Saturday, 20 August 2011

Dying at home

The Doctor Sir Like Fildes 1887 Tate Gallery
Most people no longer witness the death of a relative at home. The Victorian scene so often described by Dickens, and still experienced in many homes throughout the 1920s, has faded from memory. Even modern GPs seldom care for patients thought the final stage of dying. The hospital and the hospice sharing the spoils.

I would say that to  make yourself available to the patient and her family, where a death is to be expected, is a worthy consideration. And with the advent of mobile phones, no longer is one housebound waiting for patients to call, or expecting one's spouse to man the home phone whilst the doctor drives around with a bleep.

I say this because a few months ago I gave my mobile phone number to the family of a patient of mine dying at home form advanced malignancy. I explained that they could call me any time of the night or day, but I made it clear that I might not be able to attend depending upon my circumstances. As it happened they called me about 3am on a night when I had moments earlier taken a call from my sister advising me that my mother had just been admitted as an emergency in the local hospital.

I visited my now deceased patient. Confirmed the death and spent a few brief sympathetic moments with the family. Just this week I received a touching note from them expressing their thanks. In this week's BMJ Iona Heath writes a typically thought provoking piece on consent for cardiopulmonaty resuscitation. Suggesting that opting in for resuscitation has much to be commended for it, rather than the current opting out-which leads to many awkward conversations between doctors, patients and their relatives. She discusses the place of 'do not attempt resuscitation (DNAR)' orders and the inappropriate behaviour which professionals engage in when attending an expected death. I was struck by this helpful paragraph,
When patients are dying at home, an unfortunate cascade effect can come into play. Relatives and friends are coping well and managing to provide just the kind of gentle care that most of us hope for in our dying days, but to people unfamiliar with death the last moments of life can be distressing and frightening. In this situation, all too often the carers will seek support by calling an ambulance, and this becomes ever more likely with the decreasing availability of a familiar primary care or palliative care professional out of hours(my emphasis). Once the ambulance is called, the paramedics are obliged to attempt resuscitation, however inappropriate. Guru and colleagues documented that 10% of cardiac arrest calls in Toronto were to patients with pre-existing terminal illness, and in 63% of these the relatives asked in vain for resuscitation not to be attempted.5 The authors conclude that the carers of terminally ill patients should be specifically advised not to call an ambulance and to be given information on other sources of emergency support. (Read the rest here)
Most GPs do  not care for many patients dying at home each year. Give the family your mobile number. It's just a tiny bit of traditional family practice that will mean so much to the grieving family in the months and years ahead. And will cement your relationship with them throughout your career-assuming you're not going to change practice every 5 minutes.


Wednesday, 17 August 2011

State of the nation

'They who should be praying, or too many of them, are disputing and fighting among themselves Alas! How many professors are more concerned for the mistakes of government than for their own sins'
Thus writes John Newton from Olney, Frebruary 1778 to his good friend William Bull of Newport Pagnell.

Tuesday, 16 August 2011

There's prayer and there's....prayer!

Sometimes when I lead the service at our church I write it out rather than prayer extempore. This is how I began last Sunday, with the riots and world unrest in mind,
Dear Father God we bow in your presence this morning and come to you in the name of Jesus. We do not deserve the great mercy and love which you have shown to us and which is offered to us day by day. Thank you that,
‘the steadfast love of the Lord never ceases, His mercies never come to an end’
Dear Father we praise you for your true greatness, and for the majesty and beauty of your character. We praise you for Jesus Christ-he who is fully God and fully man-the one who stepped down into our world, to bridge the vast gap between us and you. Read the rest here

I guess that prayer does contrast rather with this prayer, prayed before the  Nascar Nationwide series race 2011. I hesitate to say 'enjoy',



Friday, 12 August 2011

Looting in a rich's man's world

How sad and indeed frightening the recent disturbances in England have been. What should a Christian think and do?

