Elsewhere in the blogisphere

Blog fog and 9 legged spider???

Posted on October 2, 2009. Filed under: Benign, Elsewhere in the blogisphere |

Arrg…it’s happened again. So busy the week has disappeared and my blog has remained unposted…. Kim can relate…in fact read her post

One thing did get my attention this week….Yes I was fasinated by a story about combatting erectile dysfunction. Apparently the venom from a poisonous spider can help as a remedy for erectile dysfunction.  Seems quite obvious really, any insect bite can cause redness, heat and swelling….well what more do you need to combat ED (That’s Erectile Dysfunction not Emergency department…..nobody knows the cure for the latter!)

Quite how the researchers came up with the hypothesis -Toxic Spider bite cures ED,  I don’t know, and if I did have ED I’m not sure how keen I’d be to try this approach…. “Well hello, nice legs, fancy going down for a bite???” (Sorry I’m feeling smutty this week!)

Hmmm, I think I’ll have to stop there, sorry it is short and random, this week, next week promises to be worse…but I’ll try my best…

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Laws of Dinosaurs…

Posted on August 27, 2009. Filed under: Benign, Elsewhere in the blogisphere |

When I am being good and reading medical blogs rather than wasting time playing Facebook games, I check in on Musings of a Dinosaur, she was recently reflecting back over her “Laws of dinosaur”. It’s in her right hand column and worth checking out…  This inspired me to try writing my own laws of clinical practice for Primary Care Nurse Practitioners…

Here goes….

Law One: They say common diagnosis are common but you can bet your arse, you get the uncommon one when you are running late.

Law Two: Always assume that the last clinician to see your patient was incompetent and therefore start from scratch with your history taking and assessment.  Especially if the last clinician to see them was you!

Law Three: Remember all your patients are going to die, just make sure it isn’t today and it isn’t your fault!

Law Four (a): Always follow your instincts. If your sixth sense is telling you to get a coffee…get a coffee! (or do an ECG or whatever…but always get a coffee).

Law Four (b- subsection 1): Always trust you first impressions, you are not being prejudice but trusting your senses.

Law Four (b – subsection 2): Believe your nose, rather that an alcoholic in denial.

Law Five: Finding the diagnosis of a patient is not as important as finding out their agenda.

Law Sicks (a): Patients obviously think that you don’t know what a cough sounds like until they have demonstrated it.

Law Sicks (b): A limping patient can walk away from the surgery without a limp.

Law Seven: Unravelling the confusion behind a simple statement, is as difficult as unravelling a simple statement from behind the confusion, because too much information when you need less is as distracting as too little when you need more.

Law Seven (revised): Keep it simple but insure you understand all the facts.

Law Eight: Advising patients not to believe what they have found out on the internet, and then printing off an information leaflet from a web page may appear slightly hypocritical.

Law Nine: Always assume your patient is a specialist consultant professor in whatever you are assessing them for, but also assume they no nothing about what you are telling them about, and then try not to patronise them.

Law Ten: The most important things to know is what you don’t know (AKA know your limitations).

These are not to replace the Dinosaurs laws which I think are fabulous,  especially “there is no cure for stupid” and “poor planning on your part does not constitute an emergency on my part”, but merely my shallow attempt to add to them. Please add your own in the comments box!

Strange fact for the day…despite it’s unpleasant nature, in someones notes I just wrote “Penis erythemous” and it felt strangely poetic.

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My 2nd WordPress blogiversary…

Posted on March 5, 2009. Filed under: Benign, Elsewhere in the blogisphere, In the beginning... |

Blimey – a year has flown by already!

I’ve two blogiversary presents for you, one is a link to another site that’s nothing to do with me, but just more silly medical stuff.  The other is a few good tracks to accompany this posting.

As far as my blogiversary goes I have little to say that I didn’t say last year…  A few things have changed. I do think I’ve become a little more insular!  Much more benign stuff about my day to day bits and pieced and less topical stuff, perhaps I should start reading again!

