1554 GMT Like many doctors, I have to put aside time for administrative work. This includes discharge letters to GPs, and reviewing pathology results. I have a pile of referrals from GPs asking for outpatient appointments and I review and prioritise each one of these.
This morning I received a large package from the national confidential inquiry into perioperative deaths. I am the local reporter for these deaths which occur within 30 days of surgery. It's important that we participate in these studies in an open atmosphere.
The current documentation relates to a new study on who operates on patients and at what time of day or night. This is important because we feel more cases are being done out of hours by junior doctors as a result of limited daytime resources.
But at all times, patient care takes priority. My senior house officer has just popped in to my office to discuss management of a patient with a bleed in his brain. I have told him to contact the neurosurgeons in Belfast.
It's likely to be a slightly earlier finish than usual for me today - it will feel like my birthday. That could be because - it is!
A: from Mr Colin Weir It is not my experience that consultants are rude to other staff, or to patients. In the current climate patients demand a lot more information from the doctor, and rightly so. We have a duty of care to patients and this includes polite behaviour. The General Medical Council include this as one of he basic duties of a doctor. Q: from G Martin, EnglandWhy are hospital consultants so rude and aggressive towards patients? I have experienced aggressive nursing staff, including practise nurses, and pharmacists. 1335 GMT Just had lunch with a couple of colleagues. We go to the staff canteen - there is a consultants' dining room but I find it too elitist. Going to the staff canteen means I can meet junior doctors, nurses and other specialists.
It is often a good place to discuss any problems individuals are having - and it's also a good way to relax. Then it's to the intensive care unit to catch up on a couple of patients. Although a lot of the management is done by the ICU doctors, they always value ongoing surgical input to patient care.
The patient I spoke about earlier who had a leaking aneurysm, was seen. After discussion with IC staff we feel he is making good progress and should be out of the unit within a few days.
A: from Mr Colin Weir I agree with Mr Newton that there are not enough places in the community in general for such patients. As you may be aware, bed blocking is a serious problem. At times we would have 10 patients occupying beds in the acute surgical unit. These patients no longer require our skills but because of a lack of funding, they take up valuable space needed by more urgent cases. Q: from Ian Newton, EnglandWhy are there no convalescent homes nowadays? I will admit they used to be miles from anywhere but we did not have such things as bed blocking like we do today. Also, why does the government not build more old people's homes? Why are the elderly forced into private nursing homes that they cannot afford? 1045 GMT On the ward with the third-year medical students, we see a patient who was in intensive care last week. We discuss aspects of his management, and talk to the patient, who was featured in Peter Gould's in depth profile - suffering from the flesh eating bacterial infection.
We discuss how to recognise the condition, how it is treated, and aspects of wound care as this is the patient's main problem now. We also talk about his colostomy and the students are taught how to recognise various types of colostomy and their uses. Then it's off to the tutorial room for a brief session on aneurysms (widening of the arteries in the abdomen).
A: from Mr Colin Weir I agree that private practice should not be the focus of your appointment as an NHS consultant. However, I feel that there should be some latitude given to allow new consultants to do private practice. First because the demand is there, and I feel that takes a little amount of pressure off NHS resources.
Secondly, young consultants may feel they are entitled to some financial reward. Indeed, newly appointed consultants may be earning less than they were as senior trainees. However, in Northern Ireland there is not quite the same emphasis on private practice, so it is not such a big issue here.
Q: from Chris Kerr, England Do you think the government's attitude towards the new consultant contract and the proposed private practice ban is going to convince many young surgeons who are about to start their careers as consultants, to stay in the NHS, or leave it altogether ? 0829 GMT This morning I have a group of medical students to teach. We'll be going on to one of the wards to teach on a suitable patient. Then further teaching in a tutorial room.
After that I usually try to grab a quick cuppa -it's going to be a long day.
Then I will be doing a ward round. This is a daily review of all the patients under my care. I have to say not every consultant does this every day, but I feel it is an important part of planning treatment and review of patients.
I find if I do this myself, then hopefully all the right decisions are being made. It is also very useful for training the junior medical staff. If there's time before lunch I will visit the intensive care unit.
I had been on leave earlier in the week. I've been told this morning that a patient awaiting urgent surgery had been admitted at 1am on Tuesday with a leaking aortic aneurysm. This required emergency surgery as it is a life-threatening condition. More resources would have allowed us to have operated on him electively - which means under controlled circumstances. This would have prevented us facing this emergency, with the increased risks to the patient.
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