Boiling

some neurosurgeons today finally cottoned onto the idea that its good to take a patients blood pressure before they turn up to an anaesthetic room at 220/120.

result!
all i got to do now is find someone to do it…
why not the nurses who do it for every other speciality already?

“that sounds fairly easy” preassessment nurse says..” go to admissions and they’ll tell you how to do it”

admissions?
who knows where that is? the admissions reception?

got to them ” err no idea” they say “,but every speciality has an admissions officer…except of course the neurosurgical…try office in admissions office for ENT outpatients…”

“neurosurgeons don’t have one of us” says ENT admissions manager ” but all thats needed is to book the preassessment on the booking form and the activity gets coded.you just red some one to book it.try the neurosurgical secretaries”

enter secretaries :”yes its do-able and we could have stab at it but we need the all clear from the manager to know how to code the activity”

manager “great do it…we ve been trying to get something like this for years” !!??

ok…its within my grasp

back to secretaries “your boss says its ok”

secreratries “well…err..ok but give us some time because there will be a backlog which will result in new letters and reschedulings”

nevermind ..at least theres a plan.

hmmm.maybe i should go back to the nurse who said it all would be fine in the first place as long as the powers that be are happy..it all seems too easy.

back to nurse :” they all say fine”

nurse ” aah well.wheres this going to happen?”
me”huh?”
nurse “we dont have a room.”
me”oh”
nurse” and who’s going to see them.im not comfortable seeing neurosurgical patients ”
me “i thought you said…”
nurse” and we have quite a lot of patients already”
me “but i told you earlier it would be 4 a day”
nurse”and who’s going to pay the extra nurse”
me “pay? aren’t you guys already doing it”
nurse”we al have our own speciality clinics for preassessment”
me “why?i thought you agreed with me it didn’t need any specialist knowledge…just blood pressure,ECG,basic stuff…”
nurse ” all the directorates pay their own nurse”
me”to do blood pressures,ECGs and ask the patient what drugs they take??”
me “yes.sorry”
door shuts

leighday vs addenbrooks

rant time
So as I said to a colleague
It is always going to be hard to get consensus from a body of professionals who believe they have a fixed job plan to respond to a dynamically fluctuating judiciary who dispense ever evolving statutory duties for which there is no adequately tailored job description currently in practice.

But it is fucking easy for judges to dispense ideals and leave the hard labour to shop floor workers to figure out.

So take the DNAR issue needing to be explicitly discussed with a patient who has capacity.
In principle totally uncontroversial.Who would disagree that the patient at least has the right to know what is being discussed about them?

Well…how about if it is deemed to risk causing “sufficient harm” to have that discussion so as to warrant not having to.
What the fuck does that mean??

And apparently “just” distress alone is insufficient a reason.

OK.so distress isn’t a potentially adverse physiological response well known to result in heart attacks,depression and stroke???

When does distress become sufficient harm?
Whenever the clinician deems it to be?
Or does this require yet another 3rd party??

It seems a judge can bang out the obvious and yet leave the tricky bit none the clearer…
Fine…no harm done?

Well actually now that great majority of the public that does not go into hospital to be educated on human rights and ethics has got to be informed of every fucking ambiguity and subtlety regarding the implications of distress and sufficient bloody harm…enough to give you a bloody heart attack,right?

And you can bet that majority of people who do not get ill to have to opportunity to be versed on NHS policy are so overwhelmed they will shirk any inkling of responsibility for themselves due to a misunderstood fear of the finality of a signature or perceived “consent” to some confusing esoteric issue that didn’t even occur to them….and the same goes for a large fraction of clinicians who are now going to forgo the opportunity to use their clinical judgement for fear of not carrying out a “process”

and then the hypocrisy.
If it’s so easy to dispense with ideAls as in the case of DNAR discussions then who would also disagree that a moribund patient should have the right to take their own life..by proxy if necessary..ethically fair,no?

No.fear of a precedent.fear of abuse of the system.fear of the potential victims in such scenarios.
but hang on…isn’t it about the principle?…and you let the little worker ants iron out the messy inconsistencies of how to make it work in practice?

Apparently not…so let’s make it “not illegal” but you still have to take the person to Switzerland…assist them in their suicide..and then come back to the UK to go through the farcical formality of being arrested at customs only to be released later..assuming it was all fairly straightforward…

Thanks for the helping hand from our highly practical and pragmatic judiciary for simplifying that for us…

Forbidden Fruit

I like many others had eventually no choice but to submit to the temptation of Apple, when all my high minded principles were finally laid to rest in the hard drive of a heathen and unsynchronised iTunes account shamefully encrypted in an AUCC file destined for the incestuous hybrid of an iPod and an iPhone,the iPod Touch.

Remember Danziger’s Britain,
almost feels like Samuel Pepys diary,or the Domesday Book…some ancient manuscript of a land from a forgotten time…early 90s navel gazing recession that apparently never was…but seemed to embody the essence of what Morrissey’s spirit was softly wallowing about in broken fenced Northern alleyways wedged between terraced Council homes in Salford.

Something bleak,something Northern,something longing,something lost.