The suicidal patient who taught me the value of time

The ambulance pulled in but unusually the crew came into the hospital alone. They informed us that a high risk mental health patient was on their way to the department, and was being accompanied by the police. This set alarm bells in my head.

I qualified as a staff nurse a few years previously. We received no mental health training, but we do look after people in real crisis. In my experience patients with severe mental health problems do not usually want to be in A&E.

I have been spat at, verbally abused and threatened. Though this was normally due to drugs, alcohol and fear, it wears you down. The environment is busy, loud and fast and even with my lack of mental health training, I know this is not conducive to calm.

When I started working in A&E I was in my early 20s and had a very naïve view of the world. A&E taught me that some people have very hard lives, they’ve experienced things no one ever should and it’s taught me everyone has a story, even if they hide it.

The police arrived and when they stepped aside I saw this child-like figure; she had closed body language, her hair was strewn across her face, and mascara ran down her cheeks. She was terrified. She sat down and stared at the floor while the ambulance crew and police handed over.

Knowing what to say is hard. You want to take the pain away but mental torture isn’t cured by painkillers.

She was in her late teens. She was having hallucinations and suicidal thoughts. Her parents had phoned the police because they were scared of her behaviour. She was screaming and shouting. She had arrived without any family. I remember a wave of sadness washing over me as I listened. How had this young, beautiful girl got to this point? How had she got to point of thinking she would be better off dead?

The patient was still visibly agitated but was no longer shouting. The crew and police left, telling us to phone if we needed them. I sat next to her, but she remained closed.

Knowing what to say in this situation is hard. You want to take the pain away but mental torture isn’t cured by painkillers. She didn’t reply to anything I said until I realised that if I was in her situation, I would want to know I was safe. I put my arm on her shoulder and told her she was safe. She fell into my chest sobbing. She stayed there for what felt like hours, holding me so tight as her make-up ran down my uniform.

I was grateful the department wasn’t overflowing that day. My manager looked over to me and mouthed: “Stay with her.” The patient told me how her parents didn’t care, how she hated herself and just wanted to be normal. I just listened, not saying anything. I thought that her parents probably did care, but just didn’t know how to help. Many people’s fear is expressed as frustration.

As her sobbing stopped the exhaustion set in. She was assessed by our psychiatric team and only then did I see how much she needed help. She thought doctors were trying to kill her. Sorrow filled me, knowing her mind was causing her to have these terrible thoughts.

The patient was sectioned. I went home and cried because I couldn’t make her better. She was only a few years younger than me and I could understand what was happening to her. This was not the first or the last time I would cry about a patient.

Weeks later, I arrived at work to find a letter addressed to me. The letter thanked me and told me that if all nurses were like me, everyone would be sane. I welled up reading it. It was my first note from a patient and I treasure it to this day.

I have never forgotten this young woman or how she changed my perception of mental health patients. She taught me so much. Most importantly that spending enough time with someone at the right moment can achieve so much. This situation taught me to take my time whenever I can, and to fight for safe staffing. This story could have been so different if the department was busy.

Years later, when I saw the patient in the local media advocating for mental health patients, I was amazed. For the first time, I felt hope and joy when seeing her; hope for her and for the NHS, joy that she had recovered so well, and that maybe I touched her life in a similar way to how she touched mine.

If you would like to contribute to our Blood, sweat and tears series about memorable moments in a healthcare career, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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The suicidal patient who taught me the value of time

Children should be taught how to wash hands, says watchdog

Children and young people need to be taught how to wash their hands properly to reduce the risk of infection, a UK medicines watchdog has advised.

The National Institute for Health and Care Excellence (Nice) said good handwashing and drying techniques should be encouraged to help lower the likelihood of spreading germs and therefore limit the use of antibiotics.

The guidance also calls for teenagers attending university to be taught how to care for themselves if they contract a “self-limiting illness” such as cold or flu.

The charity Meningitis Now warned that first-time students, who were often vulnerable to contracting the potentially deadly illness, must be vigilant over their symptoms because meningitis could easily be mistaken for cold or flu.

Health authorities across the world are trying to reduce antibiotic use to slow the growth of antimicrobial resistance.

The Nice guidance says university students should be shown how to identify illnesses that will get better on their own. They should also be encouraged to use pharmacies, the 111 helpline and the NHS Choices website, it said.

The watchdog recommends that posters be displayed around campus explaining how to wash hands effectively.

