Dentists miss the target

William Kelly, 43, extracted part of his own tooth, leaving a black stump.

There are a few crooked, dishonest dentists in the UK. Some claim fees for inflicting unnecessary dental treatment on unsuspecting patients; others take a more simple approach. They claim for work they have not done. The latter is less painful for the patient, but I will leave you to judge the degree of moral turpitude of each course of action.

There are some crooked doctors, ranging from the criminally insane Shipman to the more prosaic consultants who are on Harley Strasse when they should be in their NHS Clinic. There are also, I daresay, some crooked Scottish architects, and some crooked Irish accountants.

It takes all sorts.

But I will let you into a secret. The overwhelming majority of British dentists are decent, caring, and hard-working. Yes, they want to make the best living they can, but only by providing decent, ethical, professional treatment for their patient. It is becoming impossible to do that within the NHS although a fair number have tried. They have taken a cut in income and stayed in the NHS because they are committed to the principles of the NHS.

Note the word “professional”.

The government does not trust professionals and so has tried to control them. It seems now, as reported in The Times today, that dentists who have stayed in the NHS, who have bowed to the government control freakery by accepting a contract with target based payments, have not been able to meet the targets and are now faced with repaying tens of thousand of pounds. Serves them right, the idle sods, you may say. They should have got off the golf course and back into their surgeries.

It is not like that. I hold no brief for the dentists but, I can assure you, it is not like that. Remember what I said;

“The overwhelming majority of British dentists are decent, caring, and hard-working.”

Government targets have pushed them towards working unethically. Towards working unprofessionally. They will not do that. The Times quotes a dentist who says:

“If a patient comes in and needs more than two crowns, it costs me more to do the work than I get paid. So there is a temptation not to do the things that need doing. There is a huge potential for supervised neglect."

This government has done it to the doctors; it has done it to the teachers (see : “Life after the job from hell" ); it has done it to the lawyers (see : "Half the Cost of a no frills meal"); so I suppose it is only fair that it does it to the dentists.

But ask yourself this. How many of these NHS dentists, faced with financial disaster, will still be working in the NHS next year?

Answers on a post-card to Patricia Hewitt.

Meanwhile, across the Atlantic, Fulloseous Flap is appalled by what he calls “socalized dentistry”. Read his posts. You may not agree with him. But that is how he sees UK dentistry. Is he wrong?

The BritMeds 2007 (17)

A huge number of recommendations this week, the largest ever. It was another bad week for MTAS and MMC. When will it end?

But first the other news, and where better to start than with Dr Grumble. Or, to be more precise, Mrs Grumble

“So it was a very real surprise when yesterday Mrs Grumble announced to Dr Grumble that she is thinking of voting Conservative. As far as Dr Grumble knows, Mrs Grumble has never ever voted Conservative before.”

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OK, now it’s competition time. Your task is to watch this video without laughing:



Did you enjoy that?. It is not a spoof. It is for real. Honestly.

So what does Dr Crippen say to Andy bloody Burnham? He says get your arse round to the family described below, and explain to them precisely why this man cannot have treatment that is available in the USA, throughout Europe and in Scotland. Treatment that is also available to any English patient who can afford to go privately. (See a Tale of Two Cancers)

On the 27th April 2006 my husband was diagnosed with Lung cancer our world fell apart. You hear people being diagnosed with cancer everyday but when it happens to someone you love it turns your whole world upside down. He has been through months of chemotherapy and weeks of radiotherapy. A follow up CT scan revealed that the primary tumour has not grown but we do not know the impact of the radiotherapy because there is so much scarring around the site of the tumour. It showed however that he has smaller tumours which have progressed. We asked for the Drug Tarceva which is being used to treat patients with NSCLC.

We were told we could not have it unless we paid for it.

Full story in Action4LIfe

And when you have done your visit, Andy, perhaps you would ask your mate, Andrew bloody Dillon, the Chief Executive of your obedient quango NICE, to pop round to the house and explain why he is so keen to paper over the cracks in lung cancer treatment by funding the silly bloody “lung cancer nurse specialists” who pat patient’s hands during their unnecessarily short “journey” through their lung cancer, but is not prepared to fund Tarceva.

Commissar Dillon CBE : click on photo for full bio

They don’t have cheapo-cheapo “lung cancer nurse specialists” in France, Andrew. They have Tarceva. French patients with lung cancer have longer journeys through their illness. I wonder why that is Andrew? And Andy? (See Defrauding lung cancer patients)

Answers on a postcard to Lung-cancer : action4life, please.

I would not want anyone to think that Dr Crippen is fulminating with anger about this issue. And deeply ashamed. This is not the sort of NHS in which I wish to work.

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Bloody, whinging, whining junior doctors. It is all your fault. Add you onto the lazy GPs, the fat-cat, swan-eating, port-swilling, golf-playing consultants and those useless nurses, and you can see why the NHS has failed.

It must be true. My Lord Warner says so.

Lord Warner, has launched an extra-ordinary attack on all those who work in the NHS. He cites "productivity" issues and resistance to change within the NHS as the major causes for the failure of Labour's investment programme and programme of reform.

Read it all in : You got us in to this mess. You get us out of it.


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Rita Pal is on the warpath:

I therefore say - Strike me off GMC. I believe if I am struck off I will be free from the sword of Damocles that hangs over my head everytime I write something. I often wonder what the GMC and its cohorts think it will achieve. I certainly will never stop writing and neither will I stop exposing matters of importance to medical regulation.

and then, later in the week, it gets worse:

Spanish Inquisition Part 2 - GMC Extracting Confessions

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GPs earn £250,000 a year, work a thirty hour week and delegate most of their patient care to nurse practitioners.

Really?

Dr Rant looks at “Myths and Truths about your GP”

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The NHS computer fiasco: why do governments keep wasting such vast amounts of money?

Why do governments keep on wasting money on this spectacular scale? Because no one is truly both a) in charge and b) accountable. When Marks and Spencer was adrift and losing market share, the chief executive and many others got the sack and their reputations were damaged. No one has publicly got the sack for this vast waste of public money.

The Welfare State We’re in explains.

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Parents who give alcohol to children aged under 15 should be prosecuted, a charity has said. The call comes in an Alcohol Concern report on the government's Alcohol Harm Reduction Strategy.

The DK probably, on balance, does not altogether approve.

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‘Talking to Patsy’

Aphra Behn has been sending her some questions:

It is surprisingly hard to write a question which she cannot answer with “because I said so” or in some other blustering and flannelly way. I’ve tried “how can 6,000 hours of specialist medical training for a consultant be an improvement on 30,000 hours?” but she will burble on about assessments and better quality of training.

More here

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You are 7500 times more likely to be killed if you visit your doctor than if you meet a gun owner. Guns are dangerous and must be controlled by law, in my opinion. But if doctors are so dangerous, who controls them?

Read it all in “Doctors are more dangerous than gun-owners”

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Hospital Phoenix has retired from blogging – again. Did he jump or was he pushed?

We all wish him well, wherever he is.

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More cobblers from the Nursing Times

Heather wrote yesterday about some woo-like nonsense published in the opinion piece of the Nursing Times. Basically, the article said that obese patients were the cause of nurses back injuries. It was one of those wonderful articles that the print media so love. It had the air of self evident logic and attacked the current social demons (fat people). I am surprised it hasn’t been syndicated out to the Daily Mail (etc).

Bad Medical Science

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Adults have started bullying allergic children

It seems that direct bullying is not sufficient of a burden for some school-children with allergies, they now have to cope with indirect bullying from the parents of children who don't have allergies. It is particularly nauseating that some of these parents seek to cloak their bullying and viciousness in a defence of civil liberties.

There's an absolutely horrifying article in the current issue of Child Magazine about the food fight now raging between parents of children with life-threatening food allergies and parents of the allergy-free. The latter, apparently, have started to push back against "peanut-free" school regulations to assert their children's natural right to eat whatever they darn well please.

Full story here

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"Employees who smoke must be given time to attend clinics to help them to quit during working hours without loss of pay. NICE claims that the proposal will cut the £5 billion annual cost of lost productivity, absenteeism and fire damage caused by smoking. It believes that a business with five smokers could spend just £66 on providing advice, including the cost of lost employees’ time, and see an overall saving of around £350 in improved productivity."

"Either they've got the most extraordinary sauce, or they - a bunch of unaccountable tax-funded quangocrats - genuinely believe they are in a position to offer useful advice on boosting profits to businesses whose very essence is making money. Could anyone be that stupid?"

