nhs, Uncategorized

Got to be real

Realistic medicine to me is the embodiment of modern day, pragmatic common sense healthcare.  How hard can that be? So ladies and gentleman I present to you a day in the life of Realistic Medicine….

It was the day after the incredibly thought provoking #RealMed2017 conference.  Now I can’t say I went to work brimming with new ideas as intuitively I try to practice this everyday.  However I know that many find the concepts a direct challenge to their current practice.  With that in mind I thought I’d begin by looking for opportunities that would highlight Realistic Medicine in practice.

The educationalist in me also wanted to tie it into ‘educational moments’ in the hope of expanding the current thinking of whoever I came across.

Great, let’s do this….

No wait up, I have a pile of results to go through and Immediate Discharge Letters (IDL) to check before I go to the ward. That won’t take long and then I’m all about the realistic medicine.

What’s this? – ‘will need a follow up CT thorax in 3 months’  Ok, has it been ordered?  Also why is it needed? It’s not mentioned on the IDL. I know it’ll be documented in the case notes. Ok, got it. Back to the IDL. Surely the FY1 has not thought that their GP should be organising this?!? *sigh* I’d better dictate a letter to the GP to apologise and say we’ll be doing that.  Oh and email my secretary to get the letter done and away today before I get an angry phone call from my primary care colleague. Whoops, nearly forgot to mention that I’ll see them in clinic.

Ok, that only took 10 minutes.  That’s annoying but it’s done. No, wait I still haven’t clarified if the CT has actually been ordered….

Are you kidding me? The IT system had locked me out for putting in the wrong password – again.  It’s been glitching all week by not remembering passwords.

Not to worry, I have a very reliable Nurse Practitioner who assures me it was ordered and is able to show me it on the system.  Sorted.

Which reminds me I need to follow up on a previous discussion with my junior staff about what counts as reasonable requests to pass on to Primary Care.  I find asking them to do reflective accounts quite helpful.  One of my colleagues jokingly asks if I use them as a form of punishment. No! (but it is more constructive that getting them to write ‘I must not do it again’ a hundred times).

Part of the discussion also centres on the role the patient plays in all of this.  Do we assume that patients play a passive role when it comes to their health?  I think we do.  It is as much about explaining to them what needs done and why in order that they take ownership too.  ‘I would suggest when you get home you ring the practice to make the appointment to get your bloods done’

On that topic of shared decision making the thrombolysis phone rings as I’m mid talking to a family.  The person has just been diagnosed with cancer and we’re waiting to hear back from the specialist team about the next steps.  It is heartbreaking to see them so upset.  They just want answers.  I want to spend longer but I’m being called to the Emergency Department.  I don’t have time to just sit and listen.  I feel guilty at having to leave mid conversation.  They understand but for a moment I let one thought creep in ‘I hate that stupid phone for making leave’

Then I check myself.  Someone else needs help and quickly. I abruptly switch my focus. It’s no ones fault but never the less it doesn’t feel right.

Off we go, I take my CMT (core medical trainee) with me to see what happens.  Things go on fast forward as it’s a time dependent treatment.  We get to the decision making – I don’t think we should proceed for a variety of reasons. It’s a fairly comprehensive list of pros and cons conveyed using simple, straight forward language.  ‘Anything you’re not sure about?  What do you think?’

The reply: ‘You’re the doctor, you know best. You decide’

Right.  Well, it’s a decision.  Was it shared?  I think so.  I’ll ask them about it again later.

This isn’t an unusual day with unique situations but normal, everyday life in medicine.  Did anyone think about them within a Realistic Medicine context? Not really.

One of the comments at the conference was around ‘affecting wider cultural change and not just having these conversations in the vacuum of healthcare’.  I personally get frustrated at the language we use and the surprise to which people react with when change isn’t happening.

Adapt your language to meet the needs of who you are talking to.  Do not patronise however.  Patients, relatives and healthcare workers are smart people. They want and deserve to be listened to as well as being treated fairly and honestly.

Realistic Medicine to me is about what would you want for you and your family/friends?  It is awonderfully simple concept but to deliver it within the complexity of healthcare, well, you just need to keep it real….

For more info on Realistic Medicine can be found here:

Click to access 00492520.pdf

Click to access 00514513.pdf



nhs, Uncategorized

Hi, my name is. Who? My name is. What? My name is…..

We live in a world of constant connections and yet most of the time people do not know who you are, never mind anything about you.

We had a campaign in the NHS called ‘Hello my name is….’ to remind people to introduce themselves and restore a little humanity into a busy workplace.

