MRI – magnetic resonance imaging

This week I went to a Physics talk at my school where a teacher spoke about MRI scans, their uses and the images produced.

Scans are mainly used in order to monitor or diagnose neurological, brain or muscular conditions. At this talk I noted the interdisciplinary skills used to create and use an MRI scanner including physicists for the mechanism, electricians for the servicing, mathematicians for quantitive analysis, radiologists for running the machine and doctors for overall analysis of pictures, before patients receive their results and prognosis.

I noted that MRI scans show up areas that are ‘soft’ as light grey and ‘hard’ materials in black eg. the brain looks light grey whilst the skull looks black. This directly contrasts images of X-Rays and CT scans which are lighter shades where ‘hard’ material is found in the body. The reason for MRI showing lighter colours in ‘soft’ areas is due to it highlighting areas of the body containing water and fat. The image is made by shooting low frequency and long wavelength radio waves at the cells – those containing water (H2O) absorb some energy due to the proton in each nuclei of H-atoms, and then reemit the waves at the same wavelength.

The MRI scanner looks like a large donut with a bed which slides in and out of the central hole. Along the bed is a very strong uniform magnetic field, like that of a coil, which must overcome the thermal limit of the body to magnetise the body (it is never turned off). The current flowing through the machine is very high, in order to significantly increase the magnetic field and create a ‘superconductor’ (a metal which does not have any electrical resistance), so liquid helium is used to ensure the scanner does not overheat.

The loud sound during an MRI is due to the magnetic field and fast flowing current making a loudspeaker. Ear muffs must be worn to protect eardrums from permanent damage. Magnetic objects must never be bought near to the machine due to the extremely strong magnetic field of around 1.5 teslas (on earth the average background magnetic field strength is 50 microteslas), which would attract them into the machine, where the person is lying, at a very high speed.

Current research using MRIs includes its potential use in monitoring neurological conditions associated with losing muscle function due to fat coating the muscles. Researchers are looking for ways to monitor this condition using numbers (quantitive analysis) to get a more accurate representation of improvement or deterioration, as opposed to making a judgement using the less informative black and white pictures (qualitative data). They are looking at finding a way to count protons in the nuclei of fat molecules by monitoring the amount of radio waves reemitted from the body.

 

Emily Buchanan

 

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Down’s Syndrome

Down’s syndrome is a learning disability caused by an extra copy of chromosome 21, making total chromosome count 47 instead of the ‘regular’ human count of 46. Physical characteristics are very recognisable of a broader, flatter face, smaller ears and nose and more space between the eyes whilst an associated medical issue is an increased risk of heart problems.

There are three ways in which Down’s syndrome can occur; through non-disjunction of chromosome 21 (94% of cases), by translocation (4% of cases) or mosaicism (2% of cases). Non-disjunction of chromosome 21 is when chromosomes do not separate properly during the anaphase stage of the cell cycle, translocation is when a part of a chromosome breaks off and attaches to another chromosome, and mosaicism is when people’s cells vary in number of specific chromosomes.

Translocation occurs specifically with the breaking off of part of chromosome 21 and it attaching to a different chromosome in the parent. After receiving two copies of chromosome 21 (one from mother and one from father) and an extra chromosome 21 attached to another chromosome by translocation, total count of chromosome 21 equals three in the offspring, causing Down’s syndrome. People with translocation do not always show Down’s syndrome characteristics but do pass on translocation, giving their child the extra chromosome 21. Translocation can also occur during meiosis, when the parents do not have translocation themselves.

Mosaicism occurs either by the fertilised ovum having three copies of chromosome 21 and losing one during mitosis, or when the ovum originally has cells with two copies of chromosome 21 and during mitosis gains an extra copy of this chromosome by mistake. If the ratio of cells containing three chromosome 21s to cells containing two chromosome 21s is large then Down’s syndrome is likely, and if the ratio is small, Down’s syndrome is less affective, shown by the person having fewer of the characteristics linked to Down’s syndrome.