See : Class Dunce Gives Another Lecture

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Before I start this little rant, I want you to know that I am no Kate Moss. I’m a UK size 16 and although I used to have terrible eating habits throughout school, I try to eat a balanced diet now. There are days where I’ll eat a junk snack or chocolate bar

Twisted Barfly looks at Junk Food & Obesity

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And it was all yellow…

I was enormously angered by Prince Charles despairing of his subjects as a pill-popping nation: “I suppose the concept of being able to pop a pill that claims to solve your problem without you having to actually do anything is enormously attractive - an easy way of avoiding boring exercise or whatever,” he said in an interview with Esquire magazine.

Emily will not be asking HRH to help with her post-natal depression

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Moving on, we have noticed, here at the Ambridge Surgery, that there was a definite upsurge in “The Madnesses” over the past couple of weeks. Literally two of our long term but stable psychotic patients chose this past hot spell to drop a few of their collective marbles of their respective trays, to end up in need of hospitalizing. And there’s a whole couple of others who are simmering under.

They are all going mad in Ambridge

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Dr Rant takes a look at patients.

A simple rule for heartsinks is that if my heart sinks when I see a patient then it’s probably my problem. If I find that all my colleagues have the same reaction to the patient then the patient has a problem.

See : The patients are not the problem

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Who is the “most popular thyroid doctor in the country”?

An odd title, if ever there were. Apparently, it is Dr. Durrant-Peatfield who treats hundreds of patients, focusing on thyroid, adrenal and chronic fatigue problems, and has been the doctor of last resort for thousands of patients throughout the UK and Europe, who had given up hope of ever recovering from chronic illness.

Unfortunately, he is up in front of the GMC (again) as his treatments are unconventional.

It is all in: “Witch-Hunt in the United Kingdom -- The General Medical Council vs. the UK's Most Popular Thyroid Doctor”

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David Bradley’s friend was worried about HRT:

Either way, the recent Lancet paper, which received lots of media attention, got her all hot and bothered. She’s an earlier finisher, and is likely to be on HRT for ten years or so, is that going to mean she will get ovarian cancer. The tabloid hype surrounding the paper would seem to suggest so, but as with all statistical health studies that get pounced on by the media it’s worth taking a closer look.

Should you worry about HRT and cancer? Sciencebase has the answers

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A brilliant article on government micromanagement of the NHS, and the story of an experienced consultant coming to grief and taking early retirement.

But as we know, whereas he once had authority over the clinics, and the space to exercise that authority, his job gradually became a classic meat sandwich. He lost authority over vital areas, and instead picked up the vast new burden of central government testing. He lost authority over what happened in the hospital and instead picked up the micro-management demands of ministerial directives.

And while his balls were still on the block if things went wrong, the shots were all called by those here-today-gone-tomorrow politicos (four useless Secretaries of State in four years). Responsibility without authority- the prerogative of the schmuck thoughout the ages.

In fact, the article is about a headmaster, but if you go through it and substitute “consultant” for “headmaster” and “hospital” for “school” it is frighteningly familiar. Clearly a generic problem after ten years of New Labour.

Read “Life after the job from hell”

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Here we go:

She’d heard on the news yesterday that women who take HRT have a 30% chance of getting ovarian cancer, and since she had this pain and she’s on HRT….

Do you understand the difference between overall risk and percentage increase in risk, or have you thrown away your HRT? The Daily Mail certainly does not.

Some sense from Funky Mango’s musings

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Today the National Institute for Health and Clinical Excellence (NICE) released guidance that calls on firms to help smokers quit, particularly in the run up to the public ban on smoking that comes into force in England on 1 July.

Civitas – “classical liberal comment on the news and current affairs” approaches this in the right spirit:

I smoke… really, I started today!!

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We have not heard from the wonderful Professor Joseph Chikelue Obi for a while. He is on sparkling form:

Speaking via Satellite Phone while on the final leg of an exceedingly extensive Mediterranean Tour (which mysteriously took him through the dazzling Maltese Fortresses of Valletta , Gozo and M'dina - together with the Evergreen Sicilian Strongholds of Taormina , Catania and Pozzallo ) , Britain's Most Controversial Regulatory Critic, Professor Joseph Chikelue Obi , categorically stated :

"By means of substituted (public) online service, I hereby ethically give the outgoing GMC President , Graeme Robertson Dawson Catto , up until 12 Noon on the very first day of May 2007 to either formally vacate his post with the astoundingly diminished smithereens of dignity which he actually has left - or seriously face the highly unsavoury prospect of publicly being put on trial for Far-Reaching Fraud and Corruption.

See Abolish the GMC


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Oh! Boy, they are loving this in the United States

Or, to put it differently:

The reader is encouraged to outgrow the false Hegelian Left/Right paradigm, think independently about these issues, get empowered and help create a better world.

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A medical student starts to worry…

Today I developed a non-blanching rash on my legs. It's a petechial rash (= minute red/purple spot on the surface of the skin as the result of tiny hemorrhages of blood vessels in the skin) one cause of which is Meningoccoal Meningitis and Septicaemia.

So I got a little worried..

(note NHS direct says that with any non-blanching rash you should phone 999).

Strewth, does it really? Eczema does not blanche. That will please Tom Reynolds.

See how she coped in Non-Blanching Rash -call 999?

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Is this real general practice, or is it a hobby-doc pretending to be a GP.

It began in a rather different environment, Barcelona and Belfast dont quite rhyme. Tuesday is my day in general practice and, in the interests of trying to maintain some continuity for patients, I try to protect the day. This means a late evening to ensure all the day’s work is complete before leaving in the early morning. The patients, of course, are not interested in my travel plans. Good medicine is taken for granted, and quality means being there. But general practice is never routine; my colleague spent the evening with the police and an ambulance trying to arrange the compulsory admission of a patient while I saw an urgent extra, checked the mail and results online and completed some insurance reports. A lovely spring evening alive with birdsong when I eventually locked the chain on the metal gates at 7pm. For some, a gin and tonic clears the fog of the work but, for me it is exercise. Tonight the jog was a bit of a shuffle.

One extra, hey? That sounds stressful.

BMJ “blogger” doc tells it as it isn’t for most of us.

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It seems the not-in-my-backyard mentality is alive and well in the UK. While most people are sympathetic about the struggle facing would be buyers and workers such as nurses, they are opposed to particular new developments in their area.

I don’t want nurses living in my area, thank you, say UK Nimbies

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Cambridge Angry Medic tells of the new young doctor given a chocolate egg injected with frusemide.

But revenge was sweet.

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Outrage directed against the organisations that so misrepresent autism.

If I might be permitted to make a few assumptions I believe its accurate to say that we’ve had enough. Who are we? We’re parents like you. However, unlike you, the self-styled ‘autism community’, we are also autistic people. We are also scientists. We are also professionals working in the field of autism. We represent groups of people that you never can and never will. We are fundamentally different in attitude from you and we have had enough.

Quacks take cover whilst Kevin at LeftBrain/Right Brain has his say.

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Do we discriminate against women in medicine?

“In 1986, many trainees had to work 120 hours a week and move to different locations every few months. Women were asked the most outrageous questions at interviews, the old boy network and behind the scenes telephone calls were dominant factors in the selection process, and women who wanted to reduce their hours to spend time with their children were not regarded as proper doctors.”

Get the 2007 update from The Witch Doctor

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Sometimes you cannot get a chaperone…

A young woman came to see me with pain in her chest, just above one of her breasts, after an accident with a chair. After listening to the story I asked her to show me where the problem was, and she took off her cardigan leaving a tee-shirt on her chest. It was apparent she wasn't wearing a bra. I was slightly perplexed. If she didn't mind me seeing her breasts then she would have taken the tee-shirt off. If she didn't want me to see them I would have expected her to put on a bra this morning.

Tales from A Fortunate Man

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A man jumped into the river tonight. I was asked to stand-by on the Embankment while the River Police, LFB and a helicopter searched for him but, after almost two hours of scanning the fast flowing water, he wasn't found. He is unlikely to have survived.

A Paramedic’s Diary: In the River

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Dr Rant’s health care manifesto has caused a stir, but was not well received in all quarters. The DK was luke-warm to say the least:

…with a state-run NHS we have increasing costs, and then we have, in companies subject to market mechanisms, we have falling costs. And Dr Rant thinks that market mechanisms have failed. Er...

There you go, Dr Rant; we provide a decent health service (modelled, essentially, on the consistantly best-rated system in the world) using those very market mechanisms that you despise. We can see that it works in France, there is no reason for it not to work here.

And Tim Worstall was, well, tersely dismissive. Come on, Tim, the Rant manifesto deserves more thought than that!

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Some 130 distinguished doctors in Britain Saturday called for a boycott of the Israeli Medical Association (IMA) and its expulsion from the World Medical Association (WMA).

