Dementia, education, Uncategorized

All that matters to me


This week I was invited to talk to care home staff at Erskine.  It was part of a series of talks to raise awareness about delirium, mobility issues in those with cognitive problems and dementia.  In addition to these clinical talks were two from a relative and carer perspective.  One was Tommy Whitelaw (@tommyNTour) talking about his mum Joan.  The other was given by a family member of a current resident.

I must say when I saw that relatives were speaking I thought: ‘Wow! That’s quite a brave thing to do.  I wonder how the staff will react?’

I’m all for putting my head above the parapet but not many others are.  It can be incredibly difficult to hear feedback, no matter how constructive, without first putting it through a defensive filter.

That said I found what they had to say both incredibly moving and challenging. I don’t mean that critically either.  When you work in your own tiny eco system of healthcare you can desensitise or even forgot how a simple turn of phrase can inadvertently upset a person. To hear that your mum is ‘too good’ for a care home after you’ve spent months anguishing over the decision can bring back feelings of guilt.

We were also reminded to take the time to remember that this person is a mum, a dad, a brother, or a sister.  This person will never be a resident or a client to a family.  They are people with stories and lives of their own.

It was these talks that had the greatest impact for me.

You see we talk a lot about being person centred but if feels like being in an echo chamber at times.  What do I mean by that?  Well, it tends to be people working in the health service talking about the need to be person centred.  I rarely hear the patient or relative perspective in these meetings.  It’s also started to feel a little competitive:

‘And the prize for person who talks the most about person centredness goes to…..’

I personally feel that it you were you wouldn’t feel the need to go on about it so much. You would just be.

So what makes the difference then?  Tommy and I spoke about some of the people he’s met over the past few years.  It’s quite a list although I got the impression that those who have affected him the most are those on the ground, so to speak.  For all the pledges and promises of funding from on high it seems to get stuck on the way down to those who need it most.

As Tommy said caring is not seen as a career to aspire to. Even those working in the care home sector will struggle to get access to adequate training and education.

We have created this culture so we alone are responsible for changing it. I don’t want to hear people talking about what they should do.  I want to see them actually doing something!

I’ve always been a believer in the concept of small steps of change. You are however investing time and effort in a very distant future so it does require patience.

Looking around the room after Tommy spoke and seeing many in tears, it was clear that a difference had been made.  And that’s all that matters……

health, Uncategorized

Living the dream…

Living the dream…..

This weeks blog title was suggested by my former colleagues when I met them for dinner the other night.  We were laughing about how mad I had got when a senior manager asked me ‘How are you? Living the dream?’.  Looking back I think it was meant as one of those silly throwaway comments that the person asking is not really looking for an answer.  Unfortunately it pushed a button and as they say in Scotland I went a little ‘tonto’.  It wasn’t a particularly happy time then.

A couple years later I’m in a different place – mentally and physically. I’m in a different workplace and I’ve also gone part time.  It’s amazing!

So am I ‘living the dream’?  I’m not really sure what that means to be honest.  My dreams are weird at the best of times so I definitely don’t want to be living those! That could be another blog though….

I guess the whole thing is about work life balance although I think that very term will soon be redundant if the current trends in the workforce continue.  I was reading about Millennials (people born between 1980 and the mid 90’s)

The work to live rather than live to work is something that has resonated with me this year. The idea that there should be more flexibility in not only where but how you work.  For example does being at your desk or being seen on the ward after 6pm make you a more productive or better doctor (or any other worker)?  Are you doing it merely to be seen?  Or out of a sense of mouse wheel duty that probably someone else can do?

My new commute is far longer than the 10 minute journey I used to make every day.  It’s now somewhere in the region of an hour or so each way.  And yet I feel more energised and on top of things than I ever did before. How I use my time is different though.  My emails are done on the train.  Any projects or pieces of work are also done on the train.  I do mindfulness at the start of every day which quietens and focuses my brain.  I also like to think time spent staring out the window is a form of mindfulness too…  I get loads more fresh air and exercise which I’ll admit is also a great excuse not to go to the gym.

I finish pretty much on time every day so when I get home that’s me. Work is far away and that part of my brain switches off. Recharging even.  The other part of my brain switches on.  It’s not too dissimilar to the work side its just more fun and more silly.

This week I was at the Edinburgh Festival, the Fringe to be exact. It doesn’t get more silly than a skeleton puppet singing to Frank Sinatra in the rain.  I hadn’t been to the Festival in years and it didn’t disappoint.  While I wasn’t organised enough to get tickets the day was spent wandering the streets watching various street performers and soaking up the atmosphere.

