Layla's space

With all its sham, drudgery and broken dreams it is still a beautiful world.

Monday, June 12, 2006

Summer Service Provision

Medicine is much quieter in the summer. Fewer old grannies with infective exacerbations of their emphysema, fewer pneumonias, just fewer patients on the list generally. All of which means that those people who are unfortunate enough to be admitted to hospital when the weather is lovely are more likely to get good service.

Obviously, if it's less busy, waiting lists for scans etc will be shorter, but I also mean they will get better service from the junior doctors who care for them. We have time to go back and check that Mr Smith with neutropenic sepsis has enough fluids. We notice that he has been on 1st line treatment for over 48hrs but is still spiking temperatures and actually have time to ring the microbiologist and get advice about changing his antibiotics. We have time to repeat his blood cultures ourselves (because the ward is understaffed and there is no way in hell the nurses are going to get around to it).

We also have time to chase the results of scans and tell the patients these results as soon as we know them, rather than checking the computer quickly to see if they're back and thinking, oh well the result won't change management in the next couple of days, let's just wait, no time to go down to radiology, hunt down the radiologist who did the scan and badger them to report it for you.

We have time to sit down and think about more complex patients and how we should treat them, rather than just throwing more frusemide/Augmentin/Oramorph at them and hoping they'll go away.

More complicated patients are more likely to be kept in for full investigation of their anaemia/deranged liver function tests/odd chest xray shadow, rather than it being a case of 'we've fixed the pneumonia, everything else can be investigated as an outpatient', whereupon the patient is duly shipped out to await a load of other investigations and their poor beleaguered GP receives a scrap of paper two weeks later saying 'GP to chase results'.

On the flip side of this, fewer people stay in hospital unnecessarily in the summer, because a)waiting lists for scans/other investigations are shorter and b) we have time to tie up all the irritating loose ends that are normally put at the end of the (endless) job list and forgotten about. People can come in, have their investigations, get fixed and be discharged.

I started my general medical SHO job in the winter, and had come to believe that people just never got sorted out properly because there wasn't the time - you had to focus on what brought them in, never mind any other problems they might have, medical or otherwise, and ship them out ASAP before your team's next 'take', when another busload would be dumped on you. Doing the ward round, I always had a mental image of all the other patients who still needed to be seen, the ever-lengthening job list and the hideous spectre of our next 'take'.

Now I realise that this isn't the case. We do have time to be thorough. We are capable of providing a good service to everyone. Just for three months of the year.

If only it were always summer. If only we had more doctors.

Saturday, June 10, 2006

The Slim Fast Plan

Ah, the slimfast plan. So beautifully simple. A 'delicious, nutritious' milkshake for breakfast, one for lunch, and a 'proper dinner'. Or, a milkshake for breakfast, be hypoglycaemic by 11am whilst sitting in clinic and start alarming patients with your disinhibition, try and fill your stomach up with black coffee and be climbing the walls by 12pm and find that you are unable to take blood pressures because your hands are shaking too much, dash off at 1pm to have another poxy milkshake and nearly collapse from hypoglycaemia in the middle of the Consultant's afternoon round, get home at six feeling dead chuffed for making it through the day without scoffing chocolates on the ward like you normally do and looking forward to a 'proper', (but healthy and only 600 calories) dinner, then get invited out to dinner and bugger everything up by eating a whole mozzarella garlic bread, a huge bowl of spaghetti and a slice of lemon tart. And half a bottle of wine and a liqueur coffee. Sod it.