Category Archives: the NHS

Organ Donation

This week, an uplifting story on the news regarding organ donation caught my eye. A young 13 year old girl’s organs have been transplanted into eight different people, 5 of which were children.

As an organ donor myself, I understand the importance of the process and how many lives can be saved via donation, however the UK still has an ‘opt-in’ system. Thus, unless you register, your organs will not be donated after your death. 24 other European countries have an ‘opt-out’ system, [2] meaning everyone is on the organ donor register unless they choose to remove themselves from this list. In our modern day healthcare system I think this is a much more beneficial scheme, due to organ demand and the sheer number of people who are indifferent to the process.

Jemima Layzell died suddenly due to a brain aneurysm, and after her death donated her heart, small bowel, pancreas, kidneys, liver and lungs [1]. 8 is a remarkable number of organs for one person to donate, with the average only being around 2/3. Something many people don’t realise is how many people die waiting for a transplant, last year a staggering 457, as families said no to organ donation.

So why this blog post? Not only is Jemima Layzell’s story an incredible one, it also brings with it a few key messages. The first, opt in. The UK does not automatically register everyone on the organ donor register, so please take the time to. For me, it came through when I applied for my provisional driving licence. The second, inform your family. If you want to be a donor, tell them. Let them know of your wishes as they have the opportunity to dispute them after your death. It is an incredibly important process which can save thousands of lives each year.

 

[1] http://www.bbc.co.uk/news/health-41187008

[2] https://en.wikipedia.org/wiki/Organ_donation

Work Experience – Day 2

Continuing my work experience placement at the QEH, I had another really interesting and insightful day. I began my day following the consultant on the TSS/MAU ward round, what I found particularly interesting was looking at chest x-rays, and listening to the sounds of patients’ lungs. For those with crepalations (crackling noises), looking at the X-ray reinforced the probability of infection, due to the amount of ‘white space’ seen. One particular patient with heart failure and pneumonia had an especially fascinating X-ray, with white areas appearing in lines – as if down each bronchiole. The consultant explained to me that because of the heart failure, not enough blood and thus oxygen was reaching the span of the lungs, causing the infection to occur in this manner.

I saw a variety of patients, from the elderly with infections and some heart failure, to a young man who had overdosed on drugs, a woman with seizures and another with jaundice, explained to be due to her liver failure. The young man who had overdosed, was my first experience of a rude and unpleasant patient, who could not understand how the doctors could not spend their entire day with him. However, he was dealt with calmly by an F1 doctor, who explained that his requests were underway and some pain relief would be along shortly. I was however, occasionally disappointed at how doctors would sometimes walk away from patients when they were speaking to them, and in one case, left a frail elderly lady confused about the future of her treatment.

In the afternoon, I sat in a diabetes clinic, listening to consultations with a diabetes nurse, nutritionist and endocrinologist. Here, I was surprised at how well the nurses knew their patients, but also how medicines were not relied upon. While diabetes is managed by insulin, I also learnt that diet (carb counting) and exercise where really important in managing diabetes. Encouraging their patients to learn about how their diabetes and insulin works, and it being explained on a one to one basis seemed really effective, in giving patients the tools they needed to control their diabetes with less (expensive) medication. As the diabetes nurses had a very niche area of work, it meant that they could see their patients frequently, and give them small ‘snippets’ of information to take away at once. Not overwhelming them, I was told that this made large changes to occur in small intervals.

I have really enjoyed my time at the QEH so far, gaining an insight into both the positives and negatives of working as a doctor, and the hospital environment as a whole. I am certainly looking forward to what the rest of the week will bring.

Ian Patterson – playing God?

As an aspiring medic, it has been impossible to ignore the news this week. In fact, I was trying to drag my way through an uninspiring gym session having forgotten my headphones when this news story caught my eye. Ian Patterson was a name I hadn’t heard of before last week, yet he is now a person I just cannot seem to fathom.

Ian Patterson is a breast cancer surgeon, meeting people, often young women, when they are scared and vulnerable. He has carried out unnecessary operations on 10 known patients [1] however the exact number of his victims could be in the thousands, leaving them feeling both mutilated and violated. The crown court stated that he carried out ‘extensive, life-changing operations for no medically justifiable reason” [1].

