Being an SHO- teaching the public and when to palliate.

Sadly, I won’t have any juniors this year and I will remain at the bottom of the pile for teaching!

My teaching is now essentially health education for the public whenever they come into Accident and Emergency. One of the most recent criticisms of the NHS has been the over-medicalisation of patients when they come into hospital. See http://www.nhs.uk/news/2014/01january/pages/experts-say-sadness-is-wrongly-being-medicalised.aspx and more recently on Jeremy Vine’s radio 2 programme on 19th August 2014.

Just as we have been discussing expectations of medical students and theirs of us, I have to challenge the public’s expectations of us and mine of them. In the time that we have to talk to and examine our patients, guessing the agenda and expectation on their presentation in ED can take a lot of detective work, especially when the patients cannot talk or communicate for themselves.

My seniors have stressed the importance to us of promoting health and trying to prevent unnecessary re-attendances (it wastes our patients’ time too sitting in ED). As doctors, we are also trained to be doing something to save our patients. This has led to the term “treating the doctor more than the patient” in my local workforce.

I think there’s a link between the two. The ambulance sees an elderly gentleman found unresponsive in a care home, I see “urosepsis with end-stage parkinson’s disease in a resus bed and a blood pressure of 70/40” and then I see the DNACPR and the medical registrar and I see “should this poorly man have ever come into hospital or should he have been kept comfortable with his family?”. It is sad (and that’s not actually a medical illness, it’s a state of emotion) that we are so well trained to treat the “problem” that we do not allow behavioural economics to come into the equation and step back until we are too late and on the treadmill to treatment which may be uncomfortable and distressing to the patient.

People come to doctors because they don’t know what to do when someone is sick or poorly and 99% of the time that’s the right thing to do. However, in some circumstances we have to do what is right by the patient. Palliative care is heavily involved in well known diseases like cancer where there is a slow deterioration and often irreversible decline. However, where is the counselling and palliation for patients and their families with diabetes, COPD, dementia and parkinson’s? I often find that these patients have no idea where there illness will take them and how it will affect them in the future. Is ED the best place to educate people on this, probably not but maybe someday the patient will be grateful if I give them some advice for the future, even if it is just a few words or a leaflet from patient.co.uk.

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