This category includes posts that discuss a particular clinical issue such as unconsciousness, pain, or spasticity
First published: November 24, 2025 Last updated: November 23, 2025 In What is a diagnosis? Part 1, I explained that diagnoses can generally be divided into biomedical diagnoses supported by observable features that can be independently verified, and syndromic diagnoses based on specific collections of symptoms without independent observable features. Neither category has a complete, […]
What is a diagnosis? Part 2 Read More »
First published: November 14, 2025 Last updated: November 14, 2025 How can we tell when something is wrong with us? In a popular post (6,800 views over four years), Disease, illness, sickness, and disability, I discuss different ideas related to being unwell. I did not explain how someone knows they are unwell. The answer might
Biopsychosocial disequilibrium Read More »
First published: November 6, 2025 Last updated: November 6, 2025 In January 1781, The London Medical Journal published a 19-page review of a book written by Dr Tiffot, a member of the Société Royale de Londres, entitled Traité des Nerfs et de leurs Maladies. (Treatise on the nerves and their maladies). Since then, malady has
First published: August 31, 2025 Last updated: 31 August 2025 In 2025, in two cases of disputed clinical decisions made for people lacking capacity, the clinical decisions were overturned by judges in the Court of Protection. On 15 May 2025, Alex Ruck Keen commented on the first case, [2025] EWCOP 17 (T3), in a post
Holistic best interests in court. Read More »
First published: March 27, 2025 Last edited: March 27, 2025 The patient had previously been active intellectually, creatively, physically, and socially; after his ischaemic brain damage a year ago, he was left requiring 24-hour care, with aphasia limiting communication. While discussing his future, his daughter mentioned the magnitude of his losses and how it would
Social participation and rehabilitation. Read More »
First published: February 22, 2025 Last updated: February 22, 2025 I have been assessing patients with disordered consciousness since working in neurosurgery in 1976. Initially, most patients were people who soon recovered consciousness. In 1986, I became responsible for the Oxford neurological rehabilitation service at the Rivermead Rehabilitation Centre and, in 1988, community patients at
PDOC clinical features Read More »
First published: February 10, 2025 On 6 February 2025, three speakers at a seminar organised by COPPA (the Court of Protection Practitioners Association) considered “Withdrawal of treatment applications in the Court of Protection for patients in PDOC”. While preparing my talk, I published a blog post on being a prolonged disorders of consciousness (PDOC) expert.
Prolonged disorders of consciousness (PDOC) services Read More »
First published: January 12, 2025 Last modified: January 12, 2025 Recently, I saw a patient in a care home to give a second opinion on rehabilitation needs, and the team gave me a detailed report on their observations. I read the 15-20 page report, which included standardised assessment and personal observations. One colossal omission struck
Knowing the patient. Read More »
An expert in patients with a prolonged disorder of consciousness (PDOC) will give evidence to a court
Being a Prolonged Disorder of Consciousness (PDOC) expert Read More »
First published: November 21, 2024 Last modified: November 21, 2024 I have agreed to talk, on 6 December 2024, to medical trainees about Acquired Brain Injury rehabilitation. I decided to write a post to help me set out six principles, but as I wrote this post, I realised there was a gaping hole around the
Acquired Brain Injury rehabilitation Read More »
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