Compassion with Knowledge by Nick Walker and Ben Rayen

“When patients go to a doctor, they do so because they feel that the doctor is the person with the best chance to help them. They may be alternating between hope that the doctor will be able to cure them, and fear that nothing can be done. When the doctor demonstrates that they really care about the patient, it can immediately help put their mind at ease” Medicine and Compassion. Chokyi Nyima Rinpoche and David R Shlim.

Nick and Ben share some thoughts on their experiences as doctors,

Nick

How long have you been a doctor?

I grew up in New Zealand and qualified there before travelling a bit.  My plan was to return to complete specialisation in psychiatry, but I ended up staying in Scotland when I met my partner, and trained in psychiatry in Glasgow, Ayrshire and Aberdeen.  Next week will be the fortieth anniversary of my last day at school; I qualified in medicine just over 34 years ago. I’ve worked in psychiatry almost 32 years and as a consultant since the start of this millennium.  

Ben

How long have you been a doctor?  

I graduated from India and have been practicing medicine since 1995. I have always had Paediatrics as my core interest and started to develop my interest in Paediatrics since very early during my medical training.

Before coming to the UK, I completed 3 years of postgraduate Paediatric training from one of Asia’s biggest children’s hospitals, The Institute of Child Health, and received my MD graduation there in 2001.

I came over to UK to pursue further training the same year, went on to work at the Alder Hey, Birmingham Heartlands, Yorkhill, St Mary’s Manchester hospitals etc to name a few and then settled down in Dumfries for good. 

Nick

What is your ideal doctor?  

Long ago I learnt that perfection is unattainable; more recently I realised it’s undesirable too. Being imperfect is part of being human. Accepting these counters, the constant stress of striving to be perfect and worrying about not making it. Owning some imperfection, some room for error, is part of what makes a doctor come across as human. It makes it easier for others, for patients and their loved ones, for colleagues because they identify with that touch of fallibility. Being honest about this, reflecting on mistakes – and on good clinical decisions whose outcomes are not quite as hoped or expected – with patients, families, staff, peers really humanises the medic which in turn makes it easier to achieve the balanced, collaborative relationships at work which help make an ideal human being, and an ideal doctor. 

Ben

What is your ideal doctor? 

For me, in whatever profession we decide to pursue, we need to love it and be passionate about the job we do. 

As a doctor, I feel we are in a good position (responsible position) to make others’ lives better. I always look forward to the joy of seeing someone getting better, especially children.  

Children are different, they are very withdrawn and low when unwell and also, they find it hard to meeting a stranger like us in the hospital. However, once treated they bounce back superfast. They are back to their normal self, all over the place, chatty, smiling – these are a joy to watch, I love seeing them this way. 

This provides a doctor an immense pride, self-belief, positiveness and addiction to do such acts more. 

As a doctor, I feel with the evolution of medical management every few months, we need to constantly learn, change and develop ourselves to suit the needs of the patients of the current times. We need to have a very flexible approach rather than just stick with our own thoughts, being adaptable rather than how we were taught earlier in our training. Some of these teachings might not fit the current practices or fit for purpose for the current generation, but we can listen, change and adapt!  

Nick

What is compassion? 

To me, compassion is intentionally listening (really listening) – curiously, to understand – and then accepting without judgment, even if you disagree; and being thoughtful and wise in how to respond. And it to yourself as well as to others. 

Ben

What is compassion?  

For me compassion is all about how can I help here? How can I make it better for the patient, colleagues, or anyone else, trying to find ways to listen to them and solve their issues. How we deliver care is through relationships based on empathy, respect and dignity, it can described as intelligent kindness, and is central to how people perceive their care. 

Nick

Why does compassion matter?

Compassion matters for many reasons. In medicine, it is part of what makes an ideal yet imperfect doctor.  It matters for patients because even in very challenging cases, they feel understood, their experiences validated. Then working together, even when treatment options might be few and of limited effect, becomes a joint process for decision-making and a shared, supportive clinical experience.  For teams and colleagues, compassion matters for similar reasons. Positive contributions aren’t invisible; they are noted, commented on, welcomed, encouraged.  Questions – no matter how “silly” – and less wise decisions can be talked through and learnt from calmly and without trepidation, not avoided but turned into opportunities to learn and improve. Being compassionate models a compassionate approach; consulting someone who takes a compassionate approach feels comfortable and fosters further compassion. In its small way, this virtuous circle helps counter the shoutiness of life – and social media, and politics – in this modern age.  

