Hippocratic Oath-Modern Version
I swear to fulfill, to the best of my ability and judgement, this Covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow:
I will apply, for the benefit of the sick, all measures (that) are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I will not be ashamed to say ‘I know not‘ nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. *But it may also be in my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must Not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is better than cure.
I will remember that I am also a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
The words in Italics denote the applicable values which were Not adheared to in my mum’s case, and also highlighted the bold assumption in red from the GMC’s unadulterated arrogance toward the sanctity of Life.
Without the surreptitious permission to kill, the statement in red in the Modern Oath would undoubtedly be omitted or reworded. The above from the GMC abrogates:
Above all, I must Not play at God! as this abrogates The Commandment to Man *’Thou Shalt Not Kill’!
Personally, I wonder which God this refers to as *This inclusion is suggestive of Blasphemy!
‘By their Deeds Ye Shall Know Them’
The actions must match the words!
There are many medics who do not take this oath.
I wonder why?
Mum’s arrival time was noted @ 14.10 on Thursday the 30th at the A&E Department. A Trage nurse attended her @ 3.20pm and utilising print-outs from the G.P. , along with her covering letter, he used these to take his own notes from and proceeded to fill out his form: – hypertension pneumothorax (did not note 1995?) left ventricular hypertrophy (her previous G.P. had noted ‘some’) Recurrent U.T.I. (from catheter use in Hospital years previously which cleared up and had once only, Not recurrent ). He also noted wrongly that the G.P. gave mum 40mg Furosemide! which was actually 20mg.
This examination was done on a trolley bed, lined up in a corridor with approximately ten or more other people all in a row along one wall.
He noted that she had ‘No Ankle Oedema’, looks dry, acutely confused/dementia.
As far as she knew I was nowhere, but was actually sitting outside in A&E waiting for a call which never came. Since her stroke her thinking and answering were slowed up although she had progressed remarkably well and I relayed questions to her in a way which I knew she could understand and in a gentler and more patient manner, so she had become used to my being her spokesperson. She would never have known what day or time or year it was as she had no need to ask this at any time since her stroke. It simply never came into any equasion.
Apparently she said the wrong Hospital which was noted on his form, but she was only told by the G.P. about going to Hospital (in fact we both were, and would not know which one until we arrived) so again, perfectly understandable, if you have common sense that is, so she was not told which Hospital she was going to or even when she arrived. This was Not Dementia! Although she had some. She did however, manage to tell him that she had a citrus fruit allergy, so she was cognitive enough, just not quick or sharp enough to combat assumptions; albeit misleading ones from the G.P.’s notes. She denied the past history of COPD for the simple fact that no G.P. had ever explained this to her and as far as she was aware; even before her stroke; all she had was occasional breathlessness from bronchitis. Not because of a poor memory!
The acute lack of accurate and updated records are placing people in danger, both from wrong assumptions happening in Hospitals; who after all can only go on the records sent; which in turn only fuels an ongoing attitude that old people who are confused have dementia automatically, end of story, which is not the case or at the very least only has some bearing.
The Triage nurse did note however:- exacerbation of COPD with cardiac failure! taken solely from the G.P.’s notes: ‘exacerbation of COPD with possible super-added cardiac failure’ so his notes were indicating she Had cardiac failure, not a possibility, which turned out to be complete guessimuss!
The danger here of course, is that this was to set a precedent for others who read both the G.P.’s letter and the Triage nurse’s notes. A classic example of assumptions leading each successive medic astray.
He then wrote under Differential Diagnosis: exclude U.T.I’s (recurrent) + Pneumothorax.
* This Triage nurse did however, write the correct 20mg Furosemide on another page.
Overall the Triage nurse did well given the exaggerated and limited information sent by the G.P.
