26 November 2006

Patient Dignity

Dr Grumble does not want his male and female patients milling around together on the same ward if they are not happy with that. But the average NHS ward does not always make it easy to fully separate the sexes and Dr Grumble would sooner see the sexes together than not have a bed for his patient. And with ever decreasing bed numbers this is the choice our managers have to make.

Dr Grumble does not like having to ask patients about private matters behind some flimsy curtains which just play lip service to privacy. Read the books about how to convey bad news to a patient that is hard of hearing and it is unlikely that it would advise you to shout this information to the patient in an open ward. But these are the realities of today's NHS. Who gets the blame? Sometimes the doctors. But it's not our fault. It's the environment in which we are forced to work.

If our managers were genuinely concerned about patient dignity wouldn't they provide patients with something better than the typical hospital gown? What function do these things serve? What's the betting the hospital managers claim there is some special clinical need? If Dr Grumble wants to examine a sick man in one of these ghastly garments he has to first sit him up, then undo tightly knotted ties then somehow lift the sick patient's bum off the bed and so on. In short, it's a real struggle to expose the patient's chest. What might the patient wear otherwise? Pyjamas perhaps? What could be easier? Unbutton the front and everything is accessible. Sit the patient forward and lift the pyjama top up and the back of the chest is there for auscultation. As for the abdomen, that too is easily accessible if the patient is in pyjamas. Oh and they cover the patient's bum for when they want to walk about. Come on managers, help us a bit! Buy in some pyjamas!

19 November 2006

Georgi Markov

The case of Alexander Litvinenko who is alleged to have been poisoned with thallium reminds Dr Grumble of the story of Georgi Markov. Georgi was a Bulgarian who defected in 1969 and settled in London. In the late 1970s he turned up at a hospital where Dr Grumble used to work claiming that he had been shot in the thigh with an umbrella. He was extremely ill and clinically it appeared that he had septicaemia. Within a day or two he was dead.

Georgi Markov

The story seemed altogether a little implausible but an astute radiologist spotted an opacity the size of a pinhead visible in a radiograph of the right thigh and was insistent that it should not be ignored. Despite what might have appeared to be the mad ravings of an extremely sick man, it eventually transpired that poor Georgi had almost certainly been poisoned with a tiny quantity of ricin.

The tiny bullet which killed Georgi.
Just half a milligram of ricin (about the size of a pinhead) can be fatal.

The name of the radiologist was Jean Dow. Unfortunately her astute observations did not help poor Georgi.

The orginal reports carried in The Times can be read here. And here you can find an interesting interview with Annabel Markov, Georgi's wife.

Dr Grumble is dismayed that, though the cold war is long over, these things still seem to be going on.