Day 787

The Francis report concluded that patients were routinely neglected by a trust that was preoccupied with cost cutting, targets and processes and lost sight of its fundamental responsibility to provide safe care. An estimated 400 to 1,200 people could have died unnecessarily there between 2005 and 2008. In addition, the inquiry heard that receptionists in the accident and emergency department had regularly triaged patients

The public inquiry heard common themes of call bells going unanswered, patients left lying in their own urine or excrement, or with food and drink out of reach. Patient falls were also concealed from relatives.  An inward looking organisation, with a low staff turnover, the trust suffered from a lack of new ideas and a negative culture that became entrenched. Extremely poor nursing care was at the heart of this enquiry bringing into question ‘empathy’ in health care professionals.

Studies have shown that physician empathy is significantly associated with desirable clinical outcomes for patients with diabetes mellitus and should be considered an important component of clinical competence. ( Source: http://www.forcedo.org/wp-content/uploads/2013/03/The_Relationship_Between_Physician_Empathy_and.26.pdf)

A qualitative study of empathy in 3rd year medical students showed that inhibitors of empathy may originate in the hidden curriculum creating a greater distance between patients and physicians. Cynicism as a coping strategy, primary importance of technical knowledge, emotional control, becoming and being a professional hence keeping a professional distance from patients reinforced lack of empathy. One student explained that exploring a patient’s true feelings is not permitted. She noted that she explored and discussed patients’ emotions less than before because she felt that it is not accepted within the medical educational environment.(Source: http://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-165)

Good bedside manner is nothing but a practical demonstration of empathy. Can it be taught and learnt?

While at one level it is possible to ‘understand’ how another person might be feeling (cognitive empathy), not everyone is capable of feeling how the other person might be feeling (emotional empathy). Both are essential for people in caring roles.

In all my years as a practicing doctor, I have learnt that patients are not just a source of inspiration for me but a primary source of learning. Books can only teach you so much. Most valuable lessons come from patients and from observing the attitudes and behaviour of senior colleagues.

Considering the fact that GP training in the UK is the shortest amongst all European countries, patients must be treated with greater respect as sources of learning. In my specialist training of 7 years duration, I learnt a lot about Anaesthesia. GPs are expected to learn a fair amount about everything in 3 years. (http://www.rcgp.org.uk/news/2016/october/mental-health-is-key-in-the-gp-training-curriculum-says-rcgp.aspx)

Am I optimistic? Yes. The government is waking up. There is hope.

 

Day 786

An early morning taxi ride to Sky News studios. A brief disjointed interview. No idea where I was supposed to look as there were 3 cameras in front of me. No preparatory cup of tea, orientation or introduction. I think they assumed I was a professional when in fact I was a bundle of nerves. Despite what everyone said, I know I blew it. Well, it’s over now. A sigh of relief!

Then came another one – a sigh of sadness arising from a heavy heart, expelling melancholy from the body. My eyes fell upon his beautiful face and there… another sigh! According to old wisdom, sighing is a way of maintaining physical and mental health. It was also an accepted method of prayer, a way of communicating with the divine.

Got started with work and found more sighs of boredom, frustration, irritation and disappointment coming forth. The unburdening of the soul through a deep in-breath and out is strangely satisfying too, especially when it is not audible to anyone but you. At the end of a working day, a content sigh of a job well done.

A quiet evening at home with the cats as Si is out of town. Sigh!

“You must remember this, a kiss is just a kiss, a sigh is just a sigh, the fundamental things apply, as time goes by…”

 

Day 785

crisis-plan-copy

The above is an example of a highly inadequate safety/crisis plan. The one that Saagar was given. It does not mention the word ‘Suicide’.

A safety plan should include:

  • Reasons for living and reasons not to harm themselves
  • A plan to create a safe environment How they can remove or secure things they could use to harm themselves? Can they identify and avoid things that they know make them feel worse? These are called distress triggers
  • Activities to lift mood, calm or distract
  • People to talk to if distressed. Include contacts for general support (not necessarily confiding their suicidal thoughts) and specific suicide prevention support.
  • Professional support such as 24 hour crisis telephone lines
  • Emergency NHS contact details
  • Personal agreement that Safety Plan was co-produced and a commitment to follow when required

Include names and all phone numbers for people to be contacted

Bank of Hope 

A. Maximise the power of the individual not to act on their suicidal thoughts;

  • Increase wellbeing and resilience – enhance protective factors
  • Increase emotional resourcefulness and share simple problem solving techniques to better equip them to deal with their triggers for suicidal thoughts or adverse life events should they occur/continue;
  • Increase internal locus of control – ‘do not be a passive victim of suicidal thoughts’
  • Increase self-efficacy – uncover or learn the skills and techniques not to act on suicidal thoughts

 B. Reduce the power of suicidal thoughts;

  • Help patients see that suicidal thoughts don’t last forever;
  • Intense suicidal feelings are often short lived (although acknowledge that individuals may have long lasting suicidal thoughts which can still be very distressing)
  • Share examples of others who made serious and potentially lethal suicide attempts but who changed their mind immediately before or half way through and realised that they did not want to actually die, it was just that they felt so desperate and hopeless that they did not know what else to do to make those feelings go away. Their real wish was to feel better, not to actually die.
  • Reduce ‘the power’ of their suicidal thoughts, whilst acknowledging and validating the distress they can cause to the individual experiencing them;
  • Help the individual experiencing suicidal thoughts to view those thoughts as nothing more than ‘a symptom of distress’ (like having a temperature due to a viral illness), rather than some powerful magical impulse that they cannot resist.

Podcast: BMJ : https://soundcloud.com/bmjpodcasts/revisiting-the-bridge

(Source : Connecting with people: http://www.connectingwithpeople.org/)

 

Day 784

To honour you I get up every morning and I take a breath.

And start another day without you in it.

To honour you, I laugh and love with those who knew your smile and the way your eyes twinkled with mischief and secret knowledge.

To honour you, I take chances, say what I feel, hold nothing back, risk making a fool of myself and dance every dance.

You were (are) my light, my heart, my gift of love from the very highest source. So every day I promise to make a difference, share a smile, live, laugh and love. Now I live for us both, so all I do, I do to honour you.

Author unknown

Day 783

photo-8

(Christmas lights on Bond Street)

Christmas in London is spectacular. Most offices had a ‘Christmas jumper’ day. It was visible right from the morning commute. The young man sitting opposite me on the train wore a half sleeved, white cotton shirt, snowmen printed in a brown outline with a big red bow around their necks. Sweet. Made him look like a child playing grown-up.

As I walked into work, one of the girls appeared in a red jumper with ‘Great Baubles’ boldly printed in white right across her chest and 3 innocent little baubles drawn underneath.

The gym instructor adorned ‘DICKSOUTFORCHRISTMAS’. Bells, holly, mistletoe, reindeers, candy sticks, Santa, Christmas trees, stockings and sparkle scattered everywhere. Matching hats popped up too. Scarves flowed about. Red, green and white dominated. Ear-rings, bracelets, socks joined in. Faces carried similar themes on their eyes, eye-lids, lips and cheeks. Smiles spread across. Music jingled non-stop. Fizz popped. Glasses clinked.

The TV in the corner, quietly showed chafed lips, bitter winters, big clouds of dust, big machines, commotion, uprooted peoples, desimated towns, crying children…

Cinnamon and orange. Candles and gifts. Mulled wine and mince pie…

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Happy Christmas!