Another day gone by. Determined to do more, but keep putting things off. Gets frustrating as I know my time here is limited. There will be lots of regrets eventually.

Trying to push things forward, have great hope for the Exeter Respiratory Innovation centre http://eri.org.uk. #eri. It will however require a lot of work. We need a pathway for new projects, and a continuing conversation with all respiratory departments in the regional hospitals.

The web-site is available, just needs maintaining with new information as it comes in.

There needs to be a small group to verify and validate projects before they get added to the web-site.

Getting some pain relief

 At last I‘m getting some pain relief for my back. Taking Codeine - just 15mg a day at the moment, and it does seem to be relieving things. 

Had a great meeting yesterday with Daisy Campen and Gina Awad about getting some University student support for the work she is doing - with the Cosy Routes and anything else.

On Saturday went over to Laura Wall in Teignmouth where I was able to buy one of her prints and several bottles of Christmas gin - for presents I might add. Had lunch at The View. 

I‘ve had a lot more energy in the last days. Getting little things done.

Just had an invite for another Arena Session with Chris Scotton, Sarah Lines and Prof. Gibbons. I hope it brings some benefit - won‘t be until February or March. I think I‘ll have to practice what I‘m going to say.

Going to the burial of Meg Leng on Friday. It‘s at a natural burial ground near Totnes. Not a church or religious ceremony. Will be an interesting experience I think. I wonder whether I‘ll be ok there. Sounds like it might be a lot of standing.

Have a session with physio-therapy next week.

Extending the concept of the MDT into the day to day management of complex medical care.

Currently there seems to be a division between the role of the GP and the role of the specialist consultant.

Where a patient has an ILD condition, eg IPF, this may lead to a heart condition or, depending on the medications involved, possibly a liver or kidney condition. Each of these will be managed by different consultants, and so far as I can see, there is not always a huge amount of communication between the disciplines. It is also, more significantly, not clear which of these consultants should be the ‘lead’ contact point for the patient when faced with a change in symptoms, or a deterioration in condition.

Logically you would think it should be the GP who is managing the interactions and who should be the primary contact point for the patient.

This is turn raises the question of whether, for complex cases, there should be a single doctor or senior nurse, who effectively is a ‘named’ contact for the patient.