Similarly, children at nurseries and schools should be taught good hygiene, particularly after going to the toilet, before eating and after being in close contact with people with colds or other infections, Nice said.

Liquid soap and tepid running water should be used to clean hands after touching a bin.

Other measures to reduce the risk of illness include ensuring food and leftovers are stored in the fridge, cooked at the right temperature and properly heated through.

Prof Dame Sally Davies, the government’s chief medical officer, said: “We need to address the growing problem of drug-resistant infections as the global medicine cabinet is becoming increasingly bare.

“Preventing infections is key and so is education on how to use antibiotics appropriately. This guidance provides important information on how we can keep these important medicines working.”

Rachel Robinson, acting chief executive at Meningitis Now, said good hand hygiene was needed to combat disease but warned of the dangers of self-diagnosis.

“Asking people to self-diagnose and take a view on the seriousness of their illness is a difficult area,” she said. “While meningitis is a relatively rare disease, its early symptoms, such as fever, headache or vomiting, can easily be … misdiagnosed, even by medical professionals.

“People with meningitis can get a lot worse very quickly and we know rapid diagnosis and treatment significantly improve outcomes. We wouldn’t want people to think they should try to manage this themselves.”

Children should be taught how to wash hands, says watchdog

My dad"s heart operation taught me a few things about being a doctor

“Look at this.”

My dad handed me an information leaflet open on a page titled Sex after major heart surgery.

“It says I can’t put weight on my arms!”

“Right.” I said, not even sure what the joke was, and refusing to engage in any discussion.

Dad was due for major heart surgery. He’d recently been rushed to hospital with breathlessness, and a couple of hours later I was at his bedside adjusting to the new perspective of family member. His heart was struggling and it was serious; he needed a complicated, life-threatening operation. The operation was just before Christmas; I would be in hospital every day over the festive period, alternating between working as a junior doctor and visiting my father. As a comedian, I also had a few gigs in London lined up one evening.

Beforehand, humour kept things light. He joshed avidly with my brother that he wouldn’t be “following the light”. But below the surface we were suffering. Christmas was cancelled, no big celebration, retail and decorations stripped down to minimum. As the date grew closer we all noticed subtle changes; every hug goodbye a bit tighter, every moment as a family more appreciated.

On the morning of the operation I drove in at 6am and sat with dad until he was called to theatre. I’d never been to the hospital he was in, and although as a doctor I knew what the signs meant and where things were, I felt a stranger in the place. I walked down the corridors and passed the discharge lounge and superstitiously thought that might be a good sign. I then turned a corner and passed the bereavement lounge and, amazed at how close they were, decided not to be superstitious. I sat and chatted until he was called to theatre, then we hugged goodbye and I walked down the corridor.

I left. I got into my car and cried. I was so tired, and the weeks of holding it together had built up. As I sat with his phone and glasses in my hands, my feet crunching against empty sandwich packets from last-minute meals before hospital shifts and comedy gigs, I saw all the unread well-wishing messages flash up, including mine.

When you work in a hospital you are so consumed by the job, so busy working out what the patient needs, that it’s almost impossible to take time to consider what the family has already been through. For families it all starts much earlier: the initial concern, the anxiety, the waiting, the unknown outcome.

In the days that followed, while working I was acutely aware of this when seeing families of patients. As family, you are a team for that one patient, every waking moment is about them, everything is time critical. When working as a doctor you have to care for many people, so you do the best you can for every patient you see and prioritise. Communication is paramount. I suddenly saw myself in the families’ shoes and empathised more than I’d been able to previously.

After dad’s operation, the surgeon and nurses were cautious – there were complications, but it had gone as well as expected and he wouldn’t be waking up today. My brother and I went to see dad in intensive care, we were asked to come back in 30 minutes. We returned and were told the same, returned a third time and told again at which point we panicked and asked what was happening. Was he in trouble? It turned out they meant “at least” 30 minutes and they were just getting routine things ready. A stark reminder of how communication is so important, how timely and accurate information is essential.

Working in hospital was a strange relief; a juxtaposition of doing a job but being constantly reminded of what was happening by familiar tests, results, and medications. I was reassured by all the brilliant staff I work with – doctors, nurses, healthcare assistants and more – all of them professional and caring, consoling me that dad was surrounded by similar people.

