I found this podcast interesting, it really struck a cord with me. I just suppose that everyone has a curious mind and want to learn to new things. I am sure there is some kind of phycological description where one projects their own traits onto others. After listening to this podcast, and just a quick second of simple reflection, it is obvious the most people are not curious at all. Even more, most people might be extremely uncurious. Worse our culture caters to this uncurious attitude in the masses and it is likely getting worse. I remember when I was young that the History Channel had actually history and TLC (the learning channel!) had all kinds of intense documentaries. I remember when I could watch a four hour documentary on a single battle in WWI. Those days are long gone now. I have not watched TV in years, and to be honest reading books is probably a much more efficient way to learn. All this being said, the masses are extremely uncurious but have this extreme arrogance that they are knowledgeable. They watch a short segment on TV and repeat it verbatim.
The modern Covid hoax is excellent example of the lack of curious nature of human beings. Most people accept propaganda without question and accept any narrative no matter how ludicrous. Now we are in a time of high strangeness where reality itself is being scripted in an absurd way but most don’t even the faintest inclination to question and seek truth.
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بک لینک ها چه هستند ؟
بک لینک‌ها لینک‌هایی هستند که از یک وب‌سایت به وب‌سایت دیگر اشاره می‌کنند.
این لینک‌ها به عنوان یک تأییدیه از طرف سایت منبع به سایت مقصد تلقی می‌شوند و به بهبود رتبه‌بندی موتورهای جستجو کمک می‌کنند.
شما میتوانید این بک لینک هارا به
صورت طبیعی در طولانی مدت با
استفاده از لینک های منبع بقیه وب
سایت ها به سایت خود بدست آورید و یا لینک
سایت خود را در سایت های دیگه قرار
دهید که به این عمل خرید بک لینک گفته میشود .
به طور کلی، هرچه یک وب‌سایت بک لینک‌های با کیفیت بیشتری داشته باشد، احتمال بیشتری دارد که رتبه بالاتری در نتایج جستجوهای گوگل و سایر
موتورهای جستجو کسب کند.
Hmm is anyone else experiencing problems with the images on this blog
loading? I’m trying to find out if its a problem
on my end or if it’s the blog. Any feedback would be
greatly appreciated.
Working in A&E, I see the best of care but also the worst – and that’s not
necessarily the NHS’s fault.
A few weeks ago I was looking after an 89-year-old gentleman who
received care that utterly failed him – devastating for him and
his loved ones, and for us as clinicians. Yet it was entirely preventable.
It’s a lesson for all of us.
There is only one thing 100 per cent guaranteed in life – and that’s death.
But when it came to his death, we got it so wrong.
He was a proud family man who’d given a life of service to the country,
in the Army then as a policeman.
A keen sportsman, he was fit and well and, until a stroke hit him six months before I saw him, he’d had a brilliant quality of life looking after his beloved grandchildren.
But he’d rapidly deteriorated after his stroke, so moved in with his son and
needed carers three times a day. He was incontinent, and had to
be hoisted from his bed to his chair; he also developed dementia.
His last months of life were not what he would ever
have wanted.
A few hours before he came to A&E he was becoming increasingly short of breath –
his son called 111, hoping they’d send a district nurse to make
him comfortable. But it was Friday night, and instead a blue-light ambulance was dispatched.
Without any pre-planning for what should happen if he became
unwell, there was no clear guidance for the paramedics to follow or access to a GP, so the only choice was
to take him to hospital.
Rob Galloway’s 89-year-old patient was left languishing in the hospital corridor.
An A&E doctor, who recognised he had sepsis caused by a chest infection, gave
him intravenous fluids, antibiotics and oxygen – but what he needed was
palliative care (file image)
There he was seen by a relatively junior A&E doctor, who recognised
he had sepsis caused by a chest infection, and gave him intravenous fluids, antibiotics and oxygen.
He was then left languishing in the corridor – there were no spare cubicle spaces in A&E or
beds on a ward.
His son arrived and came to ask our nurse in charge what was happening.
Overhearing the conversation, I intervened – his son told me his
dad would not have wanted any of this.
He just wanted a comfortable death at home, not
a prolongation of his agony.
By then he’d deteriorated and was now semi-conscious but
in obvious discomfort.
I stopped the antibiotics and cancelled his blood tests and chest X-ray.
None of this was necessary or appropriate – what he
needed was palliative care. So I removed the fluids and the oxygen and prescribed morphine to make him comfortable.
Most importantly we organised a cubicle behind curtains to give him some dignity.
He was too unwell to transport home. A few hours later he passed away surrounded by the sounds of drunken and drug-fuelled patients, his
son’s tears heard by the other patients. An awful, expensive and undignified death.
It didn’t need to be like this.
Recently, my friend’s dad passed away. He was frail with heart and kidney failure.
But he had a plan for when his condition deteriorated.
