education

Letter from America

I went to my first American Geriatric Society Conference last week.  I’d been asked if I could speak about the delirium undergraduate education work to one of the specialist interest groups.  It also happened to be taking place in Orlando, specifically, Disney.

Not one to turn down the opportunity to visit the happiest place on earth I was also curious about how my colleagues across the pond approach Geriatric care.

Before going quite a few of my own colleagues asked ‘what exactly is it they do over there?  I mean, the US healthcare system is an ology one.  Do they just pick up people who fall through the cracks?’

I thought this was a little unfair. Even trying to define the role of a Geriatrician to some of our own UK ‘ologists’ is often met with blank looks.

Another question was why was I going ‘all that way for 4 days?  It’s not worth the hassle surely?’

I paused at that.  It’s true, it is a long way. I mean 9 hours on a plane with only movies, music and books to amuse you, no wifi (so no emails), free G&T and food.  Oh and some of the most gorgeous sunsets, sunrises and starry skies you’ll ever see.  Yes, it’s easy to see why some people would choose not to go.

All that aside the concept of travelling thousands of miles is not something I really consider a big deal anymore.  Since my elective in Medical School took me to Canada my view of the world has both simultaneously shrunk and expanded.  I mean how crazy is it that within the space of a day you could be on the other side of the world!

It’s not just travel that’s had this elastic band effect on my world view but social media.  It’s through this that I have had the pleasure of connecting and collaborating with so many amazing people.

This idea of connection and communication was what kept resonating as I attended the conference.

I’d been told American conferences were pretty big and this was no exception.  There was a constant hum of conversation as people moved from room to room.  It was exceptionally well organised – it even had an app! Everything was on it – downloads of abstracts, links to papers, a notes section which you could email yourself and you could even connect with other conference attendees.  Not knowing anyone I relied on good, old fashioned twitter to meet up with colleagues old and new.

The sessions were excellent too! One such presentation was on the healthcare needs of the older incarcerated population, in particular anticipatory care planning.  This is a topic that is rarely spoken about. The presentation demonstrated the gross misinformation and misunderstanding that surrounds this sensitive area.  A lot of it was in the language used and how education will be used to correct this.

It was probably why I then found myself at the session on the use of language (my favourite of the conference). The gist of it was how sometimes we can be quite flippant in our use of language. They spoke about how it’s absorption, both consciously and subconsciously, can lead to negative attitudes and behaviours towards older people.

You would imagine the people in the room would be vigilant to it right? Wrong! It wasn’t until some language was systematically broken down and dissected that we realised we can be guilty of perpetuating it too.  Not on purpose I might add but usually we’re either going so fast or not paying enough attention to realise.

‘Ceiling of care’ anyone?  How about treatment escalation plan as there should never be a ceiling of care…..

The AGS has many special interest groups reflecting the diverse, heterogenous speciality that is Geriatrics.  Happily education featured heavily – all interdisciplinary and all keen to share.

So what did I learn the most?  That we are all connected.  No matter how big the world is, or the conference, we can still find ways to come together to share common goals and aspirations.

Leadership

99 problems

This week I was sent the ‘imatter’ questionnaire to complete.  It’s badged as a  ‘staff experience continuous improvement tool designed to help understand and improve staff experience’. In other words it’s a cultural snap shot.

There are many ways that organisations will try to gather data on the prevailing mood and climate. However I believe if you truly want to know what the culture of any NHS organisation is then I suggest looking at their education departments.

Education and culture have a symbiotic relationship. It’s something that the GMC believe is important too but do we really understand what it means?

Take a superficial look and yes you will be told that most healthcare workers are supportive and approachable.  Yet something still feels off.  Reflecting on the various trainee surveys the things that are consistently highlighted are around this idea of culture, the learning environment, communication and a feeling of inclusivity.  This is mirrored in the trainers reports as well.

So there is something of an irony that as we live in a time of greater connection through social media, email etc we continue to feel isolated.

So how do we bring a sense of community back or joy at work, if you will?

