Before I pack up for the Christmas break – the last one in uni!!! – some thoughts to round off the past few months. We’ve been running at full pelt, Naruto-style, from placement to placement, after about a 6 month break from clinical medicine for many of us.
Hospital medicine is increasingly about learning to care for older people. I’ll leave you to look up the statistics, but there’s a reason we have substantial (for medical school placements) chunks time on care of the elderly hospital wards.
The transition between community and acute hospital is fraught and full of uncertainty. Discharge planning is such a risk/benefit analysis! Add to that the new peril that if you err on the side of caution, your patient might catch covid in hospital. I was mildly surprised how embedded into specialty training this was, though in hindsight, it’s really not that uncommon. Fascinating to learn about the work of, say, hospital outreach, hospice and rapid response community teams to catch people wherever they might be.
There’s a pun here, but it’s a bit surgical…
But if people in old age medicine seem keen on keeping their patients regular, they really are. It’s possible to approach bowel management somewhat logically, but no one seems to understand it. There must be a better way than sennalactulosedocusatephosphateenema: I haven’t learned it. Being regular, though: important. Eat your fibre while you still can, please.
Everyone comes from a different place. Understanding a person’s baseline is key to discharge decisions. And we in hospital don’t often get to see that because there is such a divide between community and hospital (see 1). I’m realising (late!) that acute hospitals work well for – as the name suggests – acute problems with a defined solution. Patients pass in and out from the category that benefits most from acute medicine to people who need a longer-term vision. It’s just bottlenecks every single step of the way which keep them on acute wards with the slightly useless note “MSFD” (medically suitable for discharge) in the daily review.
Which brings me on a slight tangent to the way we learn medicine traditionally: one thing at a time, considering how they affect a person in isolation. Bodies don’t read the textbook though, and are allowed to have more than one thing going on at any one time. This is increasingly evident in tools like BMJ Best Practice and its “co-morbidities” function which allows you to see how common underlying health conditions affect a presentation or condition. We even joke about it – the laundry list of medications, our incredulous looks when patients say they don’t have any health problems, as if old people were trying to trick us with their good health. How we’re taught to deal with that, though, is still
My Budget Million-Pound Question
What does a “properly” staffed healthcare system look like?
How you get the exact numbers, I don’t know. Maybe it doesn’t matter that much when the NHS has that many unfilled vacancies. But what difference would it make? And what will it take to get us there?