Six months before he died he’d sat down with his GP and family and talked through what
he wanted if things got worse: no hospital, no CPR. Just to be at home with the dog on his lap, his family by his side, with jazz music in the background and morphine if needed
for pain relief. And that’s exactly what happened.
Because they’d planned ahead, the GP prescribed morphine and other key
medications in advance, so they were already in the house – ready if
needed, even in the middle of the night. The district nurses knew the plan and were on standby
to help.
So when the time came, there was no panic, no rush to
A&E. Just peace and love. That is the power of planning.
Not every GP practice will be quite so proactive – but this kind of planning is possible.
Without it, you risk being at the mercy of overstretched services
that don’t know your wishes – and might do the very things you and your loved
ones never wanted.
We don’t talk about dying enough, let alone how we want to die.
But as medicine advances and people live longer with dementia,
cancer and heart disease, for instance, it’s just not enough to simply focus on how to keep people alive.
We need to think about how to let people go well,
too.
Too often in the NHS, when a patient suddenly deteriorates, we’re left scrambling to make high-stakes decisions without knowing what that person would have wanted.
Professor Rob Galloway is an A&E consultant
In 2016, the Recommended Summary Plan for Emergency
Care and Treatment (ReSPECT) form was brought in to avoid exactly this kind
of crisis decision-making.
It’s designed for people who are elderly, or have long-term conditions, and it sets
out, in advance, what treatments they would – or wouldn’t – want if things take a
turn for the worse.
Ideally, it’s done with the GP, during a calm, planned conversation with
the patient and, if appropriate, their family.
The form isn’t just about ticking boxes. It prompts real,
practical decisions – such as whether the person would want CPR if their heart stopped, or to be admitted to intensive care, with the implications of each explained properly.
There’s also space to record whether they’d
want antibiotics if they developed sepsis; artificial feeding if they could no
longer eat; or fluids through a drip if they were in their final days.
The kind of questions a GP might ask to help complete
the form can include: ‘If you became very unwell with an infection,
would you want us to treat it with strong intravenous antibiotics – or focus just on keeping you comfortable?’
The CPR question is a key one, as CPR is widely misunderstood.
People think it’s like on TV, with someone clutching their chest,
collapsing, followed by being heroically thumped then shocked back to life.
Although effective for sudden heart issues, success rates in the
elderly or chronically ill are very low. Most people who receive CPR in these circumstances don’t survive.
If they do, it’s often to a life of significant disability.
Douglas Chamberlain, the cardiologist who introduced defibrillators to the UK,
passed away last month aged 94. He used to say that many
patients and relatives falsely believe that a DNR (do
not resuscitate) order – don’t use CPR – means no treatment and being
left to die. It doesn’t mean that at all.
You can still have full active care, such as oxygen and intravenous infusions and antibiotics.
But if the treatments fail to save your life and your heart stops, then a DNR order means we won’t
jump on your chest.
Importantly, ReSPECT is a plan agreed between the clinical team and the patient, based on what is medically appropriate
and what matters most to the individual.
It balances clinical judgment with personal priorities, and ensures
that when decisions are needed quickly, they’ve already been carefully thought through.
Crucially, the patient’s ReSPECT removes the agonising guilt that families often feel
when they agree with the doctor to not pursue intensive care or aggressive treatment –
because that decision would already have been made, together,
in calmer times.
Yet the form isn’t used nearly as often as it should be.
Some GPs don’t get round to it. Some families don’t know it exists.
So when a crisis hits, we fall back on ambulance calls,
rushed decisions and hospital admissions that nobody wanted.
And that’s exactly what went wrong for the 89-year-old man I saw that Friday
night.
One conversation could have changed everything. If the patient is unable to make decisions due to advanced dementia,
unconsciousness, or confusion as a result of illness, relatives are consulted.
Read More
My patient, 78, fell and the week she spent in hopsital will kill
her early: PROFESSOR ROB GALLOWAY
But doctors may, understandably, be more inclined
to treat the patient than offer palliative care. That’s where a lasting power of attorney
for health can help. This is a different legal document used if you lose your mental capacity – handing over decision-making to someone
you trust.
These two written documents are kept by the patient, with copies lodged with the GP, hospital,
care home and ambulance service. The bottom line is this: if you don’t
make a plan, the system will make one for you.
So, if you have a chronic illness, or worry you may develop dementia, the most important thing you can do is talk.
Sit down with your GP. Fill out a ReSPECT form – and remember,
you can change it. And if they’re well, talk to
your parents, and grandparents, about all this.
We spend so much time planning for our weddings, our careers, our retirements.
Yet we rarely plan for the one thing guaranteed to happen.
Completing a ReSPECT form won’t stop death. But it might help you die the way you lived -with dignity, with control, and with the people you love around you.
I’ve had countless consultations where someone says:
‘I don’t want to talk about that yet’. But when is the right time?
When you’re already unconscious or unwell? The best
time is now.
A good death isn’t luck. It’s about preparation, understanding the limits
of modern medicine and the power of good conversations.
@drrobgalloway
NHS
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