nhs, Uncategorized

Do you want to build a snowman?

What a mad few days!

It started on Tuesday with the warning that the ‘Beast From the East’ was coming.  Although it was predicted to only hit the east side of the UK I thought I’d best prepare.  Or at any rate buy some thermal tights.  To be fair we’ve had these kind of armageddon warnings before so no one was really that concerned ‘it’ll be a pussy cat by the time it gets to Scotland’.

However this was to be no fluffy kitten of a storm.

Waking up on Wednesday morning it became apparent that we were in for a rough day.  Waiting for the train in a snowy Queen Street Station my phone buzzed constantly. Our rota WhatsApp was rammed with messages from the trainees saying they’d either be late with some unable to make it at all.

Despite that I honestly didn’t think it was going to be anything more than a really rubbish day.  Then came the news a 1.30pm that a red weather warning was to come into effect at 3pm.  People were advised to leave immediately and public transport stopped running.

It became clear that this was going to be more than just a rubbish day.

A mass exodus ensued for all non essential staff.  WhatsApp, email and my page was going constantly.  In the midst of the chaos people were still turning up to my clinic despite having been phoned not to come.  Trying to manage the situation was, how they say, ‘challenging’

As with any crisis you get to see a wide spectrum of human behaviours.  Now I’m writing from the perspective of a doctor who also happens to be in charge of all things junior doctor related.  It’s not to downplay or ignore the work of all my other colleagues.  It’s just how I experienced it.

To say I was impressed with how our junior docs stepped up would be a gross understatement.  I was blown away.

As the hospital emptied they took the initiative to arrange a meeting for everyone who was left to sort out what was needed.  I was acting as support/go between (or gopher for want of another description) between the trainees and the remains of the management team.

There were many rumours circulating which made trying to manage the situation more tricky:

  •  ‘your insurance is invalid during a red weather warning’
  • ‘will I be made to work nightshift if I’ve been on days’
  • ‘the buses are running – no they’re not, yes they are’
  • ‘the canteen has run out of food and is closing at 3pm’
  • ‘THERE’S NO CHIPS LEFT!!!!’

We tried to get advice from the BMA only to be told the office had been temporarily evacuated due to the weather – much to the amusement of everyone at the meeting.

Whilst it seemed to be getting a little silly it seemed to only further fuel the trainees enthusaism.  I didn’t hear one word of complaint/moan/whinge.  That was until the news broke that the pub at the Premier Inn had shut. Deflating balloon would be an accurate description looking round the room – however hero of the hour Dr Dan Beckett went out into the blizzard to source some supplies.

I did manage to get through to the BMA. Rumours were clarified.  Patient care was sorted. It was all good.

As Wednesday morning arrived the reality of what we were dealing with became apparent.  The hospital huddle was reporting next to no staff had made it in.  It had the feeling of a war zone.

Still everyone pulled together.  It was phenomenal.  We had senior management out and about in 4x4s picking people up.  Serco doing everything they could to ensure patients and staff were fed and the place was clean.  Our nurses continued to deliver excellent care. That doesn’t even cover our other colleagues in pharmacy, the labs, rehab and countless others.

All the while I was bouncing around seeing thrombolysis referrals, doing a ward round and manning the texts and WhatsApp.  Adrenaline may’ve increased my average working speed to 1000mph but I did force myself to slow down as I spoke to worried relatives/carers.

So the day went on. As did the snow. It. Never. Stopped. All. Day.

We were all getting tired at this point.  The hero in my story was my Charge Nurse Nyree Philips.  Living across from the hospital she came in off her annual leave as well as providing me with chat, an ear and later in the night, gin!  All this despite my laughing at her when she face planted in the snow as we walked out of the hospital.

I spent time with colleagues I rarely see and got to know others better.  A thought that went through my head was ‘you just don’t know’  – you don’t know what people are dealing with or going through.

We also talk a lot about how we’ve lost that sense of team spirit and camaraderie with all the rota changes.  On reflection I disagree.  I don’t think it ever went away.  We just lost sight of it.  Now I’m not suggesting we should get snowed in on a regular basis but I do think we need to try harder to make time.

As the past few days has shown even when we were at our most stretched and busiest we were still able to make the time to ask ‘You alright?  Fancy a coffee/chat? That’s what’s going to stay with me after this experience.

