An alternative day: how technology could enhance healthcare

Posted on March 29, 2012 | Leave a comment

Real day: 

I arrive at work, and quickly check my emails on my phone before I enter the signal black hole that is the hospital where I spend my working life. The SHO is not in yet, so I persuade the ward clerk to briefly give up one of only 3 functional computers on the ward and update the patient list with the details of the 2 new patients, whose names are scrawled onto the whiteboard. I skim through their notes, and cast my eyes over them to make sure nothing urgent is required. I leave a note for the SHO requesting her to arrange some tests, before I go to the secretaries’ office to hunt for a working dictaphone and a spare tape.

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Do you have a right to die?

Posted on March 25, 2012 | Leave a comment

I like to think that I am in control of my life and get very frustrated when this control is taken away, even in trivial ways: when train delays make me late, when I am waiting for an interview panel to decide whether to employ me or when a relationship ends and I am on the receiving end of the “it’s not you, it’s me” speech. I often wonder how I would react to something more serious and substantial being taken out of my control. Something such as my health, my independence or my autonomy.

Autonomy and rights are a common focus of discussion, especially as we have moved from a paternalistic to a partnership model between the doctor and patient. Such issues have become central to the debate surrounding physician-assisted suicide and assisted dying. Do we have a right to choose the timing and manner of something so fundamental as our own death? To what degree do the wishes of an individual have to come second to the perceived adverse effects on society?

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Why I’m against the Health and Social Care Bill

Posted on March 10, 2012 | 1 comment

“Are you political, then?” I was asked by a colleague yesterday who had noticed my “doctors say stop the bill” badge fixed proudly to my dress, beside my ID badge and stethoscope. Yes I am. But you don’t have to be “political” to be against this bill. You just have to want an NHS free at the point of need; an NHS in which clinicians are making decisions based solely on your clinical need; an NHS in which you can’t buy your way to the front of the queue; an NHS in which all money goes towards patient care, not shareholders. If you believe in equality and democracy you must make your voice heard, or forever regret it.
So here is a summary of why I, as an NHS doctor, citizen and patient am against the bill. At the end are things you can do to get your voice heard.

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What is the NHS for?

Posted on March 5, 2012 | Leave a comment

At a party this week I got talking to a friend of a friend who quickly discovered I was a doctor. The conversation changed from which tube lines were running and who had made the delicious chocolate brownies, to the NHS: specifically its failings. I become, not for the first time, an embodiment not only of the medical profession, but of the entire health and social care system. I was charged with defending the lack of care shown by GPs, the apparent willingness of doctors to prescribe pills for anything and everything but never to listen, the lack of a nutritional perspective from NHS practitioners and the poor funding of mental health services.

The NHS is not perfect. I have heard many stories from dissatisfied individuals, and wouldn’t for a moment dismiss their grievances. I have even been known on occasion to spend an entire dinner party lambasting its’ deficiencies. But conversations like this make me wonder about the expectations of the public of this institution of which I am extremely proud. What do they think the NHS is for?

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My health, my choice?

Posted on December 31, 2011 | Leave a comment

I spent this Christmas, as I’m sure many others did, over-indulging in rich foods and alcohol, and barely moving from the sofa. I made choices that were far from healthy, and take full responsibility for the resulting lethargy, bad skin and headache.

But on a larger scale, to what degree is an individual responsible for their health? It is all too easy to label the smoker with lung cancer, the alcoholic with liver failure or the obese patient with heart disease as culpable and look no further. And of course it is true that no-one held a gun to their head and made them smoke, drink, or eat to excess. But this view is dangerously narrow and simplistic. The actions of individuals and their health-related actions must be viewed within a broader social context. We act as individuals but we do not live in a vacuum.

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Last week a man asked me to kill him

Posted on November 21, 2011 | 1 comment

I had just told Mr George* that his end-stage heart failure had become refractory to treatment, and I thought it likely he would not survive this hospital admission. He looked at me carefully and said, “Well that’s it then. Can’t you just give me something…end it for me?”

This is not the first time a patient has asked me such a question, and will not be the last. Often the question is more ambiguous, and it is unclear exactly what they are asking for: “can you just put me to sleep?” could be interpreted as a plea to end their life, but could equally be a request for a break from their symptoms or thoughts, with the hope of a more energised remaining time afterwards. It is a constant challenge to interpret such questions appropriately and personalise support and treatment for the needs of the individual.

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