"Persistent violations of medical ethics have accompanied Israel's occupation. The Israeli Defence Force has systematically flouted the fourth Geneva convention guaranteeing a civilian population unfettered access to medical services," they said.

But the IMA has declined to condemn this action.

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Diary of a Goldfish looks at media hype, killing and the UK/USA in Iraq

I felt as most other people felt when I read about the shootings in Virginia. However, by Tuesday the media coverage here was becoming irritating to me; the analysis of nothing, the endless speculation about this or that, the voyeuristic dissection of events and characters. And I thought, my country is involved in an unofficial civil war one and a half thousand miles closer to home. Tomorrow they’ll be more bombings in Iraq; innocent people, just like these college students, people just as bright and bubbly and earnest and loving, will be have their lives snatched away whilst going about their daily business. But that will make for just a tiny wee headline.

The next day, over two hundred people were murdered on the streets of Baghdad.

No monsters. No profiles. No corpses reclining on the couches they couldn’t be coaxed onto in life. No names and photographs even. But ordinary people, faced with circumstances they considered intolerable, consumed with emotions they found overwhelming, choosing to commit evil.

One for Tony and George to answer


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Plans to clamp down on the way cigarettes are sold are being considered by the government to protect children's health. The sale of packs of 10 cigarettes - attractive to teenagers because they are cheaper - would be banned and cigarettes kept out of sight in shops."

Full story here

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In India we may criticise the medical facilities available here and hail those in the UK, but amazingly, a London-based retired radiologist consultant experienced the opposite. He described the medical facilities in Glasgow as "filthy" and hailed those in India. He said that his wife, who suffered from a head injury after falling off a bicycle, received a "far better treatment" in Ajmer and then in Delhi, as compared to NHS in the UK.

Full story here

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‘Within every patient there resides a doctor and we physicians are at our best when we put our patients in touch with the doctor inside themselves’
Albert Schwetzer (1875 - 1965)

Philip Booth of the Green party talks about Self-Management Courses for People Living with Long-Term Illness


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Free at the point of entry?

So what are we to do? Here in the real world these treatments, despite being standard practice in Europe and the USA, are not economically affordable by the NHS, though they are all funded by ‘proper’ insurance companies.

Mens sana takes a look in “But I want to pay…”

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After Blair it could soon be Cameron, punctuatetd by a brief Brown moment. But is there any difference between Blair and Cameron? Dizzy thinks there is.

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A nurse turned manager says:

Lets stop running each other down, lets stop trying to get one up on each other, after all we don’t actually do this in the course of our daily work (well I try not to). Lets start to work out the answers not just winge about the problem or am I just being a naive nurse turned manager who has got above herself?

Life in the NHS

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The Americans note that ‘Big Pharma’ corruption is approaching the UK

The Independent, one of the big UK dailies, ran a story, which is the first time the scandal has made the mainstream press on the other side of The Pond....

"The pharmaceutical giant AstraZeneca is at the centre of a storm in the US after firing one of its sales directors for comments he made likening doctors' offices to "a big bucket of money".

Pharmalot

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Why are there not enough ambulances available for real emergencies? Tom Reynolds explains : it is the maternataxis


But, thinking about it, if you do go into labour unexpectedly at home, what do you do? Midwifemuse does not think you should do this.

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The MTAS/MMC week.

“We are but mere bloggers, not the main stream media”

Channel 4 broke the story on Wednesday of the first breach of security on the MTAS site. The following day, NHS BLOG DOCTOR was tipped off that there was a further and bigger breach. I checked it out, found it was true, informed RemedyUK and then telephoned Victoria Macdonald at Channel 4. She was very interested. I asked that, if she ran it, that an appropriate credit was given to NHS BLOG DOCTOR.

I then telephoned the Department of Health and spoke directly to Mike Clement the MTAS project manager, and told him exactly what was happening.

The MTAS site was closed down within the hour.

I received this email from Mike Clement.

Dr Crippen

Thank you for alerting me to this issue.

Regards

Mike Clement
MTAS project manager.

Workforce Directorate


Working differently

The story was the lead item on Channel 4 news. I had expected to be credited as the source of the story. The final email exchange with Victoria Macdonald was:

Your site gets a starring role tonight

-----Original Message-----
From: Dr John Crippen [mailto:drcrippen@nhsblogdoc.wanadoo.co.uk]
Sent: 26 April 2007 16:33
To: Macdonald, Victoria
Subject: RE - it is true, and you can read them without even logging in to the site.

When trying the URL below, make sure you get it ALL - it goes onto a second line. It got truncated in the email. It is the last four digits of the second line that are important.

I have reported all this to the DoH.

I spoke to a civil servant called Mike Clement, who deals with MTAS and MMC



John

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It did not happen. There was a brief screen shot of the NHS BLOG DOCTOR article, but that was it. Channel 4 ran the story as their own.

Off to the BBC next time, I feel.

Mind you, I was not overwhelmed by the response from RemedyUK to whom I sent the story as well. No reply at all until long after the Channel 4 news, then:

> Thanks for the tip.
Matthew Shaw

Lots of emails from doctors, and the story was widely covered in the medical blogosphere and properly accredited. We may not be the MSM, but there is honour and etiquette amongst bloggers. See Rhetorically Speaking.

Not that exploring the holes in government data collection services is difficult.

Driving through MTAS security

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But let’s move on to a more cheerful note. Mangling Medical Careers goes from strength to strength. If you have not already, then meet “the team” here

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As always, a good round-up of all the MTAS developments at The Ferret Fancier

Who do you think said this? Where was it said?

"'I am sick and tired of listening to junior doctors complaining about their job prospects. It's a tough and competitive world out there and the public might be a little more supportive to these gods in white coats if there were fewer cases like those of Gertrude Danforth.'

He then described the sad case of an 85 year old woman who died after a low blood sodium level was missed. The coroner returned a verdict of natural causes contributed to by neglect.

See what the Ferret makes of it. He is angry.

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I thought we’d hit rock bottom yesterday. Once you’ve openly and illegally posted intimate details about applicants on the internet, I didn’t think there was anywhere else to go. I was wrong.

SJHoward


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The U.K. Department of Health has been forced to apologize after the personal details of hundreds of doctors -- including home addresses, phone numbers, sexual orientation and previous convictions -- were made available online.

Computer World takes a look at MTAS technology

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A highly trained economist does some simple arithmetic about MTAS – and shows that the government is either dishonest or innumerate. Or maybe both.

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Vicky Ford is supporting the hospital doctors:

If the process goes ahead as planned 22,000 doctors will change jobs on 1st August this year. That is every junior doctor in training in every hospital in the country. Many doctors will not even know where the reception is in their new hospital let alone the x ray department. Do not be sick in August. I am taking my children to Ireland for a couple of weeks.

As of right now the junior doctors don't have jobs. They don't know where they might be moving to and tens of thousands of interviews are still to be held. It is a fiasco. The doctors are mounting a legal challenge and there are rumours of massive compensation claims.

Full story of the lobby in : I could have made toast on the fumes rising from the doctors' heads

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Dr Michelle Tempest looks at the Medical Heroes of MTAS & MMC

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Dr Rupert Beale does not agree with Dr Crippen’s views on abortion; or, more particularly, on Dr Crippen’s views on Libby Purves’ views on abortion. So be it. Shame he was rude (see his comment here) but that does not detract in anyway from his excellent guest piece on MTAS and MMC

“I'm not going to recite the litany of blunders and half-baked lunacy that has led to the sorry mess we find ourselves in now. What I'd like to do is highlight the various forces at work behind what is happening at the moment.”

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Please send your recommendations for next week’s BritMeds to: thebritmedsATnhsblogdoc.wanadoo.co.uk

The BritMeds will now be published on Saturday morning, so please let me have your recommendations by Friday evening latest.

The Grand MTAS spoof

Saraghina: European Sprats (eSprats)

Our team has grown rapidly from providing assessment tools locally to becoming the premier provider of 360° tools across the United Kingdom. (Hcat & eSprat)

It is the end of the week.

Time for some light relief. Normally, I drop in at Mangling Medical Careers but today I have been sent a copy of the most wonderful spoof site.

If you have wondered what the poor hospital doctors have had to go through in trying to submit an application to MTAS, come with Dr Crippen on a visit to Hcat and the wonderfully named eSprat.

The Hcat/eSprat site is here.

You have to have a password to sign in, but do not let trivia like that spoil the fun.

If you have forgotten your password
If you have forgotton your password or have lost your invitation email please enter your email address below and click 'Lookup', this will randomly generate a new password and email it to you.

What a joy. And more secure than MTAS

Would you like to enter eSprat as a candidate or as an assessor? The latter sounds more fun. And it is so easy.

