Looks like we made it by @kendonaldson

IMG_3277It feels like it has been a week of firsts; first patient admitted, first baby born, first operation, first clinical meeting and, for many of us, the first time we have moved into a new hospital. Last weekend was momentous. In some ways it was momentous in its simplicity and monotonous regularity. We had a script, we followed it, and everything went to plan. Job done, easy. However I am not so sure it really was that easy. I will return to this shortly but before that a few reflections.

IMG_3283The weekend before the move John Glover (our retired Head of Communications) and the Dumfries Ukelele Band played Christmas Carols in the canteen to say farewell to ‘Old DGRI’ and a welcome to ‘Mountainhall Treatment Centre’ and the ‘New DGRI’. I was asked to say a few words after the singing and, the night before as I drove home, pondered on what I would say. My mind wandered around old DGRI taking in memories from the last 10 years. These memories centred on the Renal Unit, involving coffee and a lot of laughter, wards 7, 8 and 9 as well as most other areas. There was some sadness at the thought of patients lost and friends who have moved to new jobs but primarily I remembered all the fun. Every ward and every area drew forth memories of stories told and laughter IMG_3281had and before long I realised that what stuck in my minds eye most were the faces; the faces of people I had worked with, laughed with and, sometimes, cried with. It may seem obvious but it struck me then; this isn’t about buildings, bricks and mortar, its about people and hearts and minds. Yes, those of us moving will miss the old place but as long as we are together and embrace the new environment positively, we will be fine.

IMG_3295Which brings me to those who are not moving. This has been a particularly difficult period for our colleagues remaining at Mountainhall Treatment Centre, a building we have been told is not fit for purpose, needs lots of work done and has clearly been replaced. Most of them don’t get to go to the new shiny, fancy, ‘state-of-the-art’ building and grab a coffee in the atrium taking in the views. So what did they do last weekend? Well they rolled up their sleeves and asked how they could help. I saw many of them during the migration in both buildings ensuring the move was a smooth as possible. IMG_3294Colleagues, friends, members of Team DGRI, old and new. We cannot forget the challenges ahead and the project to refurbish the old Cresswell building is now gathering pace although it will take years to complete. We need to remember our friends in Mountainhall…even though they may find parking a little easier than most of us!

 Lets return to how easy that move really was. One of our Emergency Department Consultants, Dave Pedley, said “well, it turns out that moving hospital is a piece of cake” and, last weekend, that is how it felt…but that is most certainly not the case. 18 months of planning, 3 months preparing the hospital for use and an enormous amount of dedication and hard work from so many of our staff IMG_3284ultimately made the move seamless. Which is the main reason I am writing this blog, to say ‘Thank you’ to everyone involved. I am going to desist from a ‘Oscars style’ list of names because it would go on for ever but suffice to say that there are a significant number of people out there who worked tirelessly to plan, prepare and then execute the move. Many folk have been sleeping in the hospital in makeshift beds for weeks, some have missed many, many weekends and there have been countless sleepless nights. It was their dedication that made the Migration so easy.

IMG_3298And then we come to the move itself. The clinical teams just rose to the occasion and made sure all patients were transferred safely, the Ambulance Service were outstanding and other partner agencies excelled themselves. It was an honour to be a part of the whole operation and I hope that all of us involved remember the atmosphere that filled the new hospital over those 3 days. It was electric, charged..everywhere I looked I saw smiles and laughter. As its Christmas time I think the best word to describe the feeling was…Jolly!

 This is just the start. Many problems lie ahead and there are going to be some really difficult challenges to overcome but if we can continue to work together as we always have and remember that what matters are the people around us, not the infrastructure, then I know we will be ok.

 It looks like we made it in, now lets make it work.

Ken Donaldson is Medical Director for NHS Dumfries and Galloway

P.S. Anne Allison, I hope you like the title!!

