Posted by: Witch Doctor | September 5, 2010



A long time ago, when The Witch Doctor was a medical student, there was someone in her year that she didn’t like very much. Once she qualified, she found that she was working in the same hospital as this person although not in the same unit.

It came as no surprise to her that this doctor she didn’t like very much, identified a vast group of patients called “Old Crumbles.” He did everything within his power to guard against “Old Crumbles” entering his ward on receiving days. He did this by being patronisingly rude to any GP who phoned him asking to admit a patient who might meet his definition of an “Old Crumble.” Since most of the GPs knew their patients pretty well and were much more experienced than this green behind the years Junior House Officer, they generally were able to deal with his rudeness and their patient was eventually admitted to the ward.

It is not clear exactly what kind of patient was classified as an “Old Crumble.” Since this JHO was in his early twenties, he may have considered that anyone over 50 came into this category. On the other hand, confusion, hemiplegia, incontinence, inability to feed oneself, and multiple pathologies may have been necessary to meet the “Old Crumble” criteria. Or an “Old Crumble” may have been any patient who was likely to block a bed because it was difficult to discharge them home again.

The Witch Doctor found the term “Old Crumble” offensive. It was probably because she would not have liked her grandparents or parents or herself for that matter, referred to as “Old Crumbles”

It would be very politically incorrect nowadays to refer to patients as “Old Crumbles”

However, there is still a problem if patients who “block beds” are admitted.

The Oldest Sage Witch’s Highland Granny has just been caught up in a new way of dealing with patients so there is no bed blocking.

She was made to walk along a “Patient Pathway.”

Sometimes it was called a “Patient Journey.”

These pathways and journeys tend, if possible, not to have a hospital ward as the destination. They are also involved in keeping clinic waiting times down.

This, of course, will lead to a good “Patient Experience”

And a very good thing too!

Now I have no idea what exactly is bugging the Oldest Sage Witch’s Highland Granny, because she writes a lot of her telegrams in “The Gaidhlig.”

Nor can I explain why terms like “Patient Experience” or “The Cancer Journey” or, at the end of the road, “The Liverpool Care Pathway” or if patients slip through the net into the wards “The Rapid Discharge Pathway” annoy me every bit as much as the term “Old Crumbles.”

But they do.

They do.

No reason.

They just do.

Some day, I’ll maybe work out why they do.

And if I do, I’ll tell you.


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  1. […] They would just enforce it on The Old Crumbles….. […]

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