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, Uncategorized

Everything is everything…

So I’ve been a bit quiet of late on the blog front.  My head has been rammed with all things work related specifically the medical rota.

I don’t think it’s any secret that things had not been going as well as we’d hoped. We had (and still do have) significant staff shortages. It was becoming a total nightmare trying to balance training, education and service delivery.

It all came to a head a couple months ago and what followed were some uncomfortable but honest conversations.

I took over the day to day running of it.  First up was trying to get clarity over what needed doing first. I set about distilling it into short, medium and long term goals.  That was the easy part however I had forgotten to factor in one thing:

It turns out some people do not want problems fixed.

Yes, it’s true!

This is not a new phenomena either – think about all the projects you’ve tried to get off the ground or change you’ve tried to implement and you’ll know it’s true.

Now of course the trainees wanted it fixed as did some other like minded folk but very few other people did.

To start with it confused me. Perhaps naively I hadn’t appreciated just how many people merely talk a good game.  You can usually recognise them by their passionate agreement with everything and anything followed by doing nothing.

Then you have the people who are downright obstructive either in their behaviour or use of bureaucratic process.  This makes me angry.

At the point where traditionally I say ‘stuff it, I’m off’ I chose to dig my heels in and work harder.

It has made me hugely unpopular at times and probably damaged a lot of my working relationships with colleagues.  However things could not continue on a downward spiral.

To that end I have taken a rather detached but objective view on things. There have been some overwhelmingly positive things to come out of the work so far. Some of which I truly believe have the all the hallmarks of culture change.

There are some who have really stepped up and are effecting this much needed change.  Having the trainees involved in the rota management has been key.  We meet every week to work thorough the issues. The process is still being refined but it is starting to become more slick.

One of our early success stories is the WhatsApp group to help share information and deal with urgent issues in real time.

I also send a weekly rota update to my Consultant colleagues and the wider trainee group.

There is even representation from the management team at our rota meetings.

I know there are those who continue to be unhappy about the perceived lack of progress.  There will also be those who use the rota to push their own agendas, blaming everything on it.  Some are simply furious for all their perceived loss of power and control.

Personally I can see a glimmer of light creeping in through the thorny trees of a dark wood. It is also now that I can allow myself some breathing space to pause and reflect on where we are and where we need to go next.

The path is becoming clearer. It is one where everyone is now much better equipped with information and support.

We just need to keep going, forging new paths before we ultimately reach our destination….

Uncategorized

Danger Zone

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……

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……

 

 

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….’

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

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?

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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….