The evening after the operation complications arose that the intensive care team were struggling to sort out. I discussed with them some of the tests and instantly realised how serious the situation was; they didn’t know how it would go. We called almost every hour for updates – no change. The only reassurance was in talking to nurses and doctors who were calm and in control. They’d contact us if he deteriorated further – so we barely slept. By morning everything had changed and dramatically improved, with the previous 12 hours seeming like a nightmare.

That morning I walked in and saw him awake, I felt an overwhelming sense of relief. “Bloody hell dad, you scared the crap out of us.”

“But I told you I wouldn’t go towards the light,” he said wearily.

By Christmas day he had been moved to a ward, almost out of the woods. Yesterday he was discharged into my mum’s exhausted but delighted arms.

After dad heard how serious the situation was, he called and told me he’d asked a nurse overnight: “Did you know how serious it was for me?” The nurse smiled, put her arm round him and said: “Yes we all did. You, sir, were our Christmas miracle”.

Comedian and doctor Ed Patrick is performing his debut show Junior Optimist across the UK. For tickets and locations visit www.edpatrickcomedy.com

If you would like to contribute to our Blood, sweat and tears series which is about memorable moments in a healthcare career, please read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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My dad"s heart operation taught me a few things about being a doctor

Being an anaesthetist has taught me the power of patients" last words

Every so often, as an anaesthetist, you know the patient may not wake up and that you will be the last person they ever speak to. This operation may be their last chance at survival but it may also be the very instrument which ends their life. Something has ruptured. They may be bleeding. You don’t know if you can “turn off the tap”. The patient may be frail but you must at least give them the chance.

Getting them through the operation can be the easy part but the body has suffered enough and simply does not have the reserve to deal with the trauma. They remain sedated as the feeling of a breathing tube and the nature of being a patient in intensive care would be as unpleasant as the operation itself. You keep them alive but only under the immense power of an arsenal of drugs reserved for these circumstances. You keep them alive with the hope they may pull through, but occasionally only so their loved ones can be by their side at the moment of passing.

Barriers may unintentionally fall and their true feelings are revealed, possibly followed by a knowing laugh

A patient’s last words can be deeply profound, even prophetic of their own mortality. They can be completely ignorant of their condition through delirium or dementia. Vital organs only take minutes to become irreversibly damaged. They need oxygen, they need blood and the body’s systems are failing, often before your eyes. Sudden confusion, unconsciousness, abnormal breathing, all signs of impending shutdown. You have to take over, you have to replace that which has failed. A tube to deliver life-sustaining oxygen, fluids or blood to replenish what was lost, and anaesthesia to rest a frantic brain and spare the memory of any suffering.

Those who you can talk to you reassure. You tell them everything will be done to wake them and that there will be no pain, they will not suffer. They understand. Reassurance is easy, a few simple words spoken honestly and calmly. You gauge the mood and ask them about who is waiting for them when they awaken. How long have you been married? What kind of dog do you have? Find the right path to follow and they will lead you down a road of conversation which lasts until the point of unconsciousness. Barriers may unintentionally fall and their true feelings are revealed, possibly followed by a knowing laugh. They know their secrets are safe.

Revelations range from patients, previously brave-faced, who confess their terror at the prospect of never waking, to those who divulge a sense of abandonment of life. They have suffered enough and want this sleep to guide them gently to death. One patient admitted to having enjoyed a cheeky slug of whisky a friend had smuggled to him just before coming to theatre. People share a joke and a smile. The release of a smile is echoed in the slowing heart rate only associated with feeling calm and relaxed. The beeping machine that monitors their heart becomes a metronome of their emotion.

I remember one man who was brought to theatre for an emergency operation. He was dying but nobody knew when. The cancer had spread and was now blocking his gut. He knew the operation might kill him but wanted to take the chance that he may survive long enough to leave hospital to organise his affairs and be with his loved ones at the end. His mood struck us all. He was dying yet had a smile on his face and was quick to share a joke. No one said “see you afterwards” as we most often do, we just invited him to think of somewhere he would rather be. He smiled again – “anywhere but here” – and laughed. He never spoke again. He passed away under anaesthesia the following day with his family by his side.

Only in the hours or days following the event does the poignancy hit you. You start to reflect on not only the words themselves but the underlying emotions the patient was experiencing. There is a sadness, especially when speaking to a patient’s loved ones, but the opportunity to reflect provides a chance to learn and question your own practice. Your normal bedside manner was aimed at inducing calm before the anaesthesia itself. Did it work? Did you quell the fear in any way? Could anything have been said differently or not at all?

