‘He’s suffering so much. Please do something, doctor. You wouldn’t treat a dog like this.’
This post and the next deal with the sensitive subject of terminal illness, dying, assisted dying and euthanasia. It is necessarily emotive, and some readers might find it distressing. Please don’t continue if you think you might be affected.
Few subjects generate stronger opinions than euthanasia, assisted dying and limiting patients’ access to medical and...
If reading this post doesn’t give you a headache, you weren’t concentrating hard enough.
I once anaesthetised a man for a total knee replacement. Mark wasn’t the fittest guy in the world. He was an obese, lifelong smoker with COPD who was breathless on gentle exertion. He also suffered from constant agonising knee pain that kept him awake at night and generally made his life miserable. His orthopaedic consultant told him a total knee...
We are all for informed consent, aren’t we? Of course we are. It’s a bit like asking if we’re all in favour of an NHS that isn’t crumbling around us, a government that actually delivers on its election promises or a big win on the National Lottery. All I would say is, be careful what you wish for. While informed consent is an excellent goal to aspire to, it’s not as easy to give or receive as it sounds.
Several factors hinder the process. The information exchange involved is...
This is quite a long post. I considered breaking it up into two parts but decided against it. The subject matter is a tad cerebral, and I think you will get more out of reading it in one session, if you can manage it. It will be well worth the effort, especially if you ever find yourself in the future having to consider whether or not to consent to a spinal anaesthetic. Or an epidural, which we’ll also be covering in this post. So, put the kettle on, grab yourself...
Yes. You heard me correctly, but I’ll repeat what I just said: you’re not really asleep when you’re under a general anaesthetic (GA).
It’s understandable that there is confusion about exactly what a GA entails. Patients having surgery under a general anaesthetic certainly look like they’re asleep, lying still with their eyes closed, unaware of their surroundings. Anaesthetists like me don’t help the cause when we casually refer...
A beating heart has been the prime indicator of the presence of life for thousands of years. A beating heart means life. Its absence means death. Modern medicine forces us to accept that this rule is both simplistic and wrong. A person can be dead while their heart continues to beat in their chest. On the other hand, a person can be very much alive even though their heart has stopped. A person can be alive even if they don’t currently have a heart....
Two of the commonest complaints about doctors are that they write in an indecipherable scrawl and they don’t speak plain English. You emerge from an appointment with your GP or hospital consultant, clutching a clinical case summary that seems to have been written by randomly inserting incomprehensible ancient Greek and Latin words throughout the text (I’m assuming here that it was a printed document and not handwritten, in which case you wouldn’t have been able to read it...
Mortuary
Every doctor is used to seeing dead bodies on a regular basis. As one of the group of ICU consultants, I was a particularly frequent visitor to the hospital mortuary. However, I saw my first dead body at the very beginning of my training on day one of week one in the Dissecting Room (DR) at medical school. Actually, I saw twenty dead bodies that day, one for each tutorial group, all lined up in neat rows lying on top of metal trolleys. It was the...
When we think of a hospital, most of us picture a general ward or perhaps the operating theatre. The reality is that there are dozens of different locations within a typical District General Hospital (DGH), some more important than others, that are necessary for high-quality patient care. There are even more specialist areas in major teaching hospitals (regional tertiary referral centres), such as cardiac surgery units, neurosurgical units, major trauma...
The Last Act, Death Scene: Take 1
You and the rest of your family are at Granny’s house, gathered around her bed. She’s dying. At ninety-two, she’s had a good innings. She’s ready to go. Her health has been declining for several years, which has been hard for Granny and you all because she was always so active. It’s her failing heart. She gets breathless on...
Warning: if you are an NHS manager, or married to one, skip this blog post. This is not for you. There’s nothing to see here. Move along, please.
The NHS is a leviathan organisation. It employs well over a million people, making it the world’s fifth largest employer, and spends roughly 200 billion a year on health and social care, about 10% of UK GDP. The NHS obviously needs to be managed, and about a quarter of its employees are either managers or administrative staff. There...