I tried trampolining at Airspace for the first time. The safety video of ‘you may die’ did slightly alarm but I was not put off.  Dodgeball and gladiator style jumping over rotating bars all proved I have no sense of balance. I also seem to reflex squeal when I fall over.  I had thought this was limited to falling off inflatables in the sea but apparently not. It was hilarious fun!

The point of this….?  Living the dream is whatever you want to make of it.  Did my dream include being stressed out my head and blowing up at stupid comments?  No.  My dream is to work hard, make a difference but most of all have fun.

nhs, Uncategorized

Come fly with me….

Changeover week is always a bit of a funny week.  It starts off much the same as any other. There’s the ward round to be done, results to be chased and plans to be made.  The whole thing has a certain ease to it.  The familiarity of the team makes for a relatively relaxed atmosphere.  Everything is sorted. Everything is in hand.  Ahhhhh…!

IMG_4624Then Wednesday arrives and it’s a bit of a jolt to the system.  Suddenly the team is brand new and not only do they not know the patients they don’t know how things are done.  Its kind of like when a plane hits turbulence.  Its all a bit unpleasant but no one is in any kind of real danger.  That’s how I feel manning the ward on changeover day.  I’m the pilot of the plane trying to get us through the worst as quickly and safely as possible.  I consider our senior charge nurse to be my co pilot. We make for a pretty awesome team having been through it many many times!

So what makes it that bit easier? Talking.  Plain and simple.  It offers reassurance that the unpleasantness of the new will pass quickly. It creates a safe place so that no ‘stupid question’ goes unanswered.  And because I’m fundamentally nosey I get to know my new team better too.

It was also in this changeover week that a good friend of mine was admitted to hospital. She doesn’t work in the NHS so it was through her eyes I got another perspective on how we communicate as doctors.  I should say she’s happy for me to share this.  When I first visited she’d been in for 3 days.  In that time she’d seen several different doctors but was uncertain which of them was her Consultant. She also had been kept in the admissions area of the hospital rather than being moved to a ward elsewhere. Now my friend is not exactly the shrinking violet type so I was  surprised to hear her comment that she didn’t want to cause any bother by asking why.

Another doctor appeared when I was there. My friend was told very succinctly that ‘Your CRP is coming down but I’ve spoken to micro so we have a plan for the weekend.’

The doctor was about to walk away when my friend asked ‘and the plan is what?’

Biting my tongue is something I’m really bad at.  However it wasn’t my place to start interjecting with questions.  Suffice to say I asked my friend if she knew what a CRP was?  ‘Not a clue’ was her response.

I tried to think about what had particularly irritated me about it.  Technically the doctor had done nothing wrong.  I understood it all perfectly.  As a doctor….

So putting it to one side I visited my friend again  – day 5 of feeling sore and fed up.  I visited just before tea at which time I was asked to leave for protected meal time.  There were 3 other people in the ward.  None were old or obviously confused.  We both asked why I would have to leave.  ‘Its so we can help people with their tea’  Looking around it wasn’t exactly clear how they needed to be assisted so we asked again.  The reply was the same ‘its protected mealtime’.

So I had to wait outside for an hour while my friend ate her tea by herself. As she had been all day.  After eventually catching up I hug my friend goodbye, wish her a speedy recovery and start to reflect….

Back at work the turbulence had eased and everyone was feeling that little bit calmer.  Everything was in hand, everything was sorted.  As we became more mindful of looking out for one another I asked them to think about the people in the beds or sat out in chairs.  We thought about a time when we knew no medic chat.  We started to think about talking to our patients as people going through a turbulent time.  They are looking to us for reassurance that everything will be ok.  The best way to do that is just to talk like a normal human being – jargon free, calm and reassuring.  Like any good Captain would do….


nhs, Uncategorized

‘What’s the one thing you know now that you wished you’d known at the start?’

I asked the team this at the start of this weekend’s on call.  It was met with groans and comments of ‘don’t do it!’

Yes its changeover on Wednesday! Its like a second Halloween to the media.  There are stories designed to terrify the public of how you’ll meet a grizzly end if you are unfortunate enough to be admitted to hospital on the first Wednesday of August.maxresdefault

There are also emails reminding the senior clinicians that we run a service and targets are key during this time.