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Surviving the Long Trek by Fraser Gibb

I’m currently off on compassionate leave as my dad battles through what are probably his final days.
The palliative care journey has been overwhelming for me. It feels unimaginably different from anything I could have anticipated from years of looking at it from the other side of the fence.

So I put my thoughts down in the following Facebook post.

What I’ve learned during my crash course on imminent bereavement. 

My toolkit for surviving your loved one being gravely unwell.

1. Do what you can to stop them from feeling a) pain b) anxiety c) discomfort (itch, nausea, dizziness, or anything else). Remember that you can only do so much. There are things that will happen that you will disagree with. Make whatever effort is reasonable to have your opinion heard. Once you have expressed your opinion and heard the response, consider,
a. Is the response going to manage the problem?
b. If not, is there anything reasonable that I can do to change things for the better?
c. Remember that, despite what is happening to you and your loved one, there may be someone else in the ward that is going through the same thing. The nurses are human, and they make mistakes. That doesn’t mean that they don’t care, or are not trying.

2. Enjoy every moment of connection.
This may be no more than a glimmer of a smile, or the tiniest squeeze of a hand. It may feel like nothing to anybody else, but it is a thing to you; it may be a thing for your loved one; and it may be the last moment to remember that you ever have with her.

3. Take pictures. Record video.
It feels morbid. But it’s precious. Anything that you catch of your loved one before they go. Anything.

4. Talk as if the person is there.
Talk to each other. Talk about anything. Don’t stop communicating because there’s a palliative person in the room, but talk about things with the person in mind. Feel free to involve them as a silent member of your conversation.

5. Say those things.
The “I never got to tell him before he went” sort of things.
Tell him you love him. Explain that he’s adopted (if that feels right to you).
Whatever. Don’t let the person die without you having an opportunity to set the record straight. Even a silent witness can be a powerful one if they’re close enough to the incident in question.

6. Don’t break up with your family over this.
You may have an ‘odd’ brother or sister who doesn’t respond in the way you would have chosen. Don’t use this event as an opportunity to break up with your sibling. Chances are that they’re as wrecked by the event as you are. They may just be displaying their own distress differently. Your loved one would not want their own death to be an opportunity for schism within an otherwise functioning social unit.

7. Be kind to yourself.
You will not be able to be perfect. You will find yourself wishing you could have done some thing differently, or used other words. We are all human. Humans make mistakes. Forgive yourself.

8. Pace yourself.
This is a trek through a hostile jungle, not a stroll to the shops. It might take days and days. Work out a rota, and bring in some help. Everybody cannot be there for all the time. You need sleep. You need breaks. Don’t burn yourself out at the beginning, when the need may be much, much later.

9. There’s no such thing as a perfect death.
Things will go wrong. People will arrive at the wrong time, and events will happen when you aren’t there to manage them. Some opportunities will be missed. The best we can hope for is as peaceful a passage as reasonable, where people try their best, and your loved one doesn’t suffer too much. If you manage to get that, then you have got a precious thing

Fraser Gibb is a Consultant Psychiatrist at NHS Dumfries and Galloway

Absent Friends and Full Beam Living by Gill Stanyard

Just like the crimson poppy helps us to remember the fallen ones through War on Armistice Day, a couple of weeks ago,  it was the  Absent Friends Festival (1-7th November). It was created as an opportunity for people across Scotland to remember and share stories of ‘absent friends.’  A wall of remembrance was launched, as part of the festival, where you can post online tributes -here are just  a few that I read this morning:

 

To three dear colleagues who worked tirelessly to improve the end of life   experience of others, all to die of cancer too soon

 

    To Gordon, the garden volunteer .Just to say your recycled strawberry planters are working really well and we still miss you – a lot

 

   You told me you were dying but I didn’t want to believe it. I’m sorry I didn’t talk to you about it when I had the chance. I miss you so

 

 

I wrote the following for Robert Allan,a  fellow Board Member and my colleague who died suddenly in September:

 

