Saturday, 16 November 2013

Liverpool Care Pathway - The Bee Wee Tool

You don't throw the starfish stranded on the shore back into the water. That goes counter to all Communitarian thinking.

It really is true to say that the judgement call is always: If this one can be brought back from the brink...

The starfish may be stranded on the shore but you still throw it back into the water.

The tool may determine the generality but the laws of probability cannot be applied with such detached and clinical precision such that the individuality of the individual is ignored and denied.

Bee Wee and others are determined to develop prognostic tools that may determine life expectancy. Her latest offering is published in the Journal of Pain and Symptom Management 

The submission describes the development of a prediction tool to determine survival time using a Prognostic Scale for Chinese patients.
In conclusion, it is possible with this prognostic scale to guide physicians in predicting more accurately the likely survival time of Chinese cancer patients, and to help policy makers in establishing appropriate referral for hospice care.
The stated purpose and raison d’ĂȘtre of the tool is to provide for early referral for palliative care. Bee Wee and her EoLC cronies want to catch them early to wind them down.

The nets are being cast to trawl them in for EoLC. The tools to supplement the GSF and the younger upstart, the SPICT, are in development. We have come a long way since the Barton Method was first applied at the Gosport Memorial.

ESRC - Dynamics of Cardiovascular Ageing
New tools are being devised.

The ESRC (Economic and Social Research Council) funds research which "has an impact on business, the public sector and the third sector". That's interesting. 

The ESRC made funding available in 2009 - for research into the dynamics of cardiovascular aging.

2009... That's very interesting.

2009, the year of the End of Life Care Strategy.
The aim of the research is to establish whether physiological aging can be assessed, noninvasively, by the analysis of cardiovascular signals, eg oscillations in blood flow.
This is taxpayers' money. This is the hunt for the to-die-for tool that has to be on every EoL to-die-for Xmas list! The patents are already taken out. This EoL tool will be ready to go in less than three years to add to the EoLC armoury.

This is excellent news and will go far toward securing the NHS "now and for future generations" by eliminating those costly hospital admissions. This is like the wait for the next-generation PSP or X-Box. Your GP's can't wait to tool themselves up.

It sets Loren Eiseley's anecdotal tale in a whole new light...
“While wandering a deserted beach at dawn, stagnant in my work, I saw a man in the distance bending and throwing as he walked the endless stretch toward me. As he came near, I could see that he was throwing starfish, abandoned on the sand by the tide, back into the sea. When he was close enough I asked him why he was working so hard at this strange task. He said that the sun would dry the starfish and they would die. I said to him that I thought he was foolish. there were thousands of starfish on miles and miles of beach. One man alone could never make a difference. He smiled as he picked up the next starfish. Hurling it far into the sea he said, "It makes a difference for this one." I abandoned my writing and spent the morning throwing starfish.” 
― Loren Eiseley

Morally and philosophically, it alters nothing. The focus is always on the starfish in front of you. You concentrate on one patient at a time.

Applying this story to medicine

For many - hopefully, most - doctors, clinicians, this story surely harmonizes with the motivations that led them to follow their chosen profession. This story  inspires an already active desire to not just act the Good Samaritan to the fallen traveller but to actually provide the support and the means necessary to aid their recovery and restore them to health.

It is also true that, in non-apologetic denial of their attitudes to their calling, they adopt a detached and emotionless view that all is science and function and process. They may pay lip service to holism, but it is without soul, without belief, and the solemn duty to do no harm.

Further reading -
Liverpool Care Pathway - The To-Die-For Tool

Liverpool Care Pathway – Communitarian Inevitabilities

Footnote -

The EoLC programme was developed from consultations with PCTs on financial expenditure going back to 2007. In November 2008, the DoH launched a consultation on end of life care. The consultation closed in February 2009.

Anecdotal footnote -

Dr Henry Mannings, formed Star Throwers at a former GP surgery in the town, three years ago to provide more support to cancer patients and their families.
However, the charity’s future is in doubt after a complaint was made about the NHS-registered doctor to the General Medical Council (GMC) surrounding his treatment of two patients.
An Interim Orders Panel (IOP) of the Medical Practitioners Tribunal Service (MPTS) placed conditions on Dr Mannings’ ability to practise at a hearing on Tuesday, whilst an investigation continues.
One of the 18 month-long conditions is that he must confine his prescribing to posts within the NHS and not prescribe any medications in private practice.
It comes after a consultant made an allegation that Dr Manning gave chemotherapy to two patients with terminal cancer without authorisation.
The treatments relate to Rachel Lane, 27, and Thelma Dowsett, 78, who both died last month. However, their families have praised the treatment received from Dr Mannings and Star Throwers and said his help had extended their loved ones’ lives.
Star Throwers, an independent advice, therapy, and drop-in centre in Melton Road, Wymondham, was established in late 2009 by Dr Mannings, who has worked for the Norfolk and Norwich University Hospital in Norwich and the James Paget Hospital.
The James Paget? We all know about the James Paget. Sir James Paget must be turning in his grave! Elder abuse. Staff disciplined. An arrest which came about because someone blew the whistle. 

Bee Wee et al would take a dim view of Dr. Mannings. You don't treat the patient in front of you. They are not about extending life but winding life down. Their watchwords are futility and best interests.That's the Communitarian way.

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