UnLtd Blogs - dr. crippen

The BritMeds 1:1

Sun, 26 Nov 2006 19:33:06 +0000

The excellent Dr. Crippen of NHS Blog Doc has launched The BritMeds, a carnival round-up of the best of british medical blogging.There is a diverse range of topics and it has a charmingly eccentric british flavour/

Caring For People With Schizophrenia

Thu, 23 Mar 2006 21:11:43 +0000

The excellent Dr. Crippen has posted a remarkable account of an elegy he gave at the funeral of his friend Emma, whose life came to a premature close after years of living with schizophrenia. The account of Emma's life would be incomplete without talking about the destructive force of schizophrenia, from the time when she was a teenager until her untimely death.

Schizophrenia. Perspectives on it vary so much. There is the demonising view of some popular news reporting that implies that all schizophrenics have the potential to become dangerous to all those around them. And yet, historically, it was not that long ago that schizophrenia (like severe depression) carried a romantic air about it - it was seen as the fine line between madness and creative genius. Schizophrenia has become the universal metaphor for conflicted duality. It stands for self-indulgence and stoicism, inferiority and perspicacity, alienation and virtuosi of empathy, victim and persecuter.

The eulogy is a poignant summary of Emma's life. Dr. Crippen's charts the decline of Emma with respect and much affection. It is particularly sad to read of the gradual loss of those activities that she enjoyed: and to learn that someone who loved reading so much gradually found herself unable to read. However, we learn to admire her resilience and that she retained her humour, and sometimes mined the vein of her insight into her condition:

Bad Week for Caregivers And Those Whom They Care For

Thu, 16 Mar 2006 17:25:50 +0000

It's a bad week for carers in the UK. On Monday, Dr. Crippen posted a diary entry about his Monday morning surgery that detailed the plight of several carers. One of the carers knows that:

when social services “assess” her, she is classified as low need. She knows the system. She worked in it herself. “The best thing I could do is have a heart attack, then we would be high need” she says.

Today, Thursday, it has been announced that Councils To Cut Care For Old and Disabled. Four in five local authorities report that they are about to tighten the eligibility criteria for services for elderly and disabled people. This is in response to funding problems with the NHS that have led to greater than anticipated calls upon Social Care Services budgets.

Almost half the councils reported a cut in funding from local NHS primary care trusts. Councils highlighted the soaring costs of care for the ageing population, unprecedented increases in demand for services for children with a learning disability and rises in fees for care homes. Eighty per cent of councils said they would be tightening further their criteria for provision of services for adults. Thousands who would have received care will go without or pay privately.

So, it looks as if there is going to be no provision for those people who are classified as "low need". Even when there may be strong reasons to suspect that a lack of appropriate support now may lead to a breakdown in the carer's health and create more complex problems in the future. Some carers, like David, have never had a carer's assessment. He has been looking after his wife and son for many years. He says of his situation:

If No Man Is An Island, Is Compassion The Connection?

Tue, 14 Mar 2006 18:09:49 +0000

There is another extraordinary piece by Keith Carlson about the contrasts and ironies experienced by those who care for others. This piece is an antidote and contrast to the report about abuse by carers that is (rightly) dominating the news cycles at present, and the grisly stories featuring prominently on blogs like NHS Blog Doc's.

Keith Carlson gives us very moving insight into the currents of his working life and his vocation. He looks in on a patient and receives his good wishes for the weekend.

Our handshake was a lingering one, and then I took my leave, walked out into the light rain, and looked back at the windows of the institution temporarily housing this gentle and kind soul. He may be locked inside and I may be free to roam, but his spirit is as free as mine, and part of him left with me, and I carry it with me still. It lives in my heart, and no physical boundary can dissolve the strings of compassion which connect us all.

Amidst all the recent publicity, it is refreshing and necessary to read an account like this. And to know that there are people who are guided by their compassion and a keen sense of human dignity. It is all the more necessary when there are incidents that make us question whether some people recognise human dignity in the vulnerable. We frequently quote John Donne's Meditation XVII:

No man is an island, entire of itself...any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee

I have the privilege to run Happystance workshops with carers: the more that I meet them, and the more I come across the writings of people like Keith Carlson, the more I question whether the connection between us all is grounded in compassion. Which is back to thinking about the Dalai Lama's writing on the link between compassion and authentic happiness.

[E]thics are necessary as a means to ensure that we do not harm others...genuine happiness consists in those spiritual qualities of love, compassion, patience, tolerance and forgiveness and so on. For it is these which provide both for our happiness and others' happiness.

Not For The Squeamish

Tue, 14 Mar 2006 12:06:00 +0000

The excellent Dr. Crippen has posted a blog entry about the Monday morning surgery from hell that is emphatically not for the squeamish. In fact, as I nearly fainted a few weeks ago when watching some surgical procedure in House (sad but true, my wife needed to put me in the recovery position) - I read the text but rapidly had to close my eyes and rely on my wife for a vague description of the photograph of the infamous pressure sore. The truly shocking story is at the end of Monday's entry: as with many of Dr. Crippen's posts, it is gut-wrenching, but you have been warned that it is more than usually so if you choose to look at the photograph.

Several of the entries for this infamous Monday morning are about carers. They call for a new airing of the tired lexicon of condemnation. Caregivers who are in despair about the level of care given to the person for whom they are caring when they are in hospital (neither cleaned nor fed). And carers who know that they are the victims of their own competence and will only qualify for more assistance if their own health undergoes a significant decline. Ruefully, one carer summed it up:

Trouble is, she is looking after her husband really well. So when social services “assess” her, she is classified as low need. She knows the system. She worked in it herself. “The best thing I could do is have a heart attack, then we would be high need” she says.

