Category Archives: Learning

Cancer is not a battle … or is it?

…. at least, not for me.

Using military metaphors when writing or talking about tackling illnesses goes back at least to the 17thc, if not earlier. A study in 2010 found that patients thought physicians were better communicators when they used metaphors when talking about cancer. Only 22% if the randomly selected conversations used military metaphors – surprisingly (for me at least), most metaphors where agricultural. Dhruv Khullar writes that using military metaphors is highly personal and knowing the patient well helps to determine what to say. Carlos D. Tajer wrote an interesting editorial about metaphors in medicine and delving further, the use of metaphors in communication is more complex than I first thought. They have long lasting effects too, as in his example of Ostler and angina (1910) which has imprinted in cultural memory as – it is men who have heart disease (nevermind that females do equally, or more). Metaphors can lead to damage too, as Trish Greenhalgh in a 2010 BMJ editorial writes.

The people treating me didn’t use military metaphors – in fact, they mostly didn’t use any (the only one I got was radiotherapy = sunburn). Perhaps because I’ve had medical issues before or perhaps because I work in a hospital – who can say?


5 Things I learnt as an inpatient

I have been an inpatient recently. I was in hospital for a little over 2 weeks to have a malignant tumour taken out of my face. As well as being an oncology patient, I was also a plastic surgery patient – muscle was taken from my abdomen to fill the cavity.

While I was an inpatient, I couldn’t help observing things:

  • Ward nurses lead very regimented lives at work. Medications, dressings, wound care, and countless other things run to a timetable. There is no time for education. If you want to reach ward nurses, find out what times the handovers are and arrange to have training on the ward or nearby then and there.
  • Nurses have to read a certain amount of papers to reach CPD goals. Nurses also always have their mobiles with them and they use them for work. Why not combine them and show them how to find articles via mobile?
  • Ward rounds with clinicians seem to go faster and faster these days. When I was an inpatient 20 years ago, they were longer but due to more patients and less time overall, many hospitals have restructured ward rounds. When I started doing them in the the Acute Medical Unit at work, there was more time taken and I was asked questions. Then the restructure occurred and no time was given to an educational component. I felt like a spare wheel so I asked a geriatrician how I could contribute in a meaningful way and was invited to take part in the educational lunchtime meetings.
  • Clinicians and other specialists also use mobile phones for lots of things. Did you think the flashlight on your mobile phone was pointless? Not to the ENT and plastic surgeons – they turned them on to look inside my mouth!
  • Nurses take a lot of crap from some patients. Have you seen those advertisements recently about violence towards healthcare staff? When I was an inpatient, an incident occurred that could have gotten scary. A patient was being more than obstreperous and dragging himself around the corridors. After things had calmed down, I asked the nurses on night duty if they were OK. They looked pleased that I asked. Why not do something nice for your nurses today?

These are little learnings I took on board. I am at home now and undergoing radiotherapy every weekday until August 11.  I look forward to doing some more blog posts before I return to work.


TEBM15 – more of what I learnt

I’ve been thinking about TEBM15 lately and how I can use what I’ve learnt in practice. The first thing I aim to do is to rewrite all my lesson plans for database refresher training sessions (due to the changes to Clinicians Health Channel, I have to do this anyway). One of the tips given by a TEBM educator was only teach the essentials. So – what are the essentials in teaching say, Medline via OVID? Is it absolutely necessary to include MeSH? A senior teaching clinician here mentions MeSH in his annual searching session to interns but it is only a small section (and we didn’t manage to go into great detail about it this year). He says it is essential. I’ve included it in the past but I wonder … To put the boot on the other foot – can you effectively teach searching in an EBM course if you don’t know what MeSH is (one of the clinical attendees at TEBM15 said he didn’t know what MeSH was)? Is MeSH too technical, too much jargon? That was another teaching tip – don’t get bogged down in technical details.


What I would like to know is, if you include MeSH in your Medline searching sessions, what place does it have (do you put a lot of focus on it or briefly mention it)? Or if you don’t include it, why not? Is MeSH a technical aspect or an essential aspect? I’m in a inquiring and nosey mood at the moment so please spill the beans!!