I sat outside until I became alarmed as time was wearing on and I knew mum had nothing to eat or drink since lunch time, so I went looking for her and in fact found the corridor (which is like a cattle market not something geared for human beings, only carcases with ailments) where she had been left along with others in a line-up of trolleys. Unfortunately I missed her as she must have slid down the trolley and was hidden behind a row of taller people, and not wishing to become an obstruction in the passageway for other people passing, I returned to the A&E seating area and sat for about another hour. I had thought her to be in a cubicle and awaited a call as I obviously could not search each one. After this hour not all the hounds of Hell were going to stop me finding her, while everyone went about ignoring the people seated with no acknowledgement whatsoever. I found her where she had been parked and was so sickened that I had missed her earlier, but this time I was not moving from her side! She just looked like a little bundle, and it breaks my heart to think of her feeling frightened and alone in that place, and I so regret I never took her home there and then!
To Hell with the niceties, and to Hell with being polite by extricating myself to allow others to pass. They do not even notice and certainly do not acknowledge the poor souls waiting exhaustedly to be moved. These attitudes both anger and disgust me. This has nothing whatever to do with short staffing, it is simply mere humanity. Unfortunately there is an acute lack of this in our modern day Hospitals verging on chronic!
Many years before, when mum tripped on a step and broke her wrist, she had to wait in the same A&E department; outpatient department this time, and was sitting on the ambulance trolley. At one point I noticed (as you do when you are awake enough to realise, when someone has had a shock) that mum was feeling cold having been parked beneath an open window, and I asked a nurse for a blanket. She quickly responded to my request, and I wondered at the time why these things were not noticed by nurses or doctors in the first place but apparently not. However mum got her blanket. It was then that another older, grey haired Asian man who looked so forlorn, and who had no clothes on his upper torso; just some wires; was wheeled out into the same cold corridor, but again a cloud of oblivion was apparent, and I had to ask the same nurse ‘Could you get a blanket for this other gentleman please’? Obligingly she hurried to retrieve this, although the poor soul still looked so sad and did not appear to be much warmer, although he smiled in thanks. I hoped his family would arrive soon, but I never saw anyone. I have often thought of this poor soul sitting on that trolley so sad looking, and while I was sitting there I knew he had company and someone to watch over him although I also knew he would be oblivious to this.
This is only a couple of examples I have witnessed, and this was years ago, which prompts me to ask:
‘What exactly is going on in our Hospitals’?
What’s more, everyone in this Country should be asking the same question!
Mum lay in that corridor queue of trolleys since the Ambulance crew delivered her @ 1.57pm, a Triage nurse saw her @ 3.20pm and she still lay there until 5.50pm when the first of the FY2’s (Second and Final Year) that she and I had the misfortune to meet took her into a cubicle, (at the time I had no idea she was not fully qualified) although she was slightly better than the second FY2 who was a complete unmitigated disaster from beginning to end (the end of my mum’s Life that is).
So this meant that mum was in the cattle market queue for over four hours with nothing to drink or eat since about 12.30pm. Dehydration? No wonder so many older people are diagnosed in Hospital with this syndrome when the entire system is geared to dehydrate them. Confused will be a word you will read most often regarding my mum. Is it a wonder?
It is totally and utterly farcical.
I had to wait while she was wheeled into this cubicle and when I was finally called, mum looked so alarmed, and again I regret not taking her home there and then (in fact much sooner). I managed to pour some water into the bottle cap and gave mum eight capfuls which she drank thirstily.
I had brought a small bottle of water with me and managed to give her some from the lid of the bottle which she supped anxiously, and I felt so ashamed at this. Everytime I filled it she drank so thirstily. Had I not taken the G.P.’s word that mum would not have such a long wait if she waited for an ambulance I would have brought a 2 Ltr bottle and a cup along with some food!
There is no water available and invariably the vending machines with sugar infested drinks are empty also. This is such an inhumane way to treat people, as they sit in a corridor thirsty, and hungry with no pillows, and people walking about totally and utterly oblivious to their plight. In fact no-one acknowledges anyone!
The Entire N.H.S. requires a major shake-up because it has clearly lost its bearings, and its Ethos!
Meantime my first glimpse of this FY2 was when she walked slowly along the corridor with a large coffee cup which she had presumably just purchased, but stupid me, I thought she was in admin. as she wore civilian clothes and I had expected a white coat or jacket on a medical professional. Stupid Me.
Next came an incident with the FY2 who persistently made three attempts to pierce a needle into my mum’s arterial vein in her little frail wrist causing her extreme pain, and ignoring her pleas to stop!
I was later told this was unnecessary to obtain an arterial reading, but hey, it’s an old person who doesn’t know any better, an easy victim to practice on. I also noted that the man in the next cubicle, booming out obscenities at the top of his voice was not chosen for such favours!
Absolutely disgusting behaviour, which I have watched on television programmes since, which showed student doctors at work. They should have to try this on each other before letting them loose on unsuspecting, unwell human beings!
When my mum; in excruciating pain and pulling herself up on her hip; grabbed my arm and cried my name in a wail, ‘Oooh……’ I turned quickly to look at this imbecile angrily in the face,.
She sniggered, followed by a sideways smile.
Have you ever heard the saying, ‘Was that painful, I didn’t feel a thing?’
Hard as nails!
This, I am absolutely convinced, was what started my mum’s pain, as she had none whatsoever before this, and in fact was fortunate enough to have rarely been a victim of this phenomena.
These so called ‘final year students, frightening isn’t it? most certainly are not supervised to the depth required to deal with humanity.
Mail Online 3.8.12
‘On the First Wednesday in August when junior doctors start working on wards your risk of dying in hospital will rise by 6 per cent!
It is called, too much theory and not enough practice, and the same scenario applies to nurses, who now go through a University course.
Have you ever heard of such stupidity, when the outcome is to deal with real Live, so far, human beings. In fact I have witnessed some nurses who have appeared to all intents and purposes to actually be resentful at having to deal with real patients who have to have their physical needs attended to. In fact they were positively annoyed at the prospect!
Guess where their heads are?
It is my opinion that junior doctors just out of University and indoctrinated with the Drugs dogma are absolutely desperate to try these out on people, but haven’t a clue about the implications on different human beings and the contraindications both single and combined. . It is never a case of one size fits all, and the GMC and BMA should definately look into this potentially lethal flaw.
One doctor let slip that they are first taught to get the patient under control!
Who taught them to do this?
Sheer Unadulterated Arrogance!
A quote from an American named Jane Jacobson tells the same scenario.
‘When Jane Jacobson entered hospital medicine after qualifying in 1981, her Consultant warned her that the last thing she should do was to get involved with her patients – ‘if she wanted to get on’ ! It was to avoid such attitudes that she moved into psychiatry. “By the end of your first year as a houseman you have completely forgotten any listening, sympathising or interviewing skills you might once have had. Instead of getting involved with the patients, you hide behind your white coat (here it is civilian clothes) and start to look upon the patient as a victim and yourself as a sort of God-like figure holding all the knowledge and doling it out in bits”
Says it All!
These articles and others similar only served to confirm my own sad observations. They told me nothing I didn’t already know.
Apart from this indifferent cruelty this FY2 did manage to observe my mother rather better than her G.P. The downside however, was once again the setting of a precedent of drugs given to my mum; which she had not been on; despite the results of the Arterial sample results @ 6.23pm showing nothing too dire being wrong. She noted that she required careful fluid balance, but also ECG changes – old/new? precedent from G.P. She did however, pay attention to my telling her that mum could not swallow tablets and wrote a prescription for syrup.
Another omission from the G.P’s notes, who had to obtain permission to give mum Carbamazepine in liquid form yet failed to pass this information on.
This FY2 wrote a large list of drugs.
Just in case?
Did she actually know the implications of the following drugs?
What about Avoiding Overtreatment?
Therapeutic Nihilism would follow!
She wrote a Once Only prescription for 1.2G Augmentin IV, plus 500mg Clarithromycin (syrup) time of administration 18.20pm and also wrote a prescription for a saline drip for 19.10pm with further saline at 00.05am + 20mmol KCI (Potassium) and more saline at 04.05am.
I stopped to watch a programme called Brain Doctors and I am so glad I did this, as it gives me such a heartening feeling to see the stupendous work done by some Consultant/Surgeons in the N.H.S.
