At least two of the consultants are planning on buying us lunch in the next week and there’s some kind of meal thing today and I am freaking. out.
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I wonder how many other people on tumblr are listening to the sound of someone’s live beating heart.
Well, I try not to do both simultaneously, but…
Also, the notes on my comics that feature stethoscopes have taught me that using stethoscopes is also a very specific type of uh, interest, so your fellow heart-listeners aren’t just medblr.Heh, I actually work in the cardiac physiology department of a hospital and sometimes I can hear the sounds of the echocardiograms from the reception area!
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Hospital doctors will find new NHS order on checkups ‘impossible’ →
Hospital bosses have ridiculed a new edict from the NHS which insists every inpatient should be medically assessed each morning and evening by a senior doctor.
They claim the order is “impossible” to fulfil because so many hospitals are struggling to fill medical rotas because of widespread shortages of doctors, which are as high as 25% in some places.
The instruction came earlier this month in a letter to the chief executives and medical directors of hospitals in England from the regulators NHS England and NHS Improvement. It made clear that in a bid to cut the number of patients using beds unnecessarily, hospitals must “ensure every patient has a review at the start and end of the day by a senior clinician to facilitate discharge”.
Chalk this down as another idea by people who fundamentally don’t understand how the NHS works, or how it is on the frontline.
When you work on the ward, you as a junior doctor do a ward round every morning. Some days that ward round is led by a consultant, other days by a registrar. Consultants see all patients on some days. On other days, they see the sick and new patients, and you see the rest and report back any concerns.
Unless it’s a high acuity ward, in which case you get a consultant ward round every day.
The point is, you see patients on a ward round in the morning, make decisions about their treatments, recovery status and discharge planning in the morning, usually taking you all the way up to lunchtime, and occasionally far beyond that time. By this point, you’ve identified who can go home in the next couple of days, and what needs to happen for them to go home. And then in the afternoon, you have to action the plans made in the morning, whilst your consultant is in clinic, and your registrar is seeing referrals or doing interventions. This means that the ward junior doctor will be taking bloods, getting investigations to happen, chasing reviews, reviewing sick and deteriorating patients, preparing discharge paperworks, liaising with pharmacy, OT, PT, getting advice from other specialties, updating patients’ relatives, writing death paperworks, having best interest meetings, going to teaching and generally making sure everything actually happens. There’s a lot that we have to do on a daily basis to ensure patients get good care, and that doesn’t happen whilst we’re on the ward round. Seeing patients is an important and necessary part of the job, but it can’t be the entirety of our workday; we also need time to action the things that need to be done.
There simply is not enough time in the work day to do two ward rounds with current staffing; when would junior doctors actually be doing the work if they rounded on everyone twice? Where would they find the manpower to make it happen? Who is going to be running these consultants’ clinics whilst they do their second round of the day? Are those consultants going to see all those patients alone, or are they going to drag their junior arond again, so that they can’t do any jobs because they are busy scribing?
This isn’t even an idea aimed at improving clinical care; it literally seems to be aimed at discharge planning and getting patients home. But in my experience, it’s almost never lack of senior review that is holding people back from going home in the afternoon, and people’s clinical status rarely changes so significantly in the course of one day that someone who wasn’t medically fit that morning would be fit in the afternoon. People tend to get sick quickly, but they don’t tend to recover quite so suddenly!
It’s also something we plan for; if we’re waiting on a test result to send someone home, we discuss what to do with the result beforehand, and we’re always able to discuss any truly startling revelations with a senior when required. We don’t usually need a consultant around the ward all afternoon, as long as they are contactable for advice; it’s really not lack of a senior that stops people from going home. When discharge is delayed, it’s usually because someone is waiting on an inpatient test, or hasn’t got a package of care or equipment delivered at home, yet. Things that are out of our hands to fix.
So although I think senior review is a necessary part of the process of discharging patients, I don’t think having senior doctors review people twice a day would send many people home any sooner, as long as they are already being seen adequately frequently by easily contactable seniors. Which is usually the case.As a receptionist in the cardiology department department of a small hospital, I can say that it is absolutely things like inpatient tests that delay discharge, and often an instrumental part of getting those tests done is the junior doctors who drop off the forms, call us up to let us know that a test has become more urgent or is discharge dependent, and generally coordinate the whole thing.
I can also say that right now we have six discharge dependent patients waiting on heart ultrasound scans; when I came in this morning, that number was nine or ten. They’ll likely be waiting til next week now. We know that they are there, waiting; there’s nothing we can do without more echo staff to carry out the tests while we try to balance inpatient, clinic and outpatient requests. You want patients discharged? Give us more resources to carry out the necessary tests and that will happen sooner. Having consultants rounding on the wards so they can tell us what needs to happen can’t make a difference unless we have the means to do it.
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I wonder how many other people on tumblr are listening to the sound of someone’s live beating heart.
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View high resolution
Based off of this post by @recoversuggestions
Hahaha as if the NHS works that way.
(via shes-healing)
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Challenge: Create an image out of a word, using only the letters in the word itself.
Rule: use only the graphic elements of the letters without adding outside parts.This project started nearly twenty years ago as an assignment in my typography class at art school. Students were encouraged to see letters beyond their dull, practical functionality. The challenge is to visualize the meaning of a word, using only the graphic elements of the letters forming the word, without adding any outside parts. The challenge was very hard, but the reward of “cracking” a word felt great. So this became a lifelong project for me. In 2011, I published a book called “Word as Image” containing nearly 100 words. H/T Fubiz
(via crossconnectmag)
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Kotisaari Island in Finland Through the Seasons by Jani Ylinampa
you can also find me on instagram @mary_bu__
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(via archoftheworld)
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“I’m not really mentally ill, I’m just faking this.” - A mentally ill proverb
Theme: Linear by Peter Vidani