Thread by @Laconic_doc

@DrTerryQuinn @DrLindaDykes 1) pts with dementia - enter *their* world, don't force them into yours
2) get to know your pt before they develop delirium; then, you're their 'familiar (saviour) friend' when they do
3) if they have a pet, record the name, & ask after them *by name* each visit

@DrTerryQuinn @DrLindaDykes 4) in every encounter, ask yourself: "What are we trying to achieve here?"
5) in pts with recurrent unexplained falls, check for peripheral neuropathy - stocking distribution ⬇️pinprick sensation v common!!
6) 10% of pts with transient LOC *deny* LOC (from tilt test data)

@DrTerryQuinn @DrLindaDykes 7) [re 6)] don't ask "Did you pass out?", ask "Do you remember hitting the floor?"
8) 'Variance increases with age' (via @ProfRayTallis!)
9) we systematically underestimate renal function in little older female pts (esp using eGFR)
10) often doing nothing is the best policy

@DrTerryQuinn @DrLindaDykes @ProfRayTallis 11) Irregular verb:
I am determined
You are difficult
S/he is obstinate
12) from Atul Gawande:
a) what's your understanding of where you are in your illness, now?
b) what do you hope for?
c) what do you fear?
d) what outcomes unacceptable?

@DrTerryQuinn @DrLindaDykes @ProfRayTallis 13) BRAN questions for pts:
a. What benefits from this Rx
b. What risks?
c. What alternatives?
d. What if we do nothing?
14) what is the pt's ecosystem (priorities; support - formal & informal; idiosyncrasies)?
15) do everything possible to sustain it!

@DrTerryQuinn @DrLindaDykes @ProfRayTallis 16) it's never too early to consider Lasting Power of Attorney [UK]
17) 1st thing to do on diagnosing dementia is discuss LPoA, & advance directives (document pt's priorities)
18) address symptoms always, abN results occasionally, risk factors rarely (depends on pt's priorities)

@DrTerryQuinn @DrLindaDykes @ProfRayTallis 19) don't start a new Rx to treat a drug side-effect, stop the Rx!
20) arrange the team's day around the pt's if poss, not vice versa
21) manage relatives' expectations: "Hope for the best, but be prepared for the worst"
22) we greatly overuse drips & catheters in older pts

@DrTerryQuinn @DrLindaDykes @ProfRayTallis 23) always remember your patient is a *person*, not just an organ (or even a set of organs!)...

...that is the starting point for everything! 😊

@DrTerryQuinn @DrLindaDykes @ProfRayTallis 24) medicine is both science & art...

...as the pt gets older, the ratio of art:science increases; experience, gut feeling, & wisdom increasingly trump knowledge

@DrTerryQuinn @DrLindaDykes @ProfRayTallis Whist remembering that we all have different priorities & preferences, my watchword was "What would I have wanted for my dad/mum in this situation?"...

...it usually helped to ground me 🙂