It was centered in The John Radcliffe Hospital in Oxford, and was such a lovely modern building with equally modern colours in the interior which must make both the Staff and the Patients feel better than our extremely outdated Victorian Hospitals, which are dull, dingy and unkempt, and depressing to walk through, let alone work in. It was also spotlessly clean, unlike some other Hospitals where this phenomena is only seen spasmodically.
I watched two Surgeons in particular as they carried out operations. One was Jay and the other Alex. I could only quickly see his full name – Jayamohan – so I hope this is the correct spelling, but what a wonderful human being he is and a credit to humanity. So are the other Consultants, but the main focus was on Jay and I recommend you to try to catch this if you have not already. It may hopefully be repeated even at a later date.
The reason for my comments and interruption is to illustrate that I still have high hopes for the N.H. S. but I would most certainly and drastically cut out those responsible for any damage to people. This in turn would make for a healthier environment for the people working in it, which ultimately can only benefit patients, as like feeds on like. Just as Jay cuts out cancerous tumours, so also does the N.H.S. require to cut out cancerous tumours in this organisation, otherwise they spread. They do not get better!
The FY2 also wrote regular prescriptions:
40mg Clexane s/c (subcutaneous) given @10-12pm (Enoxaparin which is Heparin). This is an anticoagulant injected into the fat, What fat? of the stomach.
Adverse Reactions: as with all anticoagulants, bleeding is the major adverse effect of Enoxaparin. Haemorrhage may occur at virtually any site.
Thrombocytopenia with Thrombosis: Cases of Heparin-Induced Thrombocytopenia – severe serious reactions! Some complicated by organ infarction, limb eschaemia, or Death have been reported! May cause Confusion! Changes in the Potassium levels in the blood.
Before you use, Tell your doctor:
How is this done when ‘doctors’ prescribe without informing anyone?
If you have a problem with bruising easily. Yes!
You have had a stroke caused by bleeding in the brain. Yes!
You are underweight. Yes!
You are elderly and especially female as they are more likely to have bleeding episodes, (over 65 years old). especially if over 75 years old. Yes! as they are more sensitive to the dose.
If taking diuretics – mum was on Furosemide.
Especially if taking antihistamines – she had been on Piriton.
If taking Prednisolone. This FY2 wrote a prescription for 40mg Prednisolone for 7-9am but x this out for 30th. She did however leave it on prescription to start @7-9am 31st.
Common Reactions: Adrenal insufficiency, fever, chills, elevated liver transaminases.
Anaphylactoid reactions (rare).
Precautions: It has been reported that patients on Heparin Sodium ‘may develop thrombus formation’ in association with thrombocytopenia. The process may lead to severe thromboembolic complications like, skin necrosis, (skin death) gangrene of the extremities that may lead to amputation, myocardial infarction (heart attack), pulmonary embolism (blood clot), stroke and possibly death.
Resistance: increased resistance to heparin sodium is frequently encountered in fever, thrombosis, infections with thrombosis tendencies, myocardial infarction etc.
Adverse Reactions: Pain at Injection site, anaphylactoid reactions, including shock.
N.B. Significant elevations of aminotransferase *AST And ALT (liver) levels have occurred in a high percentage of patients (and healthy subjects) who have received Heparin sodium. Since aminotransferase determinations are important in the differential diagnosis of myocardial infarction, liver disease and pulmonary emboli, rises that might be caused by drugs (Heparin sodium) should be interpreted with caution.
Heparin is strongly acidic.
Fantastic! Especially on an empty stomach!
To be sure this medicine is helping your condition, your blood will need to be tested on a regular basis. Your stools may also need to be checked for blood!
No chance! Mum was never given enough food or liquids and she was constipated!
Absolutely No One!
Dosage is based on your medical condition, weight, and response to treatment. For prevention of blood clots – moderate risk 20mg.
High risk 40mg. Use cautiously and Only in Life-threatening situations. Patients over 60 years of age may require lower doses of Heparin.
What medical condition? She was not weighed! Her condition was Not Life-threatening – Not Yet! and she was in her 80’s.
