Blog

Uncategorized

Danger Zone

clcopeland

Today was a great day.  I flew a plane!

Ok, not an actual plane, I’d booked a session in a simulator next to Glasgow Airport.  For those who don’t know I am a recovering flying phobic.  A couple of years ago I decided to do something about it and went on Virgin’s ‘Flying without Fear’ course.  It was quite an eventful day but one I credit with literally putting a rocket up me to overcome my fear.

https://sparklystar55.com/2016/10/24/i-believe-i-can-fly/

Now of course my fear of flying was merely a symptom. The underlying cause was a crappy anxiety gene that manifested itself in panic attacks.  While you can’t do much about how you’re made up you can modify how things are expressed.  What helped in my case was that I also inherited a ‘don’t tell me I can’t do that’ gene.  Although my family will often say it’s just sheer bloody mindedness.  Whatever you call it it’s something that has got me where I am today and in particular into the seat of a Boeing 737 simulator.

I had decided after my exhilarating flight over Birmingham I would sign up for flying lessons.  Here’s the thing about phobias though, they don’t just go away overnight.  The control freak in me was only happy with learning to fly a big jet engine and by the way, only on sunny days with no wind.

As it turns out that’s not really something that we have in Scotland.  Oh, we do have the planes, just not the weather.  Apparently you also can’t just pitch up and ask for a flying lesson.  Something about training, cost, blah, blah, blah.  Whatever……

So I started doing some research.  I discovered most people start with small planes.  Tiny. Little. Two seater planes. No, not for me thanks very much!

To be honest I wasn’t entirely sure why I had this slight obsession about learning to fly.  A fair amount had happened since the course reinforcing just how far I’d come.  I’d flown my first solo transatlantic flight to Nashville.  I’d dealt with a medical emergency on a flight back from Gran Canaria. First time I’d cannulated someone and given IV opiates at 30,000 feet.

Mostly it was that I’d started enjoying the whole flying experience. There is a whole other world up above the clouds.  The views, the stillness. It’s just beautiful.

So back to my flying simulation – with all this positive affirmation in my head I thought it would be a breeze.  What I didn’t expect was the old familiar anxiety feelings to resurface.  So much so I nearly didn’t go. Ridiculous really!

However I applied the same strategy as I do when on an actual plane – I told them I had until recently had a fear of flying.  It seems one of their instructors also had this and now teaches people how to fly.

We started with a short talk on the principals of flying.  I was then given the option of going in the 737 or being taught in the simulator for little planes.

I have to say the flight deck of a 737 is quite impressive.  So many buttons and dials.  I decided however I wanted to fly properly so we headed back to the smaller one.

I know! I was as surprised when I said I’d prefer the two seater plane.

As I sat on the simulated runway of Glasgow Airport I could not only hear the noise of real life planes landing but feel it too.  It only added to the experience.  I may’ve been feeling teeny tiny but I was raring to go!

The next hour was spent flying around Loch Lomond, practicing banking, going up and down.  I took off (quite easy) and landed (not so easy) a few times.  To make it more interesting at the end wind, rain and low cloud cover was added.  I managed to land but forgot to use the peddles to steer once I’d got on the ground.  It finished with a rather flamboyant 360 spin.  I still managed to walk out the simulator in one piece though.

Whatever your particular phobia is I would urge you to push yourself to overcome it. There is a world of opportunities out there if you can.  For me, it’s been about coming out my comfort zone and into the Danger Zone……

education, geriatrics

A Whole New World

clcopeland

Three exciting things happened this week – I hosted my first ever Journal Club on Twitter, I attended the BMA Women in Medicine event and also presented at the Geriatrics for Juniors conference in Newcastle.

All very different but all with one thing in common – bringing people together.

