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 →

Justice and safety: a dialogue on the case of Dr Bawa-Garba

  Everyone must have a view. Thousands have expressed theirs. Many have committed to funding an independent legal review. None were there. None heard what the jury heard. Most have read the essentials of the case, and we are worried that if we commit a serious clinical error, we may be ‘hounded’, ‘scapegoated’ or ‘persecuted’, first by the criminal... Continue Reading →

From the front

  Victoria, a new consultant, pushed for the procedure. It was, as they say, a ‘multi-disciplinary decision'. A consensus had been reached and the views of all those involved was clearly documented, but it was Victoria who made it happen. She had seen that Mr S. would go nowhere until a decision was made. Due... Continue Reading →

Omissions: reading the Kennedy report on Ian Paterson

  This imagined reflection by a doctor who worked with Ian Paterson is, of course, ill-informed. I was not there. But I have read Sir Ian Kennedy’s brilliantly written report (2013), and think that the messages it contains should be seen by the wider medical community. The report is 166 pages long, but perhaps this... Continue Reading →

Keeping the options open

There are many reasons why hospital doctors can be slow to engage patients on the question of DNACPR. This is one of them. A frail patient agrees that a DNACPR form should be put in her notes. Two weeks ago she was admitted with severe pneumonia, and survived a week in ICU on a ventilator. Although she... 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 →

Guilt trips

  Two registrars talk.   A. A chill goes down my spine whenever I hear about a doctor going to jail. What about you? B. For medical negligence you mean? Not for other stuff. A. Yes. For messing up badly. The missed septic arthritis, the overlooked peritonitis, mistaken identity leading to a wrong decision... B. You feel... Continue Reading →

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