A few things I’ve been thinking about this week. The third post of a trio, which may or may not become a regular thing, inspired by Jonathan Rothwell.

Thanks to a leisurely trip on the Caledonian Sleeper this week, I’ve showered on a moving train for the first time. Reflecting on the experience, I think a quick late evening trip up to Scotland to catch the sleeper is probably preferable to those pre-pandemic early mornings when I occasionally had to catch the 0526 to London for a 0900 meeting (and still often arrive late as it only gets into King’s Cross at 0839).

One of the many thankless duties of the most junior of junior hospital doctors is to write a summary of a patient’s hospital admission to be faxed to their GP at discharge. At least it was a decade or so ago, when I was in that position.

On one occasion, I summarised that a patient had been admitted with “dehydration secondary to a diarrhoea illness.” I was surprised a couple of days later to find the GP on the phone to remonstrate with me.

The GP wanted the note to be amended to clarify that they had sent the patient into hospital because of the diarrhoea, not because of dehydration. The dehydration had only been detected on blood tests that I had done as part of the patient’s clerking on arrival at hospital.

My fellow junior doctors and I found this hilariously pedantic: after all, people with diarrhoea don’t necessarily need to be in hospital; people who are unwell with diarrhoea, perhaps because they are dehydrated, may need to be in hospital. It was a distinction without a difference.

In retrospect, the GP was correct about what had precipitated the admission, and was entitled to make their view known given that they had arranged it and knew what information they had at the time.

This experience has been swirling around my head this week because of the media discussion of admissions to hospital ‘for COVID’ and ‘with COVID’, as though the two are completely distinct entities. For most patients, this is patently untrue.

Suppose a patient has been admitted in a diabetic crisis after being thrown off their routine. Suppose a patient has been febrile, a little confused, and has broken their hip in a fall. Suppose a patient’s mental health reached crisis point after months of social isolation. None of these patient needs admission ‘for COVID’—they don’t need antivirals or monoclonal antibodies or respiratory support—but all of their admissions are, at least in part, because of COVID, rather than merely ‘with COVID’.

Many patients in hospital ‘with COVID’ rather than ‘for COVID’ wouldn’t be there ‘without COVID’.

Medicine is rarely black and white.

Wendy and I are both really lucky to live within walking distance of where we work, and also to have a lifestyle that allows us to walk. We’ve both walked for years, and in fact have changed home and work locations and carried on regardless. There’s nothing that clears my mind as completely or reliably as a decent walk.