Tuesday, 12 March 2013

Liverpool Care Pathway - Of Twits And Twitters

The tweets are flying fast and furious on Twitter, from twits and tweeters alike.

A tweet from Dr Berry, 09/03/2013
"Amazed when people in 10th decade of life reveal that possibility of dying has never crossed their mind. But I do have to bring it up! #eol "

Dear Dr. Berry, it is very likely that this is exactly why people who do attain their 10th decade of life do attain their 10th decade of life, because the possibility of dying has never crossed their minds. 

Whatever is wrong with you that just when their glass is half full, you have to come along and tell them it's half empty...? [click]

It is an accomplishment, man! Recognise that. A celebration of life may celebrate the lives of the living, also, not merely the lives of the dead. 

To this comment put to a nurse on Twitter --
"Can people not die in comfort without the LCP? What is it about the LCP that aids you with EOL care?"
These following responses made --
"if followd correctly it ensures the patient is getting the best palliative care. Symptoms of death controlled, skin care etc" "ppl cn die in comfort w/out lcp if using the same principles but that would only be possible with 1 on 1 care. Not realistic"
Upon these responses, this comment --
"This says it all - there is indeed a blanket application of the LCP, not recognising the patient as an individual, because they are so busy with time constraints and meeting targets, that they cannot provide ''1 on 1 care''."

Exactly: Not realistic. What is the Liverpool Care Pathway in practice? The replies are diverse and many.

According to a Pocket guide to the Liverpool Care Pathway  -
5.   Diagnosis of dying should be made by the multidisciplinary team (MDT)
Mark Ellul on Melibeus says, however - 

"...wouldn’t it be great if there were a document which helped doctors to make an assessment of whether someone is dying, assess their current medical condition and troubling symptoms, their spiritual (or not) views and their preferred type and level of care? This document is the LCP."
"This document is the LCP" that makes "an assessment of whether someone is dying". Mark Ellul further comments in the LCP's favour that -
"...around 10% of people managed according to the pathway will come off it as their condition improves. "
Yet, this is damning. This means that 10% of all diagnoses made on the LCP are wrong diagnoses! In any other field of medical practice this would be unacceptable, surely. Why is it not so in the field of diagnosing dying? How many cases of wrong diagnosis do not recover, but succumb? We cannot know because they are dead. And no questions are asked because that is the end purpose and raison d'etre of the pathway, that they should end their journey along the pathway - dead.

It is alarming to observe that the tool which was just pathway is become mentor, signpost and guide. Perhaps, it is on this principle that King's is rolling out Wardware...

Finally, it was announced on the Cambridge University Medical Society Face book page that,

This Friday, Dr. Sarah Steele from our very own Law Faculty talks to MedSoc on the very topical issue of EUTHANASIA.

Following the recent controversy surrounding the Liverpool Care Pathway for end of life care, this is a very relevant talk for Fresher's SCHI exams, and for 2nd years studying law in HR.

Entry is FREE for MedSoc Members, and £2 for non-members. As usual, drinks and nibbles will be provided. 

After the talk why not head over to the Union for the Varsity Medical Ethics debate at 8pm? 

This was last Friday. It is interesting to note that the talk on euthanasia is considered 'relevant' precisely because of the 'controversy surrounding the Liverpool Care Pathway'.

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