Would you like a new dinner idea?

This is a new recipe for us, but was very tasty…

It’s going to be a thread, I think. 🧵 First, break up a cauliflower into florets…

Toss in olive oil, salt and pepper.
Pop it in the over for half an hour to roast.

Already looking yummy (if you like cauliflower, which I do!).

I’m still reading @danielleofri’s book on communication…

We’re not very good at this in healthcare, are we?

And this my friends, is why I used to write these things down for my patients when I worked in the acute medical unit at the Royal Infirmary…

“Palliative care can benefit people with dementia”.

From last week’s ⁦@bmj_latest⁩, it’s good to read ⁦@kesleeman⁩ and ⁦@emelasml⁩ raising the issues of providing good care to people with dementia.

Core business for GPs & Geriatricians! bmj.com/content/380/bm… It’s interesting to read the responses to the piece.

A lot of very good palliative care already happens in care homes up and down the country.

We need to respect that there’s a lot of expertise in these settings.

GPs and care home teams are doing great things in many places.

The debate on whether we should add folic acid to food has been going on since I was a medical student.

In last week’s @bmj_latest, @munkeatlooi looks at some of the pros, cons and evidence.

Social inequalities play into this too.

Link:
bmj.com/content/381/bm…

#SDOH Folic acid has been a hot topic for years.

We know that supplementation of this vitamin during pregnancy reduces the chances of having a baby with a neural tube defect (NTD) eg spina bifida, which can cause significant disabilities.

But not everyone takes it.

Some further slides from today’s #bgsconf, this time on Pharmacy support to care homes.

Spoiler: it is a bit variable! It’s particularly variable how many care homes each Pharmacy team is supporting…

#bgsconf

A lovely presentation from Dr Pam Seenan on her team’s work with the Beatson Oncologists to improve care of older people with cancer.

Geriatric Oncology is a whole new sub specialty.

Call the COPS! (Cancer of Older People) team.

#bgsconf Funnily enough, having a Comprehensive Geriatric Assessment helped people a great deal!

Well done team! 👏👏👏

#bgsconf

Well that was truly awesome. A presentation from a medical student Maddie Pritchard from Aberdeen on the effects of social deprivation on outcomes for frail older patients.

A complex subject! #bgsconf #SDOH (social determinants of health). I’ll tweet some of Maddie’s graphs. Some fascinating results, that aren’t straightforward to explain….

#bgsconf

A very interesting account from my colleague and friend, Dr Jane Bishop Miller, at the #bgsconf.

Talking about the #COVID19 pandemic and their local response but a few key findings to share. Interesting results. The clinicians usually guessed right when the patient did or didn’t have #COVID19.

#bgsconf

Lovely to see @l_whyte at the #bgsconf today in Glasgow!

Lots of great work in @NHSLanarkshire on #Frailty and their work as a community multidisciplinary team. 👏👏 There is research evidence to back up what’s being done. GPs and Primary Care Teams can do this, but don’t have time so having the MDT is working well.

#bgsconf

Next up at the #bgsconf meeting is @GrahamEllis247, talking about the Older People’s Strategy.

How do we address the health inequalities that afflict our country so badly?

#SDOH #inequality So many challenges. Older people are often discriminated against and yet are also often quite passive in accepting what they experience.

#bgsconf

One of the most inspirational people on my Twitter timeline is @Lyndseydunn7.

Now talking here at the @GeriSoc #bgsconf on delirium and how we need to identify it and manage it in the real life situations we see every day. It’s very impressive to see what Lyndsey and the @NHS_Lothian team have achieved with their programme.

#Delirium
#bgsconf

I’m really enjoying this talk from Dr Alice Radley, a renal physician, at the @bgsconf.

It’s all about advanced renal disease and how to support older people with this condition.

It’s quite common! We need to develop a better supportive care framework for caring for people.

There are some excellent programmes around for “best supportive care” for people with end stage renal disease.

#bgsconf

Hyponatraemia. The topic we all find so difficult!

And no, it’s NOT all SIADH!

#bgsconf It’s a diagnosis of exclusion. Rule out the other things first. And do check urine sodium!
#bgsconf

Well said @HelenRSalisbury, in the @bmj_latest.

“Triage is for emergencies. Can we plan for a time when it’s no longer necessary?” Many sensible comments from Helen:

“Arguably, the patients who need us most—older patients and those with poorer health literacy—are the least likely to fill in an e-consult form, reinforcing the inverse care law.”

Louis Appleby: What has been the effect of covid-19 on suicide rates?

An important article in the ⁦@bmj_latest⁩, published a few weeks ago, but “in print” this week.

From ⁦@ProfLAppleby⁩. Thank you for your wisdom.

Some quotes for follow... blogs.bmj.com/bmj/2021/03/10… Firstly:

“What has been the effect of
covid-19 on suicide rates?

The pandemic has not seen a rise, but we should be cautious.”

Caution is always a good thing.

The gay men of Edinburgh in the late 80s taught me some of the most important lessons I ever learned.

*Patients often know more than their Drs
*There are times when we need to accept we don’t have the answers
*One of the most important things we do is to treat people equally.

https://twitter.com/thtorguk/status/1362873098215821314

Those lovely men. They came to our clinic with reams of paper from Daisy Wheel printers, all taken from this thing called the “Internet”...

You won’t have heard of it yet, but it’s going to be big...

They weren’t wrong!

How did we end up in this situation, with the care homes so vulnerable and unsupported?

It’s worth remembering some of the history here. I started my training in Geriatric Medicine back in 1992 and there were some pretty major changes happening around then... I’m going to quote some stuff from @TheKingsFund - I hope I get it right, but very happy to be challenged...

A few comments:
1. Having a mobile phone these days is not incompatible with grinding poverty.
2. Relationship breakdowns happen. Unpredictably.
3. Getting a job when you have childcare responsibilities is hard, even if the kids are at school some of the time.
#Dispatches Moreover:
4. Mental health issues aren’t always easily visible or obvious.
5. People in poverty may have a pet. It may be the only thing motivating them to keep going.
6. Many of us could live on a budget for a short time. But not 365 days a year.

#Dispatches