My feeling over the past few months is that within healthcare there has been a creeping return to silo working. Whether it’s staffing on a ward area, the rota or teaching it all feels like people are in self preservation mode. It was nice to be pulled out of that for a while and see what was going on in the wider world

I’m not sure how many of you still run journal clubs at work?  They’re something that seem to have fallen out of fashion. I’ve got to be honest, in the past I didn’t like them.  For those who are unfamiliar, the premise was that some unfortunate soul was nominated to present a ‘topical’ paper at a lunchtime meeting.  This paper would then be dissected by the audience.  It was an opportunity for scientific ‘show pony-ism’ for the statistically minded. Usually I forgot to read the paper and when I did there seemed to be far too many statistics which I didn’t understand. I learnt nothing.

Years later I have come to appreciate their value in appraising evidence which is clinically relevant to my day to day work. I am still not keen however on the traditional design of a Journal Club.

What the @GIMJClub guys have done is take the same principal – ‘have paper, now discuss….’ and refreshed the format for a wider social media audience (#genmedjc)

In the week leading up to the Journal Club the paper and its supplementary links were shared across several social media platforms.  This allowed people the time and the flexibility to read it on a device of their choosing.  I must admit though, I still printed it off and sat with a pink highlighter pen – old habits!

The discussion was fast paced and hugely interesting. I learned loads!  The bonus part was it allowed people from all over the UK to take part from the comfort of their own home.

Using Storify, I was able to capture the main points reflecting a happy couple of hours of educational community.

https://storify.com/Sparklystar55/iqcode-journal-club

This energy followed me to the Women in Medicine BMA event a couple of days later (#BMAWomenMedicine). The workshops I found the most useful were those on Less Than Full-Time (LTFT) working.  It struck me that people were somewhat left to get on with it when it came to LTFT working.  As someone who has trained and currently works, correction, is paid less than full time it is a subject close to my heart.  We are seeing a change in the workforce with more people choosing to work flexibly where possible.

The BMA have recognised this and have introduced the concept of ‘LTFT Champions’. An informal go-to person to ask advice on the practicalities of LTFT working and to also  provide local guidance.  It’s something I’m looking to introduce to Forth Valley in the coming months.

To round off the week I was asked to present at the Geriatrics for Juniors conference (#G4J17).  The guys at @AEME are heroes of mine. Not only have they advanced Geriatric education they have raised the profile of the speciality a million fold.

On a cold Saturday in Newcastle ~200 mostly junior doctors attended a day of very entertaining presentations on the different facets of Geriatrics. To my mind this reflects the growing interest in our speciality, which I hope ultimately translates into more people training as Geriatricians.

What continues to impress me most about @AEME is that they not only recognised the need for a different way to deliver Geriatric teaching but they went out and did it.  They also managed to attract like-minded individuals to give up their time and contribute too – whether through a Connect event, a Podcast or their newly formed Mentor network.  Silo working just does not exist in their world.

Now of course you don’t have to go to these lengths to get out and talk to people. Pick up the phone, email (yes, I said it; its still a convenient communication tool), grab a coffee together or meet up with other specialty colleagues before a lunchtime meeting. One of my colleagues is trying to do this very thing by booking an area next to the lecture theatre.

Either way just get out there, people. You’ll be amazed by what you find….

Menopause

It’s all so quiet

clcopeland

The joy of being on holiday is guilt free daytime telly viewing.  I have watched all kinds of rubbish this week but one thing that caught my eye was on Lorraine Kelly’s show

‘Does your workplace offer any support for women going through menopause?’

Apparently Lorraine is running a series called the ‘M Word’. Now admittedly my original intention was to catch up on high street fashion but I was intrigued to see where the discussion would go.

I’ve shared my own experience in a couple of blogs but it’s something that I continue to learn about and hence want to write about.

So back to the question – I haven’t a clue but my feeling is no.  In the NHS if you are pregnant, had a needle stick injury or are stressed then yes, there is support and very good it is too.

However when I went to my local Occupational Health department a few years ago shortly after my diagnosis they didn’t seem to know quite what to do with me.  Now don’t get me wrong they were lovely and very sympathetic but that’s as far as it went.

‘Could we tie it into your migraines?  That would work as migraine is on our list?’

‘How would that help?  I’ve not had a migraine in ages’

‘You know they say that happens with the menopause so that’s good news!’