However now that I’m finally home you will need to excuse me.  I’m off to build a snowman…..

snowmaggedon team photo
Team Snowmaggedon

 

nhs, Uncategorized

Here comes the sun

When I started writing this blog a couple of weeks ago there had just been the GMC ruling over Dr Bawa-Garba.  Not surprisingly it sent shockwaves through the medical profession.  One of the main issues was around rota gaps and trainees being stretched even further in order to cover them.

As I’ve mentioned before I am the Forth Valley medical rota lead.  Some refer to it as the ‘Poison Chalice’.  I roll my eyes whenever things like this are said in my presence.  Why?  Because it shouldn’t be so difficult or complicated to run a rota.

With that in mind I think it’s important to remind people that rotas are a fundamental necessity of the NHS.  A service that is about patients.  Or people.  People who are sick. People who are vulnerable. People who need people to take care of them.

This service can only operate if the doctors, or people if you will, are not over tired, stressed or lack the skills or support to do it safely.

This service of caring also requires processes to help facilitate the safe delivery of it.  Sometimes we refer to these processes as people too.  Behind every flow chart, piece of paper and email are people whose job is the smooth running of this mammoth organisation.

However in every high pressure service there can be obstructive, confusing behaviours or opportunists trying to push personal agendas.  I’m sure we’ve all experienced this at some points in our careers.

Now I can appreciate that people are apt to do to unusual things when they are under pressure.  I can also accept that some lack the insight or self awareness to recognise when they do.  What I can’t accept is when it appears to be wilful.  Blaming others for their mistakes, not taking responsibility or being accountable in any way.

So how does this change?

You need formal governance around any rota work. Without it there can be no consistent management, cohesive policies, guidance, processes or decision-rights to allow the safe running of the service.

The GMC have said there should be a ‘guardian of safe training’.  Now I would love if Chris Pratt came and fixed it all but this seems far fetched.  Well is it so far fetched to have processes and people that work for the service instead of against it?  A service that strives to care for people.  Well I don’t think it is.

This week I had several conversations with those instrumental in improving it.  They were long, they were at times difficult but we made progress.  I could not be more proud or impressed with the way people showed up.  I don’t just mean physically.  I mean actual showed up and had the uncomfortable conversation from a place of honesty and willingness to change.

It’s been a long, cold, winter and I think we could all use a little respite.  So as the sun begins to creep through, I think it’s going to be alright…..

nhs, Uncategorized

Shine bright like a diamond

Happy New Year!

We haven’t exactly got off to a flying start.  To be honest the NHS is usually hit pretty hard at this time but nothing like we’ve experienced this year.   However I don’t want to waste what precious time you have talking about the flu or the so called ‘NHS crisis’.  It’s well documented and I’m pretty sure most of you are still in the midst of it.

No, what I’d like to talk about are the conversations I’ve had.  While it’s felt like working in a pressure cooker at times, it is this pressure that can turn a black situation into a gem.  You just need to see its potential.

For example, talking about death.

As a Geriatrician it comes with the territory.  However if you ask hospital doctors or nurses, most of these conversations are had with people who we know are going to die.  What do I mean by that?  Those with a cancer or a progressive chronic disease like heart failure or COPD.  It’s expected and we’re comfortable in talking about it. What we’re not so good at is when the person doesn’t fall neatly into one of those categories.

How do you tell someone they may be dying  when they’re alert, not confused and want to know why they’re not getting better?

To look someone in the eyes and tell them ‘I may not be able to make you better’ when that’s what you’ve been trained to do is hard. However I have always taken the view that I don’t want the person (or their family) to be surprised. I certainly don’t want to deny what time they might have left by not being as honest as I can.

I think it would be fair to say that as doctors we tend to shy away from these kind of conversations.  There is a gradual shift in this however as people are becoming more comfortable with being uncomfortable.

Some time after I listened to a podcast with Dr Jil Bolte talking about her book ‘My Stroke of Insight’.  In it she spoke about how she lost the power of speech and understanding due to an intracerebral haemorrhage.  The part of her brain that dealt with perception of tone, intonation was still there.  What struck a chord was the way she spoke about people including doctors needing to ‘show up’  when they came to see her.  Don’t just go through the motions but really connect for the time you’re in the room.