Somewhere in amongst all that are people.  While we focus on ‘people not patients’ could we perhaps extend that to ‘people not the FY1’?

There have been great improvements over the years to move away from the traditional baptism of fire on your first day.  There are now preparation for practice or shadowing courses.  On social media there is a great hashtag #tipsfornewdocs (my top tip was ‘when on call eat at every opportunity/like you’ll never eat again).

We are much more supportive of our new doctors than ever before.  There is growing recognition that to run a safe, efficient service you have to do the proper training and education.  I say growing recognition as at times it seems we still can’t see the blindingly obvious inefficiencies.

I listened to this week by Dr Kevin Fong. It was all about ‘Lean’ in healthcare.  This has been about for years in management circles – standardise the process to make it more efficient.  Which is fine if we are making cars but we are caring for people.  A point acknowledged in the program.  I then thought about our Chief Medical Officer’s report on ‘Realistic Medicine’ which also talks about standardising process



Just at the point my head was about to explode from the buzzword bingo of management language it all became clear.  Strip away the language and what you have is blindly obvious.


Time to spend with patients. Time to gain experience. Time to spend with families. Time to talk to your colleagues. Time to finish on time.



I would therefore argue that we are missing a huge opportunity during changeover to uncover the blindingly obvious.  As our doctors move hospitals, departments and wards we should be asking them ‘what do you know now that would save you time when you started?’.

You then get a different response:

‘A map of the hospital so I know where to run when the cardiac arrest page goes off’

‘What time the phelbotomist is in and where they leave forms for those that they couldn’t get. It means you don’t discover mid afternoon some bloods haven’t been done’

‘The Treatment Room: Prepared ‘Procedure specific’ trays‘ This was beautifully presented by Dr Yesmin Karapinar an FY1 at the Women’s Medical Federation Conference in May 2016 .


‘Where’s the nearest place for coffee?’  Ok that was mine.  Where’s the nearest toilet is my second question.

Starting a new job is an exciting time for most doctors – lets ensure we uncover the time to make changeover process enjoyable as well as efficient.

Holiday, Uncategorized

For once in my life….



Holiday time has finally rolled around. Plans ahoy!  However the unplanned stowaway was Mr Virus.

Now, many will be familiar with that feeling ~24hrs ahead of the out of office button being pressed that something is brewing.  You might be mislead into thinking that its just the rushing around pre hols but be vigilant people.  I can confirm that it is in fact your immune system checking into the first class lounge as it prepares to leave for the Caribbean.

You however will be oblivious as you naively continue your plans for ‘quality family time’ complete with a world breaking effort in creating Kodak moments that all your friends and family will be jealous of.  Complete with Facebook and Instagram posts without filter – because you’re that amazing!

Then Mr Virus hits. Without realising it you have become the 5 star holiday home it had booked the year before.

Now usually I spend quite a bit of time fighting the uninvited visitors. It ain’t pretty and usually I loose. The battlefield ends up with me being exhausted, mood in my boots (I really am the most terrible person/mother/wife/friend/daughter etc etc). I would drag myself back to work with that feeling of ‘why did I bother?’.

This time I almost repeated the 10 year cycle of non learned behaviour then something magical happened. I gave in.  For once in my life I surrendered. Right at the start of the fight.

In doing so I won.

I can’t say in all honestly my recovery was quicker or less vile.  It was however a much easier process. I let the hideous thing run riot for the best part of a week.  I was almost in the third person watching it. I indulged in my guilty pleasures – reading newspapers cover to cover and watching property programs. A particular favourite being the ‘A Place in the Sun: Winter sun edition’.  I’ve travelled the world this week judging and passing comment on everything and anything. The pool is too small. The beach is too far to walk to. Its not south facing.  Two bedrooms, are you kidding me? I need three.

After my pseudo foreign trip I was fighting fit and able to witness the spectacle that is Beyonce.  The talent, the work ethic is enough to put us mere mortals to shame.

We held a moments silence without realising that at that moment we were silent to the unfolding horror that was the Dallas shooting. And suddenly my brain was struggling to make sense of the world again. Except this time there was no virus, no delirium to explain it away.

I’m not going to get into a commentary about life in the USA.  I know very little about these things to be credible.  What I do know is that violence is not the answer. I feel the frustrations – why do people act/behave in that same way they always do?

As Martin Luther King said:


So as I go into my second week of holiday I will indulge in the luxury that is my family close. The friends I treasure near. I will pray. I will continue to shine.

For once in my life I will just….. Be.