The biggest risk factor of conceiving a child with Down’s syndrome is a women’s age with risk increasing with age. Figures by the NHS currently stage that maternal age of 20 gives you a risk factor of 1 in 1500, age 30 of 1 in 800, age 35 of 1 in 270 and age 40 of 1 in 100. Risk is also increased if the person has already conceived a baby with Down’s syndrome and further increased (up to 1 in 10) if one of the parents has translocated genes.

In today’s NHS, foetuses are tested for Down’s syndrome by amniocentesis and ultrasounds. Amniocentesis is the removal of some amniotic fluid which is taken to a laboratory to be stained and looked at under a microscope to look for extra copies of chromosome 21. However, some women choose not to have this test as it increases chance of miscarriage so other less invasive tests are taken first such as ultrasounds and blood tests, before referral for amniocentesis.

Ultrasound is high-frequency sound waves to create a moving image in order to see thickness of fluid between skin and foetal neck (taken between weeks 14 and 22), with a thickness greater than 3mm likely to imply chromosome abnormality. Taking a blood sample from a pregnant mother is another less invasive and therefore less risky test, from which alpha-fetoprotein concentration can be measured. If the mother’s concentration is 25% less than normal, it is significantly more likely that their child will have Down’s syndrome so will be referred for an amniocentesis for a more reliable test.

A test that may be available in the future is the analysis of a foetus’s DNA from their mother’s placenta by week 10 of pregnancy. It is currently 99% accurate at detection which is not considered high enough to be widely available on the NHS.

Test results give people a choice; to terminate or continue with their pregnancy – an extremely difficult decision for many.

 

Emily Buchanan

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Work Experience in a Hospital – day five

I shadowed Dr R on a ward round this morning, noticing his extreme patience when speaking to a very ill patient demanding to leave the hospital, whilst the patient referred to himself as a “prisoner”. Dr R remained calm and collected, explaining the severity of his condition and  why hospital, surrounded by healthcare professionals, was the best place for him until he became stable. The patient was extremely frustrated and threatened to get his lawyer involved if they did not discharge him so Dr R calmly stated that discharging him could easily be arranged, as long as the patient understood that there was an extremely high chance that he would die or be admitted to hospital again in an emergency.

I went on to learn about two predominant types of pneumonia; legionella and mycoplasma. Legionella presents symptoms such as a persistent cough bringing up phlegm and flu-like symptoms which can be cured by erythromycin or clarithromycin. Mycoplasma is very much more serious, presenting itself in a dry cough and fever and it can damage the heart or central nervous system in extreme circumstances. Mycoplasma pneumonia is far more contagious than that of legionella so could cause an epidemic.

I saw how the junior doctors were tired, stressed and frustrated as they followed consultants making accurate recordings of observations, medicines and dosages whilst being questioned by the patient’s families and nurses for help. This in turn frustrated the consultant as he did not believe the junior doctor was completely focused on what he was saying about the patients on the ward round. I believe this is very important for all people going into medicine to see as we must have a realistic understanding of the profession that we are potentially going in to.

During the afternoon I went to a teaching of ‘wellbeing’ to medical students in which a doctor spoke to students about the role of diet and exercise in maintaining a healthy mind and body. She spoke of the fact that most medical students are perfectionists so have extremely high expectations of themselves leading to severe burnout. Burnout can lead to depression, heart disease and a weakened immune system which is reflected in patient care, decreasing patient satisfaction and increasing recovery times. The doctor focussed on resilience as an extremely important quality of a doctor saying that it is a natural quality of people which can also be taught throughout time at medical school. I learned about foods containing sugar, caffeine, nitrites and salt and how they affect sleeping routine, perception and increase risk of diseases.

Emily Buchanan

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Work Experience in a Hospital – day four

I was in a respiratory clinic again this morning with the inspiring Dr R where I learned more about qualities of a doctor. I noticed his reassurance and truthfulness when telling a patient about the severity of their illness – approaching the subject politely and respectfully whilst always reminding the patient the negative consequences of their condition.