 Robert, sorry I did not see you again after you went away on holiday. I will miss sharing your blueberries and all the banter and laughs we had. XX

 

He died whilst abroad with his partner and friends.  I cried when the news was delivered, on an early sun-filled Monday afternoon, in the Boardroom.  It was more out of shock initially and then I felt my sadness rising. I had sent Robert a text  just that morning, as I had not heard from him for a little while.  It was not like him, he was usually quick at getting back in contact.  We had been joking together just before he left  to go on annual leave about his new ‘regime’ of 45 minutes on the exercise bike whilst watching  old episodes of M.A.S.H. I had messaged him to ask if he had got back ‘in the saddle’ after holiday time.  I loved watching M.A.S.H too, it felt good having something in common. We were both very different, yet we shared good banter, laughter and stories. I  particularly used to like hearing of his time served as a Policeman in the Met, down in London, in the late 70’s and 80’s. He said it was like being in ‘The Sweeny ‘at times.

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Robert was a Board member for seven years and in that time he brought much  to improve the service and to increase patient safety through scrutiny, constructive criticism, and ensuring that the Board’s strategy met the needs of the people of Dumfries and Galloway.  Robert really embodied the  role of the ‘critical friend.’  He was a Champion of Health Inequalities and a great advocate of patient empowerment and self-management, particularly for people with disabilites. He was Secretary of D & G Voice – a vibrant and expanding disability movement, with influence in Dumfries and Galloway and also on a national and UK stage.

In a blog Robert wrote  back in April, he wrote of the many highly skilled and dedicated people of the NHS who’ .. do their best everyday.’  This can certainly be said of Robert,  who despite having multiple long term health conditions and mobility issues, he always did his best

He leaves a wife and two daughters behind. If you like, you can read his blog here: https://dghealth.wordpress.com/2017/04/26/life-in-the-nhs-a-personal-view-by-robert-allan/

 

Robert was not afraid to speak up and speak out -he never held back.  In one of the last emails he sent me, he wrote about the importance of speaking up without ‘fear or favour,’  he included a quote :  ‘All that is necessary for evil to flourish is for good men to do nothing.’ (For men include women nowadays.) (Sic)

 

That quote really got me thinking. And I am still thinking about it. To me, it is about  self-leadership and feeling safe.  Why would good people do nothing? What gets in the way of action? These days, there is no one leader. The cape of the heroic stand- alone leader, who would lead everyone out from the shadows and into the light, has been shredded. We are all leaders. The word leader comes from the Germanic word ‘leiten’ meaning to ‘light the way.’ This always gives me an image in my head of a lighthouse, with the bright beacon at the top.  I wonder how many of us feel like we are operating on full beam with our leadership?

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I have crashed many times on my own rocks of faulty thinking,  believing that I had to wait until it felt ‘safe’ to speak out.  Experience as a whistleblower in a former job and being a Non-Executive has shown me that the opposite can be true. Speaking up makes the environment safe. I am sure that there are many of us sitting on the sidelines with valuable information, insights and experience, that only we know and can share. We are waiting for the invitation from perhaps our managers or colleagues, that is not going to come, as they don’t know we have this important information. When others speak up in meetings, disagree with a decision, point out errors or provide clarity, it is inspiring. When we do it, it  can be scary and  we can feel vulnerable. ‘Pssst -it feels the same for those inspirational ‘others.’  You are an asset. You are enough. What you know matters, it may not necessarily be about a specific job or issue, it might be about you being a carer or the time when you solved a problem that others were struggling with.When you authentically act in the service of others, the environment supports you.