On the subject of  potential change and me just jabbering on about things that happened at work….

A young lad presented today and during our chat, I noticed that he had stopped taking his antidepressants. He felt he was ready to stop at the time, but things where getting a little black again…

We discussed whether restarting the anti-depressants was the way forward, to which he said:  “I don’t want to take tablets I just want you to tell me to go and sort myself out”.

I laughed and duly did as my patient asked…I also gave some self help literature. I shared my thoughts on this with the patient…

It would be a great catch phrase for me. “Just go and sort yourself out”.

I could cut my appointment times down to about 3 minutes. That’s 2 minutes and 54 seconds, to listen to the patients problem and 6 seconds to say : “Just go and sort yourself out” and open the door.

Pt: “Help, I’ve got this terrible crushing chest pain…”

Max “Just go and sort yourself out”.

It really is the ultimate in holistic care, taking into account physical and mental aspects and if the patient successfully “sorts them self out”, it surely has to be good for their self esteem and a greater sense of well being.   I’ve often thought patients need to take more responsibility for themselves rather than expecting the health care service to manage their poor dietary habits, lack of exercise and 1 day old sore throats.

Quite frankly after the last few days I could well do with taking up this approach. A few things I’ve wanted to say this week but didn’t have the nerve to (incidentally these are all things I would have said to different patients…yes it’s been one of those weeks).

1: I can not resolve your marital problems you’ve been married 27 years. It’s your spouse you should talk to not me. (Actually I did say this to her after 25 minutes!!)

2: If you’ve tried counselling, psychotherapy, every antidepressant known to the human species and still have no clinical signs of depression but feel you need help…please don’t expect me to sort you out in a 10 minute appointment.

3: It’s flattering, but please don’t come and see me every time you sniff, just so you can flirt outrageously with me and then be happy when I say you don’t need any medication or advice you don’t already know, and just because I’m male and a nurse doesn’t mean I am gay…and even if I was…YOU wouldn’t be my type (real gay men don’t wear eye shadow and their mums perfume!!)!!  If I was gay I’d be a lesbian!!

4: How do you expect me to know what is genuinely going to kill you and needs medical intervention when every time you come you tell me of 5+ unrelated problems?

OK I’m off to lay in a darkened room…really I need to this week!!  Cue soothing music…

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NHS 60th Birthday…

Posted on July 2, 2008. Filed under: Apply topically, Elsewhere in the blogisphere |

OK it’s a one off. When I started writing this it was going to be a giggle.  Comparing the 60 year old NHS to any other 60 year old.  But I apologise it became a bit of a soap box…SORRY!!!

Am I being Bold??

Imagine it’s 1948…and you’re reading the Lancet (no not online you numpty!!)

And there is Aneurin Bevan. The Lancet, 1948 :

On 5 July we start together, the new National Health Service. It has not had an altogether trouble-free gestation. (Start as you mean to go on)  There have been understandable anxieties, inevitable in so great and novel an undertaking (“Undertaking” – done by an Undertaker??? – Not sure that should be mentioned in the introduction to a health service!!) Nor will there be overnight any miraculous removal of our more serious shortages of nurses and others (One day we’ll have enough staff…right!?!?!?!)  and of modern replanned buildings and equipment. But the sooner we start, the sooner we can try to see these things and to secure the improvements we all want. My job is to give you all the facilities, resources and help I can, and then to leave you alone as professional men and women to use your skills and judgement without hindrance. Let us try to develop that partnership from now on.’

6O years on and Gordon Brown is now just considering making things clinican led again, having just filled the last decade with government targets, QOF and the like!

At 60 I’ll have spent many years working, trying to meet various targets, follow guidelines and learning everything I need to do my job (I might actually know what I’m doing by the time I retire!). At 60 can we please let the NHS be the same.  Let her retire from the task driven government target led work place and enjoy an independent old age, doing what she knows about best, looking after patient and caring for their actual needs rather than hoop jumping, tick box assessments that simply make the government look good staistically, but don’t really give quality to patient care.