She was given the high risk 40mg dose!
The rest of the prescriptions the FY2 wrote were:
1.2G Augmentin IV 7-9am, 4-6pm, and 10-12pm but these were x out for 30th, to start on the 31st, 500mg Clarithromycin IV 7-9am left blank, 10-12pm x out, then wrote another 500mg Clarithromycin PO 7-9am x out, and 10-12pm given. The Once Only prescription for 500mg Clarithromycin (syrup) was not signed as given @6.30pm! Latanoprost eye drops 10-12pm-given, 5mls Carbamazepine 10-12pm-given. 2 puffs Salbutamol (does not appear to be given). 2.5mg Salbutamol + 5mg Atrovent Neb. given 10-12pm, but x out for previous 3 x that day. 40mg Prednisolone PO x out to begin on 31st.
Prednisolone should be from 5mg to 60mg per day. In situations of less severity, lower doses will generally suffice! It should be emphasised that dosage requirements are variable and ‘must be individualised on the basis of the disease under treatment and the response of the patient.
Dose selection for an elderly patient should be cautious! The lowest possible dose should be used!
Maximum 80mg a day in divided doses 3-4 times a day until urine is protein free for 3 consecutive days.
No urine test was done to assess dosage?
Average and large doses of Hydrocortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of Potassium.
Remember the see-saw effect of Salt vs Potassium, as one depletes the other increases! Too much sodium increases blood pressure which is detrimental to the heart (and brain/stroke potential). Too little potassium is bad for the heart. Low Potassium (confusion).
All Corticosteroids (Prednisolone is a Hydrocortisone) increase Calcium excretion.
The incidence of Corticosteroid-induced side effects may be increased in Geriatric patients and appear to be dose related!
Decreased functioning of Adrenal gland (adrenal suppression).
In fact, it is an immuno-supressant and affects virtually All of the immune system. They probably delay or slow healing!
Now let’s see. All drugs are toxic therefore the immune system has to clear the toxins from the body. But, and it’s a big but. Steroids affect virtually All of the immune system, as they are an immunosuppressant!
That’ll Do It!
First Do No Harm?
Increased susceptibility to infections! Increased deposition of glycogen in the liver; inhibition of the utilisation of glucose etc. plus increase in urinary excretion. Abdominal distension, increased pressure (intra-ocular) inside the eye, (eye burning).
Glaucoma (history of), if you have this condition you may need a dose adjustment or special tests to safely take Prednisolone. Oedema, nervousness, anxiety, muscle weakness, muscle wasting.
The FY2 Never informed either of us about any of the Drugs she intended writing prescriptions for. Only that she would give mum a saline infusion for her dehydration (mainly caused by the Hospital scenario!)
It can stimulate secretion of various components of gastric juice.
Imagine feeling hungry for 22hours (when she would next eat) and having your appetite increased?
Talk about Back to Basics!
Administer oral formulation with food or milk to decrease GI (gastro-intestinal) effects.
What food? When?
Counsel patient on appropriate diet management i.e. diet high in protein and Potassium but low in Sodium – Saline solution? – and carbohydrates plus vitamins A, B6, C, D, Folate, Calcium, Zinc, Phosporous.
Prednisolone may cause the following symptom which is related to shortness of breath with exertion.
Congestive heart Failure! Caution if seizure disorder!
This FY2’s notes should have warned her to hold off with the Steroids at least meantime! Especially given the fact that they are connected to shortness of breath with exertion, which is exactly the observation of the G.P.
Steroid medication can weaken the immune system, worsening an infection you already have or have recently had!
Avoid being near people who are sick or have infections!
Can you believe this?
Furthermore the Pharmaceutical Industry uses Prednisolone tablets for the calibration of dissolution testing equipment.
At 7-9am mum was given 1.2G Augmentin IV on 31st.
Another doctor wrote and administered @ 7-9am 625mg Augmentin PO (by mouth), so did she/he not observe the ‘syrup’ prescription, or the IV prescription for 1.2G. Augmentin indicating that mum could not swallow tablets? She/he also completed the prescription with 625mg Augmentin @ 4-6pm, 625mg @ 10-12pm.