I was reminded today of the disastrous impact of smoking when meeting with a man whose lung capacity was merely 11% (measured using a spirometer). I try to prevent many of my peers from smoking and would love to expand this to the wider community in the future. I noted the patient’s response to finding out that he had poorly functioning lungs thinking that he could easily get a new pair of lungs from a donor. This is incorrect as there is a shortage of donors and if there is a donor, the lungs will go to a child with cystic fibrosis due to them having a greater need. I noticed the doctor’s calm response to his patient, explaining clearly why the replacement of his lungs would not be possible and the plan for his future relief of breathlessness using medication. Patients often forget about the large risks associated with replacement of vital organs which could completely change their quality of life (for example after the operation they may be bed bound meaning they have a high reliance on other people, or if the organ is rejected they may die in extreme cases).

I found that by using the number (in a percentage) of lung capacity the doctor was able to show the extreme severity of this patient’s lung condition in order to tell them a truthful prognosis so that they completely understood that they were in a bad state.

As a doctor is it extremely important to have a strong relationship with your patients in order to be able to talk to them about anything – even if a little embarrassing in the eyes of the patient. The doctor advised about depression, breast pain and the effects of being overweight to his patients using his knowledge to comfort them whilst telling them about the best medicinal decisions for their future.

I saw a patient with a hernia which stuck out of his tummy just above his belly button. The doctor told me that it was his intestine poking out due to intense pressure around the lungs as the man was overweight. I will be writing another blog about a condition called Sarcoidosis as this condition particularly interested me in the clinic today.

Structure and function are the key to understanding every disease. Structure is determined by doing a scan eg. X-Ray, CT scan, MRI and function is determined by tests eg. blood tests, lung capacity test.

I was particularly interested in a new innovative surgery which allowed patients to have less invasive surgery of the heart to fuse arteries by a small incision in the side of the body (a new type of keyhole surgery).

In the afternoon I spent my time in the AMU ward with Dr R where I saw lots of patients with respiratory problems. I enjoyed looking at and learning how to interpret CT scans and X-Rays and listened to the consultant advising junior doctors about which treatment to use for which patients. Everyone respected Mr R’s wishes for his patients as he was leading the way for the chance of a healthier future for everyone.

 

Emily Buchanan

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Work Experience in a Hospital – day three

This morning as I sat in a respiratory clinic at the hospital, I was greatly inspired by the consultant that I shadowed. He was intelligent, compassionate and clearly respected by all of his fellow doctors and members of the healthcare team. Junior doctors constantly came to him asking questions and asking him for his opinion about treatments and the best plan for their patients, while the nurse was extremely happy to support him in any way he could. It appeared that Doctor R made his patients feel comfortable, relaxed and positive even when the prognosis was not so positive. Whilst he always showed that he was in control to his patients, once they had left the room he was extremely busy answering calls whilst looking at other patients’ test results and giving second opinions for a junior doctor. I learned that a doctor must be able to multitask to a high enough standard that they can be focusing accurately on more than one patient at the same time. Dr R approached talking to his patients in a very different way to the two consultants that I shadowed on Monday as he explained what he thought was their current problem and history, allowing them to correct him, whereas on Monday the consultants would let the patient do the talking then prompt with questions. Both methods seemed to please the patients.

As a doctor you must explain everything that you are doing. Dr R was very empathetic when he delivered less positive news – always concerned about questions that may be in patients’  heads, so he always explained his decisions of medication to them so that they were not concerned or confused. An example of this is when Dr R attempted to explain about exercise induced desaturation to the patient without them feeling awkward, embarrassed or less able, speaking scientifically and empathetically appearing to understand exactly how the patient was feeling. He also offered them professional psychological help due to their frustration of the disease.

Many illnesses affect peoples’ state of mind due to it causing a lower quality of life. An example of this was when a patient was unable to walk due to not having enough energy (from lack of oxygen) when their legs did in fact work perfectly. Patients often explained that this not only had a negative effect on them but also on their families who they were extremely reliant upon to transport them from place to place.

Today I also learned about drugs that may be able to replace antibiotics in the future. These drugs are a much lower dose of antibiotic to boost your own immune system to fight the pathogenic bacteria that has infected your body cells. I hope that more doctors use these drugs as it will reduce antibiotic resistance, although I have to say that I am not educated in the knowledge of their side effects and I was told by the doctor that they currently only work in very select cases.