‘Right………Well, thanks for that. Bye!’

I didn’t really give it anymore thought until this week so I began looking around the internet to see if things had changed.

It’s worth noting that the NHS is 77% female and while the average age of menopause in the UK is 51 there is an increasing number of women under the age of 40 being diagnosed – 750,000. So it’s pretty common.

There are an array of symptoms associated with menopause but the one that stands out is mental health.  Many women are so debilitated with depression and anxiety that they’ve had to take time off work with some even leaving altogether.  What I found most shocking is that according to the 2014 Nuffield Health survey about a quarter of them thought their mental health problems were simply due to stress.

With that in mind I wonder how much our Occ Health colleagues ask about other menopausal symptoms in women referred with ‘stress’? Perhaps as it doesn’t fit neatly into a list I wouldn’t have thought it’s even considered.

What I have found over the past few years is a total lack of awareness never mind education or discussion.  Anything that has been done seems very stop, start.

Now I do admire those who are trying to break this cycle (pardon the pun).  Our nursing colleagues seem to have acknowledged it with the Royal College of Nursing and Midwives producing guidance.

Even the Police are taking it seriously – there’s a National Police Menopause Action group with a clearly defined processes and information for managers.

Despite all my searching I couldn’t find anything from the BMA or any other national guidance for that matter.  Last week I wrote about a workforce of ghosts and I’m reminded of this again when I think about all the women I encounter on a daily basis.

So on my return to work this week I plan to pop into my Occ Health department to ask them what our local guidance is. If we have none then I will be suggesting that one is developed or consideration given to organising some drop in sessions.

It would be nice to think that working women wouldn’t have to rely on daytime telly as their only resource. If so the only cycle that will continue is that of ignorance….

References:

https://www.nuffieldhealth.com/article/one-in-four-with-menopause-symptoms-concerned-about-ability-to-cope-with-life

https://www.rcn.org.uk/professional-development/publications/pub-005467

Click to access Equality%20and%20Diversity%20Publication%20-%20Working%20with%20the%20Menopause%2020pp%20A5_7.pdf

http://www.westmidspolfed.com/news/posts/?/Force-leads-the-way-with-menopause-awareness-training&utm_source=Magma&utm_medium=email&utm_campaign=Federation%20eZine:%20September%202016

https://www.unison.org.uk/content/uploads/2013/06/On-line-Catalogue204723.pdf

nhs

Día de los Muertos

clcopeland

My previous blog generated a fair bit of discussion around mental health and it’s something that’s still on my mind a couple of weeks later.

Since adopting (or at least trying to adopt) the 4 agreements the one I’m having the most success with is ‘take nothing personally’.  It really is quite liberating!  That said it still needs a degree of self awareness.  You can’t really blame someone else for projecting their reality on to you when in fact it’s you that’s being an arse in the first place.

It also doesn’t mean letting people away with behaving badly either. I’ve become much more aware of other people’s sense of personal responsibility for someone else’s bad mood or perceived injustice.

What I have been less good at is being ‘impeccable with my word’.  Man alive it’s hard!  It’s all good and well when everything is plodding along and you’re full of energy.  However after a day of constant paging, emails and bouncing from one thing to the next the only thing I’m impeccable with is my choice of expletives.

However it was with this fresh perspective that I went to our Consultant away day.  The day had been organised to bring together senior clinicians and management.  I’m not going to get into the detail of the day as the whole premise was to have a safe space to air views.  I would however like to make some observations based on the many away days I’ve been to over the years.

I am beginning to think that the NHS is being run by ghosts.  You know they’re there, you just can’t see or hear them.  Traditional thinking is that they are dead inside however judging by the comments made on post it notes or feedback sheets there is in fact spirit.  However that spirit is in pain, feeling frustrated and not being valued.

I always think the purpose of these days is to exorcise feelings in something akin to a purge. So is it merely enough just to write them down or stick them on a wall?

The reason I think many of these well intentioned days fail is precisely due to this.  It all gets written down and not followed through.  Many assumptions are made about whose fault it is and life goes on the same.  It’s all a bit depressing.