Ben

Why does compassion matter? 

In my dual role as a doctor and as an AMD/CD compassion is something that has to be part of everything I do and with any of my decision making. I will respond more here on the leadership role as I have provided more info earlier as the role of an ideal doctor. 

For me, the leadership role I do will always be a collective and a compassionate leadership. It is all about the people I work with, I will make sure everyone has a say and they take responsibilities. I have always tried to be there, respond to queries in a prompt way instead of leaving it to develop into a bigger issue. I try to create a positive and supportive environment and make colleagues flourish and grow. Increasing demand and complexities causes challenges, and this is a well-known factor for stress. 

I like to be part of and contribute to solution making. Even when my best solution is to listen.

Young Nick

Ben

“When we are motivated by compassion and wisdom, the results of our actions benefit everyone, not just our individual selves or some immediate convenience.” Dalai Lama

Nick Walker

Associate Medical Director Mental Health

NHS Dumfries and Galloway

Ben Rayen

Associate Medical Director W&C’s Directorate and Clinical Director Paediatrics & Child Health

NHS Dumfries and Galloway

Becoming a Flying Start Facilitator by Laura Houston

I started the NMAHP Flying Start programme at my previous job within NHS Ayrshire and Arran, where newly qualified practitioners (NQP) within the Allied Health Professions (AHPs) are encouraged to complete the programme to aid the transition from student/graduate to working as a fully qualified healthcare professional. I then started my new job at DGRI, NHS Dumfries and Galloway, where I completed my final unit and then became a Flying Start Facilitator, mentoring a NQP through the programme.

Completing the programme was very useful with regards to continuing professional development. It allowed me time to reflect on my clinical practice which I otherwise would not have been able to do; this in turn allowed me to feel less overwhelmed as well as allowing me to provide the best possible person-centred care to service users. Flying Start has allowed me to encourage the facilitation of learning in the workplace with regards to colleagues and students as well as the NQP I had mentored through the programme; and it has allowed me to be more mindful of supporting those requiring assistance in the workplace. With regards to leadership, I was able to put my knowledge into practice when I have been supporting students on placement within the x-ray department, as well as new staff members. I have also participated in calls with a group of NQPs to share my Flying Start experience with them and provide feedback on their ideas. Finally, Flying Start has inspired me to constantly think of new ideas to aid improvements in the workplace through the use of new audits and being more confident in sharing my ideas with others, thus creating evidence to improve practice and services.

Mentoring a NQP through Flying Start was very manageable for me: they would email me any queries they had then they would send me their documents to read and feedback to them when each unit was ready to be signed off. After signing my first NQP off for completing the Flying Start Programme, I am really looking forward to mentoring someone else who is keen to complete the programme. Flying Start within the x-ray department isn’t generally promoted, so I am aiming to make more people aware of the valuable skills gained and opportunities that can arise as a result of completing the programme.

Laura Houston, Diagnostic Radiographer, Imaging (x-ray dept), DGRI, NHS Dumfries & Galloway.

Email: Laura.houston3@nhs.scot

The Power of Movement by Emma Miskimmins

It is no secret that COVID-19 has impacted everyone one way or another and that our NHS services have been (and continue to be) pushed to the absolute limits.

Although it is clear that COVID-19 is not yet a thing of the past, we are beginning to move forwards and learn to live alongside this virus.

In order to move forwards successfully, and to improve the current circumstances for health and social care and most importantly, its service users – we must tackle the major issue that is deconditioning.

An article by Pubmed (2005) describes it as “a complex process of physiological change following a period of inactivity, bed rest or sedentary lifestyle. It results in functional losses in such areas as mental status, degree of continence and ability to accomplish activities of daily living. It is frequently associated with hospitalisation”.

The lockdowns that have occurred as a result of COVID-19, plus the anxiety of potentially catching the virus, has resulted in a large number of the population staying at home, becoming less active and as a result, becoming deconditioned.