During the afternoon I shadowed a fourth year medical student in the Acute Medicine ward (AMU). I was interested to hear a heart murmur which was confirmed by a junior doctor after the medical student hypothesised the specific type of heart murmur. I noticed how knowledgeable the medical student was when she explained in detail everything about the specific heart condition to the junior doctor when she was asked as a test.

It was interesting to see the dynamic in the ward with students reporting to junior doctors and junior doctors reporting to consultants. There was clearly a hierarchy in amount of experience but everyone respected and supported each other, concerned about one another especially about those who were on call last night.

I encountered patients who suffer or have suffered recently from bronchiectasis (had also had had a thoracotomy) causing wheezing and coughing after having a lung tumour removed, lung scars causing nodules to appear on their CT scan,  recurring chest infection, osteoporosis, chronic asthma, polymyalgia rheumatica, exercise induced desaturation causing breathlessness, pulmonary embolism, lung collapse, breast cancer, severe emphysema, low T Killer cell count and a heart murmur.

Emily Buchanan

 

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Work Experience in a Hospital – day two

Today I was fortunate to experience a meeting in which consultants met with other consultants (over the internet) to discuss current patients to ensure that everyone agreed about the plan of their future treatment. I was particularly interested to see that there were also representatives from a sister hospital as some procedures take place there as opposed to in the hospital where I had my experience.

In this meeting, one doctor whom I assume was the most senior led the discussion and concluded it by giving the best solution using all of the present doctors’ advice.

Some issues that needed to be resolved were whether they would give a frail elderly patient invasive surgery or whether the risk was too high. Doctors make decisions on the basis of amount of risk. Medication and surgery all come with risks and the decision to prescribe medicine or carry out surgery is done on a basis of severity of the patient’s condition and therefore whether it will improve the patient’s health in the long term. The lead doctor said that surgery must be “the least invasive but most informative”. In the meeting I also noticed cost was a significant factor when deciding whether to allow multiple scans for the same person.

After discussing all current respiratory patients, the doctors went on to talk about the meeting of NHS deadlines. I was discouraged that they said that it was “physically impossible” to reach the NHS’ deadline to release results of CT scans when checking for lung cancer within 3 days. They announced that there was not enough money in the budget to employ another staff member to improve quality of service so they were forced to move their patients to other hospitals where they may receive a better quality of care.

I also visited the respiratory ward where I shadowed a consultant and a junior doctor on their ward round. I was told that a ward round happens twice a day to check progress of the patients in order to ensure medication is working and therefore to advise the nurses about changing dosage or type of medicine being given to the patient. I noticed that the consultant was completely reliant on his team of junior doctors who were prepared to check up on all other cases that the consultant did not get round to seeing, and the nurses to give attention and medication where needed. I saw the doctors as kind, understanding, encouraging, intelligent and trustworthy.

I was interested to see that a sixteen year old patient was brought to the adult ward even though their age suggested that they should be in the paediatric ward as the doctors from the paediatric ward believed that this was the best place for him due to the severity of his pneumonia. I noticed a dynamic change in behaviour of healthcare professionals when the nurse failed to confirm with the consultant about bringing this patient to this ward so there may not have been a bed available for them. He stated that they must always check with his ward before bringing up a patient so that the vulnerable patient did not have to be moved unnecessarily. I saw that the nurse apologised profusely and the consultant accepted the apology immediately for the benefit of the patient.

I enjoyed speaking to a patient about his quality of care in a private ward and feel that I improved his day by giving him my time to listen to his medical story. I loved to speaking to him after my hectic time in the non-private respiratory ward as it felt more relaxed and enjoyable – it is a shame that every person cannot afford this quality of care. From this I learned the complexity of some people’s illness as it can stem from a simple lifestyle choice from many years ago which is most commonly smoking.

It is impossible for me to remember every condition I saw today however the most memorable thing was seeing the draining of the lungs into a transparent glass jar. It was so fascinating and the doctor explained to me that all the liquid is infection between the lungs and pleural membrane.

I look forward to my day in clinic tomorrow.

Emily Buchanan

 

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Work Experience in a Hospital – day one

This week I am extremely fortunate to be gaining work experience at a hospital working with doctors, nurses, healthcare assistants and foundation-year doctors in the respiratory department. Over the next week I will be documenting what I learn from my experience, using my blog as a diary. Every day I am scheduled to be visiting a different area of the respiratory department including clinics, meetings, ward rounds, as well as sitting in teaching of radiology, respiratory and wellbeing to medical students.

