I realised one of the highlights of my clinical career to date whilst on holiday in late May. The email from my secretary commenced with the customary heart sink mid-holiday introduction.
“I know you’re on holiday but……”
Dare I read on? Was it a complaint, or an adverse event? Had I somehow misread the AMU rota and failed to turn up for my on-call? What followed was, in fact, delightful:
The back story to this post-card, anonymised and reproduced with kind permission of the author, involved two years of regular visits as part of my community geriatrics service. Sometimes I would provide advice on technical matters such as iron supplementation, courses of steroids and management of cardiac dysrhythmias. Sometimes I would provide thoughts on aids and adaptations. Other times I would help to consider prognosis, what acute hospital might add and whether management in the community was preferable. Sometimes I would just listen to how life was panning out for my patient, and for her devoted daughter.
By the time of the visit to Lourdes by “Jumbulance” (see: http://www.across-uk.org/pilgrimages-holidays/the-journey/) my patient required hoist transfer from bed to chair and had fluctuating arousal and moderate cognitive impairment related to Lewy Body Dementia. That she made it at all is a credit to all involved. That she had such an amazing time is either evidence of divine providence, or of the power of engaging in meaningful activity, depending on your world-view. That she and her daughter recognised some contribution from the systematic and patient-centred approaches that we encourage through geriatric medicine is nothing short of humbling. I genuinely shed a tear – but don’t tell any other hardened Scotsmen that, or they’ll mock me down the pub.
So a happy patient and a happy carer experiencing a happy life event. I guess I should be happy. But as a reflective practitioner I find myself wondering whether I could have done more of the technical stuff better and earlier to slow or reverse her functional decline. As an academic with an interest in models of service delivery, I wonder whether using so much of me, for so long, is an efficient and effective way to provide care. Managerial colleagues might define this in terms of the question “did I do the right things?” and “did I do the things right?”
It’s important as geriatricians that we continually strive to improve. We know that our patients are not hopeless – as other parts of society and/or our profession might seek to have us believe – and our response to that has to be continued innovation and reflection - even when it seems things have gone well.
So it is good to see in this issue of the newsletter that the Society has contemplated both of these questions.
Under “doing the right thing”, there is the innovative work of the NHS England Vanguard sites in providing new models of care to older patients in ever more integrated and connected ways. Russell Pitchford’s article is an excellent case study of work in progress. Andrew Clegg reminds us that we need ever more sophisticated and nuanced research approaches to build the evidence base for interventions in older patients with complex medical problems. The numerous policy challenges outlined in Patricia Conboy’s policy digest reminds us of the campaigning and proselytising still to be done if we’re to ensure best-evidenced care gets into practice.
Under “doing the thing right”, the detailed report from the Society’s spring meeting is evidence of colleagues from across the geriatric subspecialties seeking to ever-refine their protocols and approaches to make sure we do the best for our patients. Amit Arora’s piece on the Choose Wisely campaign reminds us that weighing the available evidence may often result in us working within shared decision-making frameworks to limit investigative or interventional algorithms. In her piece on benchmarking, Leigh Jenkins reminds us of the importance of measuring what we do against acceptable and accepted quality criteria.
So it’s nice to feel, as I reflect, that colleagues around the country are doing the same and that the answers to my questions – well some of them at least – are in the BGS Newsletter!
That leaves us with the as yet unopened can of worms as to whether one should check one’s emails during annual leave. At the end of this particular editorial I’m left thinking that there’s no such thing as being too connected, when connectivity delivers news this good. I may not feel the same way, though, next time I read those heart-sink words.