Ironically this has led to a multitude of other issues, including increased admissions (particularly with the older population) putting more pressure on the health and social care system than ever before.

But why?

Inactivity reduces our muscle strength and exercise tolerance, however, it does so much more than this, especially the older we get.

Decreased levels of activity and movement can result in:

• Inability to carry out ordinary daily tasks, increasing our dependence
• Issues with incontinence and skin problems e.g. pressure sores
• Significant increase for risk of infection
• Significant increase in chances of developing a multitude of co-morbidities such as heart disease, depression, cancer, dementia etc.
• Significant increase in risk of falls, in turn increasing the risk of e.g. fractures

And that is only a few examples, each one making the chances of developing the others higher and higher. All of the above also greatly increases the chances of a prolonged hospital admission. A hospital admission reduces the need and motivation to be active and to move, therefore the risk of further deterioration and further deconditioning increases, resulting in a vicious circle for both service user and health and social care services which is extremely difficult to break.

So what can we do?

This obviously is very individual and depends on a persons’ abilities and circumstances, below are just some examples.

Within the community –

• Any movement is better than no movement, try using an interest or hobby as a motivating factor – e.g. gardening, swimming, walking, cooking/baking etc.
• Making small changes – try making a point to get up every hour for a small walk and stretch – this is particularly important if spending the majority of the day sitting or if you have decreased functional abilities.
• Encouraging loved ones, friends and family to participate in movement.
• Reducing risk of falls – wearing proper supportive footwear, uplifting rugs, cables and clutter that may get in your way during movement.
• Seeking out community activities – a great way to keep up with or learn a new hobby and also met new people.
• Accessing support at the right time – if your activity levels have decreased for any reason and you are now finding it difficult to get around, it is important to let your health provider know. They can help figure out why this has happened (examples could include; low mood/anxiety, social isolation, increased levels of a sedentary lifestyle due to COVID, illness/injury) and get you the right support at the right time. Research shows early intervention and prevention is critical in maintaining independence and reducing risk of illness, injury and hospital admissions.

During a hospital admission –

• Ensuring if you are able to, keep as active as possible. If you are unsure about getting up/moving by yourself – please ask staff who will advise you on this and also exercises you could be completing to help you stay active and strong. All staff should be supportive of keeping active during your hospital stay.
• Wearing your day clothes – hospital does not mean you need to wear your pyjamas all of the time. Comfortable clothes such as leggings/joggers etc are advised however, pyjamas should be kept for night time only. Get Up! Get Dressed! Get Moving!
• Sitting up out of bed (especially when eating and drinking!)– whilst it is recognised you may be more fatigued whilst in hospital due to recovering from illness or injury and you may need a rest in bed at some point during the day, it is important that you sit up out of bed as much as possible during the day otherwise. This will help you maintain strength and reduce your risk of developing things like DVT’s and chest infections.

• Sticking to routine – this is important to help us feel more “normal” and therefore likely to be more motivating to get up and get moving. It is particularly important to maintain a good sleep routine.
• Bringing things to keep you busy such a books, wordsearches, puzzles etc. This will help prevent falling into bad habits such as sleeping for prolonged periods of time during the day.
• Bringing in appropriate and supportive footwear that you can walk well in.
• If you have been referred to Occupational Therapy and/or Physiotherapy, ensuring you engage with your sessions as much as possible will help to support your activity levels and also increase/maintain your independence.

By completing all of the above, you have a much greater chance of reducing the length of your hospital stay and recovering quicker!

(Office for Health Improvement and Disparities 2022)

For more information on how to stay active at home and within hospital, please visit the NHS website: https://www.nhs.uk/better-health/get-active/

Alternatively, for further support and information, contact your GP or if already referred to an allied health professional (OT, Physio, community nursing, podiatrist, dietician, speech and language therapist etc) they will be able to support with this also.

Get Up, Get Dressed, Get Moving!

Is the message we’re trying to Share

But why should I get moving?

I’m in hospital!

Don’t you care?!

I feel poorly, I feel weak, I just wish to lie in bed

I need sleep to feel better,

Now let me rest my head!