So why not try something different and call these days what they really are: ‘Day of the Dead’ and no, I’m not being facetious.

The Mexicans believe that the day celebrates the cyclical nature of life in particular how new life can come from death.  Why not in these team building, management away days openly talk about the past but with one major difference – let ideas and life evolve and flourish.

I know some of you will be thinking ‘but we do that’ however I’m here to tell you it’s the exact opposite that happens. Why else do we keep having the same conversations if things are moving forward?

What we need to do is restore a little faith and breath renewed life into our workforce. Acknowledge the past but not stagnate in it.

Let the spirit of our NHS live…..

nhs, Uncategorized

You Got the Love

clcopeland

When I started writing these blogs it was with the intention of starting some conversations and understanding different perspectives.  Most of all I wanted them to be authentic.

This week I gave serious thought to resigning.

A perfect storm of events last week lead me to sit down and try to put into words why.

As I read it back the following day it made for painful reading.  Most of the issues centred around everyone else and how I was reacting to their behaviours and attitudes.  There was very little about the actual job of being a doctor.  A job I love.

When I’m under severe stress or pressure I withdraw. I go into a mental bunker and stay there while my brain conducts a sort of mental purge.  All kinds of garbage can come spewing out.  Most of it is a series of imaginary conversations all of which are in fact rooted in reality.  Things I wished I’d said, what that person would’ve said if I had.  A whole lot of nonsense really.  However it’s this nonsense that depletes my energy and causes unnecessary friction.  It had also brought me to the conclusion that I no longer wanted to work as a doctor.

For those of you reading this who have never experienced it I genuinely admire you.  I do believe though that the vast majority are not so blessed.

My mental health is such that I can recognise the signs and choose to retreat.  I need to let my mind do it’s thing but at the same time try not to pay attention to it.

During these times I rely on practicing mindfulness (Headspace) so I can literally watch the thoughts float in and out my mind.  At the point I have to stop concentrating and ‘let my mind do whatever it wants to do’ I never cease to be amazed that it does nothing. Nadda.  No thoughts at all.  This amuses me no end given the constant chatter of it at any other time.

I also listen to podcasts. Shortly after listening to one such podcast I had something of an epiphany (or mini psychotic moment depending on your perspective).  I listened to an interview with Don Miguel Ruiz.  He wrote the book ‘The Four Agreements’.  I’m not one for airy fairy self help stuff but this book has made a significant impact on me.

The four agreements are simple:

1. Be impeccable with your word

2. Don’t take anything personally

3. Don’t make assumptions

4. Always do your best

Hearing him speak and then reading the book has really forced me to stop and take a proper hard look at my own perception of the world and how it’s so dependent on the opinions of others.  My preferred poison of choice – the one telling me I’m not really good enough.

What I have found in the space of a week is that like mindfulness, when you put a stop to the white noise you are left with something of a void.  I’m not sure what to make of it just yet other than it’s very quiet. If I’m being entirely honest the silence is taking some getting used to but it does feel good.

I also can’t say with certainty how it will ultimately impact not just my professional but also my personal life.  I do feel like there has been something of a seismic change in my outlook.  I also believe it stopped me from giving up on something I love.  And that can only be a good thing……

 

 

nhs

A Change Is Gonna Come

clcopeland

This week I met up with Jenni Burton (@JenniKBurton) she’s one of the smartest people I know and I love when we get time to have a proper catch up.

Predictably as two medics we got to talking about all things work related. In particular education, training and rotas

I’d been involved in meetings this week about how the medical rota was running.  It’s no secret that we’ve had problems and I’d come on board in recent months to help.

Managing a rota can be a bit of a poison chalice to be honest.  There’s a constant tension in trying to deliver both training and service so it can seem that no one is ever happy!

Of course what doesn’t help is some people going down memory lane and thus any discussion turns into the Four Yorkshireman, Monty Python sketch.

‘You were lucky to work 100 hours a week,  we used to work a 100 hours a DAY!’ 

