Another week in hospital

Norfolk, October 2011

The wards allocated to me at the moment are tricky, and the patients are time-consuming. I don't know why they should be any more difficult, but somehow they are. The wards also seem less organised, and I trust the nurses less to do the things I need them to do, like ensuring that the supplements and feeds that I prescribe are available to give to the patients when they need them. The patients, as always, are rather poorly. There is, however, a much larger proportion that are able to speak, and a significant number that actually recover enough to come off tube feeds and supplements.

The clinics remain my favourite part of the week, and I can now add Russian and Polish to the list of languages spoken by patients that have needed interpreters in my clinic. None of us has yet earned the certificate and medal for a full clinic with no DNAs. In one clinic (not mine), there were just two patients, although at least they both turned up.

We have had some input from the Dietitians working in the morbid obesity service, describing what they do and the thresholds and criteria for referral and for surgery. The thresholds are pretty high to be eligible for surgery, and the waiting list is long. They expect to carry out between 100 and 150 bariatric operations during the year. We asked whether patients in their clinics are successful in losing weight, and the answer without hesitation was, depressingly, "no." I am not sure whether they meant patients who have surgery or those who don't.

There has also been an employee 'Wellbeing' event, where various stands were set up to publicise various health-related services to staff in the hospital. I volunteered to cover the dietetic stand for the Community Dietitian, for just a couple of hours while she was at a meeting. Among the stands describing counselling, orienteering, catering and much more, our little stand was in a cluster next to two gorgeous squaddies advertising British Military Fitness courses on one side (outdoor fitness training military-style) and Health At Every Size on the other side.

The HAES program originated in the US but has been taken up by a local Dietitian whose research contradicts established wisdom (aka evidence-based opinion) on weight reduction. She suggests that dieting has been proven not to work - the vast majority of those who lose weight gain it again shortly afterwards - and yo-yo dieting often leads to gradual increase in weight over time. So the HAES approach is to address the person, their self-worth, happiness and general health, and let the weight sort itself out once people start to appreciate the barriers to change that they face in their particular and individual circumstances.

I can certainly see some value in this approach, and can imagine pointing some people in their direction - people who are simply unable to lose weight by conventional means (eating differently) and are not likely to be helped by three-monthly appointments of 15 minutes with a well-meaning but ineffectual Dietitian. The other attraction to the HAES stand was their scales, which were covered in pink fluffy fabric and had descriptions rather than numbers for your weight: 'Hot', 'Ravishing', 'Beautiful'.

What else this week? Badminton, watching DVDs from the sofa, Lola II visiting last weekend and The Boy this weekend. I have had a cold developing since Saturday. We went to the Falconry Centre yesterday, the first genuinely warm and sunny day since May, and I am now rather pink, mostly on one side.