidence suggests that patients do not want it? The... Continue Reading →

Hollow heroes

Artist unknown, photo taken in Covent Garden market 14.12.13 Justifiably or not, young doctors are inspired and motivated by the thought that they might, one day, save somebody’s life. Opportunities come rarely, but spend long enough in a hospital and one day you will find yourself in a situation where a single action (be it... Continue Reading →

The moment: a tale of three doctors

‘…in the raw cold of that leaden crisis in the four-and-twenty hours when the vital force of all the noblest and prettiest things that live is at its lowest…’ Charles Dickens, Our Mutual Friend _____ 'This seraph-band, each waved his hand: It was a heavenly, sight! They stood as signals to the land, Each one... Continue Reading →

The cusp: ethics of the learning curve

  There is a moment in medical training when you think you are ready to go it alone. The difficulty is deciding when that moment has arrived. Independence, working without supervision, is a watershed moment. Imagine this situation. A gastroenterology registrar who believes that she is ready to deal with bleeding ulcers receives a phone... Continue Reading →

“It was as though I wasn’t there”: the problem of the invisible patient

The CQC has published the results of its 2012 national in-patient survey. Some aspects of it were picked up by the Independent newspaper on 16th April 2013. One of the observations in the ‘Doctors and Nurses’ section is that:There have been improvements in the results for questions asking about doctors and nurses, with the majority of respondents... Continue Reading →

Memory failure after medical error: the building blocks of experience

  There is a contradiction in medicine that has always interested me - the need to form a complete psycho-social picture of each individual patient (aiding empathy) versus the need to depersonalise, categorise and store their medical story (thus adding to experience). When things go wrong, this tension results in a paradoxical lack of humanity.... Continue Reading →

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