I believe it begins with the culture and at its core, organisations placing a high value on education and training. It also requires organisations to recognise the multi faceted nature of the problem

Take for example educational supervision. In many organisations there is an imbalance between number of trainees per trainer. We need to look at ways to not only encourage more people to become trainers but for them to feel supported in this role.   To my mind that comes from providing courses/time specific to the needs of local trainers.  Currently people are forced to go elsewhere – assuming they can given the current service pressures. So it makes no sense to me why there isn’t better local Faculty Development to make it easier for people to access these courses.

Another hugely important area is to better engage with our primary care colleagues.  They are renowned for delivering excellent training but again remain isolated and disconnected from secondary care.  I believe that through more collaboration we could share learning on every level from how to deliver training but also in shared educational events. In my experience, these type of events lead to better understanding, more collaboration and adds to a more inclusive culture.

Our medical students also play an important yet understated role in the culture of the local workplace.  They may appear on my ward rounds but I rarely see them elsewhere.  This isn’t meant as a criticism but I do wonder why they aren’t made to feel more part of the team?

I also spend a lot of time listening to our trainees and they tell me that they feel our particular hospital has something of an identity crisis.  It may be a District General but it has the workload of a tertiary centre without the workforce to match.  Why is there not more trainee advocating going on?  This may seem a trivial point but again it does have an indirect negative affect on the culture.

We have Realistic Medicine to weave into not only the content but the delivery of our education and training programs. To do that we need to be more forward facing and flexible.  Part of this will come through working with colleagues in e-health. We should be more creative in the ways we deliver our traditional CPD – not just face to face but stream or record them for people to watch at a time that suits. Podcasts would provide even more flexibility.

However motivating a workforce that feels somewhat downtrodden under the weight of the service is perhaps the biggest symptom of something not being right.

So you can carry out survey after survey but if your organisation comes back with 99 problems and education ain’t one of them then you have a much bigger problem….

faith

Find the river

I love this time of year.  Increasingly more so than Xmas even with all its twinkly sparkliness.  Easter is definitely my new favourite.  Why?  Well, I think it’s the most hopeful time of year.  The clocks have just sprung forward giving us lighter evenings.  The birds are singing and there’s a general sense of things coming back to life.  However it’s the sense of hope that Easter brings that I love the most. And it’s hope that I want to focus on.

I was at church today and as you might imagine everyone was in a jubilant mood (there were three confetti cannons!). I expected the sermon to be equally uplifting so you can imagine my surprise when the pastor opened with how terrible it all was. People were sad, they were bereft, the church was about to get much worse.

I began to wonder if I was in the right place.  As he went on I thought about making a sign saying ‘Easter = happy’.  Spiritual nourishment it was not.  Then he quoted this by Jurgen Moltmann:

‘That is why faith, wherever it develops into hope, causes not rest but unrest, not patience but impatience’ 

Ok…… This was interesting.

Now I don’t want to get into the detail of the rest of the sermon – it turned out to be one of the most inspiring and uplifting ones I’ve heard in ages.  I also think that some reading this won’t be particularly interested in it. So why I am mentioning it? In that moment it challenged every idea I had about hope.

I had always took hope to be this thing that you could hold onto tightly like an unshakeable solid foundation giving you security.

Hope is also something that I have thought to have both spiritual and non spiritual connotations.  For example every year I hope that the Pittsburgh Steelers will win the Superbowl. My hope never gives up until its clear they are not in the Playoffs.  I digress…. Everyone has something they are hopeful for whether it be a cure for cancer or merely that it won’t snow again.  To suggest that it causes unrest and impatience came as a bit of a shock.

In reality this is something I’ve been struggling with recently in my day to day work.  In particular the work I’m doing around education.  In the main I would consider myself to be a positive person.  When it comes to getting things done the hope is to get people to see the why in order to get to the how.

So I was surprised when I found myself telling an audience at a delirium conference that i was getting grumpy and a little fed up. I felt like I was always preaching to the converted.  We have yet to see delirium education imbedded into induction programs. It is yet to be made a priority within our clinical governance structures. We also still talk about other quality clinical indicators but not delirium.