I think that with any rota it’s important to acknowledge that in many ways things have got better.  However we are working in a different culture.  One where the focus seems to be on the training experience and less about the work itself. I don’t think the balance is quite right.

So I think we need to be honest about what we can and can’t deliver training wise while trying to maintain a proper service.

It occurred to me as we were talking that while I spend a lot of time ‘clarifying understanding and expectation’ with my patients and their relatives, I don’t always extend that to our junior medical staff.  What I mean by that is clearly defining expectations and explain some of the decision making process.

As an organisation we need to be up front about saying there are two choices:

1. The best training experience you will get is not through going on umpteen courses, it is by being at work.  Going on ward rounds, getting to clinic, talking to relatives, running the acute take etc. This is enhanced by continuity i.e. keeping you on the same ward most of the time. In order to deliver that it is going to mean compromise.  In this case fixed annual leave, less study leave and few swaps.

Or you can have this experience:

2. You get to go to all your study leave, have your holidays when you want but the overall team will be spread extremely thin.  The compromise here is you accept that you will be moved around a lot to cover gaps.  You may even have to do more on calls.

You cannot have both.

There is a service to run and sick patients who need doctors of every grade to look after them.  There’s also the fact that you also get paid for this and quite well, relatively speaking. That in itself comes with professional T&Cs that come with taking on this job.

It’s not just Forth Valley that haven’t got the rota quite right yet. I do think we need to try different things and see what works.  Jenni was telling me that when she worked in Leicester they offered exit interviews for trainees.  I think this is a great idea and much better then the trainee surveys (they always seem slightly out of date and skewed depending on the number of replies).

Potentially real time change could be achieved by allowing trainees to shape and deliver their training while keeping it in line with local needs.

What we don’t need is a talking shop where we are seen to be engaging with trainees but won’t follow through with the difficult conversations or decisions.  Of course none of this should be done in isolation.  It is as important to have these discussions with Consultant and Nursing colleagues.  I don’t really think we have really acknowledged that their role is also changing as we have more gaps/less trainees.

I do believe we will ultimately get this right. It may be a long time coming but I do believe a change is going to come…

Holiday, nhs

Club Tropicana

clcopeland

Holiday resolutions – full of good intentions and emphatic declarations of how things will be different but how long does it take for them to be broken?

In my experience…. a couple of hours…. then the familiar feeling of never having been away sets in *sigh*

This time I decided to try approaching my return to work rather like an extension of my holiday.  It has many similar features after all.  Not convinced?  Well lets look at the evidence……

Packing

The night before I pack my work rucksack, sadly It’s not nearly as exciting as actual holiday packing.   For a start there’s no inflatable unicorn drinks holder. However it does contain the same essentials – a form of ID, portable air con in the form of my lovely Spanish fan, a variety of snacks and money, well at least a card that’s been paid off this month. I think…

The fragmented night before sleep

I wake up. Again. It’s 5.20am, it’s dark and I suddenly realise that my alarm has been set to 6.30am instead of 6.00am?!?  I leave at 6.45am for my train.  Horror of horrors I could’ve slept in!  Thank goodness I woke up except now I have 40mins before I actually needed to be up and I’m proper awake.  Oh joy. Yes the sleep before you head off on hols is pretty much the same as that the night before heading back to work.  Rubbish!

 The journey

I have no pre allocated seat and there’s no drinks trolley bringing me gin (this is a work commute people, not the time zone freedom that international air travel permits!)

I do however have my own entertainment system in the form of noise cancelling headphones, podcasts and music. Sometimes the white noise of people snoring or tapping on their phones can be perfectly pleasant too.  Rather like the background hum of a plane. Must not fall asleep. Must not fall asleep. Zzzzzzzzzzz

You have reached your destination!

The destination

It’s bright and sunny as I arrive at the Costa del Larbert.  I see some people outside enjoying the ‘fresh air’. The aroma of freshly ground coffee and muffins greats me as I walk through the doors. White washed walls of the building remind me of the Mediterranean.  Yes, my brain is beginning to fall for this being just like on holiday. I wonder if I’ll have any messages……

The welcome pack

Good morning Dr Copeland – you have 204 new emails. That is so nice!  I bet it’s all good news.

