geriatric

The new fifth vital sign

Wayfaring to lil ol lady: Did you enjoy your visit with your family?

LOL: All my family wants to do is f***, f***, f***!  (Each F* punctuated with pelvic thrusting, of course)

Wayfaring: Oh….kay. Um…

LOL: They’ll f*** you too. They’ll f*** you and you’ll like it!

Wayfaring to nurse: Uh, it looks like Ms. T has another UTI.

Is Your Character Treating Enough Old People?

Okay, I get it. Young people getting sick is sexy. They’ve got so much to live for! Hopes! Dreams! Aspirations! They never got to say I Love You, they’ve never voted for their favorite leaders! Their first beer, even!

It’s so much better to write about 17-year-old Birch, amirite? Who wants to hear about her 79104-year-old great-great-aunt Mabel’s stay in the ICU for sepis? The only aspiration Mabel has is aspiration pneumonia!

(yeah, i went there.)

Okay, before you yell at me: I care about Mabel. I care about every patient who comes across my ambulance, okay? From the 500-gram (1 lb) NICU baby to the 110 year-old granny.

The truth is that in the USA, and increasingly abroad, the average patient will look more like this

than like this

despite what House tells us. (Also, hospital lighting is never that pretty. Ever.)

A full half…

Keep reading

anonymous asked:

I'm trying to under what a MDT really is- could you explain the different occupations within a multidisciplinary team and why MDT is so important (like what the purpose of it is) (this is for interview prep as well)

Right, so the MDT is a bit of a buzzword in that med schools love bringing it up. But like all buzzwords, the meaning can become a little obscured.

Broadly speaking, an MDT is any ‘multidisciplinary team’, which is a team made up of doctors from various specialities plus specialist nurses, and may also include occupational health, physiotherapy or other colleagues.

The reason we need MDTs is because people can have very complex care needs that span across specialities. This is because it’s been recognised that when patients have needs that involve different specialities, they are vulnerable to falling between the cracks, or not having their full needs met. In a system as busy and as complicated as the NHS, and given that each specialist deals with thousands and thousands of patients a year, the MDT was formed as a way of ensuring that when an important decision needs to be made about a patient’s care and support, all the relevant professionals are in the room and on the same page.

Very commonly, it’s used to refer to a cancer MDT. When someone is suspected to have cancer, their GP refers them to a specialist for appropriate investigations under a 2 week wait rule. Their xrays/cts etc and any biopsies are then discussed in an MDT meeting. This meeting involves:

  • specialists from the speciality at hand (for example, respiratory doctors) who depending on the speciality, may also be the ones operating to remove the cancer. If not, then the relevant surgical team will also be there.
  • pathologists, who review the slides and help explain what the biopsies mean
  • radiologists, who explain the findings in the image, and can help stage the cancer, which
  • oncology doctors, who will advise on the appropriate non-surgical treatment such as chemo or radiotherapy.
  • Representatives from the palliative care team and Macmillan nurses will also be there.
  • There is usually also a team coordinator to ensure the entire process runs smoothly and all the relevant teams are kept in the loop.

During the cancer MDT they will review the evidence and come to a decision about how advanced that cancer is, and therefore what the best treatments would be. Rather than one individual doctor deciding, or each speciality just doing their bit, they come together to make sure they are all aware of where that patient is heading. It will then fall upon that patients’ specialist to have a consultation with the patient and explain what the results are, which teams will be involved, and what the plan is. During this conversation, there is almost always a Macmillan Nurse present, who then supports the patient through their journey.

An MDT meeting does NOT have to be cancer related; an MDT is any team involving more than one discipline. For example, in geriatrics, we had MDT meetings regarding patients with complex needs or under multiple specialities; OT, SALT and PT would usually be there, as well as the Ward Sister, geriatrician, social worker etc. It’s usually a meeting that’s planned in advance (because everyone is super busy!) but it doesn’t have to be. The aim of most geriatric MDTs is either deciding the ceiling of care (how much can be done for them by all the team members/specialities) or how we can discharge that patient with all relevant care and precautions in place to stop them coming to harm in future. It’s really important in geriatrics,because the older you get, the more likely you are to have problems that span different specialities and the more help you might need from different teams to get you well and supported enough.

On paediatrics, I ended up ‘calling’ an impromptu MDT because a patient with special dietary needs was meant to be going home with their new foster carer, but their bloods deteriorated just before discharge. The dietician, pharmacist, ward sister, social worker, foster carers and I all just happened to be around at the same time. As their medical status had changed, we got together and made a plan to keep that patient safe and ensure we were all on the same page, whilst I kept the consultant involved updated (and sought their advice, of course) on what was happening via phone. The end result was an agreement on what needed to be done, and how best to look after them without causing unneccessary delays which would have happened if we hadn’t all been around to plan together. Although this wasn’t a formal meeting (though it meant that I stayed late documenting it meticulously) it achieved everything that an MDT is meant to achieve; multi-disciplinary care which leaves no needs unaddressed.

I hope that helps to answer your question.