As despicable as this is, the real question I cannot be alone in asking is how did this go on for so long? The first of these ten patients was operated on in 1997 [1] and concerns have been raised since. Ian Patterson worked in the private healthcare system, and if any positives can come from this hugely negative situation it is that issues which need to be address have become evident. Restrictions and regulations must now come as a result of this medical crisis, helping to protect those across the healthcare system – including the private sector.

A doctor has a huge amount of responsibility, and a worried or anxious patient can easily believe everything that comes out of a healthcare professional’s mouth. I hope that this incident does not prevent patients trusting their doctors and nurses, but that it does stimulate the necessary questions to be asked. I hope the NHS and other organisations act quickly to help improve protocol, as a situation like this can never happen again.

[1] https://www.theguardian.com/uk-news/2017/apr/28/ian-paterson-the-likable-breast-surgeon-who-wounded-his-patients

[2] http://www.telegraph.co.uk/news/2017/04/28/ian-paterson-charmed-patients-scrimping-treatments-funding-luxury/

PrEP – preventing HIV?

A couple of weeks ago, I read an interesting, if not startling, BBC article surrounding the Scottish NHS. This lead me to research more into the treatment which the NHS in Scotland has recently approved to fund and routinely offer to its people. This treatment is known as ‘PrEP’, and it has been proven that a daily dose can protect those at risk of contracting the virus [1].

How does PrEP work?

PrEP is an anti-retroviral drug, fitting with the nature of HIV as a retrovirus. This means that HIV is composed on RNA, and contain reverse transcriptase, which is an enzyme. This allows the viral RNA to be transcribed into DBA after entering a host cell. This DNA can consequently be integrated into the DNA of the host cell and expressed – one of the key problems with treating HIV is that it is a retrovirus. [2]

PrEP therefore, prevents the virus from multiplying if it enters the body [1] without major side affects [4] . Therefore, it is a preventative treatment as opposed to a ‘cure’ for HIV. Taking the pill consistently each day has been shown to reduced the risk of HIV infection by 86% alone [4] – a staggering number, however with other preventative methods such as the use of condoms, this number increases [3].

What are the benefits?

What is remarkable about this drug however, is that it is estimated 1900 Scottish people could benefit from the drug, and the huge amount of money (around £450 a month per person) which the Scottish NHS is investing, [1], but also saving. For each person who does not become HIV positive due to the use of PrEP, the NHS in Scotland with save £360,000 in lifetime treatment costs [1] – prevention is better than cure, they say.

I think this is huge step in the right direction, when fighting an incredibly stigmatised disease. The treatment has the potential to help improve quality of life, save money and to reduce the numbers of those suffering with HIV in the future. I can only help that our NHS follows in the steps of NHS Scotland

[1] http://www.bbc.co.uk/news/uk-scotland-39552641

[2] http://www.medicinenet.com/script/main/art.asp?articlekey=5344

[3] https://www.cdc.gov/hiv/basics/prep.html

[4] http://www.tht.org.uk/sexual-health/About-HIV/Pre-exposure-Prophylaxis

Hospital

I sat down last night to watch the new BBC documentary ‘Hospital’ purely because I thought I would find it interesting, and it would give me a small insight into hospital life. However, it did much more than that, it confirmed the research and evidence I had heard in the news, and put into perspective the harsh realities of medicine.

Without going into too much detail, as I will leave a link to the first part of the series below, it is based at the Queen Mary hospital in London – one of the five affiliated to Imperial College London. The hour orientated primarily around two cancer patients who both required operations and a lady who had ruptured her aorta, travelling to the hospital from Norwich. Although, the main focus of the documentary was the chronic bed shortage the hospital was experiencing, a ‘code red’.

It became increasingly apparent to me that the wait to know if either of the cancer operations would be allowed to go ahead, was entirely due to the uncertainty of a bed being available for them to recover in. A seeming waste of anaesthetists, surgeons, nurses and theatres, all unused due to the bed shortage. Many scheduled operations had to be cancelled due to the hospital not knowing how many trauma patients would need ICU beds, as the brutality of the fact that doing the best for the hospital was not the best for every patient was clear. For instance, one of the cancer patients with oesophagus cancer, had already had his operation cancelled previously for the same reason, and it was cancelled again on the Monday of this week, but in doing so a bed was freed for the lady with the ruptured aorta. While luckily the operation was able to take place on the Tuesday, the prospects of having to operate in a specific window after chemotherapy for the best results, and the reoccured cancellation was obviously a serous worry for the patient.