Please enter the email address or registration (GMC/NMC/AHP) number of the assessor, not the trainee. If you have not previously registered as an online assessor please enter your email address and you will be able to register on the following page.

And then a few gems from the side bar. Don't you love acronyms.

RCPCH Pilot Update
Please ignore the deadline of 1st June 07 for completing 6 ePaedCbDs or PAEDmini-CEX’s.

My min-ePAT assessor has not received their min-ePAT email
If your assessor has not received their min-ePAT email, you can re-send it via the DaNA home page. Please ask them to make sure that the e-mail has not been filtered into there spam folder. This is particularly important if they have a Hotmail or AOL e-mail address.

RCPCH eSPRAT: Sign Up Extended
Year 2 and Year 4 paediatric SpRs who expect their next RITA to fall between late-July 2007 and January 2008 can still sign up for the next round of RCPCH eSPRAT assessment

I think I have got that. If Rita falls sometime after late July she can sign up for eSPRAT.

A fun game for the whole medical family. Explore the site and enjoy… but spare a thought for the young doctors in MTAS who had to do this sort of stuff for real.

The Crippen Diaries 2007 (17)

Not quite Emergency Ward 10

Monday 23thApril

The first patient in came to discuss her newly diagnosed ENT condition. She developed chronic recurrent dizziness after a prolonged fairground ride. It was not helped by any treatment we could give her, and the first ENT specialist was not able to help her either. All scans were normal. The second ENT specialist told her she has “mal de barque” syndrome.

In days gone by, I might have flannelled a little. I am old enough now not to be ashamed of ignorance. I told her I had never heard of it, and said “Lets ask Dr Google.”

Most of the stuff that came up was in French. Phobic postural vertigo was one definition. This lady exhibits no signs of phobias and she is most certainly not mad. More research needed her, and probably a chat with the ENT specialist.

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A charming 19 year old girl who has just been bounced by the blood transfusion service because she is anaemic. She brought the information with her. Her haemoglobin is 11.9 and should be 12 or more. She is entirely well though her periods are a little heavy. She is also O Rhesus negative, so the blood transfusion service do not want to lose her.

The difference between 11.9 and 12 is within experimental error. She will take some iron for three or four weeks, and I am sure they will be able to have her back then.

Brilliant that a teenager will do this in return for a luke-warm cup of tea and two of those oddly named “Nice” biscuits.

++++++++++++

Bill presented just before Easter, on the afternoon of Thursday 5th April, to be precise. The previous day he had noticed that his urine had been red on two occasions. Not unwell. No prostatic symptoms and, considering he is nearly seventy, that is pretty good. On direct questioning, he said that his urine stung a little as he passed it. This needed checking out. You cannot get urine microscopy over a Bank Holiday. I arranged for two urine specimens and some blood tests for the following week. The blood tests were normal. In particular, the PSA was normal. Both urine specimens showed a lot of red blood cells but no evidence of infection. His blood pressure is normal and his prostate does not feel enlarged.

He needs further investigation.

On Monday 16th April I referred him to the haematuria clinic. We have excellent urologists locally. They have always provided a good service, even before the two week rule nonesense. Bill has an appointment with one of the consultants a week tomorrow, Tuesday 1st May. Eight days away.

Bill is not happy. He has not had anymore blood in the urine, but he has been reading up about “microscopic haematuria” on the internet and is frightened that he has bladder cancer. He wants me to get onto the hospital and bring his appointment forward. He has indeed phoned the urology department secretary who told him, as they always do, that his appointment can only be brought forward if he gets “a letter from your doctor.”

Bill may have bladder cancer. I understand his concern. But he will have gone from presenting in primary care to sitting in front of the specialist within a little over three weeks, and that three weeks included the long Easter Bank holiday.

It is not in my gift to “bring his appointment forward”. I could write to the urologist but I am not going to. His clinics are all ready full, and he is doing the best he can. I sympathise with Bill. Blood in the urine is frightening. (If you doubt that, put half a dozen drops of red ink into a lavatory bowl – it does not take much to look dramatic). But on any criteria, he is being sorted out as fast as anyone could expect.

This is more than anxiety. It is the unrealistic expectations generated by a system perceived to be “free” at the point of entry.

Tuesday 24 April

I have a degree of sympathy with the local “housing needs commissariat”. It must be very difficult when you only have a handful of house to share between hundreds of disadvantaged unmarried mothers. I have no sympathy, however, with the strategy they use to get people out of their office. “You need more points. Get your doctor to write a medical report”.

All well and good.

“Mr Jones is a bilateral amputee currently living in a bed-sit on the third floor with no lift…”

I wish it was like that. Usually, however, it is a sad and see-through attempt to connect a small patch of damp in the bed-sit to that vague history of asthma that some one once mentioned to Samantha when she was a child.

When the housing department used to write to us for medical reports, we used to charge for them. They wised up to that. Now they tell the patient to “ask your doctor for a report.” They do not pay. We still do them. What else can you do? Today’s Samantha is at her wit’s end. She has three children and lives with them in a wholly inadequate one bed-roomed maisonette. She wants a three bed-roomed council house with a garden.

Samantha probably was a bit asthmatic as a child, and one of her three children coughs a bit more than he should, and there is a damp patch, and there is not a garden, and there is an alcoholic living next door and I cobble a few words together and send it off to the council and nothing will happen.

It is a game we all play. The “letter to the housing department” game.

++++++++++

“I’m not a tablet person, doctor.”

This opening gambit (yes, it is a gambit in the real sense of the word if you say it to a doctor) always makes my heart sink.

“But I have not been sleeping well, so I have been taking Valerian Root. Is that all right?”.

“Thought you weren’t a tablet person, Mrs Davies.”

Mrs Davies does not understand. I run through the history. There is no obvious reason why she is not sleeping. I have not got a clue about Valerian Root, so I consult Dr Google who soon takes me to Homeherbs.com which tell me that:

Valerian is well known for its sedative qualities and its ability to relax the central nervous system and the smooth muscle groups. It has been used as a sleeping aid for hundreds of years and has also been indicated for anxiety, confusion, cramp, depression with anxiety, dysmenorrhoea, hives, hypochondriasis, hysteria, improving circulation, intestinal colic, lack of concentration, menopausal dysfunction, retarded and scanty menstruation, migraines, nervous excitability, palpitations, PMS, rheumatic fever and pain, stress, tension and tranquiliser withdrawal.

Valeriana officinalis

God, that is brilliant. Why did they not tell me about it at medical school? It cures nearly everything including hypochondriasis, hysteria, the menopause and rheumatic fever. I think I will leave a large vat of it outside the health centre and go home. And it is only £10.95 for a hundred capsules.

++++++++++

What’s a STEMI?

Andrea is 72 and, on Easter Sunday was gardening when she developed “a very odd indigestion which made me sweat” and fell to her knees in the garden. He husband dialled 999. She was admitted to hospital and, it is quite clear, had superlative treatment. Same day angiogram. All that should have been was done. She was discharged on day five, feeling well and entirely asymptomatic apart from a sore, bruised groin.

The only thing that had been missed was an explanation.

STEMIs had not been invented when Dr Crippen was a hospital doctor. I told her what it stood for and that it meant a “small heart attack”. Is the word “small” justified? Well, in my book, anyone who walks out of hospital after a heart attack feeling well, with no angina, and no heart failure justifies the use of the word “small”.

We talked about what she could and could not do. Pretty much anything, really, including being Vice President of the United States! Andrea has never smoked and has always been fit and active. She is a keen walker and a regular swimmer.

“So why have I had a heart attack, then?”

The answer is age. When she was born, life expectancy for a woman was about sixty-four. She has won. When I was a child, people of 72 were old.

They are not any more.

++++++++++


Thursday 26 April

David, the alcoholic who needs in patient detoxification, and who me met last week turned up this morning. I was fully booked so he saw one of my partners. He was appallingly drunk.

“Smells of alcohol at 11.00 a.m.” the note started. And there, let me digress for a friendly warning. Never, never go to your doctor when you have just had a drink. You may only have one unit of alcohol a year, but if your doctor smells it, he will note it physically in writing, and mentally as well. For ever after he will wonder about your “real” drinking habits.

David gave my partner a bad time. He was not violent but he was abusive and demanded some Librium. My partner refused to prescribe for him at which stage David started swearing.

Finally, my partner asked him to leave.

We had a long discussion over coffee about the best strategy to adopt to deal with drunks. My partner was not very sympathetic.

There are big issues underlying.

Can a person’s behaviour become so unacceptable that they forfeit their right to medical treatment? Alcoholism may be an illness, but some alcoholics are near to unmanageable. It is easy if they are physically abusive but supposing the problem is solely that they will not take advice. That they keep turning up drunk?

Where does one draw the line?

