Latest news with #juniordoctor
The Guardian
a day ago
- Health
- The Guardian
As a long-term psychiatric patient, I've had superior care from the NHS
I read with interest the letters about psychiatric care in the NHS (11 July), prompted by Rachel Clarke's review of Bella Jackson's book Fragile Minds (A furious assault on NHS psychiatry, 30 June). I have not read the book but, as a long-term psychiatric patient, I would like to make two points. First, care naturally varies in quality, suitability and success. Following three years in unsatisfactory private care (after many previous years in NHS care), I have happily returned to the NHS. I find its care superior, but hamstrung by limited resources, which can mean waiting many months for an appointment. But I have never been treated badly, as Jackson suggests is common, even when in the worst state. Second, I was struck by what Jackson says a junior doctor said to her (as quoted by Clarke): ''Let's quetiapine them today!' And I asked him why quetiapine, and he said, 'They put you in the best hotels for conferences.'' As Clarke says, this is ludicrous, and certainly the only time I have heard 'quetiapine' used as a verb, which strikes me as improbable. Quetiapine has been a generic drug since 2012 (ie open to any company to manufacture and market, just as, say, paracetamol is). I cannot believe that a junior doctor would prescribe it in the hope of being put up in a 'best hotel' for a conference. It has long been the first-line treatment for psychosis, and for good reason: it works. I have been on quetiapine for 15 years. It's not an enviable position to be in, but I am glad it exists, and grateful to those who have – quite rightly – prescribed it to and address supplied I was disappointed to read that Cathy Wield was 'subjected to increasingly damaging interventions, including electroconvulsive therapy' (Letters, 11 July). I was treated with ECT for severe depression (with my full consent) in 2006 and it saved my life. In subsequent years when I had relapses, it again was highly effective as a treatment and I recovered fully, and have been well for the last five years. I would hope that patients won't dismiss ECT as a potential treatment for depression based on its negative portrayal in the press, but be guided by NHS professionals who prescribe what they believe is best for the individual and address supplied
The Guardian
15-07-2025
- Health
- The Guardian
New research shows a blindingly simple new procedure can help save children's lives in emergency departments
An eight-year-old child attends her last day of school before Easter holidays, plays with her siblings, has dinner and gets ice-cream. The next day she develops a headache and vomiting. Then, as her hands grow cold, her parents take her to the local children's hospital. Minutes after the child is triaged as lower priority, her mother tells the emergency department clerk that she is concerned about white patches in her daughter's eyes. A junior doctor decides this can wait. One minute later, the child's mother is back at the desk. This time, a nurse documents a high temperature and heart rate but doesn't act. An hour later, the child can barely speak. A nurse acts. Two hours later, the child is dead. The diagnosis: fatal sepsis due to Streptococcus A, the same bacteria that causes strep throat and tonsillitis. The subsequent coroner's inquest in 2023 uncovers excruciatingly painful details and missed opportunities. On the night of the incident, one nurse was responsible for nine patients (a reasonable ratio is one to four) but sometimes two nurses were responsible for up to 60 patients. Combined with a shortage of other resources, disaster was waiting to happen. For their part, the parents described repeated failed attempts to escalate their concerns, their anxiety for their child mixed with worry about 'being kicked out of the hospital for being rude'. They described staff avoiding eye contact and seemingly not taking the spectre of a rapidly deteriorating child seriously enough. The whole ordeal was unbearable, so it was only a matter of time before several Indian professionals asked me what I intended to do, implying that also being Indian, I had an obligation to raise the uncomfortable issue of racism in healthcare. But given the string of omissions that resulted in the tragedy, I found it glib to attribute the entire occurrence to racism or unconscious bias – and indeed, no such allegations or findings were made during the inquest. I reflected on the question of what I should do as a parent who has experienced both loss and medical emergencies. When your child's life hangs in the balance, or worse, that child dies, in that moment, there are no healing words, only noise. It was impermissible for anyone to say, 'I know how you feel'. I also reflected on the question as a doctor who has made her share of errors. No matter how many inquests absolve the individual and implicate the system, the avoidable death of a patient is an intensely personal failing. It is a memory that clings to you, wakes you up in the middle of the night and humbles all but the most insight-less person. I didn't write about the incident at the time, but the thought that gnawed at me was, 'if only someone had listened to the parents'. Recently a group of Australian researchers has designed a pragmatic study to examine the relationship between parental concern for clinical deterioration and critical illness. Over a period of two years, across nearly 74,000 children younger than 19 presenting to a paediatric emergency department or inpatient unit, parents were asked one simple question: 'Are you worried your child is getting worse?' Of the nearly 190,000 responses, just under 5% indicated concern for clinical deterioration. The first notable finding, therefore, was that contrary to assumptions, parents of sick children don't cry wolf, they act judiciously and respectfully. The second sobering finding was that compared with patients whose parents did not have a documented concern, patients whose parents reported a concern were more likely to be admitted to intensive care, receive mechanical ventilation, and die during admission. As if this were not lesson enough, parental concern was found to be more strongly associated with ICU admission than any abnormal vital sign including abnormal heart rate or breathing, cardinal signs of deterioration relied upon by clinicians. In 19% of cases, parents reported a problem several hours before any vital sign abnormality. I had to read this multiple times to absorb the significance. It's all very well to have bright rooms and fancy equipment but what is the most child-friendly thing of all? It's to ask the parents if they are worried. If the findings can be replicated, this 'intervention' will turn out to be blindingly simple and yet, potentially life-saving. This is the stuff of good medicine – cheap, effective, widely applicable. Coming from the world of adult medicine and geriatric oncology, what applies to sick children applies just as much to sick adults. Caregiver concern should be labelled a vital sign. But while we all know the importance of eliciting such concern, the truth is that it is commonly neglected. Now, there is evidence to insist on change – not just to record concern proactively but to build robust systems that respond quickly. As I wrote this column, I kept thinking of the bereft parents who don't need a study to validate their bitter lived experience. No one can remedy their loss but the least healthcare professionals can do is pledge to patients and their carers to never again to put our assumptions before their instincts. Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
