Synopsis "A Face To Meet The Faces: Posts from the Illusions Of Autonomy blog"
This is the third collection of blog posts to be published since I started writing regularly in August 2012. The title of this book, A Face to Meet The Faces, represents a change of focus. I am interested in describing the workings of the medical mind - all the ticks, clicks, springs and processes that are engaged before the first word is spoken to a patient. I do not suggest that the face we present is insincere, but it is professional, and it will not express our every thought. Occasionally, as Dev finds in 'The good in him', those processes result in an entirely wrong impression being given to those whom a busy doctor is trying to help. At other times our usual natures and inhibitions are challenged by special situations, and we find ourselves 'Making deals' (with patients who wish to self-discharge), or dancing along the fine line between treatment and bodily assault ('A rare and unpleasant duty: involuntary treatment and the deprivation of liberty'). Those normal natures can render us susceptible to pride ('Diary of a medical anecdote', 'Hollow Heroes'), expediency ('The perils of reassurance') or paralyzing timidity ('Being comfortable with uncertainty'). Elsewhere, subjects have grabbed my attention randomly (the Hurricane Katrina healthcare catastrophe for instance), or I have reacted to observations in the media ('Bed X'), or to important policy developments (such as changes in organ donation). The core preoccupations that fuelled the first two collections - end of life care, autonomy, resuscitation decisions, the Liverpool Care Pathway, medical futility - are still represented (Replacing the LCP, Notes on a judgment). A new feature is the 'ethical adventure' or Interactive Ward Ethics section - a role playing, decision making exercise inspired by the Fighting Fantasy books I read as a child. The reader is asked to decide, on behalf of the well-meaning and conscientious young doctor Nina, what to do in a variety of challenging situations. There are three in this volume, and the idea is to roam vicariously through the actions of a sometimes luckless substitute! It can do no harm to illustrate how we sometimes struggle to accommodate the emotional dissonances encountered in healthcare, although I do not pretend to set out solutions. The first, most important step, it seems to me, is identifying the challenges. I hope this collection of articles serves that purpose.