++++++++++


Friday 27th April

More news of David. He saw my partner yesterday. (see above)

Regular readers will remember David, the snooker-playing Welsh alcoholic, who lives locally with his partner, and has a son in Wales. David needs in-patient detoxification; he needs help with his underlying chronic depression; he needs help with his chronic anxiety problems; he needs help with his alcoholism; he needs to be assessed and followed up by a trained psychiatrist.

Dr Crippen has not been able to help him with many of these needs. Last week, as you will recall, he took a gargantuan overdose of medication. Re-read what happened to him in last week's diary, here.

The hospital were no help, and the alcohol team were reluctant to see him as he keeps drinking. Bit like the diabetologists not seeing people who have high blood sugars, but I digress.

So I took him on. I saw him with his partner. I agreed to de-tox him on an outpatient basis provided his partner kept the medication, and provided he did not drink. I started him on a high dose of chlordiazepoxide (Librium) to cover the withdrawal, and I saw him every day, with his partner. It all went brilliantly for four days. On day five, however, when we were due to start reducing the medication, he turned up an hour late. He turned up drunk. His partner was at her wits end. I spent a long time with him. He asked me to prescribe Librium, Valium anything, but I did not dare do it in view of what happened. I offered to continue seeing him daily, and made him an appointment for the following day. He did not come.

I have not seen him since. But, as I say, he saw my partner yesterday, and stormed out of the consultation. What happened to him next?

During the morning, my secretary brought in a fax.

click to enlarge

click to enlarge

Please make no mistake. David is not an easy patient. He is, in fact, a pain in the ass. No one would dispute that. But he is ill. And his illness manifests itself with "bad behaviour". If David does not get want he wants, he drinks. He takes overdoses. He falls, or jumps, into the river. For all that, I feel ashamed to be working in the British National Health Service.

Take a look at the letter in more detail.

"...he had been found the previous day in the river by the police"

There must be more to it than that. You do not "find" people in the river. Someone dialled 999. Someone pulled David out. Or did he just say, "Good afternoon, officer, I am having a swim"?

MSE (mental state assessment)

Appetite - "not bad
Sleep - doesn't sleep
Alcohol - large amounts, but dry some days.
Illicit drugs - see history : but the history is an equivocal one line.
Mood - flat of affect.Tearful at times.
Communication - good account of history. Articulate. Good eye contact.

This might pass for a mental state assessment for nursy, but a medical student offering this up in finals would be failed. "Flat of affect"? More normally we would say "Flat affect". This is a history taken by someone who does not use language well.

"currently off sick with an ankle injury"

David is "currently of sick" because he is pissed all the time.

"Last incidence of overdose Friday 20th"

Correct. But nursy does not seem to be worried by that.

"Does't want to die and just wants help"

Why not give him some help, then, before he accidentally kills himself. What more does he have to do to make you show some concern?

"David presented as a pleasant man, who is aware of his problem, but lacks the ability to do this. The above incident, hopefully proved to be a "wake up call". And he did appear genuinely shocked at how close he came to death. However, given all his additional support, I did not feel he warranted admission at this time."

Strewth!

OK, nursy, maybe English is your second language, but what does the first sentence mean? And do you not read your letters before you sign them?

A "wake-up call"? It has not woken the psychiatric department up.

Would someone out there tell me what exactly David has to do to "warrant" admission? Would someone out there tell me what David has to do to see a consultant psychiatrist? The only strategy I can think of is to go privately. Sadly, incapacity benefit will not cover that.

This is why Dr Crippen is so fed up with the lack of resources, and the dumbing down of the service to well meaning amateurs like this.

And finally, David did not turn up for his appointment this morning.

MTAS - what next?

It is, I suppose some sort of journalistic coup that, shortly after Dr Crippen phoned Mike Clement, the MTAS Project Manager at the DoH, the decision was taken to close down the MTAS site.

There was no alternative.

Today's news, revealed in NHS BLOG DOCTOR, that it was possible for doctors to access each other's applications and personal information by simply inputting a random number was a gross breach of data security. The MTAS site had to be closed to protect that information, to protect the doctors.

A lesser concern, but still an important one, is that this breach of data security may result in a criminal prosecution against the MTAS administrators. Maybe even against the blessed Patricia herself.

And now a trivial matter. Or a matter that seems consistently to be treated as trivial by the department. What happens to the doctors? MTAS, for all its failings, is their source of information about forthcoming interviews and appointments. There is nowhere else for them to turn.

A young doctor writes to RemedyUK to ask:

So, after a further breach of confidentiality today the DoH have shut MTAS down to investigate the problem. That's all very well but if a load of us are supposed to be interviewed next week how are we supposed to now

a) find out whether we have an interview
b) find out exactly when and where that interview will be held
c) select an interview slot

Correct me if I am wrong but MTAS was the only way to do all of those things. I think some people were sent emails letting them know they had been invited for an interview but the vast majority were not.

The provisional dates for my interviews have been given as next Wednesday and Thursday but this has not been updated since we were allowed to change preferences and I don't know what to do next.

Oh! Great! Who does this doctor ask? Who does he phone? There are thousands of young doctors in exactly the same position.

Maybe they should try:

Mike Clement
MTAS project manager.

Workforce Directorate
Department of Health


Working differently

MTAS site closed for "essential maintenance"

Further reports tonight

NHS BLOG DOCTOR was tipped of this afternoon that there were further huge security problems with the MMC and MTAS sites.

Yesterday, Channel 4 revealed that the applications and private records of senior medical students apply for their first jobs could be viewed by the general public. No sooner had that loophole been closed when it emerged that anyone could access confidential records of ALL the doctors in MTAS without even registering with the site.

I though that was outrageous and, without wishing to appear mawkishly altruistic, I contacted the Department of Health and informed them. I spoke to a Mike Clement. I then phoned Channel 4 and gave the story to Victoria Macdonald.

Within the hour, the MMC/MTAS site was no longer available and was showing a message apologising for the inconvenience and saying that the site had had to be taken down for “essential maintenance”.

Essential maintenance indeed!

I have now received the following email:

Dr Crippen

Thank you for alerting me to this issue.

Regards

Mike Clement
MTAS project manager.

Workforce Directorate


Working differently

In terms of the doctors’ right to privacy, it is right and proper that the loophole has been closed. There will be a further report on Channel 4 news tonight.

In the meantime, I can only speculate as to what “working differently” might mean.

************
A Department of Health spokesman has now finally and specifically admitted that the MTAS site has been closed because of poor data security.

Metro.co.uk blog awards

Dr Crippen was pleased, indeed flattered, to find that NHS BLOG DOCTOR has won another award, the METRO.co.uk award for “Best Political Blog 2007”

Full details here.

MTAS - would someone tell me this is not true

Click on Picture

Dr Crippen needs some help. Some reassurance. I need to know that a message I have just received is a leg pull.

The message is an email from (another) distressed young hospital doctor. He has asked to remain anonymous. I have advised him to stay exactly where he is. The police are on their way. Comrade doctors do not deserve or need anonymity, so it is off to the Gulag...sorry VSO...for him.

His email says this:

I wish to bring to your notice how MTAS continues to be a ridiculous way of medical recruitment.

Any applicant can see ANY correspondence sent by another candidate or from MTAS to another candidate by just going to his inbox and changing the message number displayed in the url.

Please check for yourself.

In good will,




A beaten, pulverised NHS junior doctor

Dr Crippen cannot check this himself as he is not registered with MTAS and so cannot get into the system. Do not laugh. I may be the only person in the country who cannot get into the system...but I cannot. I have tried.

Surely this cannot be true.

Would someone kindly check it out for me?

+++++++++++

I have, as I say, not been able to check this out, but I have now has several emails, as well as the ones in the comments, to confirm that it is true. I have also had an email saying:

Take care!

You are inciting people to commit a criminal offence by hacking the MTAS web site in order to verify this claim, and your whistleblower is already guilty by his own admission.

I genuinely feel for the jnr docs., but a criminal record is not worth it – that will really destroy their careers.

I suppose this may be technically true, but I cannot think of any other way to confirm the presence of this new and appalling loophole. This does not need to be an attempt, with malice aforethought, to "hack". Accidentally transpose two digits and it will happen accidentally.

+++++++++

It gets worse. No, really, it does. You would not think it possible, but it does.

You do not even need to log onto the MTAS site. Dr Crippen has just been sent a URL address, which ends in four numbers. Put any random four numbers in at the end and you are taken straight to a MTAS reply to a junior doctor offering him/her a job. The recipient is not named, but it is probable he/she could be traced by replying to the hospital who offered the job.

Dear Oh! Dear.

++++++++++

Dr Crippen has spoken to a civil servant at the DoH this afternoon and advised him of the loophole so that it may be closed.