Today I sat in the respiratory clinic with two doctors, both very different in their approach to dealing with patients. The first doctor was a very good listener, allowing her patients to explain their concerns and then prompted them in order to understand the background of their problem. She then went on to ask about timescale, dosage and medication whilst using the words “better, worse or the same” to measure improvement or deterioration in a patient’s illness. Once the doctor had listened to the full background of the condition from the patient’s point of view, she told them the scientific reasons for their discomfort (even taking the effort to draw a diagram of the heart in one circumstance) and concluded with her plans for their medication now and for the future, then asked if they have any questions.

It was very interesting that the doctor had not previously seen these patients even though they had visited the respiratory ward many times before, as she was covering for their doctor who was on a ward. I believe that this lack of continuity of doctors is unacceptable for a patient’s care as the doctor had to rush to read the patients’ history as they waited outside for long periods of time – the doctor said that she must hurry as she did not want “grumpy patients”. I also felt uncomfortable with the fact that the clinician could not prescribe a drug for more than 28 days even though the patient had a long-term condition so was required to come into the clinic every month to get a new prescription, using the doctor’s time. The patient could not get the medicine from their GP due to the GP surgery not being allowed to prescribe the specific inhaler as there was not a great enough demand for it in the area so was too expensive.

I noticed that there were two healthcare professionals in the room at one time, the nurse guiding the patient to use the spirometer and helping with paperwork and the doctor who analyses the results of tests and puts together a healthcare plan for the patient whilst listening to their requests and concerns. I was pleasantly surprised to hear that often there are two doctors in one clinic as a patient’s condition may overlap with two specialities (for example arthritis and systemic sclerosis), although none of these appointments were taking place today.

I also noticed the encouragement of exercising to all patients, proving the importance of exercise in improving respiratory conditions due to it being more efficient (and cheaper) than using drugs. One scheme that was recommended to more than one patient was a pulmonary rehab program in local gyms that consists of exercises from Physiotherapists to do in-session and at home. Unsurprisingly most people that came into the clinic were smokers or past smokers and I was pleased to hear that all but one patient had given up smoking within the last five years – I believe this is a success on the NHS’ part as smoking has become less fashionable.

A good example of care was when the doctor remained in her chair to greet a wheelchair-bound lady in order to make her feel comfortable and at ease and when the doctor took time to speak to a patient’s husband when he wanted to talk about the death of his brother. I would describe both doctors as gentle, kind, welcoming, open, trustworthy, organised, knowledgeable, empathetic and reassuring.

Some medical conditions that I witnessed today were a heart murmur, respiratory tract infection, systemic sclerosis, heart strain causing leaky valves, arthritis, COPD, lung clots, glaucoma, post infective hypersensitivity, severe asthma and scarring on the lungs.

 

Emily Buchanan

 

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The Power of the Potato

I am extremely lucky to have a family roast dinner every Sunday and fish and chips every Friday lunchtime but in the light of the recent potato scandal this may change.

The Food Standards Agency, who research about food safety and nutrition-related diseases in order to make the UK population’s food as safe as possible, have noticed a link between cancer and foods full of starch that are cooked at high temperatures. New Scientist magazine have suggested that this is due to ‘sugars and amino acids reacting together’ on heating to release chemicals. The chemical that the FSA are most concerned about currently is acrylamide which is said to be a carcinogen (causes cancer). There is no scientific evidence for this link in humans, however acrylamide does not seem to be a very healthy chemical to be ingesting.

Acrylamide is C3H5NO which is prop-2-enamide and decomposes without heat to form ammonia, carbon dioxide, carbon monoxide and nitrogen oxide, putting it on the US’s list of extremely dangerous substances. It is clear why we should not be ingesting this dangerous substance from what we know from basic GCSE knowledge that carbon monoxide is a colourless, odourless gas which binds irreversibly to haemoglobin, in turn preventing oxygen forming oxyhaemoglobin and therefore causing cells to respire anaerobically. Ammonia is also a very unpleasant, pungent smelling gas (at school we only use dilute ammonia in chemistry lessons due to its smell and it also being known as an ‘extremely dangerous substance’.)