A person’s last words can be a defining moment. You speak to families and you tell them there was a smile, even a giggle. The fact that this was their last conscious, communicated thought will hold in the memory of anyone who cared for them. “Yep, that sounds like him!” Another smile. A seemingly impossible moment of happiness.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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Being an anaesthetist has taught me the power of patients" last words

My patients taught me how to heal after losing my mother

Graduating from medical school and becoming a doctor was an unforgettable experience. I remember transitioning from theory to practice, books to reality, hypothetical exam scenarios played by actors to real-life stories of patients. During my initial years as a junior doctor, I thought I knew it all and was mastering the skill of empathising with patients. Little was I aware that I myself, the doctor, would soon be dealing with the gripping sense of loss and grief that many of my patients were all too familiar with.

It was a summer evening and I was driving back home with an uncomfortable feeling in my stomach. My mum had travelled to Sri Lanka to help take care of her elder sister and had fallen ill with dengue fever. She was due to be discharged that weekend and Dad had decided to fly over to accompany her back home. Despite this, something made me feel nauseous that night. I put it down to irrational worry and long hours at work. I got home and soon fell asleep, a routine I was all too familiar with being a junior doctor.

The next thing I remember is being woken up at 2.30am by the ringing of my dad’s phone. I hurried into his room as an uncomfortable feeling came crashing down on me. I saw my dad in floods of tears and instantly realised that my life had changed forever. My mum had passed away and my world was falling apart. An overwhelming feeling of numbness took hold of me for weeks on end. I had expected relentless pain and to be shedding constant tears but this happened rarely. There were times when I was desperate to cry but failed miserably. I often asked myself how much I cared – did I not love my mum enough? Surely I should be crying all day and night? With time, the numbness transformed into the feeling of grief and reality soon dawned on me.

I changed jobs and started working on a cancer ward. A powerful memory from this job is that of a young boy peacefully asleep at the foot of his father’s bed. The young dad had an inoperable cancer and we had earlier informed the family of his poor prognosis. The strength and graciousness with which they took the news still bewilders me. I was moved when I asked the little boy what he aspired to be and he replied, “My dad”. The innocence of the child, the integrity of the family and the strength of the patient made me realise how unbelievably resilient people can be at the worst of times.

I had to break the news to a teenage girl that her mum was dying and was unlikely to make it through the weekend. I watched helplessly as she broke down and kept screaming for her mum. I struggled to hold back tears as the young girl inside me started calling out for my own mum. I felt about two feet small for thinking that I understood what suffering was. I remember being taught about bereavement and the various steps of the grieving process at medical school. But none of this prepared me for what I had to deal with that day. Being able to share the young girl’s grief had humbled me in a way that no formal medical education could have.

Many times during the job, the only thing I could do was to hold a hand or provide a shoulder to cry on. One thing I learned from losing my mum is that no amount of verbal consolation can lighten people’s suffering. Instead, just simply being present at someone’s side can be enough. I am thankful to all the patients and their loved ones for teaching me how to feel, how to ache and eventually, how to heal.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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My patients taught me how to heal after losing my mother

One dying patient taught me that doing nothing can be brave

“There is something actually, doctor.”

I turned around in relief.

Anxiously twirling my pen, the piece of armoury I still felt most comfortable with as a junior doctor, I hurried back to her bedside, drug chart poised.

Annette was an 82-year-old lady with lung cancer. It was my first month at the hospice. We’d been trying everything to ease her breathlessness. From medications to mindfulness, chest physiotherapy to visits from the chaplain … nothing helped. And now a lump formed in my throat every morning, as I tentatively roused the frail outline curled into a ball, each day bearing a starker resemblance to a child. Her words were interspersed with a soft, gasping rattle, as I’d ask the same question: “What can I do for you Annette?”

I don’t remember learning much about end-of-life care at medical school. Or perhaps I didn’t pay much attention. After all, I went into this job to keep my patients alive. Thinking about death wasn’t a subject that resonated with the newly qualified me, raring to go into action, scenes of bloody heroics reflected in my eyes as I was unleashed onto the wards.

