Autonomy and the changing self: commentary on ‘Patient Undone’

  I was immediately drawn to Deborah Bowman’s Radio 4 programme on how her approach to medical ethics changed during her own experience with breast cancer. It was her ‘undoing, personally and professionally’. By this she means that the certainties that had guided her as a professor of medical ethics, as a teacher, were upended... Continue Reading →

Introduction to ‘From Every Angle’

  In this the 6th collection of posts from Illusions of Autonomy I have explored complex situations through the perceptions and voices of those involved. This exercise is creative, and was inspired by William Faulkner’s 1930 novel As I Lay Dying. In this he describes the final days of Addie Bundren in the voices of... 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 →

Introduction to ‘When Windows Become Mirrors’

     When Windows Become Mirrors The 5th collection of articles from Illusions of Autonomy   Dedication To the readers of my blog who through their interest have encouraged me to keep writing for 5 years, and especially to those who have helped spread the word on Twitter, that powerful but mercurial invention. *** This... Continue Reading →

The edge

There isn’t time to go into every complaint in a typical clinic. There just isn’t. So, however open my initial question (‘How are things?’), I narrow down to the important matter quickly. Most patients understand this, and tacitly agree to drop other concerns. It sounds like bad medicine; it is certainly non-holistic, but it is... Continue Reading →

In my day

Reading about the situation at Derriford hospital, where two doctors found themselves responsible for over 400 people, I thought about my own training in the 1990s. Before you slap the computer shut or throw down the phone, I should say that although there is a fair amount of ‘in my day’ reflection here, it is not my... Continue Reading →

Think like me

Last week I delivered a lecture about resuscitation decisions. Part of it was a scenario, carefully thought out with my co-presenting colleague. We described a lady in the 80s, living in a residential home, with a degree of heart failure and some other co-morbidities, who had been admitted with pneumonia. There were markers of severity indicating a... 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 →

When death is not the end

This week’s report about a nurse being disciplined for failing to ‘revive’ a clearly deceased nursing home resident, has caused consternation. According to the description given, the woman was ‘yellow, waxy, almost cold’. But a rule mandated that the nurse on duty should commence basic life support and call an ambulance. For her to be... Continue Reading →

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