In the mean time, I am sure that this, from the DoH MMC site, may help:

What about the security of my personal information?

The Department of Health and their partners take the security of your personal information very seriously. We have taken a number of measures to ensure that the information you provide to us to help you to gain your next position within the NHS is carefully managed and securely processed. This situation is constantly monitored and reviewed to ensure that potential risks are minimised.

For further information on how your personal data is used please see Terms and Conditions.

+++++++++++

The MTAS debacle continues

The Government spokesman was not in a position to comment

Ill thought out, rushed, incompetent, uncaring, irresponsible…I could go on as I try to encapsulate the failings of MTAS. But tonight I put the thesaurus away, for tonight MTAS moves into burlesque.

Someone left the computer on and forgot to set a password.

As a result, as Channel 4 revealed earlier this evening, all the details of final year medical students applying for hospital jobs were accessible by the general public. We are not just talking names and address. We are talking everything.

Not only can we see what they wrote in their applications; their addresses; their phone numbers; who their referees are. We can also see if there were white, heterosexual, gay Asian, Christian, Jewish or Hindu, and we can also see if they have got police records and what the crime was. (Channel 4)

Remedy UK is the organisation formed to protect the hospital doctors' rights. It goes from strength to strength.

"I'm absolutely gob-smacked, I don't know whether to laugh or cry. I'm not going to be able to laugh because it's so serious. After I've scraped my jaw up off the floor I'll say that I'm not really surprised - it's a level of ineptitude that has characterised this whole procecss. It takes the concept of a botched IT job just to a new dimension." (Matt Jameson-Evans, Remedy UK)

No Minister was available for interview tonight. Instead they issued this statement:

"We apologise to any applicants whose details have been improperly accessed. This URL was made available to a strictly limited number of people making checks as part of the employment process. (Anonymous DoH spokesperson)

Where is Hewitt? Where is Hunt? Where is Flint? Where is dear old Andy Burnham? They are all deep in the bunker.

This has affected first year junior doctors - hundreds and hundreds of them. Whose sexual orientation, whose mobile telephone numbers, home addresses, etc have been left wide open for anybody knowing the URL. Experts say the level of data included in the applications makes it a gold mine for identity theft and fraud. It is also likely to be a breach of the data protection act and could lead to criminal charges. (Channel 4)

The full report, including the video of the Channel 4 news program can be seen here.

Dr Crippen is, for once, lost for words

A party political broadcast on behalf of the Conservative Party

This video from Andy Burnham MP, Labour Minister of State for Health, reduced Dr Crippen to helpless fits of laughter. I thought at first that it was a spoof. But it is not.

One of the final signs of political psychosis is when you start to believe your own propaganda.


The video, and a question and answer session with Andy, is not as you might expect a lampoon on WebCameron. It is for real and has been published on the Labour Party website.

I defy you to keep your face straight. And then you can move onto the Q & A session, from which I present two (outrageously) edited excerpts. What a joy!

Mr Tucker, Maidstone asked
Do you think a wait of 31 weeks to see a physiotherapist for treatment at Maidstone Hospital for an ongoing Tennis elbow problem is acceptable? I don't. I have had to pay privately to get this treated. You need treatment like this quickly to stop the problem developing, which would in the long term, save the NHS money.

Andy Burnham MP, Minister of State for Health answered:
I agree, it is not acceptable...

Stephen Marshall, Glasgow asked
My mum died in hospital in Sunderland last year following her hip op, fair enough, she was 86 and knew she was taking a risk. But on the orthopaedic ward she was just left. I had to keep pestering them to come and see to her. They put up a drip but never checked if it had got clogged. A lot of the staff were foreign and did not bother to shift themselves very fast. Then when she was really sick she was whisked into ITU where the treatment was brilliant but just too late. Can't there be anything in between?

Andy Burnham MP, Minister of State for Health answered:
I'm really sorry to hear about what happened to your mother. Whilst I think that the NHS does deliver a brilliant service to the vast majority of patients, there are times when the service falls below acceptable standards....

Read the full answers and more, much more, on the Labour Party website here.

As for Andy? I think he should keep taking the tablets.

Stalinist health care for the mentally ill

British "Care in the Community"

The closure of long stay mental hospitals started under Margaret Thatcher. A new strategy of “care in the community” was introduced. Many chronically mentally ill, semi-institutionalised patients were turfed out onto the streets. As always the schizophrenics suffered the most. The promised community psychiatric nurses did not materialise and the patients were left to wander the streets.

An army of bag-ladies and tramps.

New Labour is extending this policy to hospitals that used to admit patients who had acute mental illness. It is closing psychiatric wards across the country. Wards that were providing a place of safety for the acutely mentally ill.

As always it is being done in the name of improving health care. Not a mention of cost-cutting. The government waxes eloquent. The mentally ill do not wish to be in hospital. They prefer to be treated at home, in "the community". If you had seen the average psychiatric ward in a British hospital, you would not want to be on it either.

A doctor from Hertfordshire sends me this:

Click to enlarge

Bastards.

“The number of council houses is being reduced so that Hertfordshire Partnership Trust can provide more damp and dirty bed-and-breakfast bed-sitters, run by unscrupulous profiteering landlords, for unmarried mothers and their children.”

Lying bastards.

“The number of in-patients beds is therefore being gradually reduced so that Hertfordshire Partnership Trust (HPT) can provide more treatment for people in their own homes.”

Crisis Intervention Teams are composed of non-medically trained amateurs who are incapable of carrying out a proper psychiatric assessment. They fill in their tick-sheets and almost invariably discharge the patient. They are a barrier to mental health care. GPs can no longer get their patients seen by a psychiatrist, unless of course they can pay to go privately.

Dr Crippen despairs. No wonder I could not get David into hospital. He did not want to be dumped, sorry "treated, at home.

Read the handout carefully. But do not make the mistake of thinking that this is only happening in Hertfordshire. This is national government policy. This is Patricia Hewitt.

This is New Labour.

A lesson from America

Dr Helen Smith

Dr Helen Smith is a forensic psychologist in Knoxville, Tennessee who enjoys commenting on popular culture, politics and psychological issues.

We met Helen a few weeks ago when we were discussing the raw deal that women with heart disease get in both the UK and USA. She describes her struggle to get the doctors to believe that she was seriously ill in More Than You Wanted to Know About My Heart Attack

Helen is now taking a look at what can be done to prevent a repeat of the tragedy at Virginia Tech

"Most of the discussion centered around zombies and shotguns as well as various strategies for dealing with school shooters. The gunsmith had a good strategy to avoid a mass shooting, don't go to universities where you can't carry [a gun]"

(Helen in conversation at a recent blogfest in Tennessee)

In my opinion, if we have mentally unstable students who have made threats, have behavioral problems, etc. in universities and schools who do not hold themselves or the student accountable for their behavior, there is no other alternative than to extend the civil right to [carry a concealed gun] to the potential innocent staff and students who may encounter the wrath of such a person. If universities and schools won't take responsibility -- and they won't -- then someone has to. (Dr Helen Smith)

To the British ear this sounds outrageous. Arm students so that they may defend themselves on campus? Most of us would say tighten up the gun laws. It has never been easy to purchase a firearm in the UK and, after the Dunblane tragedy, which took place eleven years ago, it became even more difficult.



We may giggle at Charlton Heston, but Helen Smith is not Charlton Heston. She is a well-known forensic psychologist and a formidable and much respected opinion. Her husband Glen is probably the most influential blogger in the world. (Instapundit) Along with many colleagues Helen would argue that it is British gun control that has failed, not American.

Helen quotes Professor Barbara Oakley, a professor of engineering at Oakland University, who writes in the New York Times

Still, the Virginia Tech shootings have already led to calls for all sorts of changes: gun control, more mental health coverage, stricter behavior rules on campuses. Yes, in a perfect world, there would be no guns, no mental illness and no Cho Seung-Huis. But the world is very imperfect. Consider that Britain’s national experiment with gun-free living is proving to be a disaster, with violent and gun crime rates soaring.

In other words, most of the broad social “lessons” we are being told we must learn from the Virginia Tech shootings have little to do with what allowed the horrors to occur. This is about evil, and about how our universities are able to deal with it as a literary subject but not as a fact of life. Can administrators and deans really continue to leave professors and other college personnel to deal with deeply disturbed students on their own, with only pencils in their defense?

I was not aware that we were "experimenting" with gun-free living. I thought it had always been like that.

Can it seriously be argued that we have got gun control wrong in Britain and that we can learn from the Americans? Perhaps we need to take on the debate.

A year of paediatrics

Paediatric Grand Rounds

Clark Bartram is an American paediatrician

“who takes care of newborns of all shapes, sizes, and degrees of health, and a sceptic mucking about a credulous world.”