Wow! I feel better for that.  It’s like have a big bowel movement and getting a load of crap out!  (Not dissimilar to this blog in general (thought I’d say what you were thinking!. I’m big enough to take criticism.  I’m tough, I don’t just smell strong!))

HAPPY BIRTHDAY NHS!!!!  Sometimes it all seems a bit bleak, the politicians stick there oar in, the media moan about it, and grumpy patients send letters to the papers (those content rarely do).  But 24hours a day, 7 days a week, come hell or high water, there she is ready at a split seconds notice to save lives, make people more comfortable, manage everything from slight aches to chronic agony, bring babies safely into the world and much more besides.  She’s not a machine, she is about 970,000 people, including 33,647 consultants and 376,767 nurses and midwives.  Bringing in life and giving dignity to those ending.   So I say “HAPPY BIRTHDAY” and a big thank you to her.  I say that as someone who has experience on both sides,  as someone who has experienced extremely difficult times from the public side and felt the support and professionalism of the NHS.  Here’s to the next 60.



Elsewhere sad news: She may not be 60 but ER Nursey has decided it is time to Blog retire, obviously she shall be missed.  Good luck and I hope the withdrawal isn’t too severe.

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Crippen you love us, part two.

Posted on February 7, 2008. Filed under: Elsewhere in the blogisphere | Tags: |

I was checking out my Bloglinesaccount today (something I tend to forget to do, what with facebook blog buddies etc..) and I spotted that Dr Crippens “NHS Blog Doctor” was up and running again (and has been since the start of Jan).  Quenching all rumours about alien abduction etcetera.

Crippens wasn’t cute – “they” bought him back.

…and what has that old Curmudgeon Crippens been writing about….yes, he has been Nurse Practitioner bashing again.  I would like to point the good reader in the direction of my last Crippens related post.  Which pretty much says it all.

Crippens is currently having a moan about a new, over marketed group practice, that is offering free gym membership when a patient registers with them…


…I agree this sounds a little bit dodgy, especially when considering the Code of Practice for Promotion of NHS servicesas flagged up by Crippens.  But it is his NP bashing which I don’t agree with….

The Melbourne Grove Medical Practice (MGMP), has a statement on its website that reads:

You don’t need to wait to see a doctor.
“Our prescribing Nurse Practitioners are highly trained and are able to deal with the vast majority of medical issues that you present us with. They are able to diagnose and prescribe medication and work closely with our GPs on any cases about which they want a second opinion. As we have a growing team of nurse practitioners, you could save you time if you want to get in and see us as quickly as possible. You don’t need to wait to see a doctor!”

And the old Curmudgeon goes off on one… 

“If your child or your grandmother is really ill, do you want them to be “assessed” by a nurse practitioner and only passed on to the doctor if the nurse practitioner deems it necessary? Is that safe? If you believe it is then I am nought but a luxury, an expensive luxury at that, and superfluous to requirements.”

Now I’m not defending the MGMP in any way, but Crippens is misquoting, and as I have said before, Nurse Practitioners are not simply triage nurses.  The MGMP statement said nothing about their NP’s simply “assessing” the patient.

An NP Assesses, Diagnosis, Plans, Implements and Evaluates the patient. (It is called the Nursing Processes and it has been about since the 1970’s).  And then his comment about “being passed on to the doctor if the Nurse Practitioner deems it necessary”.

It is called “getting advice”.  Crippens doesn’t get it. He wants to be treated as a Superior-being compared to the humble NP. He wets his bed at night worrying that NP’s are going to replace GP’s totally.  Nobody (with the exception perhaps of the cost-cutting bureaucrats), wants that.

The main thing Crippens doesn’t seem to get, is that it is called team work!!

I don’t mind being a link in the chain.  I see a patient and I either:

1: Sort them out & send them away (about 95% of the time)

– maybe even (shock horror) refer them onto secondary care.

2: Get the GP to see them.