This frustration continued into the leadership course the following week where I was challenged to essentially get my own house in order before tackling bigger or loftier projects.

I found myself thinking about a comment from my previous workplace in which I was told ‘you can’t be a prophet in your own land’.  Was history repeating itself?

I asked a colleague how they thought I was perceived by others ‘Challenging, very challenging but in a good way!’

I was beginning to loose hope.  Not faith but hope that anything I did was ever going to matter or make a difference.

‘That is why faith, wherever it develops into hope, causes not rest but unrest, not patience but impatience’

Today on this beautiful spring day I have renewed hope.  A sense that my deep dissatisfaction with how things are done will inspire unrest in others.  I hope it will make people impatient for things to be better.

After all we’re closer now than light years to go…….

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……

education, geriatrics

A Whole New World

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

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

https://www.rcm.org.uk/sites/default/files/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

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…

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

 

 

Uncategorized

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….

health, nhs, Uncategorized

Lovely day

It’s that time of year again – changeover week. This changeover, more than others, is a particularly busy time.  It’s when our new FY1’s start.  No longer are they on the wards or in libraries learning the theory. Now it’s time to put it into practice.

It’s both terrifying and exciting!

This year I was again involved in the ‘Preparation for Practice’ course that our Resuscitation team and Simulation Centre organise.  The day takes our new doctors through an array of simulated scenarios using Forth Valley specific paperwork and protocols.

The team involved is huge and varied reflecting the breadth of the expertise involved in caring for our patients and keeping them safe.  What I particularly liked was the involvement of our current FY1’s.  They were brilliant in offering practical tips but more importantly reassurance that it will all be fine. It was also lovely to see how far they’d come since taking part in the same program the year before.

For some though the reality of it all became a bit much. The day came at the end of a long week of induction and shadowing. The scenarios are specifically designed to be as realistic as possible but with an emphasis on a safe learning environment.  However no matter how much you tell yourself the ‘patient’ bears a striking resemblance to your FY1 shadow buddy the situation is real.

There was a dawning realisation that patients don’t behave like they do in textbooks.  They don’t tell you what’s wrong straight away.  You have to work it out based on the clinical exam. You have to have the confidence that you are hearing crackles in the chest and not just the rustle of the sheets on the bed. Then there’s the tests.  Why do they not come back straight away?  Of course that’s assuming you can get bloods off them – some don’t have great veins or are so confused they wont let you near them.

However there’s a sigh of relief when it becomes clear what’s wrong. A plan can be made and treatment started.

In my scenario however our patient didn’t respond to treatment and began to deteriorate.  In real life that happens and it is stressful.  As a doctor (or a nurse) to try your absolute best and see it not working is the worst feeling.  The time that you were willing to speed up to get the person better you now wish would slow down to give you more time to fix them.

One of the objectives of our scenario was how to have those difficult conversations when things are clearly not getting better.  My role was to demonstrate a positive discussion about a treatment escalation plan. Any conversation that involves resuscitation has to handled with great care and sensitivity but always with the intention of doing the right thing by your patient.

After the scenario had finished we had 15mins to debrief and discuss what had just happened.  Pretty much everyone thought they had done terrible.  Of course this wasn’t true but that’s what this particular stress does to doctors and nurses.

In real life what also tends to happen (especially out of hours) is they will be asked to immediately go straight into another high stress situation.  There is precious little time to write up notes never mind reflect on what went well and check everyone, including yourself, is ok.

This kind of chronic stress was something that was never really talked about or acknowledged when I first qualified.  Some twenty years on and induction programs now include sessions on well being and stress management.

As I was writing this Bill Wither’s song came on the radio with the lyrics:

‘When the day that lies ahead of me
Seems impossible to face
When someone else instead of me
Always seems to know the way’

I took this as a sign!

So as our new doctors take to the wards I can’t make the patients behave in a more predictable fashion.  Nor can I take away the feeling of nausea.  I can however ask how it’s going and buy the coffee. So to that end I know it’s going to be – a lovely day…..