I don’t like the hospital, I want to go home

I’ve already done my therapy,

Now please, leave me alone

The OTs, the physios, the nurses,

They do their very best,

To get you up and moving

And independent again

But this isn’t enough you say, surely not,

Tell me why…

Not moving for long periods is bad for me you imply?

Not moving for long periods can reduce your independence,

It makes you weak, it makes you tired, it will increase your dependence!

You’ll end up with us longer,

Your therapy will be harder,

It increases your chance of your health deteriorating faster

So please,

Don’t think you’re bothering, or causing too much hassle

Get Up! Get Dressed! Get Moving!

You’ll certainly recover faster

Emma Miskimmins is an Occupational Therapist at the Galloway Community Hospital

A GP’s response to Scotland’s health and care data strategy by Rob Walter

This blog was first published on FutureScot on 11th August and can be seen at https://futurescot.com/getting-the-best-out-of-patient-data-is-key-to-unlocking-future-health-benefits-in-scotland/

It is important that clinicians’ voices are heard in the consultation around Scotland’s new health and care data strategy, which closed recently (12th August).

Busy GPs like myself are the trusted gatekeepers at the coalface of healthcare.

We have first-hand knowledge of just how important it is that the right information is available to the right clinician at the right time, wherever the patient interacts with health and social care services.

What then can the new data strategy do for me that might improve patient centred care? 

A legacy of trust

An early step in healthcare data access was the successful introduction of the national Emergency Care Summary by NHS Scotland in 2006. This allowed patients to consent to access to their health data at the point of care delivery, rather than consenting in advance for data upload.

It was widely accepted and trusted by the profession and patients alike, with high uptake compared to other nations’ summary care records and provided out of hours and emergency care access to prescribing and allergy records.

We need to build on that and the trust the public have given us with their information.

We’ve come a long way since 2006. Electronic patient records have become richer and technology has developed to allow multiple users involved in a patient’s care to share it and input data.  Patients themselves can also choose to share data captured by personal devices such as smartwatches.

This huge growth in information brings many more opportunities to improve both individual and population health. But we also risk losing important details amongst a tsunami of information

Risk of information overload

It is essential the systems we use are both intuitive and help guide the user with structured data capture.

We need to be able to handle the volume and present it in a concise and meaningful way, surfacing the current abnormal above the background noise and giving clinicians evidence-based resources and treatment pathways.

The end goal must be that data can be amalgamated and analysed in its entirety so that clinical decision support works across the whole patient record and not just in ‘my view’ of it.

Technically, there are many ways to achieve this but for me the key components are:

• interoperability (systems talking to other, using standard FHIR (Fast Health Interoperability Resources) messaging);
• retaining a diversity of systems to meet the different requirements of different areas of medicine and social care;
• Maintaining confidentiality and integrity through strong role-based access that ensures universal understanding of what is and isn’t allowed to be viewed by specific users in role, whilst ensuring clinical safety in the background.  This is imperative if we are to retain patients’ trust.

The importance of clinical coding

To mobilise this data requires standardised coding. Historically, primary care has relied on the READ V2 coding system which has served its purpose and has now been retired. The future is SNOMED CT – an international coding language that has a UK specific version.

It is a much richer code set that is well structured and uses ‘semantic tags’ to help categorise types of codes. For the end user, choosing coded information is simply a case of searching for terms, or with good clinical systems, automatic presentation of the best terms to use in a structured manner.

Once we achieve all of this, we will be delivering a high-quality data set which we can then interrogate and learn from.

High-quality data will drive better care

A rich, comprehensive, and accurate data repository that can be analysed in near real time offers so much for the health service in Scotland.   

For example, machine learning algorithms can identify patient cohorts who would most benefit from intervention – allowing us to target our limited health resources to those most in clinical need. 

High-quality data can also drive valuable research into new treatments and medicines, and this is recognised as a key part of the vision for Scotland’s new data strategy.

The consultation paper rightly highlights that we must tread very carefully – using health and social care data ‘for the public good’ and adopting a transparent approach to reassure the public that their data is being used appropriately.

Dr Walter is a GP at the Gillbrae Medical Practice in Dumfries, and clinical intelligence director at EMIS, which provides clinical systems to more than half of GP practices in Scotland.