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 →

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 limits of kindness: a patient with ‘pseudo’ seizures

Twelve years ago. A hospital at night. 9PM, and the night shift has started. My raggedy handover list contains many jobs; patients to review, “sickies” to keep an eye on, a chest drain to perform. At 9.30PM the bleep goes off - ‘fast’ bleep. Not a full crash call, but I need to rush. The... Continue Reading →

Resilience – from within or without?

  I have been confused about resilience. To me, it always seemed very sensible to focus on it, this ability to 'bounce back from tough times, or even triumph in the face of adversity'. It surely is part of the ‘hidden curriculum’, as Horne and Peters refer to it in their BMJ article, ‘Ensuring our... Continue Reading →

Wrecker

On this blog I have explored the challenges involved for doctors who engage patients in conversations about resuscitation. I have written about the emotional energy consumed in initiating them, and in The Hill, a series of 7 episodes, I described the spectrum of reactions seen in patients and relatives. Recently I gave a lecture that... Continue Reading →

Fear and medicine – friend, foe, natural bedfellow?

Juliet entered the ward expecting a normal, busy day. But the face of her colleague Nethmi who met her by the nurses’ station told her that something was up. “What?” asked Juliet, responding to Nethmi's wordless warning. “Mr Peterson. Bed 19. They took his vascath out last night.” “So?” “Did you tell the nurse to... Continue Reading →

Death eclipsed

  Finding the right balance between active treatment, which may include surgical or semi-surgical interventions, and palliative care, can be difficult. The two can go on in parallel, of course, but often a full palliative care assessment and plan takes place when the primary medical or surgical team have drawn a line under their management.... Continue Reading →

Checklist mentality

  The case for checklists has been made so well – see this fantastic article by Atul Gawande – yet those responsible for embedding them struggle. They are an effort, an obstacle, an apparently petty imposition. I know it’s the right patient! I know they’re not on Warfarin! I know what equipment we need to... Continue Reading →

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