This may sound an obvious thing to say but working in such a pressurised environment it’s something that’s easily forgotten.  Not on purpose I might add.  Its just we become very task orientated when the place is so busy. I totally understand how that may come across but do not confuse it with not caring or not doing a good job.  It’s just sometimes there is very little left to give.  You need energy to make a connection or have an uncomfortable conversation.

On that note she spoke of being accountable for the energy you bring to the room.  So with that in mind I try hard (not always successfully) to leave whatever baggage I am dealing with at the door.

It then becomes about compartmentalising. How do you teach that?  I’m not sure you can to be honest.  Stopping to reflect is key.  Even mid ward round.  I’ll often throw out questions with no expectation of an answer. It can generate some interesting discussion though.

It was during one such conversation I was reminded by one of the FY1’s that medicine is taught as black and white but life and people are colour.  You need to allow for that.

So that’s whats made this flu crisis so interesting in some respects.  People are being forced to behave in ways they don’t like or are used to. They’ve had to not only show up for the patients but also their colleagues.

One things for sure people are having to dig deeper to find that reserve.  Let’s see if 2018 will lead to something more sustainable for the future……

Leadership, nhs

Music

Up until this week I’d considered the concept of ‘team work’ to be within the context of sport. Organisations such as the NHS have also adopted it however I’d never really thought about it within the context of music.

My daughter has recently started learning the glockenspiel and plays in the school band.  She’s pretty good – yes I’m bias but she can play the Star Wars theme tune note perfect and with no sheet music. Come on, that’s good!

Anyhow I digress…. The kids have a completion coming up so having been rehearsing hard.  This particular morning the parents were treated to a performance of how they were getting on.  At the end the teacher explained to us some of the non technical skills they were learning in addition to the actual music.

I found it fascinating.

There were 5 main features:

  1. Focus – the kids were told to ignore any waving or shouting from the audience. By ignoring any distractions they were to walk to their positions looking professional. Focused on the music ahead.
  2. Tempo – each piece of music has a particular speed restriction.  Knowing it means everyone in the band adheres to it, neither going too fast or too slow.  The team goes along at the correct speed
  3. Leadership – keeping an eye on things is the band leader or the conductor.  The band members are advised to look to the conductor to ensure they are playing at the correct speed and at the right time.  The conductor themselves has the job of keeping everything harmonious and on time.
  4. Vision – is it what the composer wanted? Does it sound like what was envisaged for the piece.  The conductor can only do their job right if the various parts have the correct notes, in the correct section and aligned perfectly.
  5. Resilience – when it all goes bit pear shaped can you listen to what’s going on around you to pick it up again?

Point 5 I found the most interesting concept. It essentially spoke to me about the idea of silo working that I’m seeing at work.  What I liked about it in this context was while everyone has their own part/instrument to play, they are taught to listen to the other band members to guide them when they get lost or play a wrong note.  They don’t just give up and stop playing.  They get right back into the music and continue to contribute.

I think we need more of this in the NHS.  I do accept there are those out there trying to do this but they are still in the minority.  I have yet to fathom why.

While I was mulling this Kenny Dalgliesh came on Sunday Brunch.  Amongst the many questions asked of King Kenny (my husband tells me I’m legally required to refer to him by this name) he was asked what is was like to change from being a player to a manager?

In his very matter of fact way he explained that essentially he wasn’t part of that world anymore.  He noted that when he’d walk into dressing rooms the conversation would stop.  It was fine though.  He understood the change from playing with your mates to being the one who makes the tough decisions and enforces the rules.  Sure you can have the banter but at the end of the day the players look to their manager for guidance.

I see this in my work.  I am the big bad rota meister. I am also the one who constantly goes on about having structure and action plans. I am the one who walks into a room and the conversation stops.

However these days I have a choice of rooms to go into.  There are some that require the direction of a conductor.  And then there are those full of composers trying to create the vision.

At the end of the day the choice is clear for the NHS – we can collectively create beautiful music or continue to tolerate a big old noisy mess.  I am optimistic that the answer will be music to our ears…..

nhs

Día de los Muertos

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

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

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

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….

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:

http://www.gov.scot/Resource/0049/00492520.pdf

http://www.gov.scot/Resource/0051/00514513.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?