small medic mini-blog

fragments. see https://smallmedicsketches.wordpress.com for more

small reflections from the other side

I've just finished a run of nights off the delirium ward

I now see delirium everywhere

where before it was “agitated confused” or “drowsy confused” I now recognise “hyperactive delirium” and “hypoactive delirium”... and I see the dangerous transition points where valuable information gets missed, or plans are never actioned.

Had a registrar on the ward for the first time since I started – first time in 3 weeks, probably

And she went “I've been on the ward as the only doctor... I'm [grade] and I'm doing all these bloods and NOK updates...”

I feel like I've missed something?? like obv the reg should do the decision making but

idk

I used to be assigned to a bay of 15 patients, most with acute medical problems we were actively treating. Now I have 12 in the ward.

Yet I'm finishing jobs about the same time... leaving late in recent days mostly because of tricky procedures and discharge delays due to medication

._.

#geris

When I moved to this ward, I was struck by how long people stayed on.

But, actually

it's been quite good to know my patients so I could tell other teams about them from memory

And to contact families so regularly that we need only update them on small, granular things – and until they recognise my voice

Continuity, eh

#geris #reflections

Last Christmas, I was self-isolating with actual Covid infection and trying to get takeaways without getting in contact with my vulnerable housemate

This Christmas I will be working

I do observe, I promise, but logistically it is... difficult.

A log for wins at work, because I think I'll need it.

Got drawn into medical take for £40ph with escalated escalated rates after discharge ward round. So having done 10-12 TTAs on the new system, went on the take with a ridiculous number of people to see...

And I've only spent 2 days on frailty, but was immediately given a patient who would clearly benefit – care home resident, came in after a fall, history of dementia. Meaning I knew what sorts of things were good to do for this patient! Had a good conversation re risks and benefits of admission too.

Feels good to have seen and thought about this lots, and be able to apply this in an undifferentiated situation.