He also writes Unintelligent Design (Tales from the Not So Normal Newborn Nursery), and is presenting his choice of the best contributions to Paediatric Grand Rounds over the last year.

There are some gems.

A neonatologist’s (Neonatal Doc) strong and wise views on home births and the dangers thereof; Sam (Blog MD) looks at treating children with cancer; Steven Parker on treating children with antipsychotic medication, and the argument that ensued (Flea & Karoli) ; our very own Shinga (Breath Spa for Kids) looking at the use of steroids in children with asthma; Philip Gordon’s (Tales from the Womb) brilliant description of Sudden Infant Death Syndrome and more, much more.

Dr Crippen was flattered to find his own article about the attempt to persuade mother’s that cow’s milk was poisoning their children included. This story grew out of an advertorial run by the BBC as “news” but then developed when the BBC back tracked, edited and largely re-wrote their article without acknowledging their mistake. Fortunately, the whole sordid story was tracked by the perfectly wonderful News Sniffer.

Take a look at a year of paediatrics on Unintelligent Design.

Doctors for reform : core medical services

Health care for the poor

Today I came across the most horrifying expression I have heard since the inception of NHS BLOG DOCTOR. “Core services” sounds benign, but put it in the context of the modern NHS and marry it up to the shibboleth of “free at the point of entry” and see what you get.

Not much.

Doctors for Reform have just produced a characteristically thoughtful document:

click on image

This document addresses the NHS sin that dare not speak its name. The sin of charging for health care.

Whatever the politicians may tell you, the NHS is no longer “free at the point of entry.” It may be as far as the letter of the law is concerned, but it is not in spirit. For a long time but particularly over the last ten years the door to decent healthcare has been closed to many patients.

Examples are legion. To name but a few: varicose vein surgery , anything that can be labelled as cosmetic, IVF, and dental treatment have long been near impossible to find on the NHS. Front line treatment for various cancers depends on your postcode. The NHS lung cancer patient gets his hand patted by the “lung cancer nurse specialist". The private patient gets Tarceva.

Dr Crippen has had patients die on the waiting list for radiotherapy and for cardiac surgery. That does not happen if you have private health insurance.

Something needs to be done. What do we wish to achieve?

Every UK citizen should be entitled to, and be able to obtain, a reasonable standard of medical care within a reasonable period of time, independent of wealth and status. (Dr Crippen's NHS mission statement)

Note that I do not say that the NHS should be committed to health care “free at the point of entry”. The politicians say that. They dare not say anything else. It is a lie. Healthcare has never been truly free at the point of entry. Some health care has been free but (and more and more) much is not.

The “great and the good” have always gone privately and received a better standard of care. Now more and more people are, as the above document shows, “topping up” their health care. And if you are waiting for coronary artery surgery, this is the only sensible action, if you can afford it. Make no mistake, if you cannot afford to, you have a higher risk of dying.

Healthcare has to be rationed. The only question is how best to do it. You can ration it by stealth; by closing the NHS doors to patients with certain conditions; or by pretending there is no rationing by having waiting lists upon which some patients will die. We can mitigate the need for rationing by eliminating abuse of the service. Sometimes it is cynical abuse, more often it is abuse by people who do not understand that health care is expensive.

There needs to be a front end charge for health care. Yes, a “charge” at the point of entry. That charge needs to be a percentage of the costs of care that each patient needs. And yes, that means that some will pay more than others; that those with poor health will pay more. The system must be properly safety netted by means testing so that none will be denied health care because of cost but all must pay something.

A front end charge at A/E departments and health centres of, say, £20 would overnight solve most of the problems of abuse. We can go on from there. A charge of £30 for missed appointments; a charge for lost prescriptions; a charge for ambulances with a penalty charge for those who thoughtlessly use ambulances rather than taxis.

The figures I give are off the top of my head. The precise charges would need thought. But the principle is essential. People must be taught that health care is expensive and the only way to do that is to make them reach for their wallets.

Everytime I float this idea, there are howls of anger. But, make no mistake, many patients are already taking the initiative and paying for a health-care “upgrade”. Doctors for Reform say:

We have also described key trends, widely accepted among healthcare commentators, that suggest that such payments will become more rather than less prevalent over time. Yet at present the issue of “top-up” payment and indeed funding reform remains a taboo in frontline politics.

It has to be recognised that the use of top-up payments is increasing but on an ad hoc and dispersed basis. We need to face up to this rather than ignore it. We need a more realistic debate than politicians of all parties are willing to allow on how to define core services and the role of top-up payments.

In simple terms, the rich are buying additional quality health care whilst the poor make do with a “core service”

The concept of Patricia Hewitt defining NHS “core services” is horrifying. But that is where we are headed. The poor folk can be educated in the comprehensive schools by teaching assistants, and have their health needs catered for by nurse-practitioners and health-care assistants. The rich will continue to pay for public schools and for medical advice from doctors.

We need to give all people the right to contribute an amount they can afford towards their health care. If we do not, soon only the rich will be able to access decent health care provided by doctors whilst the poor struggle on with a second rate service from "health care assistants".

Wi-Fi, mobile phones and honey

Next week may be challenging for British GPs.

We are going to be asked if it is “safe” to have Wi-Fi installations in schools and at home. And, for good measure, there may be some questions about mobile phones and bees.

The silly season is not yet upon us but Sunday is a difficult day for newspaper scoops, and so there is always a slight air of “silliness”. Headline stories are run for one day, but then disappear without trace.

Today, the Independent is running a “Wi-fi” warning. It tells us that:

• Several European provincial governments have already taken action to ban or limit Wi-fi in the classroom. (But no details are given of where this action has been taken.)
• Stowe School has “partially” removed Wi-fi because a teacher was ill. (How do you partially remove it?)

And then it goes on to tell us that:

“virtually no studies have been carried out into Wi-fi’s effects on pupils, but it gives off radiation similar to emissions from mobile phones and phone masts."

A tendentious and provocative bit of juxtaposition if ever there were, from the school of gutter journalism that produces headlines like “No truth in the rumour that Princess Margaret had an affair with Mick Jagger.”

This is a scare story, with no facts to back it up. Far more interesting are reports further on in the paper, quoting some journalists of real repute: the bloggers.

The excellent Grrrlscientist, who is a molecular evolutionary biologist, asks “Are cell phones killing bees?”

• I've heard a lot of strange hypotheses in my life, but this one is one of the strangest: mobile phones may be wiping out bees.
• A Swedish research team found that radiation from mobile phones kills brain cells, raising the possibility that teenagers could become senile in the prime of their lives.
• All in all, the potential health damage due to radiation from hi-tech gadgets combined with the loss of the world's bees is a very scary prospect.

My gut reaction is that this is nonesense; pseudo-scientific quackery. I have never believed that proximity to radio waves and electricity pylons has any affect on health. I doubt that Wi-fi and mobiles are a threat either.

And yet, and yet…life is full of uncertainties. I am not aware of any definitive research that demolishes theses theories and, anyway, it is impossible to prove a negative. It is this impossibility that becomes the Quack's charter.

I have three problems:

1. Our house is full of teenagers, computers, Wi-fi and mobile phones.
   
   
2. Over many years of exposure to radium, Marie Curie suffered radiation burns and finally died of leukaemia.
   
   
3. I love honey.

++++++++++

It gets worse. It is not just the Independent.

Tim Worstall points out to me that the Sunday Times is at it as well. See Tim on "Cancer Clusters and Mobile phone masts"

The BritMeds 2007 (16)

“In any pantheon of really, really, really thick bastards….”

So starts the DK as he takes an outsiders' look at the Secretary of State for Health

We can always rely on the DK for a coruscating Anglo-Saxon analysis of the NHS as seen from the outside. From the inside, of course, Dr Rant and his team are the spawn of the DK and have kept us all hugely entertained. Those of you how have missed some of Rant’s rants should take a look at:

Stick this pole up your arse, Patsy

Cervical Cancer : What a tosser

Think again Splatzy

It would be fair to say though, to borrow the words of the late and not so great LBJ. that it is always easier to piss in to the tent. The Rant team of doctors have therefore been taking a look as what we could to save the NHS. They do not, as you would expect, mince words.

Take a look at :

Dr Rant’s manifesto to save the NHS

++++++++++

Children down, vaginas to go.

“I’m a medical student, get me out of here, finished paediatrics, and was not looking forward to gynaecology, but then realised that “I love vaginas”

++++++++++++

Tempers appear to be heating up at Harrogate with the RCN voting for industrial action.
Frontpoint systems takes a look at the nurses, who are getting angry

+++++++++++++

PJC Journal (I am not a number, I am a free man) looks at the latest bit of government control freakery in “Tag dementia sufferers says Science Minister”

++++++++++++++

A medical student struggles through mock OSCEs


+++++++++++++

“For many, the NHS is part of what it means to be British. It expresses values that are ingrained in the British character - fairness and decency, compassion and a belief in the power of community.”

