Specialist GP Nikki Vadgama provides some tips to make your next paediatric eczema consult easier. She includes a review of new guidelines, resources, websites and medications for paediatric eczema management
Life, it’s a bit risky but isn’t that the point
Life, it’s a bit risky but isn’t that the point
![Hokitika backyard](/sites/default/files/2018-10/Hokitika%20backyard.jpg)
It’s time to take a risk. (This is my daily fix!)
We need more risks. Not stupid risks but calculated risks. Risks that challenge us to be smart and to deal with them, minimise them and resolve to get better when our calculation is amiss. It’s called learning from our mistakes.
So, confession time (always a risk). As an eager house surgeon in Bath, I was responsible for the death of a patient. It still hurts me to think of it.
The surgeon, Mr Howard John, had done a massive operation, which started out as an abdominal aneurysm resection, and went on to remove an incidentally discovered bowel cancer and also required a repair to a nick in the bladder wall.
It had actually all gone quite well. Over the weekend, the patient’s urinary catheter fell out and I, failing to see the importance of it remaining in situ, said to the nurse that we’d see if he passed urine OK.
When, on the next ward round, Mr John saw the catheter gone he was not a happy man. I was mortified and went later to see him and apologise, expecting a “bollocking”.
He was immensely kind with words that I’ve carried around ever since: “If you’re not making mistakes Martin, you’re not trying. Now you’ve got your work cut out to try to get him better.”
The patient, a dear man, died 10 days later. I’d learned a big lesson, painfully.
I am always reminding my self: “I won’t make that mistake again, but it’s OK because I have so many bright, fresh new mistakes to make.”
And indeed, that patient in Bath was not the last patient for whose death I was at least in part, responsible, and maybe there’ll be more. If you want doctors who never make mistakes, you’ll have to do without doctors. Being human sometimes sucks!
Calculating risk is factoring likelihood with seriousness. But we also have to consider the consequences of not taking risks.
Let’s consider school children going out on adventure events. It’s physical, it’s challenging and it extends their skills and starts to hone their judgement. But sooner or later, someone will get hurt.
Everyone learns something and life goes on. We take sensible precautions to avoid head injuries, major fractures or death but every once in a while one of these does occur and it’s tragic. It’s usually the consequence of a whole number of factors interacting so that all the holes in the “Swiss cheese” line up.
And yet, would it not be more tragic if we heeded the cry “This must never happen again,” and school adventure trips were cancelled forever, or another layer of ridiculous regulations were put in place.
That particular set of Swiss cheese holes was never going to happen again, but at some other time a completely new set of holes lines up and the cycle of further regulation is in danger of repeating itself.
But living in a “cotton wool society” is probably worse. We live in a time of regulation and litigation where futile efforts are made to make life absolutely safe and the skills of self-care and judgement are allowed to wither.
We should be teaching our kids to manage risk, not avoid it.
I heard some time ago that in Japan, they had replaced soft landing material in children’s playgrounds with hard surfaces – it reduced overall injury rates. I’ve just found a brilliant weblink with this and other similar stories.
Do read it!
And here’s another story, confirmed just this morning in the streets of Akaroa. Sue, a local notable, confirmed the hilarious tale about getting a phone call from “Health and Safety” saying she had acted illegally by hand pruning the roses around the war memorial (as she’s been doing voluntarily for the past 30 years). Why? It was a public space and she was…wait for it… not wearing helmet, ear protection, high-viz vest, steel caps and there were no road cones with notices saying “work in progress”. She just told them to stuff-off and was told she’d be getting a letter.
See what I mean?
(No letter so far. Pity. I feel like phoning the council and complaining that they are not following up with enforcement of their health and safety monitoring.)
Here are a few other photos I’ve enjoyed taking where detail, tones, form and texture please my eye. What risk here you might ask
1. I don’t want to look ridiculous.
2. You’ll think they’re just boring.
3. I’ll be accused of plagiarism (having just seen a small exhibition of something similar at Christchurch Art Gallery).
Hell, what’s the worst that can happen? After all, I’ve spent most of my life looking ridiculous and the sky still hasn’t fallen in.
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