Not that dis-similar to a GP managing their patient and either sorting them out and sending them home or referring them to a consultant. NP simply have the “luxury” of asking their GP colleagues for advice.   So in direct response to the “good” doctor: Yes, I think it is safe for NP to see the patients, Yes, you are a “luxury” (but not in the way you meant it), and No you grumpy old git, you are not superfluous to requirements!

And why would a Doctor not like working in a team? Something to hide?

  ‘arold, is that you!

 And on the subject of team work, lets all get together for a Change of Shift…

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Search for the hero…

Posted on January 10, 2008. Filed under: Elsewhere in the blogisphere |

Subtitle: Mighty Mouse, Melonman and me!!

My PhotoA little Mousie friend of mine has recently started in the Emergency department. The Emergency department is a great place to work, but as her story tells – sometimes things happen outside the department when you don’t have the team around you.

If you have read her blog, you’ll see she was one of the first on scene to a horrific car accident while off duty.  It seems that as a new member of staff in the emergency department, it was a cruel twist of fate that she should find herself there; bad luck, especially taking into account the severity of the accident and the fact she was in uniform.

Luck has a lot to do with things…

I have also been first on scene in nasty car accident, although luck was much more on my side than on Mousie’s. In fact apart from the accident not happening, things couldn’t have really been any luckier…

A nice day, a nice stretch of dual carriageway with a high fatality rate associated with it. 

Mr & Mrs M.E. Nurse (both nurses – one experience trauma nurse, one ward sister), little baby Nurse in back. The dearly beloved (TDB) Mrs Nurse was driving.  (She is a terrible back seat driver, so I let her drive mostly!)

Over taken by a speeding 4×4.

Max to TDB: “Look at that idiot – he’s got a “Children on Board” sign on his car so he thinks that entitles him to race around like a looooooony”

The 4×4 starts to swerve, looses control and hits the central reservation, does a complete roll across the road and lands on its wheels in a lay-by. (That’s lucky for a start).

Misses us by a few metres, luckily TDB was slowing before the crash, just because she does when a nutter speeds by.

TDB rings the 999 (911 for those Yankee readers) and stays with sleeping baby. Max gets adrenaline surge and jumps heroically out the car. (As Mousie said, we all dream about these moments!!!)

What follows is a little nightmare…(but only a little one). Stupid driver gets out all shook up and is shouting at everyone and generally being aggressive. Front seat passenger has fine shards of glass all over her face and small bleeds from each. Nothing bad but looks scary to the toddler and ~10yr old that were on board and are now walking about zombiefied and crying. 

Still in the back of the car is one teenager laying near the door and apparently unconscious. Driver starts to try open the mangled back door to get to her but can’t. He was a bigger chap than me by a long shot, but I have super trained adrenaline power and somehow tear open the mangled door……cooooool!

The girl comes around and the driver gets her out the back of the car, against my wishes, but I take over and support her neck. She obviously had not been wearing a seat belt and had been thrown around.

A young woman from another car is now on scene, we seem to have an instant bond. The youngest child is crying, the driver is shouting at her to stop and thus making her worse. I ask the new woman to take a look at the girl as her head is bleeding, she brings her near me and together we take a look. Pretty big cut, so she uses something as a pressure pad and cuddles the girl. The others all seem fine, but wound up.  My brilliant assistant and I talk to everyone and calm the whole situation down. Everything is in control. The driver lights a cigarette, and gets shouted at in no uncertain turns by my new friend and me to put it out.

In the distant the melodic chiming of fire engines.  My new friend turn to me and says: “You handled this well”.  I return the complement.

“So what do you do?” she asks. I answer, she smiles. I return the question.

“Oh me, I’m a Police woman!”

The ambulance arrives. I was expecting to get barged out the way. I must have been oooozing coolness and experience, as they left me where I was and let me lead the log roll. This was not my town, these were not my old buddies, never met them before.  Really quite flattered, shame about the crippling leg cramp I’d got from being stuck in the same position on the cold road!

All cleared up, I return to my car, to find my daughter awake and being amused by a fireman – good job they came then really!

