Sunday, February 23, 2014

Say it if you mean it

Last night I tweeted out my bemusement at some of the tweets I was reading with regards to NHS Change Day- and it launched an avalanche of tweets with supporters and sceptics joining in equal measures. It even prompted a blog which I read with interest but at the very outset, if anyone wants to know about my views on the NHS Change Day or other such initiatives, read this or this

I will be honest- the reason I decided to make a pledge was simply because of 2 reasons- Firstly, Pollyanna Jones asked me- I know her from work i had done previously with her- and beyond anything, one thing has always shone through...a genuine fierce desire to improve patient care...and in my book, if someone like that asks, thats good enough for me. Secondly, Roy Lilley's blog..again i know Roy and am aware he polarises opinion but I do know that it takes something extraordinary to break that curmudgeonly cynical heart...a few weeks back, he had thrown his weight behind it and I was in. 
The others involved- such as Natalie Silvey or Damian Roland - i don't know much about. Damian mentions some kind words in his blog about me- but believe you me, I am nowhere near "pretty awesome". My ego is huge, am incredibly cocky, in some eyes, maybe proud...but beyond that do try and improve patient care - or at least as best as I can. Yep, that's pretty much me in a nutshell.

Anyhow, to me, NHS Change Day is something where you pledge to do something that is beyond the norm...but then I saw pledges appear such as "pledge to ensure safe care"; "pledge to ensure equality in workplace"...and something deeper sets itself out. The same principle which has also created cynics about campaigns such as 6C or #hellomynameis. Have we got that isolated or even insulated in work, has it all become so unbearable that we now have to pledge to be compassionate, pledge to say "thank you", pledge to "treat each patient as a member of my family"? If that's where the health system has got to and perhaps Francis does allude to that, then thank god we have even got this event to reiterate to folks what they should be doing...in my opinion..naturally. Saying thank you to staff, not tolerating discrimination, not tolerating bullying should be an ingrained aspect of being a human being, leave alone an NHS employee.

As I said, its my opinion- but I suspect the good thing is that it indeed is driven by the grass-roots (though arguably some cynics oppose even that). In between there are some absolutely brilliant pledges...read the ones about a CEO planning to read bedtime stories to the kids or a CEO pledging to visit patients daily- who have no families. Heart warming...outside what they need to do, outside what they are paid to do...a brilliant gesture for which I have nothing but utmost respect.

To the organisers, a bit of cautious optimism around this...don't let this be hijacked by people jumping on the bandwagon with pledges which raise questions "what  have you been doing so long?" And to counter the cynics? Create some outcomes..some tangible benefits...otherwise its just a social movement which looks amazing to the social media world...but in the vast expanse out there? Another name tag to add to the multiple initiatives...don't allow cynicism to build...allow all to see benefits of such a great cause. Ask people to pledge..say it as if the mean it...not be a part of or jump on to the bandwagon...or have old wine repackaged in new bottles. The NHS needs a boost of optimism...we all know it- and for anyone who works with me, will know thats probably consists of majority of my day job...showcasing hope and optimism.

Pollyanna, Damian, Natalie et al? This is YOUR project..let it be yours and I wish you all the best for it too.However let the euphoria be tempered by its eventual outcomes. However, in the words of Sir William Ostler..."The philosophies of one age become the absurdities of the next..and the foolishness of yesterday has become the wisdom of tomorrow". 

Godspeed ladies and gentlemen.

Friday, February 14, 2014

Prism of our own lives


A flicker of annoyance creased my brows.Yes, there was no denying it..as they say, the mirror never lies....there was a little bit more weight around the midriff than I should carry. Didn't like what I was seeing in the mirror and annoyance certainly was the over riding emotion. 
And believe you me,I try my best to ensure I don't put on weight, with good enough cause too. Just crossed 40, family history of diabetes and hypertension, Asian heritage..would tick the box on all counts as a high risk to having problems. But you know what, it's darned hard to make sure the healthy diet and exercise happens on a regular basis...not because I am lazy but mainly because life, work, kids, travelling takes away time from your hands.The health evangelists would tout that as excuses but when most days you leave the house before 7 am to fit everything in and then come back home sometimes around 9 pm, the desire or even energy to exercise somehow seems to be lower down the priority list..I would rather spend the 20 minutes discussing Spider-Man with my son enthusiastically explaining the importance of webs..or trying to tease my daughter about the increasing "noise" from her room which she claims to be music.

And that's reality. And that's life..and in a nutshell why most people find it so difficult...its not that there isn't necessarily the desire but life has a different perspective on it. When the "present" needs sorting, who has time to protect oneself from the ravages of "future"? I have never ever berated or even criticised anyone coming to my clinic , whether type 1 or type 2 diabetes, for inability to lose or even putting on weight....simply because I struggle to do so myself. Recently due to personal ailments, I couldn't exercise...it was frustrating but at least it was temporary...but it certainly put into perspective what pain can do to you and your daily life. 
We all seem to have an amazing ability to preach, amazing innate sense to lecture..but tell you what, behind that desk,its always easy to give a lecture on the importance of healthy food, the relevance of exercise...but after that,we go back to our own lives... don't live the lives of those who go through their daily travails...so an easy way out is always to lecture and then move on to the next patient. if we all knew so much, how come we don't have lithe, toned athletic looking HCPs all over the NHS? I will tell you why...they all have lives and their daily grind where it isn't that simple.