I spent six years being trained how to deploy our ever-expanding arsenal of technology. My satisfaction, and my identity as a doctor, came from a feeling of competence. Just as a sculptor feeds his passion by constructing new statues or a carpenter by chipping away at fragile antiques to restore them to their beauty, so I fed my sense of worth by fixing what was in my control.

I had just about grasped the choreography of medicine: people agree to become our patients and we agree to try and fix them until the very end, as all manner of machinery trill and beep around their frail figures.

But Annette was not being fixed. And I was running out of tools.

“Do you know what I’d really like, doc? Some KFC.”

As I sat with her later, watching her surprisingly nimble arthritic fingers tear apart a bucket of chicken wings, I couldn’t shake the feeling that we’d surrendered. I knew our battle with death can never be won, but I had a niggling unease that we were retreating prematurely.

It soon became a ritual. Every few days I sat with her as she licked her fingertips and painted stories of her childhood. She soon confessed her biggest fear – dying alone at home. She didn’t want us rummaging in our armoury for something else to deflect the grip of death, as it inched closer.

So we listened, and we stopped. A week later, Annette passed away, surrounded by her family. I had never before thought of what a good death should look like. But as I stroked her hair with prickling eyes, I knew that I had just witnessed one.

I began to change my view of end-of-life conversations. I soon saw an irony in them: when it came down to it, done well, they were not about the end at all. They were more about life than any other conversations I had ever had with my patients.

This job has made me contemplate the questions Atul Gawande, a surgeon, writer, and public health researcher, so eloquently asks. Have we built our system around the few patients that exceed survival expectations, at the expense of preparing the rest for a more likely outcome? Through our struggle to curb our medical urges, are we failing to hear what really matters to them at a time when their choices should be most respected? Is there a tendency to preserve every fibre of life, to glorify longevity, over what actually makes our lives worth living?

Our lives are stories, and we want to be the authors. And in stories, the endings count. I’ve learnt that, as doctors, we need to be better at shaping those narratives, at helping patients with their endings.

After six years of medical school, death is a certainty that I must admit I shrank away from. But a picture of Annette and her bucket of KFC is now etched in my memory. I thank her for the lesson she taught me: that sometimes, doing nothing is the bravest decision of all.

If you would like to contribute to our Blood, sweat and tears series which is about memorable moments in a healthcare career, please read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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One dying patient taught me that doing nothing can be brave

What working as an FGM counsellor taught me about female sexuality

I had the birds and the bees conversation with my daughter when she was around four years old. I told her that sex is an act that two consenting adults choose to do and I stressed that nobody should touch her body in any way that makes her uncomfortable.

We have revisited this conversation over the years. I told her that her genitals are called a vagina, not fanny, nunnie, minnie or down there. I was sick and tired of the pervading belief that women and girls can’t describe our body parts directly.

Now nearly 10 years after that conversation (she’s just turned 14) teenage hormones are in full swing, with eye rolling and tuning me out while listening to Rihanna. But I love the fact we have frank open conversations about most things and I truly treasure the times we don’t agree. I love that she has her own views about the world.

With that in mind, I want to share some thoughts about my work that made me think of my daughter and the pressure girls around the world face in relation to their sexuality.

Related: Feminism is breaking through the rigid patriarchy in Pakistan

As part of my work with the Dahlia Project, a counselling service I founded for women and girls who have undergone female genital mutilation (FGM), I run sessions for refugee women where I talk about the cultures they grew up in.

The discussion always leads to sex, and a recurring theme is virginity. Many of the women are educated and considered liberal in their way of thinking. They say their daughters are equal to their sons. However, they also say they want their daughters to remain virgins to protect them from harm and so that future husbands will respect them.

What interests me about these conversations is that the women openly talked about being cheated on or beaten by their so-called respectful husbands. I nudged the women to reflect. “Did remaining a virgin work for you?” I asked. “Did it prevent the violence and betrayal he had caused you?” Many were baffled by my questions. By our second session some of the women were starting to realise that cultural patriarchy was alive and well in their homes, and they were complicit in committing the oppression they had endured against their own daughters.

Society high-fives men with multiple sexual partners

Sadly I only had two sessions with these women, and they left me questioning this universal obsession with virginity. I remember newspaper articles about Kate Middleton, being slut-shamed in newspaper articles for not being a virgin before marriage and rumour has it Diana had to prove her virginity before marrying Prince Charles. If a woman is sexually free or has multiple partners, society shames her and makes her feel bad about herself.

