tag:blogger.com,1999:blog-2482732367812174734.post3423006527403044437..comments2024-02-28T08:42:52.675+00:00Comments on The Junior Doctor: "Don't try too hard, doctor"Dr Michael Andersonhttp://www.blogger.com/profile/05340927185641717290noreply@blogger.comBlogger15125tag:blogger.com,1999:blog-2482732367812174734.post-59768867407265291512011-11-22T14:39:48.383+00:002011-11-22T14:39:48.383+00:00Any junior doctors taking exams but don't have...Any junior doctors taking exams but don't have enough time to revise properly or find it hard then PasTest - the specialists in<a href="http://www.pastest.co.uk/" rel="nofollow">medical exams revision</a> ,courses and books will be helpful for last minute revision.Med studenthttp://www.pastest.co.uk/noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-39768854246720491132011-11-22T14:34:53.383+00:002011-11-22T14:34:53.383+00:00true. don't try too hardtrue. don't try too hardAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-13460498665584848522009-02-19T18:33:00.000+00:002009-02-19T18:33:00.000+00:00HI - you are quite right about the difference and ...HI - you are quite right about the difference and that these advance decisons are not as black and white as people think. My late husband in his 80s, when in the end stage of heart failure, told our GP no resuscitation nor anibiotics if he got pneumonia I then asked him what if he got pneumonia next week as a result of gettting a grandchild's cold and he said to treat it. He didnt mean as early as this. In the end though I was able to allow him to die of pneumonia when he was too ill to make the decision because I was clear then about what he wanted when. So the moral is that good discussion and clarification is needed. mary PAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-36303279349709640262009-02-13T19:36:00.000+00:002009-02-13T19:36:00.000+00:00As always a very intelligent and thought provoking...As always a very intelligent and thought provoking entry Dr Anderson. You are a credit to the NHS.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-69123207202782297132009-02-09T16:28:00.000+00:002009-02-09T16:28:00.000+00:00Just found your blog and I think it's brilliant. ...Just found your blog and I think it's brilliant. I'm a wannabe anaesthetist 5th yr medical student with finals looming, and reading your entries gave me a much needed boost of motivation. You've also helped me focus on why I'm actually putting myself through all this shit; to be a good doctor, even a good anaesthetist, one day soon. Reading your blog counts as revision, right? :)Dr Lhttps://www.blogger.com/profile/02759972974719860793noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-31392624077654951062009-02-07T18:23:00.000+00:002009-02-07T18:23:00.000+00:00As above, this is an interesting take on the situa...As above, this is an interesting take on the situation and one I hadn't really thought of.<BR/><BR/>Typical psychiatrist, eh?<BR/><BR/>In our hospitals, anything more challenging that a mild chest infection or an ingrowing toenail is enough to require 'the hospital' and although we are trying to improve physical care of psychiatric inpatients there is only so much you can do...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-5455963916326138112009-02-07T17:10:00.000+00:002009-02-07T17:10:00.000+00:00Some very fine and difficult deliemas to understan...Some very fine and difficult deliemas to understand but you;ve put them accross brilliantly!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-16087798476029881062009-02-07T10:41:00.000+00:002009-02-07T10:41:00.000+00:00Thank you everyone for your kind words. I went see...Thank you everyone for your kind words. <BR/><BR/>I went see Bill during my lunch break yesterday and he’s recovering well from his surgery. There were no dramas or crises during the anaesthetic or surgery, but Bill’s now 2-3 days post-op and this is the danger time because this is when things tend to go wrong. I really hope he pulls through.<BR/><BR/>To respond to a couple of specific points above, Anonymous & DrJDR, thinking back again to my chat with Bill, I think he and I had different ideas of what “trying hard” means. (I think) he thought it meant CPR whereas I thought it means giving a good anaesthetic so that, hopefully, CPR doesn’t need to happen in the first place and this is why I had a bit of trouble getting my head around his words.<BR/><BR/>DrJDR, you raise some good points about advance statements. Bill’s daughter said that Bill didn’t want resuscitating, but what does resuscitation mean when you apply it to anaesthesia? It’s one thing if Bill was found dead on the ward, but in theatres, he will be constantly monitored and watched so that signs of deterioration can be picked up and acted upon long before he has a cardiac arrest. Is acting on these signs “resuscitation?” I wasn’t lying when I said that I’d respect his wishes, but if you think about it, it’s quite hard to decide where the line is. In the theatre environment, what is “resuscitation” and what is “a basic level of care?” I’ll give you some examples to highlight this dilemma and say how far I would have gone with Bill.<BR/><BR/>If he became overly sedated and obstructed his airway:<BR/>Would I do some airway manoeuvres (chin-lift, jaw-thrust) to unobstruct it? Yes. Is this resuscitation?<BR/>Would I give oxygen? Yes. Is this resuscitation?<BR/><BR/>If he started to become hypoxic and his oxygen saturation started to fall:<BR/>Would I ventilate him with a bag and mask? Yes. Is this resuscitation?<BR/>Would I intubate him and convert to general anaesthesia? Yes. Is this resuscitation?<BR/><BR/>If his blood pressure started to fall dangerously low:<BR/>Would I give him intravenous fluids? Yes. Is this resuscitation?<BR/>Would I give him inotropes? Yes. Is this resuscitation?<BR/>Which one?<BR/>Metaraminol? Yes. Is this resuscitation?