 

Self-leadership is a ‘rendezvous with reality’ according to International Coach Lars Sudman …he urges us all to go looking for ‘feedback’ to enable ourselves to grow deeper in our self-awareness and  to reflect on our decisions and how we are framing issues. Asking for feedback can often result in tumbleweed city being unleashed.  Try it for yourself and see what response you get. Do you hear a faint whooshing noise?! People don’t always think the ‘truth’ is a good idea. However, we can give ourselves feedback, based on our own reading of a situation and how we felt we did. If you ask yourself now about the worst leader you have experienced, what did they do? Did they shout? Did they use shame as a way to gain compliance and control? Did they with-hold information? Now score yourself out of ten, for the same things. How good are you at sharing information with others, for example? Based on your scores, what is your plan to execute your leadership and make improvements?

 

Research at the University of California has shown just 2 -5  minutes a day of this can increase compassion for yourself and others, thus leading to better decisions and less stress.  Harry Kraemer, Professor of Strategy at the Kellogg school suggests this mini-reflective exercise could be the key. Ask yourself:  ‘What are my values, and what am I going to do about it?’ He writes “ This is not some intellectual exercise. It’s all about self-improvement, being self-aware, knowing myself, and getting better.”

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This is nothing new, Marcus Aurelius, was a philosopher and Emperor of Rome from 161 -180 AD.  He was one of the most powerful men in the world and was described as a ’beacon of ‘leadership’. Every night he would  sit down and reflect on his day, and prepare for his tomorrow by asking  the question “I will encounter difficult people tomorrow, how will I react?” If you ask yourself now about the best leader you have experienced, what did they do? How did you feel in their presence? Now score yourself out of ten, for the same things. Based on your scores, what is your plan to execute your leadership and make improvements for your tomorrow?

 

Several years ago,  Bronnie Ware, a Palliative-care nurse from New South Wales in Australia captured the regrets of people who were dying, when she was with them in their final weeks of life. Ware wrote of the phenomenal clarity of vision that people gain at the end of their lives, and how we might learn from their wisdom. “When questioned about any regrets they had or anything they would do differently,” she says, “common themes surfaced again and again.

 

Here are the top 5:

  1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.
  2. I wish I hadn’t worked so hard.
  3. I wish I’d had the courage to express my feelings.
  4. I wish I had stayed in touch with my friends.
  5. I wish that I had let myself be happier.

If you reflect on these, what’s your greatest regret so far, and what will you set out to achieve or change before you die?

When others from the Board and I attended Robert’s memorial service,  I learnt lots of things I didn’t know, such as he loved the music of Leonard Cohen.

Here are the lyrics to ‘Dance me to the End of Love’ by the man himself. It is my wish that you enjoy your dance -and my wish for Robert that he is now safely inside his ‘tent of shelter.’

Dance me to your beauty with a burning violin

Dance me through the panic till I’m gathered safely in

Lift me like an olive branch and be my homeward dove

Dance me to the end of love

Dance me to the end of love

 

Oh, let me see your beauty when the witnesses are gone

Let me feel you moving like they do in Babylon

Show me slowly what I only know the limits of

Dance me to the end of love

Dance me to the end of love

 

Dance me to the wedding now, dance me on and on

Dance me very tenderly and dance me very long

We’re both of us beneath our love, we’re both of us above

Dance me to the end of love

Dance me to the end of love

 

Dance me to the children who are asking to be born

Dance me through the curtains that our kisses have outworn

Raise a tent of shelter now, though every thread is torn

Dance me to the end of love

 

Dance me to your beauty with a burning violin

Dance me through the panic till I’m gathered safely in

Touch me with your naked hand or touch me with your glove

Dance me to the end of love

Dance me to the end of love

Dance me to the end of love

L.Cohen     

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If you would like to add your own tribute, to absent colleagues, or relatives you have lost, follow the link.  Sometimes we don’t get the chance to say the things we really wanted to.

https://www.toabsentfriends.org.uk/content/remembrance/

 Gill Stanyard is a Non Executive member of NHS Dumfires and Galloway Health Board

 

 

 

 

Patient Centred Care – Your Actions Today by John McGoldrick

A wee story.

George ‘Geordie’ ‘Specs’ Hastings was 72 when he died on 29 January 2017 after a short illness.