And that is why when I read articles on "how easy it is"...it makes me annoyed. Yes, indeed diet and exercise is all paramount but lets be a bit more realistic about it, shall we? We have issues with food pricing, issues with accessibility, cultural issues....all of which does not help. There is no denying the importance of what a Mediterranean diet provides but don't  make it all sound so simple and more importantly, don't make others feel guilty or bad for not doing something "so simple". Life isn't the same for everyone so using glib terms such as "you should make time for such important interventions" isn't the way ahead.

You want to tackle this..do so properly. We have a long way to go when the biggest event held in the UK over last 10 years- the Olympics- is sponsored by CocaCola and McDonalds...that plastering of their logos make it more acceptable, not less. Food industry is where the battle is..so lets do so properly..and while that's happening, a bit less of the "Oh, Mrs Bloggs, you have put on some weight" followed by a pause.  We must,as healthcare professionals, have a better approach towards the whole weight loss angle..an overarching policy at a public health level, start at schools,,colleges, explain the importance of knowing how to prepare food yourself and perhaps even consider leading the way as regards being fitter individuals. And more importantly, try and appreciate why diet and exercise may not be so easy to do, rather than be judgemental about it. 

Life has a funny way of stacking your priorities.As a healthcare professional, your focus maybe to make Mrs Bloggs use 20 minutes each day for brisk walking and help her reduce her future risk of heart attacks. Her priority maybe to use the only spare 20 minutes in her day to sit with her grandchildren and read them a storybook. 
Lesson to self? Don't judge others by your own life or barometers..we are all different...so are our priorities. A bit more realism, a bit more understanding will probably take us further more than walking ourselves into a state where we view the world only through the prism of our own lives. One can only hope. 

Saturday, February 1, 2014

The Pledge

It's everywhere nowadays..you turn around and you hear about it.."NHS Change Day..a movement being driven by front-line staff to improve the NHS". I must say I have never been a blind believer, in fact, as with most things of my life, I do have views on it...never been an evangelist supporter of it as the slightly older cynical side looked at some of the pledges..and asked "So what"? For me, every single thing boils down to one thing..has it actually improved patient care? Has it actually made any difference? I have spent 4 years and a bit in management and have grown tired of so called "leaders" spouting clever words on power-points, come up with projects which look swish but in the end has done little for patients..for sure, it has improved the working conditions of some..and that is absolutely fine as long as its helped improve patient care. If not, then they have been clever words, use of political skills to further ones' careers..little else.

Anyway, back to NHS Change Day..I have asked some of the pioneers of this idea as to what it has actually done apart from create a slogan...and I have done my own background research...and then mostly found people involved with it who are young, passionate and primarily burning with the desire to actually make a difference...less of people who are driven simply by idealism but more by the desire to help. So, in my book? Its worth an effort, worth joining the cause, worth seeing whether a personal "pledge" would help.

So, at the very outset, lets put a disclaimer..the idea below is NOT mine. I read about it somewhere in an article written by Dr David Kerr, one of the most innovative diabetologists I have ever met..always ahead of his time. So, with due acknowledgement to my first Diabetes Consultant, I would like to try and do this for my patients...otherwise known as "The Pledge"..
For every patient admitted under me on the ward, how would it work if they or their relatives or next of kin received a "menu card" which started by a promise from me that the ward would make all efforts to make their stay as comfortable as possible. How about having clearly documented times for drug rounds, times for food rounds, times when the medical review will happen, my name, contact number and email for queries...and designated times each day to discuss progress of their care directly with me?

Would it work? I don't know and for sure there are few hurdles to cross as regards discussing with the ward staff about feasibility...but the bits I can personally do..will surely happen. About 4 years ago when I started getting more involved with the adolescent service in diabetes, I kicked off the process of giving patients my emails and phone. I was told by all and sundry how that would disturb my lifestyle, how I would be inundated by patient calls/emails...the real fact? It has never happened. In the most, patients are respectful of my time and use it when they need to..in fact, the feedback has been very positive.which has enabled me to roll it out to my endocrine patients. So why not now extend it to the ward patients?

This indeed will be interesting and for sure I will feedback how it goes. As a department, over the last 5 years, we have received only 5 complaints and comparison to others show we are nearly 20 times proportionately less. That fills me with pride as that showcases, I feel, a good department staffed by patient friendly, passionate staff. It also gives me confidence to put my name, phone and email to the patients admitted. Doesn't cost a dime but could help allay a lot of anxiety for patients being admitted...so why not give it a try? After all...what's to lose?