Breakfast Rounds

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Which comes first – my role as a doctor or my role as a human being ?

Recently, with clinical need exceeding inpatient bed availability, patients have been forced to spend the night boarded in their local Emergency Departments. Which brings me to my dilemma.

Imagine I come in at 8 am. I start with a “ward” round on these overnight patients. I come to patient number two and find a frail 81 year old lady who has been in ED for hours with very little to eat or drink. I look for a health care assistant or hospital volunteer who could bring my patient some breakfast. There isn’t anyone. I look for my patient’s nurse and find she is stretched between several other patients, about to start antibiotics on someone septic while simultaneously organising the urgent transfer of a patient she needs to take down to CT. (gone for another 30-40 minutes at least). So it comes down to me –  do I  stop the round and make tea and toast for this lady and other overnight stay patients myself ? Or do I delegate the task –  knowing it may be an hour or more before it gets done – and instead check whether the remaining boarded patients have serious medical problems to sort ?

I honestly don’t know. Like Australian Lieutenant General David Morrison, I believe the standard you walk past is the standard you accept. And this is a standard I can not accept.

My friend and colleague Damian Roland wrote about being the kind of consultant who answers the telephone.

Another friend (and fellow ED consultant) routinely pushes patients on trolleys to the CT scanner when a hospital porter isn’t available.

While noble and good for the individual patient concerned, I wonder if such actions might weaken the system further, putting future patients (and staff) at greater risk. (“We don’t need more reception staff / porters / health care assistants – the doctor can answer the phone / push the trolley / get breakfast…”)

I guess some of it depends on how we as doctors communicate these issues to hospital managers, and how hospital managers in turn respond.

Till then however, my dilemma remains …

 

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Reflections on ‘firefighting’

A thought came to me while watching the trailer for Deepwater Horizon at our local cinema recently. We use the term “firefighting” in the Emergency Department almost daily – as a way of explaining our focus on immediate shop floor crises, often at the cost of proper planning for the future. But what exactly does “fire fighting” involve ?

Certainly a team of people – we generally don’t expect a single fireman to deal with a burning house on his/her own.

It needs specialist training, and constant updates in best practice.

Finally, firefighters are inherently heroic, aware they may be called upon to sacrifice their lives every time they get called out.

Looking at EDs across the UK, and at our own, how often do we send a multidisciplinary  team of both emergency and in-hospital specialists (doctors and nurses) to deal with episodes of shop floor overcrowding and severe clinical risk  ? How often are those of us leading the response really trained in managing critical imbalances between emergency demand and available resources ? (good article by Damian Roland on unconscious incompetence at scale). How far are we ready to go in sacrificing career progression, even job security by speaking out when the situation calls ?

There are reasons why even with our best intentions, the fire in UK Emergency Departments continues to burn …

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#FEARLESS Compassion

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Friday, the 27th of May 2016, saw the launch of what was originally meant to be the first of five sessions on developing Compassion in Practice in the Emergency Department – a series we had named “Two Wings”. We had seven participants of different backgrounds, all international medical graduates, all motivated and gifted individuals. The session began with a shared lunch at restaurant close by – bringing back memories of a time when consultants would take their juniors out for a meal. We then moved on to our Post Graduate Education Centre where we watched a video and shared personal reflections on the common journey that connects us – bringing joy, relieving suffering and trusting our own music – either on a piano or in clinical practice.

I would love to have ended there but of course the journey into compassion is rarely that easy. Minutes before the session, what had been “we” (organisers) suddenly became an “I’. I won’t go into why my co-organiser got pulled – it still feels quite raw. Yet in the honesty of that rawness lies the challenge of compassion – and its strength.

Damian Roland, a respected colleague and friend, shared in a blog recently how there may not be that much for the NHS as a whole to learn from Leicester City Foxes incredible Premier League victory. For me as an individual though, it feels different. Against the odds, against conventional logic, with little money and up against the ‘big boys’ of the Premier League – a team comes out of nowhere and wins. A story to identify with – compassion in emergency care !

So my challenge for today is to uncover  #FEARLESS !

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