StepsGeorge was one of the town’s characters, seen and greeted by many as he sat on the doorstep of his flat in Assembly Street, Dumfries. George had a very full and active life, working in many of the key establishments in and around Dumfries. He was a family man, a much loved Dad, Granpa, Great Granpa, a big football fan and just a popular guy who always had a smile, ‘hello’, quick quip and happy chat. He amused many with his stories and his legendary sun tan was achieved he claimed in (on) ‘Door Steppie’, many puzzling where that exotic place was. The volume of family and friends attendance at his funeral service reflected the status he had in our community.

George ‘took ill’ and was in painful, deteriorating health for a number of weeks in late 2016, culminating in his attendance at the Emergency Department, DGRI on 15 December 2016.  George had been under the care of his GP(s) and District/Practice Nurses, with little apparent improvement in his ‘sciatica’ as George intimated to folks.

His attendance at ED saw him immediately admitted to hospital, the duty ED Doctor recognising a significant deterioration in George having seen him some 3 weeks earlier and the review of George’s ‘on line’ recent blood test results indicating a significant health problem –news to his family. From then George was submitted to a range of checks, tests and treatments for what was quickly identified as tumours on his spine, bladder and lung. The immediate response and care provided by the ED medical and nursing staff was exceptional.

He was admitted to ward 7 and the medical team contacted the Oncology team in Edinburgh. This resulted in George being transferred to the Western General Hospital for a spell of treatment before returning to DGRI ward 12. It was here that he and his family experienced ‘Open Visiting’ which made life easier for all of them. Unfortunately though, due to bed pressures, George was transferred to a Cottage Hospital that did not have the same visiting freedoms. This led to extreme frustration for Georges family and friends as they had to travel some considerable distance to visit him only to find they had to wait for some time in an area they didn’t know to get ‘access’.

Why was George moved to a Cottage Hospital some distance from friends and family? Well this is sometimes necessary when beds are tight but is not seen as good practice however we must remember the need of the patients at the ‘Front door’ who need admission and maybe extremely ill. However in this case something was missed….George was dying, this was beyond doubt. There were no beds in the Alex unit but was he the best person to move to a CH? This is answered when it became apparent that George ‘needed’ a blood transfusion and required transferred back to DGRI to receive this.

Following this George was moved to a Nursing home where he died one week later on 29th January 2017, 45 days after initially presenting to ED. This last week was not the best for him as caring staff did their best with a dying man who was in pain and discomfort. This raises some questions; did George require a trip to Edinburgh in what was to be the last month of his life? Was it fair to move him so many times, 6 overall, when he was dying and needed a little comfort, love and continuity? Did he require the final move in his last days? DGRI was busy, it was the Christmas and New Year spell that often leads to real pressures but what happened to George? He just disappeared in the busyness and ended up being passed from pillar to post, not the best way for such a kind, respected man to end his life.

There may be no easy answers but there are some things we can do – our New Hospital will have open visiting on all wards and we can replicate this in all our hospitals. We can have more realistic discussions with patients and their families to prevent unnecessary trips either to Edinburgh or other major centres and for other treatments that may only prolong death rather than life. But the main thing we can do is remember George, and all the other patients like him. They are not simply ‘bed blockers’ or ‘the stroke in bed 3’, they are people, with lives, families, friends and stories. They matter and as such should be treated with kindness and respect.

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Thought for today

George was a ‘Ten out of Ten’ chap.  His end of life care and treatment did not reach that standard.

We often hear that lessons learned and procedures put in place will make sure no repeat of the identified problem events.  As you go about your professional business today – will you really make sure that you listen to patients views and wishes, that you ask Whose Needs are Being met? and What Matters to Them? to do our best to ensure that there will be no other terminally ill patients who have to suffer a similar journey to that of George Hastings?

