Friday, 23 November 2012

Liverpool Care Pathway – The Final Destination

Do 30 years experience count for nothing?

A major problem with the LCP is the recommendation of pre-emptive prescribing in anticipation of symptoms presenting. The possibility of errors in diagnosis are compounded. 

Symptoms that may or may not present are a signal that the diagnosis is following the correct route map and is on course! The 'art' of medicine is to listen to what the body is telling you. The 'art' of the practitioner is to hear and to understand. That is true humility.

Observation, observation, observation!

This is the British Medical Journal -

Dutch research reflects problems with the Liverpool care pathway

Assessing dying

12 May 2008

With 30 years' experience as a geriatrician, I always found it difficult to predict death, which is what is being sought here, in order to implement the LCP appropriately. While the LPC offers useful guidelines on the management of end-of-life symptoms, it seems to be rushing in with sedation and opiates without considering whether hydration and nutrition are also still valid treatment.
Competing interests: None declared
Competing interests: None declared
Bruno Bubna-Kasteliz, Professional Adviser
Office of Health Ombudsman, Millbank, London W1P 4QP

A prediction of death is a diagnosis of 'dying'.

LCP apologists laud the fallacy of their protocol and shout that the Pathway is a reversible Pathway; should the 'LCP-ed' patient present appropriately evidence of improvement, then they are removed from the protocol, they say. It is not a final destination. And yet, therein, is admittance and acceptance of misdiagnosis.

Evidence of misdiagnosis is not something to be proud of; it is a humbling lesson to be learned that nothing is certain, even certainty. Error is a hard taskmaster but these are lessons to be learned and to be learned they must be if they are not to be repeated.

But, no. The LCP apologists are not at all humbled by the amazing resilience of life; they are only enamoured of the certainty that every journey is destined to reach its terminus and that it is their ordained task to assist it along its pathway to that final destination!

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