People like to be called by their name and I try very hard to remember it.  However I’ll be honest if the nurses move people around in the ward for whatever reason it will completely throw me.  I always refer to my patients by their preferred name but I will map them in my mind as a bed space number.  I then need a hook.  The lady who loves watching Strictly.  The man who worked on Christmas Island during nuclear testing.  The lady with the pink fluffy dressing gown.  Once you give me the bed number and hook I can rattle off all kinds of specific facts about them from blood results to the CXR findings;

‘Oh yeah, Mrs Smith Rm 9, bed 2. Has pneumonia, delirium and acute kidney injury.  CRP was 102, now 86. eGFR was 23 and is now 29. Lives alone, Package of care three times a day.  1 daughter and 2 sons. Loves Strictly Come Dancing’

Move her to a different room and I will think she’s either gone home or worse that she’s a brand new person.  I have been known to look blankly at the junior doctors until someone whispers ‘was a Louise & Kevin fan…’ 

‘Oh yeah, Mrs Smith…’ and off we go again.

So what is the big deal about a name if I can recall all that detail?  Well, no matter how much detail I can remember nothing is as important as the person’s name.

This was reinforced when I called a person by the wrong name in clinic recently. I had been talking about someone else with a similar first name and I stupidly used that name when I went to call them in.  They were understandably annoyed. I was mortified. Despite apologising and going through all the detail it took some time before I could convince them I knew what (and who) I was talking about.

I have even more trouble with colleagues.  It’s not just about taking them out of their work environment and seeing them in civvies.  It’s when I meet them at a conference or in a different work environment (think rotating trainees).  Not only do I struggle with their name but also in what context I know them from.  It’s a nightmare!

I have often joked that people but especially doctors should wear a badge stating; ‘Hello my name is… you may know me from such things as your FY2 on nights, that ALS course we did 7 years ago, that time I referred you someone at 2am etc etc’

Admittedly my response is something along the lines of ‘was I crabbit?’  I always assume the worst of my harassed past self.

So while a name is without question important, I do think we ought to see beyond it.  To me it’s the person behind it that matters – so come on then, what’s your hook?


Losing my religion

I went back to church for the first time in months. I’d decided to go back to the church I was baptised. It is a very joyous place.  My husband refers to it as a ‘happy-clappy, flag waving kind of church’.  Now it was also probably a coincidence but on this particular day there was even a confetti cannon.  Some of the leadership had just returned from a sabbatical so it was the congregation’s way of welcoming them back but still, come on, a confetti cannon people!

Faith and medicine to me are inextricably intertwined.  I could not do what I do without it.  It would make no sense.

Many would disagree with this outlook.  Now I’m not about to get all judgmental or preachy on the topic.  It is a contentious one that’s for sure.  However I do want to get into some of it.

In this service we heard about a baby boy belonging to one of the congregation.  He was undergoing heart surgery that morning and we were asked to pray for him.  I listened to the technicalities of the operation through my medic/science filter – it wasn’t sounding that hopeful.  Even if he did survive the long-term outlook was not going to be that hopeful.

Many in the congregation prayed.  Now you may question the power of prayer.  It’s ok, I get it.  How on earth is that going to work?  It makes no scientific sense.  I’ll be honest, I was even thinking that as I prayed with them.

However in that moment I was struck by just how much energy there was in the room just through the active murmuring of a prayer. Now what is it they say? ‘energy cannot be created or destroyed it can merely be transformed’.  That’s science. That’s fact. So where was all this energy going?

It would probably be the right time to mention that the baby survived the operation and is going home.  A miracle?  My scientific head can’t fully accept that – I know first hand all the scientific wonder that will have gone into making it a reality.  However I do believe that a parallel force was also at work.

More than that I know that the family will have been lifted and supported by that positive energy.  No medicine can quite do that.

For me that is what faith is all about.  It’s the bridge between the incredulous and fact.  I see it everyday in work.  All of us in healthcare will have had experience of those who, on paper, should no longer be with us and yet they are.

I think too we forget about about the behind the scenes effort that people put in with prayer and support. As doctors we are concerned with the numbers, the tests and results but a lot of the time we don’t ask about the other stuff.

In a time where person centred care is at the heart of what we do, we don’t ask what is in the heart of the person.

I think it’s one of the last taboos in medicine to be honest.  No one talks about it for fear of being labelled as a crazy nut job.

Yet, for many faith, is what comforts and sustains them though tough and dark times.  A hospital admission is just that for many.  So why not ask?

I haven’t quite figured it out myself yet.  If the person wants to talk about God then I do as well.  After one such occasion one of my trainees said she thought I was brave for doing it but admired my honesty.  I shrugged it off at the time. My view is simple – I use my God given scientific brain to figure out the medicine.  When it gets hard or makes no sense then it’s my faith keeps me from losing my religion….