John McGoldrick was a friend of George Hastings

The man With The Tea Trolley by Alison Wren

image1Hello! My name is Alison! I work as a Clinical Psychologist in the Clinical Health Psychology Service; the final member of the team to blog this month as part of our service promotion! Part of my role within this job is to help individuals and their families manage psychological distress caused by or maintained by physical health problems. Of course as a psychologist I do this at a professional level, but do we always need to be a psychologist to provide psychological care to those who need it?

 
This is the story of a man with a tea trolley; an ordinary chap who made a big difference to me at a particular moment in my life when the chips were down. I didn’t know him and he didn’t know me. We only met once and we don’t keep in touch. He probably doesn’t even remember me. He didn’t need to do what he did; it definitely wasn’t in his job remit and he probably bent the hospital rules.

The story starts on a Saturday afternoon several years ago when my husband unfortunately had a heart attack and was admitted to our local coronary care unit. It all came as a bit of a shock as he had none of the typical risk factors. He wasn’t overweight; he didn’t have high cholesterol, and had never smoked. He drank sensibly and walked miles every week. The event itself was fairly low key; just a burning sensation from throat to stomach followed later by an aching jaw. Symptoms so low key that he still image2went off to a football match that afternoon as planned. Twelve hours later after a trip to A&E (“just to be on the safe side”) our worst fears were confirmed. I’m happy to say that after a successful angioplasty he made a great recovery, but at the time we both pretty devastated. I was beside myself with worry. My stomach churned and my thoughts raced out of control “Was he going to die?”, “Would he have another?”

“Would he be able to stay active?”, “Would he still be able to work?”

image3I felt overwhelmed. How would I help my husband to cope if I was struggling myself? I had no one to talk to and could not voice my fears to my husband who needed me to be strong. As a Clinical Psychologist with many years experience working with people who have experienced distressing life events, I knew that my thoughts and feelings were normal but I was at a loss as to how to help myself.

The coronary unit that my husband was admitted to was located in another region in the UK and has now closed. My husband received excellent medical care, but as a worried spouse I felt alone. Nurses and doctors were busy. Visiting hours were limited (I was not permitted to stay longer than an hour). I wanted to be near my husband and to feel that others understood that we were in this together. I wanted reassurance. I wanted information. I wanted someone to ask me if I was alright. I felt that I needed looking after too.

One afternoon with all this weighing heavily on my mind, the man with the tea trolley came into my life. I had seen him before on and off during my visits serving hot drinks and biscuits to the patients. He was always cheerful and took the time to have a chat with people. He bustled passed me as I sat in the visitor’s room. I guess he must have noticed my forlorn expression through the window, because he doubled back and came into the room. What he did next was a small act of kindness that changed my day, and helped me feel a little better.

image4He simply smiled, gave me a cup of tea and said, “It’s hard isn’t it? How are you doing?”

We chatted for a short while about this and that, and he listened to me as I told him what had happened. Of course he couldn’t answer my medical questions, or give me any assurances about the future. He couldn’t really do anything as such, but he was there for me at the right moment and he seemed to understand. He knew I needed a friendly ear. I never saw him again, so I didn’t get chance to thank him. So whoever you are, thank you! That cup of tea made all the difference.

image5Dr Alison Wren is a Clinical Psychologist for the Clinical Health Psychology Team at NHS Dumfries and Galloway

The Buzzzzing Fridge was Back! by Elaine Ferguson

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Bzzzzzzzzzzzzzzzzz

 

How does being asked to do a blog remind me of a buzzing fridge? Well simply, a buzzing fridge was the image, along with the above facial expression, that came to my mind when Dr Ross Warwick, Lead for the Clinical Health Psychology Service, asked me to write a blog as part of our service promotion. His request provoked feelings of anxiety accompanied by forgotten memories of a much wanted, all singing, all dancing fridge purchased years earlier to make my life complete. Instead, it had left me feeling bewildered and anxious with all my attention and behaviours being taken up trying to fix the BUZZ that emanated from inside the fridge. Automatic thoughts predicting my imminent failure resurfaced: the BUZZ was back!

