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Introduction
Published in Derek Steinberg, Complexity in Healthcare and the Language of Consultation, 2018
But if systems consultation can help us as healthcare professionals to work more effectively with each other, dealing with our private doubts about it as we go, is it possible to extend this kind of curiosity, understanding and partnership to our patients and clients too? This book explores this as well. To take this question seriously needs a strategy, not intent alone, and while systems consultation would be helpful alongside the clinical approach they cannot be merged seamlessly. The special value of the systemic approach is in its fundamental distinction from the clinical perspective; its enquiries and findings are different, sufficiently so to require a different identity and role from the purely clinical one. The ‘third kind of consultation’ therefore is not proposed as a hybrid formed of the other two, but as a kind of binocular, two-handed approach to all healthcare issues: the well-tried, well-tested and generally well-taught clinical approach on the one hand, and the relatively new but promising systems approach on the other. So you will find in the brand new medical bag I am recommending not one new piece of equipment but a pair, and I suggest we will be needing them both in twenty-first century healthcare, whose changes, chaos, complexity and increasing difficulty is already very well under way. In medicine, and in healthcare generally, we are going to have to move very fast to catch up.
Recollections
Published in Ian R. Gray, Medical Anecdotes and Humour: Myocardial Medley, 2018
Heart attacks evoked a quieter response. The medical bag would be checked first for morphine. The exit from the house was speedy but more considered. You could almost see the words of reassurance to anxious relatives forming on my father‘s lips ready to issue forth as soon as he arrived. I soon learned that these visits might take a long time, as one of my treats was to join him in the car and sit outside a ’visit‘ until he re-emerged; I often finished reading almost a whole book. The patients rarely went to hospital. Only occasionally was my wait in the car enlivened by the clang of ambulance bells: the patients either did very well or died in their own homes. If the latter occurred a mournful but guarded account would be given to my mother when my father arrived home. Summarised, it was usually, ’Old so and so didn‘t make it.’ A thousand words could not have been more graphic. Much better to hear was the casual, ‘Oh, we pulled him through.’ What and where was pulled, I wondered?
Clinical examination
Published in Nicholas Summerton, Primary Care Diagnostics, 2018
A wealth of information may be gained by careful observation of the patient long before we reach for our medical bag. This can incorporate straightforward clinical findings such as anaemia/jaundice to providing an insight into the patient’s health behaviour, emotional state or general wellbeing. Even a glance at the dentition may help; a tooth count of less than 20 has a positive likelihood ratio of 3.4 for osteoporosis.9
A Pandemic Refocuses Bioethics on “The Big Questions”
Published in The American Journal of Bioethics, 2020
Brian M. Cummings, John J. Paris
A lengthy era, in which the prevailing ethic was practical virtuous judgement and Hippocrates’ belief that medical decision making was best left to the doctor. During the later portion of that time span, whatever a physician could provide was contained in the little black bag that identified one as a doctor. The ‘medical bag’ contained very little: a stethoscope, a tongue depressor, a small rubber mallet to test neurological reflex, sulfa drugs, and morphine for pain relief. This era is captured in an 1891 painting by Sir. Luke Fildes entitled, ‘The Doctor’ in which an elderly doctor sits beside a dying young girl, hand on chin, waiting to see if she survives the night—or not. The distraught parents, barely visible in the background, gaze on helplessly.
Psychosis Related to COVID-19: Reports of a Disturbing New Complication
Published in Issues in Mental Health Nursing, 2021
A much lengthier psychotic episode was described by Lim et al. (2020), whose patient was a 55-year-old White woman in the UK who had survived acute COVID infection but returned to the hospital with persistent paranoid delusions and florid hallucinations (e.g., nurses were devils, monkeys were jumping out of a medical bag). She was not clear of psychotic symptoms for 40 days. Prior to developing COVID, this woman was healthy, taking no medications, and had no history of mental illness. She was successfully treated first with haloperidol and later risperidone. The authors proposed that an inflammatory state (indicated by elevated tumor necrosis factor) caused or contributed to the psychosis.