In the body acrylamide is thought to cause damage by converting to another compound causing DNA mutation during transcription. This can lead to uncontrollable divisions of cells in the body in numerous locations. [Please read my skin cancer blog for more detailed information about a particular cancer.]

The FSA’s hypothesis that acrylamide causes cancer derives from their study of giving water containing different concentrations of acrylamide to rats and mice in laboratories. The results from this were that several cancers were caused however we do not know if this is the same in humans as it would be unethical to do the same test on humans.

Interestingly, as waste water is treated with this chemical, it has been estimated that one glass of water contains around 500 times the amount of acrylamide as one portion of roast potatoes! Perhaps we should be worrying about our water intake instead!

This leads me to believe that we do not have to cut out roasted potatoes, baked jacket potatoes and fried chips all together but should reduce our intake or cook them at a lower heat and for less time in order to significantly decrease the amount of acrylamide entering the body. The FSA’s official advice is to ‘go for gold’ in colour of starchy foods, check the packaging for recommended cooking instructions and to not keep raw potatoes in the fridge releasing more sugars that could bind to amino acids making acrylamide when heated.

 

Emily Buchanan

 

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‘Hospital’ – BBC 2 Documentary Episode 3

Today’s episode was a fascinating insight into Charing Cross Hospital’s Neurosurgery department including some clips from inside the operating theatre, as well as interviews with patients, their families and a consultant about his view of the NHS’ waiting time problems and whether outsourcing should be used for more patients. During this episode, it was estimated that there are 10,000 neurological surgeries per year – this figure is particularly high at Charing Cross hospital due to its impeccable reputation and high success rates.

The majority of the program was centered around the fight between consultants and doctors for the highly sought after intensive care beds (IC) beds which are used for patients after a major operation, patients with major trauma and at least one must be left in case of the arrival of an emergency patient. The fight for beds in this episode was shown by the waiting times for planned neurosurgical operations which were all around nine months. This is absolutely unacceptable as seeing similar specialists in Germany is said take only “two to three weeks”.

I often find when watching Hospital that I feel stressed and bothered by the content due to the extensive waiting times and the extremely large-scale organisation and planning that has to be done by consultants and doctors. I feel that this is cleverly shown by the producers of Hospital in order to make you gain an understanding of how healthcare professionals are feeling working for our NHS. Every person in the United Kingdom should be watching Hospital in order to get a taster of how our doctors are feeling in our current overstretched NHS system so that the population can unite to bring about change.

In this episode I was particularly unnerved when brain surgeon Kevin O’Neill made tough decisions about whether to consider operating on his next patient later that day whilst operating on a brain with multiple aneurisms. He spoke of his wasting of time “chasing, phoning and waiting” to be given permission to start his operations when he should not have to worry about beds, and should be able to spend his time operating on more patients. I noticed in one particular instance there was (once again – like in episode 2) an incident where there was no ward bed available for a person coming out of intensive care as there was a problem with discharging the patient. This has a knock-on effect throughout the hospital as consultants cannot start their operations until there are intensive care beds available for post-operation.

Throughout the meetings of the consultants with the organised administration staff, consultants were constantly stressing the importance of remembering that every operation must never be treated as a number (which is sometimes hard for people to understand due to the enormous number of patients) but must be treated as a patient in every individual case. This is one of the most influential reasons that consultant Kevin O’Neill does not support outsourcing to private hospitals. He stressed the importance of continuity of healthcare professionals throughout a patient’s medical journey as the patient and their doctor form a relationship which in turn helps to maintain standard of care. I believe that once patients are seen and have operations they are treated correctly and with respect throughout their procedure and during their recovery period, however, as one patient said “the bit before that is a disaster, an absolute disaster”. He had been waiting for his operation for nine months.