While dating I’ve been asked how many men I’ve slept with. This idea of being judged based on the history of my vagina is absolutely ludicrous and another form of control of women’s sexuality. My brother and all the men in my life are never asked such questions yet alone judged on them. Society high-fives men with multiple sexual partners.

I had my first sexual experience at the age of 18 with my then husband (I’m currently happily divorced). I didn’t make the choice to stay a virgin. I did so for two reasons. Firstly, I wasn’t the girl boys were lining up to date. I was a super nerd who didn’t wear makeup or pluck her eyebrows. So, no temptation or struggle for me. Secondly, my mother told me sex was great and nothing to be ashamed about. As a teenager I wasn’t keen to try something my mother enjoyed (remember that trick, parents).

Related: Anti-FGM campaigner Leyla Hussein: the women who made me

I remind my daughter that whenever the day comes that she wants to lose her virginity (why is it something you lose, like a precious possession?), it is no one’s business but hers. If anyone tries to judge her based on her genitals, I tell her to just walk away.

I tell her that our vaginas are very special and powerful, we bleed and give birth from them, and it’s her right as a woman to enjoy sex one day. It’s a beautiful and enjoyable act. Patriarchy tried to prevent me and over 200 million FGM survivors from living as sexual beings, but through therapy and a loving supportive partner many of these women can and are enjoying sex. There is hope.

Dear world, women have sex and enjoy it, so get over the idea that virginity is something to protect.

Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter. Join the conversation with the hashtag #SheMatters.

What working as an FGM counsellor taught me about female sexuality

Children taught to tell dad and mom: never use A&E

Kath Evans, head of patient encounter for young children at NHS England, advised The Occasions: “We know that use of A&ampE services is rising. We also know there are options to feel differently about the range of alternatives. They could wait until finally tomorrow, or go to the GP or neighborhood pharmacist. It really is about finding out and kids are a potent medium for carrying out that.

It is hoped the message, fronted by a knitted monkey, will form a typical part of personalized, social, health and financial education lessons after a study located that much more than 50 per cent believed it taught kids about the costs of using the wrong NHS services and that they could pass this message on to dad and mom.

Helen Sadler, the major schoolteacher who wrote the “Monkey Wellbeing” series, stated: “If one youngster per 19,000 principal colleges did not go to A&ampE with a lower finger, that would save £1 million.”

A song telling children what to do will be utilised by schools. “When Monkey’s feeling poorly and will get an damage / He does not have to swing straight to A&ampE”, it says, before advising: “out of workplace hrs, if Monkey’s sick up in his tree / Go to the walk-in centre of out-of-hours GP”.

Kids who have learnt about alternatives to A&ampE can be awarded a Scouts-fashion “NHS Explorer” badge.

Children taught to tell dad and mom: never use A&E

Healthcare is not a solution, no matter what neoliberalism has taught us | Humphrey McQueen

“We are all socialists now”, explained Britain’s chancellor of the exchequer, William Harcourt, in 1894. He was remarking that his liberal opponents have been united in favour of municipal reservoirs. Must socialists these days intone, “We are all neo-liberals now”? Not that we support promoting off the waterworks rather, 120 many years following Harcourt, we have been forced to defend the (figurative) water provide against people who would.

Opponents of neoliberalism have absorbed several of its presumptions. The most pervasive is to repeat the lie that sell-offs are privatisations. To say personal and not corporate is to do the function of our enemy’s spin physicians. The word private helps make the counting-house sound neighbourly. Similar mischiefs movement from parroting reform rather of denouncing de-types.

Health is the latest and most prominent de-kind, even though education, employment, housing and transport are also topic to comparable inequities. Unequal outcomes from people 5 pillars of each day lifestyle compound each and every other, possibly nowhere far more so than for psychological sickness.

Our well-being is the outcome of their interaction, not just a physical situation of an individual. As the socialist epidemiologist Fiona Stanley puts it, the actual brain drain commences just before birth. Consequently, provisions for equitable care have to be created on “social” equality. Each and every policy should encounter this test: is it likely to increase social equality across the generations?

From that beginning point, I have usually been vital of Medicare (and its ancestor, Medibank) as a curative model funded in component by a flat-rate tax. My objection has never been to a universal technique but to the fact that Medicare has never ever been one particular. Nothing at all right here has come within coo-ee of Britain’s nationwide overall health support.

