Hello and welcome!

January 11th, 2009

This is Bruce Hugman’s blog about Healthcare Communication – anything and everything relevant to creating the best relationships with everyone in healthcare, especially patients. It’ll include things he forgot when he was writing the book, new ideas and thoughts, book reviews, international developments in communications, comments on your ideas and suggestions – lots! Read, comment – and then go to the forum if you’d like to air your views and discuss them with readers all over the world.

Gender issues: cultural curiosities and big issues

April 21st, 2009

Gender: cultural curiosities and big issues from India and Thailand

In Chapter 20 of the book, (Sex and sexual orientation), I wrote about the sensitivity of minority gender and sexual orientation issues, including: the adaptation of documentation to take account of same-sex couples, whether in legal or informal partnerships; the recording of next-of-kin choices; personal pronouns and names for transgender and transsexual individuals – and several more important questions.

Two international news stories draw attention to special cases of these issues, which are interesting and revealing. The first, reported in the Bangkok Post 20 April, 2009, relates to hijras – the people of the ‘third sex’, thought to number at least a million individuals in India (and more elsewhere in S.E. Asia).

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Whistle-blowing, ethics and patient care

April 20th, 2009

Whistle-blowing, ethics and patient care:
some thoughts and lessons

Margaret Heywood, 58, a nurse at the Royal Sussex Hospital, Brighton, UK, was struck off by the Nursing and Midwifery Council for failing to ‘follow her obligations as a nurse.’ Concerned about the treatment of elderly patients, in July 2005, she filmed conditions in her hospital, undercover, for the BBC Panorama programme. (Reported by BBC News, 16 April 2009: http://news.bbc.co.uk/2/hi/uk_news/england/sussex/8002559.stm)

I am not in a position to comment on the detailed rights and wrongs of this case (though there seems to be strong evidence in favour of the nurse’s position), but the controversy raises issues which are important for all of us and for achieving the best possible healthcare.

Following discussion of this case, some specific lessons and recommendations appear at the end of the post.

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Healthcare and the effects of poverty

April 11th, 2009

Poor more likely to die after heart surgery
 Narrowing health gap relies on ‘good start’ in life
 Smoking, obesity and diabetes not only factors
Sarah Boseley, Health Editor
Friday April 3 2009
Copyright The Guardian

People who live in deprived areas of the country are more likely to die after heart surgery than those from more affluent places, even after allowing for the effects of smoking, obesity and diabetes, a new study shows today.

The research suggests that health inequalities have deeper roots than lifestyle choices. An editorial that accompanies the study in the British Medical Journal says poverty needs to be tackled if the health of the entire nation is to improve.

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How risk scrambles our brains

April 11th, 2009

Risk
The science and politics of fear
By Dan Gardner
Virgin Books, 2009 (paperback); ISBN 9780753515532

This is one of those great, elegant, clear books about complex subjects which are a joy to read.

Its scope is an understanding of the psychology, sociology and politics of risk and risk perception in almost all aspects of our lives, from familiar, everyday risks like car-travel, to the big perplexing issues of environmental toxicology and terrorism. There are some specific examples from medicine and pharmaceuticals (the US silicone breast implant crisis, and lots about cancer and cancer risks statistics among others), but the book deals with much broader issues which shine a bright light on all aspects of risk in healthcare.

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The mysteries of placebo

April 10th, 2009

This is a really important topic which I hardly dealt with in the book. It’s one that scientists don’t really like because in many respects it’s not measurable and it belongs more to the mysterious realms of psychology, mind/body studies and psychosomatics – all pretty scary for medics.

But it’s scientifically and therapeutically very important. In some respects, it really ought to be categorized under ‘treatment’, because any action, including what seems like no action or neutral action, always has some direct effect on health and welfare and is not, as commonly assumed, actually neutral or empty at all. The giving of a sugar-pill or even a diagnosis itself have no pharmaceutical or surgical components, but either may affect the physiology and/or the psychology of the recipient in important ways.

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Something for the pain (book review)

April 10th, 2009

Something for the pain
One doctor’s account of life and death in the ER
Paul Austin
W W Norton and Company, 2008
ISBN: 978 0 393 06560 2
www.paulethanaustin.com

This is a great book, written by a man wrestling with all the challenges and contradictions of emergency doctoring. His competence, intelligence and humanity make his practice distinguished and his writing riveting and illuminating. The technical and emotional journey is a tough one, but his acute awareness and thoughtful introspection enrich this memoir with vivid and instructive accounts of relationships with patients and colleagues; of failures and successes; of the emotional impact of facing the daily drama of the ER: how much time is there for empathy and compassion? How far should suffering be kept at a distance? What is there to offer to the bereaved?

Austin’s practice seems to be a perfect blend of technical competence and expert communications – even though there are times when he fails by his own high standards. Against all the odds of pressure and disorder, he struggles to maintain his humanity in relations with patients and colleagues – even those whose weaknesses or obstreporousness compromise the work.

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