The part of this weeks episode that interested me the most was the showing of non-invasive ultrasound brain surgery. [I read about something similar in last week's New Scientist (14/1/17) about transcranial direct current stimulation (tDCS) to treat tinnitus, depression and strokes.] This newly found ultrasound surgery was shown to treat a problem deep in the brain causing constant shaking (tremor) of the arm. I hope to find out more about this surgery as I believe that this is the key to future operations, saving doctors time, equipment and beds, allowing more patients to be saved in a far shorter amount of time.

 

Emily Buchanan

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‘Hospital’ – BBC 2 Documentary Episodes 1 & 2

Two programs have been shown so far from the current BBC 2 series ‘Hospital’ in which St Mary’s hospital in Paddington opens its doors to BBC cameras to reveal the truth about the NHS crisis. I believe it is extremely important that as many people of the British public as possible watch the program in order to understand exactly where problems currently lie in the NHS. I believe that the more people that we educate about the crisis and expose major flaws in the system, the more likely we will be able to persuade the government to spend money on a solution. The tax payer funds the NHS and therefore it is their decision as to how it is run.

It was very interesting to see that highly qualified consultants had to wait around and check for beds, wasting precious time of which could be spent with a patient or researching. Before I watched ‘Hospital’ I did not think that this job is done by a surgeon but by skilled administrative staff.

Lack of beds is shown as the biggest problem at St Mary’s. Whilst a team of 14 people arranged their day around performing an operation, the operation did not end up taking place due to no ICU bed being available for after the patient’s operation. Many emergency trauma patients were coming into the hospital via emergency ambulances, taking up the precious ICU beds. I learned that beds will be given to patients in order of priority. This is extremely understandable as they would like to help as many patients as possible and if someone is near death they must treat that case first, using up any pre-arranged and less urgent beds. However, this is extremely frustrating for patients who have pre-arranged ICU beds as they mentally prepare for their operation and are often sent home, having to wait another four weeks or more. These last minute cancellations of arranged operations mean that doctors waste their days waiting around and have to spend time rearranging the surgery. If there were more beds available, all planned operations, along with emergency operations, could take place and doctor’s would no longer have to worry about rearranging appointments and checking availability of beds for a ‘go ahead’. A delay in appointments on one day also means rearranging future appointments in order to fit the rearranged operation in the consultant’s schedule.

I saw that ward beds were also wasted due to the fact that there was no care system put in place as an intermediate step between hospital and home. If there was an intermediate step, people could be discharged from hospital wards safely with the reassurance that they will be looked after for as long as needs be, whilst not putting a strain on the hospital beds that are in extremely high demand. There must be a better care plan put into place for elderly people who are discharged from hospital as they are weak and particularly vulnerable. Currently, these elderly patients stay in A and E until they are completely better – this wastes bed space and equipment and means that consultants cannot get on with their job as there are no beds available for the patients that need them. The day we tighten up discharges from hospital is the day that we will see more beds available, more people being saved in a shorter amount of time and less wasting of doctors’ precious time.

I learned more about a healthcare professional as a role in society as opposed to solely a profession as a nurse feared to discharge a patient who was well enough to leave due to him having nowhere to go as he is homeless. This is another clear case of failing in the discharge system. The man spent a week in the hospital after he was well enough to go home due to the fact that there is no recognised place for him to go. This wasted his bed and other precious resources. Nurses and doctors are taught to express their duty of care and this nurse showed her duty of care to the homeless patient as she spoke about showing the same amount of care whether the patient is “from Buckingham Palace or a park bench”. It was said that he could have been discharged a week earlier as he was fit enough to leave but was not discharged due to the nurse’s concerns of his future living plans. There has to be a recovery location available after stays in hospitals so that the nurses and doctors can be reassured that the patient’s condition will not deteriorate due to a poor environment during recovery and the bed can be used for the next patient.

I truly believe that this television program can change people’s opinions of the NHS – many people have the misconception that it is the doctor’s own fault that they have to wait so long to be seen or referred, and through this program they can see the true workings of a hospital and the number of hours spent catering for every patient’s needs. For me as a potential future doctor, I will use this program as an example of where I would like to see changes in our NHS whilst appreciating how lucky we are that every patient receives outstanding healthcare through the NHS, even though we may have to wait to be seen.

Many condolences to Peter’s wife and family – a truly brave, patient and appreciative man.

 

 

Emily Buchanan

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