My initial catastrophic thoughts, images, feelings and behaviours reminded me of how uncomfortable it is when we are asked to do something that feels overwhelming or out of our comfort zone. Avoidance is often how I try to resolve these feelings of distress and discomfort but I can’t think of a time when that solution has actually helped! So with Ross’s words of encouragement ringing in my ears (“It’s good for your development”) and a reminder to myself that “avoidance doesn’t help” I decided to feel the fear and do it anyway. (Practise what you preach Elaine!).

For the past three years I have worked as a Psychological Therapist in the Clinical Health Psychology Team. Prior to this I worked as a Mental Health Nurse in busy wards and community settings. During my career I have not always been given the opportunity or support to look after my own psychological and emotional needs in the workplace. On reflection this impacted on the enjoyment and satisfaction I gained from my job. This affected my ability to live true to the values that had brought me into the field of mental health, i.e. helping and supporting the psychological wellbeing of my patients. From this experience grew a passion to look after not just my patients but also the emotional wellbeing of my fellow workers.

Part of the Clinical Health Psychology Team’s values and philosophy is the inclusion of colleagues in the work we do to develop and facilitate lasting psychological change in patients with long term health conditions. Crucially this includes helping staff think about their own emotional wellbeing and how we can do this in busy, chaotic and at times distressing working environments. In a nutshell if we look after ourselves, our patients get a better service.

This takes me back to my buzzing fridge. It too was meant to add something to my life but like some of my earlier working experience it became a source of annoyance, frustration and sadness with all my attention focused on the aspects I disliked about it. My attention drifted to the high pitch buzz and it started to taint my entire view of it. The pleasure and excitement began to be replaced by frustration that no matter what I did, I couldn’t stop the buzzing. Shaking it, turning it on and off, opening and closing the door, and finally shouting at it made no difference. Thoughts rushed in “I can’t even pick the right fridge!”, “The shop has sold me a broken fridge, I’ve been conned!”

 

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It was at this point my friend popped in for a cuppa (too early for a cocktail). She admired the new fridge. How dare she!  I pointed out the buzzing and she said “Sounds fine to me; how are you?”  We got talking about family, friends, work, hobbies, and nights out and generally putting the world to rights. When she left I suddenly remembered the buzz from the fridge. I tuned in and yes it was still there. Curiously it didn’t seem so loud and it didn’t seem to annoy me as much as it had done earlier. What had changed? I realised that I had stopped focusing in on the buzzing because talking and sharing with my friend was of much more value and importance than listening to my new fridge. I had put my energy into doing what mattered. The more I had talked about what was important to me and my friend, the less I had noticed the buzzing.  I had enjoyed sitting in my kitchen with the fridge that buzzed. The buzz eventually became a low level necessity which assured me all was in working order with my new, shiny fridge.

Elaine 1My buzzing fridge has once again melted into the background. Why? Well simply because I have chosen to get on and write this blog and whilst doing so I have remembered why I enjoy coming to work every day. I get the opportunity to work with people like you who are passionate about their jobs but like me have buzzing fridges of their own which can leave them feeling distressed, disillusioned and unable to do more of what matters to them in their working days and home life. My job allows me to remind you that you are important.

If you and your team would like to know more about the training and consultation we offer, that may improve your own personal psychological wellbeing which in turn assists us to care for our patients and each other, please get in touch.

To quote my boss “you don’t need to be a psychologist to provide psychological care”. My friend wasn’t. So maybe I would add another question to Robert Barton’s list from his blog, the one that my friend asked me … How are you?

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Elaine Ferguson is a Psychological therapist for the Clinical health Psychology Service at NHS Dumfries and Galloway

 

 

 

 

 

Questions Are the Answer by Robert Barton

Rob 1Patients often feel overwhelmed and intimidated when they attend hospitals and clinics. These are busy places, time can be tight and, as professionals, we can unwittingly send out signals that might prevent patients from engaging. Unsurprising then that on many occasions patients say little and ask few questions. An unpublished American study showed that from the time they arrive until they leave, men ask an average 1.4 questions, including asking about parking!

