Elinor Burn is a Department of Medicine for the Elderly (DME) and Quality Improvement (QI) fellow at the University Hospitals of Derby and Burton NHS Foundation Trust, in this blog article reflects on her year in post.
Taking a step off the conveyer belt of medical training can be a daunting move for trainees, who have become accustomed to the continued encouragement for career progression. It’s a choice that is not actively encouraged, but does allow(s) space to refocus through dedicated time doing a different kind of work.
After crawling to the end of my core medical training feeling exhausted, I took on this year as a chance to change gear, step back and remember why I enjoy and chose to do medicine. By filling this fellowship post I accepted the challenge of taking forward a service design programme. This has been in the form of a surgical liaison service, a project still in its infancy. It was a steep learning curve – service development is something that I’ve never actually been taught to do. Continue reading →
Be good to older people. Many of your patients will be frail and vulnerable. Much of society may view them as a burden. You should not. These are mothers, fathers, husbands and wives. They have been on this planet two or three times as long as you have and many of them will have rich tales to tell. It is your job to look after them as well as you can, with empathy and kindness.
Be part of the team. Physiotherapists, occupational therapists, other allied health professionals and experienced nurses will know things that you don’t know – both day to day information, and nuggets of clinical wisdom. Introduce yourself to them, ask about progress, and feed back relevant information. You are now working in a multidisciplinary team.
Older people are really complicated. Acute coronary syndrome (to give just one example) will rarely be treated in a standardised fashion on an elderly ward. Some patients may be suitable for all the drugs on an ‘ACS protocol’. Others may not be suitable for more than one (or even none). Far more will be in between. Look at what your seniors are doing, and ask them why. Remember there is very little black and white in geriatric medicine and different doctors may do different things. Think about their reasoning and decide what kind of doctor you will be.
David Shipway is a final year registrar in geriatric medicine working at London’s Charing Cross and St Mary’s Hospitals, Imperial College NHS Trust. He is currently developing a new comprehensive surgical liaison service for patients undergoing gastrointestinal surgery.
With population ageing, the number of oldest old undergoing surgery is increasing markedly. For anyone who’s recently been the medical registrar on-call, it will come as no surprise to hear that there is considerable unmet need on the surgical wards of the UK. But the experience of pioneers in this field has proved that reactive post-operative care is not enough: a proactive approach immediately following the decision to operate is needed to improve outcomes for older patients undergoing surgery. Continue reading →