This leads on to not only the medical issues caused by the bed shortage, such as the cancellation of operations, but moral implications. Patients need to retain their dignity in hospitals, and have enough privacy while recovering, but when operating at or over full capacity, this is hardly possible. The hours the surgeons spent presenting their cases for why their patient needed their operation and a bed were endless, while irritating for the surgeons themselves, this clearly showed that their patients were at the forefront of their mind, and they were their priority – restoring my hope and faith in the hospital environment.

So what did I learn from this documentary? What I expected to be some interesting cases and miraculous recoveries turned out to be a stark reminder of the harshness of medicine. It supported what I had previously heard about hospitals being overrun, but also the obvious desire of medical professionals to do what is right by their patients. It showed that tough decisions are having to be made everyday, and none of which are easy when they can influence peoples lives so dramatically.

 

This is the documentary link – http://www.bbc.co.uk/iplayer/episode/b088rp75/hospital-episode-1 it was a really insightful watch and I would definitely recommend it as an eye-opener.

The NHS – Is patient care the priority?

nhs-01-e1401362913281After a week of mock exams, I decided it was time to start thinking about the real world again, and catch up on all the news stories and articles I’ve missed in the past weeks due to my revision. It is undeniable that in the past year the NHS has endured severe turmoil, the good, the bad and the ugly. How can we save a system which does so much good throughout our country? I came across an article in which the Royal College of Nursing has said that ‘conditions in the NHS are the worst they have experienced’. This is incredibly alarming, because it means an incredible system which provides opportunities for people from all walks of life could be in jeopardy.

Additionally to this, leading doctors have warned Theresa May that lives are being put at risk due to pressures on the NHS. It is very easy to get caught up in the news and money surrounding the NHS, but it is incredibly important to remember that they key aim of this institution is to provide healthcare to everyone, and to benefit the lives of people.

Earlier this week, the BBC released shocking record numbers of patients who were facing long waits in A&E. This document showed that this winter has proven to be the most difficult in over 10 years, with almost a 1/4 of patients had had to wait more than 4 hours in A&E just last week. This means that only 75% of patients were seen within the target hours, at no fault to our healthcare professionals, but a system which is not allowing them to flourish.

The main aim of the healthcare professionals in any hospital is to provide the best care possible for their patients. However on the contrary, the Chief Executive at the Royal College of Nursing has said she has heard from frontline nurses saying they were told to discharge their patients before they were fit, just to free up beds. This leads to quality of care concerns for every nurse and healthcare professional, trying to their best to do good in an overrun system. There have also been urgent appeals for investments to help ‘over-full hospitals with too few qualified staff’ by the Royal College of Physicians.

What is truly daunting, as that there are lives at risk. Each patient has a life and hopefully a family to go back to after their hospital treatment, and the prospect of not returning children home to mothers or husbands home to wives when more could have been done is an awful one. Alongside these frank issues within hospitals themselves, there are problems with discharging patients as due to difficulties with placing people in social care.

 What should be done?

It is evident that immediate and long term measures are both needed to address the current and inevitable issues within hospitals and the NHS, and it is a system that needs saving. A crisis in funding has led to inadequate care for some patients, and everyone deserves the best treatment possible – the principles of the NHS is that it is a national health service, open to everyone. When we can not provide the care needed, we are failing as that service.

Having said that, things are looking up. The issues within the NHS are not solely down to funding, there are not enough healthcare professionals themselves to treat the patients. Since last year, 3100 more nurses and 1600 more doctors are working within the NHS, and £10 billion has been pledged to investment in the transformation of NHS services and relieving the press of hospitals.

I think the NHS is an amazing system, providing amazing treatment to everyone throughout our country. Without it, there would be far more deaths per year, and the poorer members of our country would not be able to maintain their health, or get treatment. However, it is evident that it needs reforming, reorganising and needs to remember that the heart of the organisation is the patients themselves. Patient care is the priority of each healthcare professional, doctor, nurse or midwife and it should be the heart of the system they work in. The first part of the change however is accepting it needs to happen, and I am hopeful that the changes in the future will create a much more beneficial and fluent system.