Ooooo – what’s this? An animated email trail.  I forgot to pack my holiday read so lets see what’s this about. Right…. They said what?….. . So I said…… And then he said…. And then I was like ‘no way’ …. So I said to her…. And she said…… And then…… Lol, a winky face emoji…..

Well I’m glad that didn’t escalate and everyone is still talking to each other.

I best head to the where all the action is – off to the ward.

Good morning welcome meeting

Hello everyone and welcome to sunny Costa Del Larbert.  It’s great here – lots to see and do.  On that note Mr X fell last night and doesn’t seem quite himself.  The family of Miss B wants to speak to you.  And can I ask who’s covering….

Beep, beep, beep

It’s my welcome back page – how many have phoned in sick?  Well that is a problem….

Back to reality

While all this is going on my brain keeps popping up ‘Club Tropicana’ while I wait for the computer to load or the person to pick up the phone.  I smile at the ridiculousness of it all.

Holidays are, by design, a break from reality.  A chance to recharge and switch off from work.  However today tells me that by injecting some of my holiday mood into everyday work life, occasionally there is fun and sunshine.  To be honest all that’s missing is the sea….

Holiday, Uncategorized

Hey, how you doin’ Sorry you can’t get through. Why don’t you leave your name. And your number and I’ll get back to you….’

clcopeland

There’s been a lot of chat on twitter about annual leave and email checking.

My colleague tweeted that he’d managed to clear  500+ emails of the thousand or so he’d come back to post hols. What followed was an interesting thread discussing the pros and cons of auto deleting emails.

Now I have a small confession to make at this point. The volume of emails my colleague received…. I’m pretty sure were generated in part by me and rota discussions (well he did go on holiday at changeover).  For the first week he was copied into every email. I’d assumed he would want to know.  I stopped doing it in week 2 as it was starting to get ridiculous not to mention pointless. As long as emails were being actioned did it matter if he knew about every, single, decision? I decided no.

So that’s what made this twitter thread so interesting.  This idea that you could delete 1 – 2 weeks of your professional life hoping that people would understand and leave you alone to relax in peace.

Now while I support this concept, I know others do not.

My experience is that there are quite a number who use the excuse you’re on holiday to email about things knowing that you’re not around.  And not in a good or helpful way.  There is definitely power politics at play while your out of office is on.

‘Oh I’m sorry, were you not aware of that?  I did copy you into the email’

Hmmmm…..

Of course there was a time when I would get quite wound up about this.  However I have come to realise it says more about them than me.  I can choose not to react/care.

A further dilemma is how to manage the return to work email overload.

What would be lovely is if some reliable, trustworthy person from each facet of your professional life did a ‘return to reality handover’.  Rather like the handover you might do about your patients before you go on holiday.

It would be succinct and available on the morning of your return.  I have tried this with said colleague who went on leave – I even messaged him with a ‘of all the c**p in your inbox could you read mine first?’

Then there’s the welcome party when you get back to your clinical area:

‘Can I just ask you about….. I sent you an email’ 

‘I’ve literally just got here, I have no idea what you’re talking about’

You usually need to wait a few minutes for shocked expression to disappear from the persons face.

Again the expectation is that while you say you’re not checking your emails, they believe you secretly are and that you’re lying if you say you don’t because who doesn’t check their emails on holiday?!

I do believe the sincerity of those who are trying to get people to take an actual break and encouraging them to auto delete.  I just don’t believe that everyone will do this.  I’m not even convinced that it’s needed if I’m being entirely honest.  People will do what people will do.

My response:

‘Hiya, I’m on my holiday at the mo.  I start back on September 11th however it’ll take me a few days to catch up.  If it’s important then page me or resend on that day.  Thanks.’

I usually add a bunch of who to contact at the end too.

Ignorance is bliss as they say but mental health, well, that’s priceless…

nhs, Uncategorized

Got to be real

clcopeland

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…..

clcopeland

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?