The fourth episode followed doctors at Great Ormond Street Hospital (GOSH) as they deal with some of the most difficult decisions in medicine.
The programme highlights that while technology can keep the body alive, it may not always be the best thing for the patient and family.
In this exclusive interview, Colin Wallis, Consultant in Respiratory Medicine, talks about technological advances in respiratory medicine and decision-making.
How long have you worked in paediatric respiratory medicine?
"I’ve been at GOSH since 1992. This was my first consultant post in paediatric respiratory medicine, having worked in general paediatrics previously."
What was it like having documentary makers involved in your consultation with and care of patients?
"It was difficult at first and it did take some time to get used to. Sometimes you were worried that it might influence the consultation having an outsider there. But in fact, I think that over time I became less and less aware of them being there and we just carried about our normal business.
"It was credit to the documentary makers that they were able to blend into the walls as you’re trying to have difficult conversations, so I think that they were very sensitive to these matters."
In what way has the field of respiratory medicine changed since you first started practicing?
"I think one of the big things is that we now have the facility in respiratory medicine to provide and support home ventilation. Some of those children are ventilated via tracheostomy, others receive support while they are sleeping at night time through a mask.
"But certainly, the introduction of non-invasive ventilation in the case of the mask, has made a huge impact. In 1992, I think we only had 3-4 children who we were ventilating at home and we now have 200."
What are the risks involved with home ventilation?
"It is very disruptive to families so your family life changes forever. There is a significant impact on siblings, holiday plans, and the privacy of your home is gone with the presence of carers. Also, what pets you can choose, what kind of house you can live in, where you can live - all these are affected by the need to ventilate your child at home.
"However, ask any family and they would much rather have their child at home than in hospital."
Where do you see paediatric respiratory medicine going in the future?
"I see home ventilation and non-invasive ventilation becoming an increasing part of paediatric respiratory medicine.
"I do think however, that we are going to have to look very carefully at how far we take this technology, because there is a temptation to say because we have it, we will use it. And it’s not always in the child’s best interests.
"But the other thing is that we have to find out a way of getting the children home quicker, as they are tending to languish in hospital and there are various reasons why this happens.
"I think relationships with the community have got better, but I think there is a need to get protocols in place and to help ensure a general acceptance that this is a reasonable thing to do and is done fairly often. We've done it over 50 times, maybe 60 times from this hospital, and it seems a pity that we need to reinvent the wheel each time.
"But it is a fraught business. It's extraordinary what we’re doing really when you think about it, and we can’t get too blasé. It’s a high-risk business."
Read part two
Read the second part of our interview with Colin Wallis as he talks about decision-making processes.