This account from a GP's surgery that could be somewhere near you is a bundling of the daily distress experienced by carers and a ghastly example of yesterday's report on elder abuse. Yet, as this took place in a hospital that could plead substantial staff shortages, does it somehow not fall within the legal framework that would allow the hospital to be prosecuted? Does it somehow fall under a Crown Properties exemption?

A GP In Despair: We've Got Some Medicine, Where's The Care?

Sun, 05 Mar 2006 14:58:25 +0000

I have recommended Dr. Crippens's NHS Blog Doc on several occasions. It is, by turns, a funny, provocative, gut-wrenching insight into what it is like for GPs who are attempting to provide decent medical care within the NHS. The recent entries are gut-wrenching, plain and simple (hint, you will need to look at the comments and read about what happened on Friday morning to grasp even an iota of the anger and despair underlying this post).

Dr. Crippen has written about the lack of availability of basic nursing care (such as the debridement and care of bedsores) on many occasions. He has painfully detailed times when his own judgment and knowledge of his patients was over-ruled by the application of a protocol by someone who does not know his patient (most notably: the incident of the aneurysm and the paramedics; and the difficulty in admitting a patient whom he had assessed as suicidally depressed - Friday's entry). Dr. Crippen has the medical knowledge and (very obviously) a sense of care that is only found in those who are dedicated to their vocation. It seems as if, very regularly, he is frustrated from exercising both of those qualities.

All of my recent reading about allostasis has emphasised that medical innovations have had an extraordinary impact on our quality of life, well-being and longevity. However, in his essay in Allostasis, Homeostasis, and the Costs of Physiological Adaptation, Sterling argues that these extraordinary, high-level medical interventions are being delivered in a low-level, mechanistic way. He argues that these interventions are most successful when they are delivered in the rounded context of care that address all a person's needs - which probably encompass basic nursing needs, and the comfort of human contact.

The Caregiver Burden

Thu, 16 Feb 2006 17:48:05 +0000

I’ve previously written about the varying health costs of caring. Today, the New England Journal of Medicine published the largest study ever to quantify caregiver burden and the widower effect.

The findings pretty much reflect your intuition on the subject. Carers are most stressed/vulnerable when a loved one is admitted to hospital. And, as per previous research, carers well-being is related to the degree of cognitive or physical disability in the person for whom they are caring. The BBC carries a good summary of the paper. And the findings of the paper are robustly lampooned over on NHS Blog Doc (which is rapidly becoming an addiction). However, the paper will be worth a look when it is available online for what it says more generally about the impact of caring on social networks. And for the observations around the impacts of different illness and varying levels of disability on the well-being of carers.

Accounts like this reaffirm what I want for the Happystance workshops for carers. However, I’m very aware that such interventions or activities have to be offered appropriately. Which works against offering it at the riskiest time, as recommended by these authors. And possibly reinforces my belief that the workshops should be available on a regular basis and to offer a way of strengthening carers’ own stress-management and resilience techniques.

Blogs As Creative Outlets

Thu, 16 Feb 2006 16:43:17 +0000

There are many entertaining workplace blogs. Many of these give disgruntled workers a place to vent and to exercise their creative writing talents. Others offer a fascinating insight into:

the dilemmas that face GPs in today's NHS (the excellent NHS Blog Doc)
days in the life of an EMT with the London Ambulance Service
a remarkable account of a Traffic Warden and how his intervention probably saved a motorist's life

Blogging is a new creative outlet for many people. There are blogs that detail life in diverse families. And blogs that provide remarkable accounts of what it is like to live with a terminal illness or a disabling condition. There are audio blogs and video blogs of such remarkable quality that they amount to personal mini-documentaries.

I know a number of people who have learned a lot about their lives from blogging about it. It is like adopting a different perspective and considering aspects of your life that may typically go unconsidered.

Depending on the age-group (and the available resources), imagining that you were going to contribute some written, audio or video blogs entries about your life, is one of the exercises that I use in Happystance workshops. I was recently working with some young carers. Some of the participants were reluctant to join in some of the laughercises. They seemed to be very grave, and quite anxious children: some the self-reports indicated that they were experiencing distressingly little happiness in their lives. However, when I introduced this exercise, the difference in some of the children was remarkable. They enjoyed being the presenter of a mini-documentary about themselves. They came up with a host of ideas about items that interest them.

Happiness As Flexibility Of Mind and Openness?

Wed, 15 Feb 2006 16:56:17 +0000

There are several classic experiments that are summarised and commented on in Prof. Seligman’s Authentic Happiness. The consistent result is that positive emotion allows us to be more flexible, creative and open to new ideas.

I was thinking about this today when I read the explosion of comments on the topic of ME on the excellent NHS Blog Doc. The original article discusses the dilemma that faces Dr. Crippen when asked to provide a sick note for a patient with ME, a condition that he does not “believe in”. Take a look at the comments and the references that are provided in them. They are truly fascinating, and they seem genuinely to be contributing to a desire to learn by the GP in question. Dr. Crippen seems to be taking a real-time journey of listening and discovery that leads to him discussing a new assessment of his patients who currently have the label, ME.

I was recently lamenting that depression and anxiety statistics should not be used to comment on the prevalence of happiness. And I was exposing my thinking on various matters (such as the diagnosis or treatment of depression). I’m actually quite comfortable with holding “on the one hand this, on the other hand...” opinions. I just find it difficult when talking with people who want a definitive viewpoint.