Cardiopulmonary Resuscitation (CPR)
In the last post, we defined what we mean by cardiac arrest and learnt that there are only three cardiac arrest rhythms: shockable, PEA and asystole. We also briefly covered how each of these three arrest rhythms needs to be managed. A shockable rhythm (VF or pulseless VT) must be defibrillated without delay. The reversible causes associated with PEA (the 4Hs and the 4Ts) need to be diagnosed and treated as soon as possible. Asystole usually means it’s game...
Heart attacks and cardiac arrests (Part 2)
Cardiac Arrest
In the last post, we defined cardiac arrest as the sudden, unexpected collapse of the heart’s mechanical pumping action that is potentially reversible. In this post, we’ll look at some of the causes of cardiac arrest, what types of cardiac arrest benefit from the use of a defibrillator, and the principles of resuscitation. In the next post, I’ll take you through the mechanics of how to perform cardiopulmonary resuscitation CPR if you are...
Heart attacks and cardiac arrests (Part 1)
In the next two or three posts, I want to talk about some acute cardiac conditions that people have usually heard of but are often a bit unclear about, or even completely misunderstand. The list includes heart attacks, heart failure, shock, cardiomyopathy and cardiac arrest.
Heart attacks
There are more than 100,000 heart attacks in the UK each year. The good news is that more than 7 out of 10 victims live to tell the tale. Actually, it’s really great...
Other NHS hospital staff (Part 2)
In the last post, we looked at all the different types of nurses who work in NHS hospitals. In this post, we’ll concentrate on the other clinical staff you might run into.
Midwives (aka Madwives)
I didn’t include midwives in the previous post because most midwives today aren’t nurses. Midwives have actually been regulated, independent medical practitioners in their own right since The Midwives Act, 1902. However, at the inception of the NHS in 1948, the...
Other NHS hospital staff (Part 1)
As there are so many different types of nurses, I’m only going to talk about them in this post. In the next post, I’ll deal with some of the other groups of clinicians you might encounter during a hospital stay.
Nurses
If doctors are important to the safe and effective running of a hospital, the nurses are downright indispensable. A hospital without nurses is the worst hotel you have ever stayed in – it’s noisy, particularly at night, lacking in privacy and with...
Doctors (Part 2)
Surgeons
There are more surgical specialties than you can shake a scalpel at. In order of decreasing IQ, they include:
Neurosurgeons, aka brain surgeons
Every young and ambitious schoolboy and schoolgirl dreams of becoming a neurosurgeon. It kind of makes sense that this group of doctors is the most intelligent, at least among the surgeons. They work on other people’s brains day in, day out, so it stands to reason they get to know what makes a really good brain tick and therefore...
A whole bunch of people work in NHS hospitals: doctors, nurses, physiotherapists, occupational therapists, radiographers, phlebotomists, cardiology and respiratory technicians, cleaners, porters and hospital managers. I debated whether to include the managers on my list. Do they do anything that could reasonably be described as work? I decided to include them in the end for completeness. They do, after all, outnumber all the other groups put together. (That statement may not be strictly...
I will be posting a series of articles in this blog about hospital life soon. Entitled Who’s Who and What’s What: Inside NHS Hospitals, it's an insider's guide to how hospitals really work. The series will attempt to inform, explain and demystify what it is that doctors, nurses and all the other clinical specialists get up to behind your back if you're unlucky enough to be admitted to hospital.
Here are some of the topics I'll be covering...
Making sense of all the different medical and...
On 4 June 2020, the GMC (General Medical Council) wrote to inform me that it had erased my name from the UK register of medical practitioners and revoked my licence to practise. In other words, I had been struck off. I hadn’t done anything wrong. I had taken early retirement to escape the relentless pressure and stress of life on the NHS frontline as a consultant in anaesthesia and critical care medicine. After forty years, I was burnt out. The letter from the GMC marked the formal conclusion...