I don’t think of myself as a great doctor but I know there is no success in medicine without preparation and organisation therefore I have just spent 2hours organising our inpatients medical case note folders after today’s #WardRounds @DrGrumble @CLOSLER @j59dd
I don’t know what had happened in the 3 weeks since my last Physician of the Week but someone must have decided that entropy into chaos was the best way to organise inpatient clinical notes and won everyone over. Entropy is easy, organisation is unremitting hard work
I cannot do #WardRounds nor #Outpatients without knowing who the patient is as a fellow human being and without Problems Lists but many contemporaries seem happy without either. I follow #LarryWeed @VisualDx @writer_samshem
Night SHO this morning

‘Who organised the patient folders yesterday? That made my work last night so much easier.’

I said ‘Me’

SHO ‘It’s the small things that can make a big difference’

@icureiosity @nialldowney
This week have had numerous conversations with several inpatients about #Shackleton’s escape from Antarctica
Earlier in the week a farmer told me about still using his 1963 #MasseyFerguson tractor but that didn’t impress today’s farmer still using his one from 1961! @Trisha_the_doc Image
They both knew exactly how much they had cost to buy @Trisha_the_doc

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More from @doctorcaldwell

21 Jun
It’s interesting I’m being told how long is ideal in #NHS for Clinical Consultations in Outpatients by ‘management’, who can hold as many meetings of undefined purpose and length as they wish at short notice & expect my participation @djnicholl @PeteGordon68 @vincentconnolly
The most important Meetings in #Healthcare are between Patient and Clinician but are not the ones valued and prioritised by management

dropbox.com/s/vd7fybw50ml9… Image
Imagine if management’s meetings were subject to same rules as outpatients?
Schedule 6 weeks in advance
New Agenda items 30 mins max, Reviews 15 mins. Extra items can be added by anyone but all items must still be discussed. Items for other meetings can be added in Willy Nilly
Read 12 tweets
19 Jun
In #OrdinaryDying the vital organs progressively fail until heart stops last #CPR cannot work & should not be done

In #CardiacArrest heart stops first & #CPR may work before irreparable damage to brain & other vital organs

#DNACPR allows for a Calm End of Life in Ordinary Dying
#IWantAPeacefulDeath

My picture of my ideal inevitable dying definitely does not include inappropriate #CPR

Paint me a picture of your future end of life setting

If you want a Peaceful Dying you need #DNACPR & a Power of Attorney to protect yourself

dropbox.com/s/8kd2g6v6341j…
I had a great sense of relief this week agreeing and signing Scottish papers for Power of Attorney, knowing that if I lose my capacity to express and decide on my wishes, I have trusted people to act on my behalf @drkathrynmannix @KitzingerCelia @djbeckett
Read 4 tweets
17 Nov 19
Yes, that’s what I trained for too

I weep watching our Junior Doctors wrangling with dreadful disconnected paper & computer IT which gobbles up their working time & undermines their Clinical Reasoning thus putting Diagnosis & Patient Management at risk
At a ‘Winter Pressures’ meeting on Friday I said we could make our already good 4hr performance an hour better if we had Usable IT and cut out the quintuplication of information into multiple different bad paper & computer IT systems @acutemedicine @PeteGordon68 @nhshBoyd
I type Discharge Summaries using the horrible #NHSHighland #IDL software but it has to be something really really important to persuade me to use Hospital version of #SCIGateway for inter hospital referrals - retyping name address GP into badly designed IT. Intensely frustrating
Read 4 tweets
9 Mar 19
#DNACPR or Will For The Final Stages of Dying?

dropbox.com/s/7ybniuov566r…

I observe that every Consultant struggles with DNACPR because of the negative framing. We (I?) must change the framing

@JohnLauner
Consultants & Juniors at #FortWilliam like this

You are not dying now
Your health is frail
One day your health will deteriorate badly and
We will know you are dying and
What should we do for you then?

Patient usually answers

Let me go, Doc

dropbox.com/s/7ybniuov566r…
Then we have to say

Sounds like you said

Me, #IWantAPeacefulDeath?

Then in this crazy UK culture you need a Red #DNACPR Licence for a Peaceful Death

‘Oh no, Doc, I’m not going to be #DNACPR

We must reframe the whole ‘Near End of Life’ conversation @JohnLauner @TheIHI
Read 12 tweets

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