<BR/>Ephedrine? Yes. Is this resuscitation?<BR/>Atropine? Yes. Is this resuscitation?<BR/>Adrenaline? Yes. Is this resuscitation?<BR/><BR/>If these things didn’t work, would I start chest compressions? No.<BR/><BR/>Basically, rightly or wrongly, I’ve taken his “I don’t want to be resuscitated” statement to mean “I don’t want chest compressions.” I think that if I’d not done the things I’ve listed above, I would have been negligent and not providing the best care I could. In a way, you could say that anaesthetists are continually resuscitating their patients as they have their surgery, so a patient coming down for surgery who “doesn’t want to be resuscitated” poses a particular dilemma for us.Dr Michael Andersonhttps://www.blogger.com/profile/05340927185641717290noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-70921522084390359112009-02-06T15:06:00.000+00:002009-02-06T15:06:00.000+00:00So what happened?! Did he make it? You've left us ...So what happened?! Did he make it? You've left us on a cliffhanger...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-31669846255898048722009-02-06T11:21:00.000+00:002009-02-06T11:21:00.000+00:00I tend to agree with comments of Anonymous above.H...I tend to agree with comments of Anonymous above.<BR/><BR/>His request to you seems to have been concerned specifically with resuscitation in the event of it being required. This does not really have any bearing upon the efforts that you will make to give a good anaesthetic - which I'm sure he would be keen for you to do.<BR/><BR/>Clearly, if you made a mistake with the anaesthetic and he died as a result this would be a major problem. However, if you were to do your best with the anaesthetic and for whatever reason things went wrong with the operation to the stage that he did need resuscitation, you would at that point need to consider his views.<BR/><BR/>In a way, I'm a little concerned by your statement that "I'm going to ignore what you said and I'm going to try as hard as I can". Whilst this might apply to the anaethetic etc, would this also apply to resuscitation if needed? If something had gone wrong in the operation, and he needed resus, would you have allowed it to proceed or would you have stepped in to stop it, on the basis that you knew that this was not what he wanted? You might view this as not doing your best, but on the other hand this was his decision. This is a man who is clearly in full possession of his faculties who does not wish to be subjected to the trauma of CPR etc.<BR/><BR/>Following the recent Mental Capacity Act we are now required buy law to take into account 'advance statements' such as these. If attempts had been been made to resuscitate him and his daughter had later complained to the hospital that his wishes had been ignored, the hospital might find itself in trouble. <BR/><BR/>I guess what I am saying is that doctors often struggle when patients want something different than what we believe is best for them. However, it is their life and not ours, and we need to respect that. Most of the time, the law requires that we should allow people to choose what they want to happen to them, whether we agree with it or not.<BR/><BR/>There are exceptions - most of my patients fundamentally disagree with their treatment, and I am legally empowered to enforce it. But this does not apply to the vast majority of treatment given, and by and large we need to think very carefully before doing something which conflicts with the patient's ideas of what should happen to them.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-22111199835739689062009-02-06T09:05:00.000+00:002009-02-06T09:05:00.000+00:00What they all said...I've said it before, and I'll...What they all said...<BR/><BR/>I've said it before, and I'll say it again - I want you looking after me if I ever have to have an operation!Johttps://www.blogger.com/profile/17965300148218903639noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-55822455643540834762009-02-06T07:00:00.000+00:002009-02-06T07:00:00.000+00:00Yet another thoughtful, intelligent post, Bill is ...Yet another thoughtful, intelligent post, Bill is a lucky man, whether or not he survives,he will know, and his family will appreciate your attitude and sensible approach to his treatment.<BR/><BR/>We need more doctors like you in the NHS.Angus Deihttps://www.blogger.com/profile/00436552827944508728noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-42627001729884648312009-02-05T22:46:00.000+00:002009-02-05T22:46:00.000+00:00[What the Jobbing Doctor said] But also:I'm not a ...[What the Jobbing Doctor said] <BR/><BR/>But also:<BR/>I'm not a medic, I don't know what I'm talking about, really, but cetainly from the point of this layperson there's a gap you could put a bus through between trying your best for Bill in terms of getting what you do, and how you do it, as close to just right as you possibly can and the sort of resucitation with jumping on chests and big electric pads that Bill may well be trying to avoid. <BR/><BR/>I don't think you need to feel you're not doing what Bill hopes you'll do in getting him safely through his surgery.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-29334646655301435982009-02-05T22:32:00.000+00:002009-02-05T22:32:00.000+00:00Reading this, I can't help but think that you are ...Reading this, I can't help but think that you are the type of anaesthetist who is a true credit to your hospital and to the profession.madsadgirlhttps://www.blogger.com/profile/02406362172304786268noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-41120989280812139962009-02-05T22:21:00.000+00:002009-02-05T22:21:00.000+00:00Thank you for a thoughtful, humane and ultimately ...Thank you for a thoughtful, humane and ultimately decent post, Michael.<BR/><BR/>You are really a credit to the profession.<BR/><BR/>JD.Jobbing Doctorhttps://www.blogger.com/profile/15556376882759955757noreply@blogger.com