This meant that 7-9am on the 31st mum was given 1.2G IV Augmentin plus 625mg PO Augmentin, giving her Double the maximum recommended dose of Clavulanic Acid.
This other doctor also wrote a prescription dated 31st @ 12.35 for 1G Paracetamol. I can only imagine that the pain in mum’s arterial wrist veins along with the injection in the stomach, plus hunger pains must have been very painful indeed!
Remember, I had no idea about these prescriptions!
Standard adult doses for respiratory tract infection etc. is one 500mg tablet of Augmentin every 12 hours or one 250mg tablet every 8 hours. For severe infections of the respiratory tract, the dose should be one 875mg every 12 hours or one 500mg every 8 hours.
So between 7-9am until 4-6pm = 9hours plus another @ 10-12pm =which =6hours, equals3x625mg = 1875mg PO + 1.2G IV was given over 15 hours!
N.B. Two tablets of the lesser dose should not be given as this would Double the Maximum Recommended Dose of Clavulanic Acid. Due to differing content of Clavulanic Acid, not all formulations are interchangeable.
*Drink plenty of water, juice or other fluids (e.g 6-8 glasses per day). *Contains Phenylalanine (this makes the heart race).
Hepatic dysfunction, although rare, is more common in elderly.
Side effects are as those for other beta-lactam antibiotics.
Adverse reactions: Abdominal discomfort, loose stools, nausea, vomiting, Vaginitis! Cholestatic Jaundice, flatulence, headache, hepatic dysfunction, Thrombocytopaenic, Anaemia, agitation, anxiety, dizziness, confusion, AST elevation.
Feeling generally unwell, yellowing of the skin and eyes (jaundice) and dark coloured urine. This may be a sign of liver disease which may occur while using Augmentin or even a few weeks after stopping!
Symptoms such as fever, sore throat, can be a sign of lack of white blood cells!
All these symptoms would follow!
Why, would anyone with even half a functioning brain place such reliance on Drugs which do these things, let alone prescribe them to unsuspecting, unwell people?
At 4.32am a further Arterial sample result was produced, showing an improvement.
Bear in mind that mum had not had the Overdose yet.
Mum spent the night in a ward where I had accompanied her @ 8.30pm (another two hour wait for a bed- they weren’t kidding when they stated ‘No beds for the elderly’) Just over six and a half hour wait!
The senior nurse wrote her notes: Incontinent of urine.
Yet, @ 05.00am wrote: ‘Not yet passed urine’? Pain score ongoing! Acutely confused!
She did however notice that the pneumothorax was in 1995, and that she was clinically dry but needs careful fluid balance, and epilepsy was three years previous (stroke).
The downside of taking others’ notes is: Known to +geric (she was not to know either that this was once only), also once again she was another person to write recurrent UTI! Relative participation – Nil in Attendance- I had accompanied mum to the ward?
Initial Care Plan seen and agreed by patient –Yes, box was ticked!
Acutely Confused. Pressure sore risk assessment.
Appetite was marked as 1 = Poor! Yet – at 11am a nurse wrote ‘diet and fluid taken, assistance given with gobbling’!
She was doped up, dehydrated, starving and had not eaten for 22 hours!
By the morning the results of the Microbiology test (blood culture) showed:
Aerobic Bottle day sampling.
No Growth from both bottles after 24 hours!
Bottles will be incubated for a further 4 days.
No further reports unless a significant growth is seen.
No Growth was seen!
Yet mum was still on all of the above drugs?
No one took any action to alter these!
On the 31st the Consultant visited and upon reading the Biochemistry and the Haemotology reports wrote:
‘Not That Unwell’.
Remember this and what follows when you think about the Liverpool ‘Care’ Pathway!
‘A patient in the Throes of Hunger is compared to one having been Bitten by a Snake!’
There are One Hundred Million Neurons (Brain in Gut)!
The Star entered the first premises on the 30th and on the 8th in the second premises made her
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