A taste of your own medicine

6680441249_b6ed9537f5_oDipti Samani is a Speciality Registrar (ST6) in Geriatric medicine working in the East Midlands South Deanery, and tweets at @HmniDipti. In this blog she looks at an inventive approach to NHS Change Day.

“Treat others as you would wish to be treated” is something I have heard time and time again growing up. I wonder if this is only true in personal relationships and dealings. Can we, and should we, extend this out into our professional lives, both in terms of our colleagues and also to the patients that we treat?

After my 2014 NHS Change Day pledge to walk in my patients’ shoes for a day by wearing a continence pad: ‘Continence: My Conscience is Clear’; I decided this year to go back to the roots of NHS Change Day and Damien Roland’s idea to taste the medicines that we give to our patients.

The aim of doing this was not just to know how (awful) some medicines taste, but to give myself and others an appreciation and awareness of what our patients go through. I wanted to highlight some of the alternative medications where available and to increase our compassion towards patients.

I took some of the common medications prescribed to older people to a lunchtime meeting in our department. The medications included: laxatives (Lactulose, Laxido), food thickeners, Sando-K, various nutritional supplements, Calogen and Hypostop – I’m sure you can think of more, but these were the most benign, unpleasant ones I could think of. The experiment was completely voluntary and I was impressed that all grades of doctor from medical student (who seemed to think it was some kind of initiation) to consultant took part. Of course I couldn’t have done this without the support of our departmental pharmacist who sought permission to support us with samples.

Feedback given from the tasters included recognition of the difficulties experienced by patients, increased care when thinking about prescribing, and empathy with patients’ experiences. It shows that it is sometimes easy to forget about the person behind the patient, and by putting ourselves in their place, it is possible to re-awaken our compassion for them:

I would love to go one step further to see if we could all be more compassionate and kinder towards each other in the work place. Patients are here to get better and we could acknowledge that they may be having a rough time; meanwhile, each of us comes to work only to do our best and to help people, and a lack of compassion with unkind words or actions towards each other just serve to depress this aim.

I would wish that by giving ourselves a taste of our own medicine this NHS Change Day, we will hopefully be able to get closer to treating others how we would like to be treated ourselves.

Photo credit: Ian Lamont via flickr

Which drugs to stop in which older patients?

Tischa van der Cammen is a Consultant Geriatrician and Carolyn Sterkeis a public health researcher. Both are based at the Erasmus University Medical Center in Rotterdam, Netherlands and have recently published a paper in Age and Ageing journal.polypharmacy

Drug treatment has brought many benefits for older patients. For example, the treatment of hypertension in patients aged over 80 led to a major reduction in stroke and mortality, as was shown in the HYVET study.

As people age, diseases may accumulate, and hence older patients usually are prescribed several drugs at the same time. It is ‘rule rather than exception’ that patients above age 75 use 4 or more drugs, this is called polypharmacy. There are a variety of definitions for polypharmacy – in the UK it is generally 4 or more prescribed medicines – as specified by Department of health and Rollason.

Inappropriate poly-pharmacy in older patients may lead to negative health impacts Continue reading

Age and Ageing collection: Developments in Stroke Medicine

Dr Victoria Haunton is Clinical Research Fellow and Honorary Specialist Registrar at Leicester Royal Infirmary.

Prof Tom Robinson is Professor of Stroke Medicine at Leicester Royal Infirmary and is an Associate Editor and the Supplements Editor for Age and Ageing journal.MCA-Stroke-Brain-Humn-2A

A collection of 10 Age and Ageing papers is free to view on the journal website.

Despite the dramatic revolution in stroke medicine, levels of stroke knowledge amongst the general public remain surprisingly poor, and there are still significant difficulties in getting patients to access stroke services promptly. Stephanie Jones et al sought to try and understand these problems in their important integrative review. Worryingly, they found that people struggle to name even one stroke risk factor or stroke symptom, particularly when open ended questions are used. Knowledge is especially poor in older members of the population, ethnic minority groups and those with a lower socio-economic status, but there is also a surprising lack of knowledge amongst those who have already suffered a stroke. Furthermore, there appears to be a real paradox between what people say they would do and what they would actually do in the event of a stroke; whilst at least 47% said they would contact emergency medical services if they suspected they or a relative were experiencing a stroke, only 18% of stroke patients had actually done this. There is therefore an urgent need for further public education. In light of their findings, Stephanie Jones and colleagues suggest that the ideal campaign should minimise barriers to health services and provide cues to action. Continue reading