The next day I ring the hospital, all were discharged the same day. Nasty accident, landed in a lay-by, the right way round, Police woman and experience emergency nurse on scene immediately… Lucky….very freaking lucky.

So my little mousie friend, experience is nice and something you will gain (already have gained and learnt from), luck however you have no control over.

You don’t become Mighty Mouse over night….

If I’d been on your scene, the tragic outcome would have been the same.

If you’d been on my scene, the lucky outcome would have been the same.

And what is this about a melon man……the 3rd car on scene contained someone a little less experienced, who really wanted to help, so he ran around the dual carriageway collecting pieces of watermelon that had been flung out of the 4×4 when it crashed.  I saw what he was doing and it put a smile on my face. I had to try not to laugh when he came up to the scene, prior to the ambulance and asked me….

“What shall I do with the bits of melon I’ve collected?”

I gave a suitable calm friendly answer….honest!

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Crippen you love us…

Posted on June 28, 2007. Filed under: Elsewhere in the blogisphere |

That Moaning old git has been at it again – nurse practitioner bashing. It was Mental Nurse who got him started again.

On June 25th he started NP bashing again….boring.  Just this once I am going to lower myself – because I feel passionately?

No, thought it might be fun.

I know Dr Crippens hides a secret passion for Nurse Practitioners, he just get confused between love and hate.

I am one such Nurse Practitioner…I sit in a GP surgery, behind a desk, with my tie on, call my patients and then:
Assess, (Diagnose), Plan, Implement and Evaluate their care (this is called the Nursing Process – cool hey?).  I even – heaven forbid – prescribe.

Am I bound by Protocol? Hell no! I am (he’d love this bit) – an autonomous practitioner…. Crippins are you there? No? I can relax, I don’t want to be responsible for his blood pressure going up.

Do I work for the NHS? NO!  I work for a partnership of GP’s.  Yes – those mad fools employ me!! 

WHY would they employ a NP?  I hear you ask,  Well the truth is 2 fold:
1: I’m good at my job,
2: I am cheaper to employ than another Dr. ( oh I feel so degraded and cheap – sob sob)

They can save money and buy sports cars instead of employing a Dr!!- WOW!

Hang on then – so the NHS don’t employ me – the Doctors themselves do….

Max ‘n’ Crip’s
Yes I am Frankensteins Nurse Practitioner. Doctors created my job…. Queue demonic laughter HA HA HA HAAAAAA – If it wasn’t for Doctors wanting me I’d be a “normal” nurse in an A&E (ER).  

I know my scope of practice and I have no concerns about asking my colleagues (sorry I obviously meant superior doctors) about things I don’t know….and…are you ready for this…..sometimes they even ask ME for advice… Oh, I hope Crippen isn’t reading I don’t want to be responsible for his chest pain?

I should stop, but I am enjoying myself….

 The movie “based” on the true story..

Historically Dr Crippens have been murderous creatures, is Dr John Crippen in fact related to Dr Hawley Harvey Crippen?  Perhaps Dr HH Crippen’s wife wanted to move back to the USA to be an NP, and thus he murdered her. Perhaps this deep seated hatred of NP’s has been in the Crippen family for years.

Dr John Crippens seem to enjoy being rude about NP’s – is it that he enjoys our attention really?  In the way a son might about a mother perhaps!! Sigmund where are you????

He is perhaps a sad man who just needs to have a big hug. Go on John give us a big manly hug. Make it your mission to embrace a Nurse Practitioner. You never know you might just grow to like us…

And yes, I know, if that big blogging monster Crippens reads my little blog he will slate me, and make rude comments. But actually I don’t give a monkeys.  Why haven’t more NP’s commented? – I know the answer, they’re busy seeing his patients while he spends all his time blogging. (and yes – I am a blogger too – so I am skiving as much!!)

Dr. John Crippens I send you big manly hugs, and as much sarcasm as you like. 

Meanwhile the fantastic new Nursinglink.com is hosting Change of Shift….plenty of reading so grab a coffee and a bourbon, if the urge takes you!

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