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This post is about questions, using them to encourage patient’s to actively engage in their healthcare and things we could ask to help shine a light on the complex mix of physical and psychological issues accompany illness.

 

This topic is particularly close to home for me.  My elderly mother has recently attended outpatient clinics in Edinburgh where she felt unable to ask questions during her appointments and was left no clearer about her condition. What’s more, because some questions were overlooked the professionals involved had a very sketchy picture of what was happening to her and this affected the success of treatment.

 

In Clinical Psychology we tend to start asking questions at the beginning of a consultation so the patient can understand why they are there and what to expect from the appointment.  This includes setting the agenda, a practice that could have value in other clinical settings as it ensures we have common goals for the available time and promotes collaboration (and involved patients tend to have better outcomes, Redding, 2017)

 

To set the set the agenda and make constructive use of time we might ask questions such as:

  • What would you like to get from this appointment?
  • Why have you come along today?
  • What would be helpful to you today?
  • This is why I think you are here and this is what we need to do, are there any questions before we begin?

I couldn’t attend appointments with my mother so we set her agenda by writing an outline statement of her problem giving clear information about her condition. This approach proved to be a great help to the outpatient clinic, helping them to understand her problem more clearly and how it manifested day to day, helping her achieve better outcomes.

 

Patients in clinics may have many questions about their treatment that are primarily used to gather information: what is this test for? When will I get the results? How do you spell the name of that drug? Can I park in the ambulance bays?  We may ask similar closed questions in the course of a consultation like “is this the worst it’s been in the past month?”  Using closed questions are useful when we want factual information and can create opportunities to ask open questions or invite a broader reply like “can you tell me a bit more about that?”

 

My mother was attending outpatient appointments to address poor mobility caused by an arthritic condition. During the appointments she was examined, her medication checked and the appointment would end with something they hoped was helpful. Questions about how she was feeling, what she thought and how her behaviour had changed were overlooked. If they had been asked they would have realised she felt a bit low and useless, had thoughts like “nothing is working so what’s the point” and her behaviour had changed; she went out less and stopped enjoying life. This all affected her condition which continued to deteriorate.

 

When patients are suffering from a health problem they can experience a whole range of unhelpful emotions that could affect their treatment. These emotions can be grouped under three headings.

  • Loss: sadness, down, and depressed.Rob 3
  • Fear: anxiety, panic and terror.
  • Anger: rage, frustration or irritation.

Emotions can lead to unhelpful thoughts about health that can often be untrue. Feelings and thoughts can lead to behaviour changes the patient makes often with the intent of helping matters but in reality can have the opposite effect.  So making small changes in our routine practice can help us become more familiar with our patient’s condition by understanding how it makes them think, feel, and act.

 

Involved patients have better outcomes. But if they are less likely to ask questions because of the environment, what open and psychologically-aware questions might we ask to help us have a better understanding of their problems?

Thoughts:
What does that make you think?
What runs through your mind when that happens?
When you feel like that what does it make you think?
What images come to mind when that happens?

Feelings:
How does that make you feel?
How do you feel when that happens?
When you think that how do you feel?

Behaviour:
What did you do when you thought that?
What did you do when that happened?
Is there anything you do that you find helpful / unhelpful?

Physical sensations:
When you feel that way do you notice any physical sensations?
Do you notice any physical changes when that happens?
Have you noticed any physical changes when you get those thoughts?

In psychological therapy it is important to invite people to make changes to their usual practice. So, with that in mind, which of the above questions will you commit to try at your next clinic?

References
Don Redding (2017) Patient engagement: A ‘win-win’ for people and services NHS England Publication.

Robert Barton is a Psychological Therapist with the Clinical Health Psychology service