I appreciate the positive aspects of Medicare. Without having it, in the United Blunders for illustration, I would be either dead or homeless. As it was, from 2001 I was at least $ 5,000 out of pocket for treatment method-related expenses above five many years of diagnosis and adhere to-up, not such as reduction of earnings.

The surgeon warned that I would in no way once again be ready to bend it like Beckham but that the reduction of a thigh muscle was a small price to shell out for getting alive. So was the $ 5,000. Nevertheless, its outlay was a reminder of how far Medicare has often been from universal coverage. Not everyone has the money or friendships to meet vital extras.

In spite of these prolonged-standing complaints about Medicare, I caught myself frothing against a co-payment for GP visits. That surprise sent me back to the source of my objections, Richard Titmuss’ 1962 tome, Cash flow Distribution and Social Adjust. He showed why universal services delivery is the only route towards better social equality, because in a single technique of healthcare the wealthy and powerful have a existence-and-death curiosity in generating it work.

So what is our activity? We want to fight our way out of the corner into which neoliberalism has backed us, and insist on universal programs funded by steeply progressive tax-costs on capital more than on profits, on house as properly as on revenue.

The Coalition’s proposed $ seven co-payment is regressive. But the flat-rate Medicare tax, even though it calls for those on typical weekly earnings to spend a greater lump sum than someone on the minimal wage, isn’t much much better. one% on $ 35,000 of taxable cash flow collects $ 350 on $ 70,000, it is twice as much at $ 700. That doubling is not progressive.

A progressive charge would run like this: 1% stays at $ 350 out of $ 35,000 but 2% on $ 70,000 would be $ one,400. Alternatively of the increased revenue earner paying out only twice as considerably in total, she would contribute 4 instances as considerably. However, increased earners are much more most likely to lessen the taxable element of their income by deductions and dodges – they have to be abolished.

Medibank and Medicare taught us to wear this kind of flat-fee impost – the GST, the flood levy, and the national disability insurance coverage scheme. Now we have the deficit tax. My only objection to the last is that it is not everlasting and not steep ample. In an perfect globe, Westpac’s Gail Kelly and her mates would be on a marginal charge of 90%.

In a even more concession to neoliberalism, we’re all encouraged to advocate equality of chance when the call must be for equality of outcomes. It is one particular point for each Australian to have the identical charge of accessibility to heart surgery. It is an additional to get the same top quality of care at Bourke as in the Jesus Hilton (aka St Vincent’s Personal).

Also few defenders of Medicare recall the local community health program (CHP) from the 1970s. The first CHP was set up in 1964, in Footscray, Melbourne, by the Australian meat market workers union. Its purpose was to supply remedy to injured meat workers and research the brings about of industrial accidents.

The trade union clinic and research centre, as it was referred to as, became the model for related services for girls and Indigenous Australians which nonetheless exist these days. Campaigners for the extension of Medicare need to put an even higher effort into rejuvenating CHP centres, to make them our universal provider. They need to be the heart, brain and lungs of wellness in each and every neighborhood and at each and every workplace.

But this kind of a point looks hard these days, if not extremely hard. It truly is not that neoliberalism is a vicious idea in the twisted minds of evil men and women, whether or not John Howard and Tony Abbott, or Julia Gillard and Bill Shorten. Neoliberalism expresses the necessity that capital has to expand by commodifying each and every factor of our lives.

To stop the spread of that illness it is important to reassert the vision that Titmuss celebrated in his 1970 masterpiece, The Present Romantic relationship. He contrasted volunteer Uk blood donors with the US victims of a free market place in plasma and noticed that wellness care has practically none of the characteristics of a consumer good.

Nevertheless, Australia’s commonwealth serum laboratories were privatised in 1994, below Paul Keating, who produced Medicare a important plank of his “social wage”. How long will it be prior to the efficiency of supplying blood is completely de-formed by market place signals? If we go on settling for Medicare, for the third best, we shall end up with a futures marketplace in blood.

Titmuss was appropriate: healthcare is not a merchandise. Unlike when we buy footwear, as patients we have little thought of what remedies we will need. Lastly, we are not in a position to return them, least of all from the grave.

Healthcare is not a solution, no matter what neoliberalism has taught us | Humphrey McQueen

Taught by the internet: tomorrow"s medical professionals are getting educated online

With the Twitter revision group twitfrg, users revise with a pretend patient. Photograph: Alamy

Online communities can be excellent sources and a indicates of communication to assist health-related college students and junior doctors.