I don't have any special wisdom but I find Mike Ovey's comments quite helpful,
'A Christian explanation could begin with one of the more sensible secular comments. These are "consumer society riots", says Dr Paul Bagguley, who is a sociologist at Leeds. This is very perceptive. It points clearly to the consumerist, acquisitive nature of the looting, and it hints that these are the kind of riots that a consumer society (and let's not forget, that's all of us) has. It hints that this is the kind of riot you expect from members of a consumer society, not from those who refuse to be part of it. That does not allow me to say the looters are totally alien or other, or even "enemies of society" in a straightforward way. The looters are committed to the consumer society. They're "us", not simply "them".'
It's worth reading the rest here although I do think he is somewhat patronising about a Christian response which consists of care, concern and presence which he briefly mentions. And prayer doesn't get a mention.

However the subject of consumerism and it's negative effects are going to have to be faced. A book I read a year or so ago called Affluenza is a powerful indictment of a society which glorifies wealth and possessions  (eg Chris Evans and his multiple Ferraris) effects such inequalities breeds.

As a Christian I need to grapple with my innate tendency to acquire possessions and the powerful and yet subtle grip that they can have over me. As Jesus said, 'And why worry about a speck in your friend's eye when you have a log in your own?'


Tuesday, 9 August 2011

More difficult people..

With the horrible rioting going on in England just now I continue to reflect upon the dignity of all people-a belief which is hard to hold onto when so many people are intent on mindless violence.

Nonetheless dignity is something we all have as human beings made in the image of God with 'bestowed worth rather than acquired worth'..for more on this watch a very helpful talk from John Ortberg here...

Thursday, 4 August 2011

Difficult people...

I've already referred to a wonderfully helpful talk that John Stott gave in 2006 reflecting upon his many years of Christian ministry. I can't help but make comparisons with the challenge that faces me daily in my work as a GP. Not all patients are likeable, some are ungrateful, and a few are downright awkward. Many are just a little wearying.  But Stott's reflections upon the words of the apostle Paul recorded in Acts 20.28, Keep watch over yourselves and all the flock of which the Holy Spirit has made you overseers. Be shepherds of the church of God, which he bought with his own blood, are so thoughtful,
'If the Father the Son and the Holy Spirit are all committed to care for the people entrusted to us, should we not be committed to their care as well?'
Although the patients on my list are not exactly my 'flock', as a follower of Christ myself, and believing that God has placed his image in all men and women, I do have a similar responsibility.

Stott goes on,
'When I see 'difficult' people queuing up to speak to me after my sermon, I speak to them before that reach me, in my mind
"What a precious person you are. How valuable you are to God: Father, Son and Holy Spirit. It is a privilege for me to be involved in your care."
I find this extememly effective. it changes my attitude towards them immediately...I recommend it to you.'
And so to tomorrow's busy surgery....


Wednesday, 3 August 2011

Caught in the middle

Highgate box junction
My eldest daughter Sarah kindly sent me this link to the  London Evening Standard report on the money that Transport For London have raised from fines imposed on drivers who stop on the yellow grid at a notorious crossroads in north London.

The cameras caught me in the box for 3 seconds a couple of months ago and fined me £60.00. That's £20 per second. It certainly makes public transport seem a bargain.

If only Beeching hadn't scrapped so many lines in the 1960s,  many people would be using the railways for their commute over short distances, linking small towns together, and so reducing cars on the roads. How lovely it would be to see far fewer cars on the roads and a corresponding increase in cyclists. Take a look at the public transport campaigning website, and Campaign for Better Transport.

Nearly 30 years ago I cycled the 12 miles from Olney to Bedford on the A428 with my then very young daughter sitting on a tiny seat on the crossbar. The thought of attempting that now....(and not just my fitness and the seat being a tad small for Sarah!!).

Three more years

fa
Hannah's first day GP training
My youngest daughter Hannah has just started a further three years of training to become a GP Already she has done six years at medical school and two years as a junior hospital doctor.

What more is there to learn?

Looking back over my career I'm conscious of the need to learn and re-learn on a daily basis. Not only the knowledge base of the essence of medicine which grows so quickly, but the challenge of applying yourself to the myriad of differing situations which you face each day. These situations frequently require lateral thinking superimposed on a core of knowledge and experience. Its a great career and I hope she gets as much interest and enjoyment as I have had.

A light touch

Just pebbles Its great to be back in the Hebrides. Although lots of rain is forecast this week, yesterday was a pleasant surprise. So we...