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Br J Gen Pract. 2007 December 1; 57(545): 1012.
PMCID: PMC2084128

Decerebrate rigidity

Two stories to finish with: recently an old colleague was called into our community hospital with his wife because her elderly mother had just been admitted there and had immediately become acutely distressed. The story was that on being greeted with the now-compulsory, ‘Hello Mrs X do you want to be resuscitated if you die?’ she had flown into a panic of anxiety because, like so many other patients in the same situation, she couldn't decide whether to say yes or no. It was indeed the first thing she had been asked on admission and needless to say the person who asked it hadn't been allowed by ‘the rules’ to give the slightest hint of advice on how to answer.

So, after arriving and taking in this situation my friend had an inspiration. He called over the nurse on duty, who happened to be someone both he and I have worked with for many years and enormously respect, and asked her, in front of his mother-in-law, ‘Could you tell me how often resuscitation is successful on this ward, Carol?’. ‘Yes,’ she said with her winning smile, ‘in the 25 years we've been open I don't think we've ever resuscitated anyone.’

Story number two took place in another and remote part of the country and also concerned an elderly patient, this time one being cared for at home in the terminal stages of an illness which was associated with respiratory distress. It was the weekend and the dispensary was closed and the nurses had run out of hyoscine for the evening injection. A solution appeared, however, in the shape of a GP with an ampoule of hyoscine in his bag, although, as he explained, one a little past its expiry-date. Of course the nurse gave it and the patient passed a peaceful night, waking in the morning grateful and at least temporarily refreshed. That would have been fine except that there had also been a second nurse present who felt it her duty to report her colleague for giving ‘an out-of-date injection’. The latter found herself hauled up before her non-nursing superiors and given a severe reprimand which caused her, as you can imagine, a great deal of distress.

Now, I think these are both examples of the same sort of thing and I think it is high time it stopped. It has gone on long enough and the arguments have been rehearsed until nobody has any excuse for being unaware of them, even non-nursing superior nurses. It is not just an amazing coincidence that expiry dates on ampoules of drugs are often exact whole numbers of years from the corresponding dates of manufacture — they are obviously approximations. Equally obviously they must incorporate a large safety margin. To imagine that life-saving drugs turn into poisons on the stroke of midnight, like Cinderella's coach, is childish stupidity. If anyone is worried that courts will use this sort of half-wit notion to condemn conscientious practitioners who are putting the real interests of their patients first, then it is high time the professions guaranteed to stand by their workers at the coal-face and face down this sort of ignorance, not foster it.

Nor of course am I just talking about nurses, who number among them some of my favourite people in all the world. And nor am I just talking about expiry dates and daft resuscitation consent procedures. The fact is that this sort of rigidity is marching into all walks of life and all the professions. And this is important because if we wish to remain fit to call ourselves professionals, in the sense that doctors in particular mean the word, we have to continue to work to brain and not to rule.

And if anyone asks, ‘yes, but would you give an out-of-date drug to a member of your own family?’ the answer is, yes, I gave some slightly-out-of-date amoxicillin to my wife last week, just before she went to America to visit that branch of her family. And yes, I am still registered, perhaps this is the reason. So come on, someone from the strange and distant land of decerebrate rule-followers, make my day.


Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners