Wednesday, 19 October 2016

Books that make men cry

What a stunning book. A bright, talented young neurosurgeon recounts his journey into medicine and the story of his all too brief career cut short by his cancer and then his grappling with death.

Like Kalanithi I believe in the power of literature and would love every doctor to read, mark, learn and inwardly digest this book. It's almost a one-sitting read so beautifully written and so thought provoking. The pilgrimage from dynamic doctor to weak, helpless patient is not easy, but the insights gained would enlighten any practicing doctor-especially  those who haven't had to grapple with serious illness in their own lives or close loved ones.

Patients are our best teachers, and when a doctor becomes a patient he or she is often given a unique perspective which can change one's practice for ever. If Henry Marsh (he of Do no harm) thinks every doctor should read this book, I'm not going to disagree. Did I cry? Yep, sitting in Cafe Nero, as the epilogue described his final days and hours, I welled up, thinking of Kalanithi's story, my own mortality and how precious life is.



Monday, 17 October 2016

One step forward

So what has technology deprived us of?

I was thinking about this whilst doing some tidying in my study (a task that makes painting the Forth Road Bridge manageable). I found some beautifully handwritten letters that I had received from a good friend and colleague (who is now too elderly and frail to write), which I had clearly not had the heart to dispose of. His writing style produced an immediate recollection of him as a person and friend. And so I still bemoan the loss of the hand written (particularly the Lloyd George notes). Yep I realise some writing was hard to read and positively untidy, but at least there was less of the searching for the wood amongst the trees that so often occurs when I'm  trying to read a hospital discharge summary.

But back to Lloyd-George, those natty little folders and continuation notes that became increasingly unmanageable wth the explosion in typed correspondence fighting to squeeze in. But a few seconds with such notes gave so much information that I just don't get with the ubiquitous System One (I wonder who has become a millionaire on the strength of System One's dominance?). Anyway within a flash of holding L-J notes I can tell if the patient attends often (thick or thin folder), I can also tell if she has seen multiple doctors by the varying handwriting, and also what her maiden name was, since it will have been crossed out on the front cover (ah, so she's a Smith etc, I bet she's Mary's sister..), and for some, like Elizabeth Taylor,  it may have been crossed out a few times!!

And then what about electronic prescribing?  Yep I'm well aware of the potential for error and the problems we had in the 'old ' days of handwriting all the repeats etc, but there is something about hand written instructions on the script, which is then ceremoniously passed to the patient. It was somehow more personal and perhaps all the more effective for that. Now I don't even have to look at the patient, I just type the script and tell them that it has gone electronically to the chemist. Then I fleetingly look at them and ask if there is anything else. But one of the joys of the handwritten script was timing the moment of pass-over to the patient. The handing over of the script brought the consultation to a neat conclusion. So much more effective than, "OK we're done then, goodbye".

Yet again, good old TS Eliot got it right,
“Where is the wisdom we have lost in knowledge?Where is the knowledge we have lost in information?

Don't lose the shock!

I was talking to a patient this week who has worked in very senior positions in a number of companies. We were discussing how new employ...