The net can make learning to be a medical doctor easier, if you know where to access the proper assets. Far more importantly, the web is effectively addressing the flaws of conventional offline studying.

Twitter

Sophie Bishton, a junior physician, was “fed up with conventional learning and getting talked at all the time” and so founded the Twitter finals revision group (recognized as twitfrg) in October 2012.

Users are invited to participate in a situation in actual time. Prior to the occasion, revision notes associated to the situation are created accessible online. At a prearranged time, a tweet is sent marking the beginning of the situation.

Bishton says: “It really is a protected finding out setting with a pretend patient and small risk. Twitter makes you concise, which assists with sensible examinations – you have to be to the level with out currently being rude.”

From there, consumers contribute to the discussion employing the hashtag #twitfrg, going by means of the stages of diagnosis and explaining their reasoning. Sophie and other organisers tweet as properly, both to propel the discussion or to include added materials, this kind of as a graph or diagram.

“It truly is really present,” Bishton adds, “registrars and consultants chip in with factors about the most current guidelines and research. They have a tendency to be more approachable online.”

Advantages

On the internet learning adds variety, also. Health care students from all above the country who are taught in different methods can exchange techniques. Similarly, it is an chance to share clinical encounter that some college students – because of the way their program functions – won’t constantly be familiar with.

For instance, you could have only a minor GP speak to and then, in your third yr, be sent straight to work on wards.

Sophie adds that there is the chance for follow-up when the scenario finishes. “There is a chance to say ‘this is what you must have been thinking’ and ‘here’s exactly where you could have saved the circumstance.’”

Afterwards, tweets from the discussion are grouped collectively employing Storify and dependent on the case, added notes are supplied.

On the internet interaction also addresses regions of concern. In the journal Occupational Medication, Deborah Cohen and Melody Rhydderch wrote about the value of recognising the wants of health care students’ bodily and mental well-currently being.

They say: “The impact of ethical conflicts, publicity to death, human suffering and emergency situations on young medical college students can not be underestimated.”

Despite the fact that twitfrg is largely a revision resource, Bishton adds it also acts as a supportive, non-judgmental surroundings exactly where students can share their experiences and give guidance to other people for coping with day-to-day life.

As with all degrees, the pressure to study and learn can usually lead to a sense of isolation. Speaking to other students of the same area can offer help and reassurance and hold this kind of emotions at bay. “There is camaraderie and it can bring out the folks who are struggling”, Bishton says.

doc2doc

Professional bodies, this kind of as the British Health-related Journal (BMJ), also give communities. doc2doc, a series of forums and blogs, was founded in 2009 and now has in excess of a hundred,000 members from all over of the globe – 50% are medical students.

Matthew Billingsley, digital engagement editor for the BMJ, says doc2doc’s a lot more experienced clinicians are quite supportive of college students.

Discussions variety from questions about ethics to assist interpreting X-rays and ECG results. There are also closed forums, available only to people who are verified as registered with the Common Healthcare Council, and a small choice of eBooks and other sources.

Geeky medics

While online learning seems to have an edge on classic lecture and guide based mostly methods, it has a way to go just before twenty-1st century techniques will substitute the established indicates of educating.

Lewis Potter, a medical doctor working in Newcastle who set up the effective revision website Geeky Medics during his third 12 months, says “publishing on-line is a no-brainer and the incorporation of it into standard methods can increase studying, but at the moment we are not taking advantage of the rewards these new technologies have the likely to provide.

“What we usually see is the emulation of the traditional studying model: a revision book that releases an iPad app model, displaying the content as it is in the book, with no further performance. From a finding out perspective, that adds really small advantage.”

Geeky Medics publishes interactive quizzes as well as movies that demonstrate clinical capabilities (its channel is partnered with YouTube). Lewis says that improving finding out is dependent on content currently being “developed from the ground up” for a platform and its particular talents. He predicts that as soon as that is accomplished effectively, “on the internet approaches of understanding will largely supersede more traditional strategies at present in area.”

Added assets

Podmedics. Audio slideshows from a number of qualified medical doctors and surgeons covering a broad range of topics. £30 per year.

OnExamination. A assortment of examination preparation materials supplied by the BMJ, including questions banks.

Taught by the internet: tomorrow"s medical professionals are getting educated online