I have two days off after a weekend on call with a steep learning curve, so my brain does need that break.
Just writing some reflections and portfolio sign offs now and thinking
It was pretty fitting that one of my first big learning events was recognising when people were actively dying. That was something I was afraid of, starting off – knowing what was reversibly unwell and what wasn't, and with all the things around that: discussing when people might not survive resuscitation; when to make the call to involve palliative care.
Being in Frailty has helped with making these conversations much more common, and led by seniors used to making these decisions compassionately and sensibly.
Listening to the palliative care team was an education. Listening to how they navigated difficult conversations and family dynamics helped show a way that was calm and clear about uncertainty. In medical school, palliative care teaching was often about generic “breaking bad news” and prescribing. Let's be frank, most of my “palliative care revision for finals” was 80% prescribing, 20% “soft skills”. Learning about palliative care in FY1 has been 20% prescribing, 80% communication skills and styles of patient assessment.... like most other clinical specialties, really!
I have no answers. Coming alongside people and talking about this with them is becoming a bit easier with practice, especially when I know it can be done with compassion and gentleness.
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.
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.