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 →
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 →
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 →
‘…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 →
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 →
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 →
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 →
In this imagined scene I explore the reasons why junior doctors rarely blow the whistle on poorly performing senior colleagues. I have not been in this situation, and the words I place in the mouths and minds of my protagonists are based on suppos...
When a new junior trainee attended for his first clinical supervisor meeting I asked him to challenge what he saw on the ward, and not to be afraid to slow down the pace of things if he felt that his patients??? needs were not being met. A week late...