Who said that? You will not believe it. Mens sana takes a look in “Then and Now”

++++++++++++

An anguished patient finally finds effective treatment for his chronic disabling medical condition, but it is not available on the NHS

+++++++++++

The Big Opt Out looks a the Public Accounts Committee, which has published a truly damning report on the NHS computer project.

+++++++++++++

Choose and Book is unnecessary and is driving GPs mad. Looks like the hospital doctors are enjoying it too….

Dr Grumble takes a look

+++++++++++++

A young doctor sits in with the "health care professionals".

A lady comes in for her pneumococcal vaccine. She is at high risk of getting pneumonia because she has chronic obstructive airways disease from smoking. She tells the Nurse that she doesn't understand why she needs this jab because she has already had her flu jab. The Nurse tells her that the difference between pneumonia and flu is that "pneumonia is just a really really bad case of flu"

And then :

A 9 year old girl is brought by her grandma because she is having headaches….

Dr Crippen’s practice does not let nurses and HCAs loose in this fashion.


++++++++++

The Parable of Gibbo

When I was at medical school, in our first year there was this guy called James “Gibbo” Gibson. Gibbo was a complete pisshead. I mean, Gibbo was the kind of student that gives students a bad reputation. He would go out a get hammered literally every night for three weeks straight and, on the few occasions he did manage to make it into uni for lectures, he would just fall asleep, hungover. Unsurprisingly, Gibbo failed his first year med school exams. Our med school allowed him to re-sit the year, but Gibbo didn’t change his spots, failed again and was eventually kicked off the course. Gibbo switched courses and did a physiology degree and this is when I lost touch with him. I heard that he had to re-sit a year of his new degree but eventually graduated with a third. Fair enough.

Fast forward to the first day of my surgical house-officer job (in my first year as a qualified doctor) and I had walked onto my ward for the first time. I’m introducing myself to a couple of the nurses when I hear a voice behind me saying, “Mikey-mate! How are you!”

It’s Gibbo. Gibbo is dressed very smartly, wearing a nice suit. It turns out that Gibbo had been appointed as our ward manager.

The junior doctor is very angry. See how he proposes to manage the managers

+++++++++++

A mother of four died after a “gross failure” by NHS staff to provide basic medical attention on two separate occasions, an inquest has ruled. Alison Christian, 36, died in agony from a perforated duodenal ulcer after accident and emergency doctors and a nurse answering an out-of-hours phone line failed to detect the symptoms of peritonitis.

Do we need this sort of Eye on Britain from the colonies?


+++++++++++

The American right wing is looking at all the faults of he NHS and predicting that Hilary Clinton will bring them all over the the USA.

So says BizzyBlog

They do not seem to care much for British contraceptive advice to children either.

+++++++++++

Wat Tyler, normally economically sound, believes that anyone who works for the government should be paid as small a salary as possible.

…but like it or lump it, what he says represents what the general public think of overpaid, fat-cat consultants.

Wat would undoubtedly agree with this:

A brilliant and insightful report from the National Audit Office (NAO) has proved beyond a reasonable doubt that NHS consultants are big lazy fat bastards who gorge themselves on tax payer's money while doing minimal amounts of work.

Dr Rant looks at the hospital consultants

++++++++++++

…if you get a Paramedic then you are guaranteed to survive, while if you get an EMT then you just have a 'stretcher monkey' and. will. DIE.

Tom Reynolds is very unhappy


++++++++++++

Recently I've been struck by the fact that the NHS seems to be going through a phase of Taylorism or (so called) Scientific Management which was a fad in manufacturing management circles in the 1920s, but now seems to be being applied to services industries, as well. The days of the men in white coats and stopwatches not stethoscopes are here. The idea is that you break down all the actions needed into lots of component parts and look for the most cost effective (ie quick, cheap, and deskilled) option for each. You can see why accountants might like it.

It was a pretty awful (and unsuccessful) management fad, turning people into robots on the factory assembly line making cars, and didn't last long. But it's even more horrifying now, applied to medical services as it makes access to fully skilled medical professionals more and more difficult.

Unhappiness caused by exposure to a Health Care Assistant

+++++++++++

How many nursing students does it take to determine that a patient is dead?

Okay, so this story about nursing students’ lack of supervision has surfaced in the UK recently. I was prepared to read about something shocking, like say a nursing student who was left alone with a coding patient. Instead I read that this student was complaining that he had been left alone with a patient from a dementia unit that had soiled himself.

Pixel RN has the answers

++++++++++

Empathy! Empathy! They’ve all got it empathy!

Mental nurse looks at nursing training as it was 25 years ago.

+++++++++++

The jaundiced views of a free born Englishman from behind the barbed wire of a Wiltshire farm - blasting the Bogusmongers and other assorted pondlife.

An Englisman’s Castle takes a look at patients starving to death because nurse do not have time to feed them

+++++++++++

James Gerrard, a GP in Leeds, said: "Out of the six doctors in our practice, three of us object to abortion. I had made up my mind on abortion before entering the medical profession. I feel the foetus is a person and killing that foetus is wrong."

The Stand to Reason Blog looks at the “abortion revolt” in the UK

++++++++++

On a cheerful note, a new blog from Dr David Coddingsteine provides some excellent pictures, and tells us why “I buy books I never read…”

+++++++++++

Compared to the NHS the Gromboolian state health system looks like pre-Nightingale Scutari. Only those with a desire to commit suicide by hideous disease would use it willingly. Virtually everyone with western expectations (and I include the growing Black middle-class, here) has private medical insurance. Yep, we have the dreaded "American system" every leftie talks about whenever someone tries to reform the NHS.

The Remittance Man, an ex-pat Brit living in the colonises looks at the NHS

+++++++++++++

A DOCTOR was today facing a medical hearing after punching his partner and breaking his nose.

Oh dear. More tales from the GMC

++++++++++++

Dr Crippen is fed up that the local psychiatrist cannot be bothered to see alcoholics. (See David’s story here)

And there is evidence that even brief intervention by a doctor will help.

++++++++++++

Grade Inflation spells loss of freedom in the NHS
Nurses are rapidly replacing doctors in out-of-hours services throughout the NHS (though this is driven by poor financial management inside the primary care trusts rather than good patient care).

The Adam Smith Institute

+++++++++++

There is a shortage of nurses to care for premature babies

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Grandma was a suffragette

the looming abortion crisis isn't because of changes in the law, or because of increased campaigning from the pseudo-morality peddlers who hang around outside clinics with their photoshopped foetuses and dubious scientific facts. It's because some doctors feel that their personal opinions should stop them doing their job.

Could you pass the “dinner party test” on abortion?

++++++++++

NHS BLOG DOCOTOR got Manchester Me thinking – and he says that “I do believe there is a psychological aspect to this illness and that is why CBT does help some patients and not others.”


++++++++++

Your daughter is MINE because its my ’societal preference’!

More schools will be encouraged to hand out the morning-after pill to underage girls after a strong endorsement of the service from Ofsted inspectors. Around one in three children already has easy access to condoms and emergency contraception - without their parents’ knowledge or consent - thanks to sexual health clinics based at secondary schools.

The Americans do not like it. How do the Brits feel?


++++++++++++

The MTAS/MMC week

Dr Crippen took last week off MTAS. The problems have changed a little, but they have not gone away. The doctors are not getting a fair hearing from the media, and in particular the government’s media mouthpiece spins a plausible web of deceit:

Holby City ignorantly and misleadingly showed a junior doctor being offered a job while in the operating theatre with his consultant, and upon being offered the job the junior mentioned how content he was with becoming a consultant faster than ever thanks to HMG's butchering of medical training.

The Ferret Fancier takes a look at the biased BBC’s dramatised whitewash of MTAS

++++++++++

If the computer says no, it’s VSO says Dr Grumble

+++++++++++

The young men (and women) are angry about MTAS, but it is not just angry young men (and women). Dr Michelle Tempest reports an exclusive interview with an eminent Cambridge University Physician, an ex-dean of medicine.

+++++++++++

On the same day as Mr Blair was trying to sell or spin his NHS legacy, Mr Johnson (Chairman of the British Medical Association) said:

"It's disgraceful that thousands of our best doctors could have their NHS careers wrecked through no reason other than government mistakes and poor workforce planning."

The Psychiatrist is angry

++++++++++++

SHP has a piano lesson. What’s that got to do with MTAS? Think about it.

++++++++++++

Not so happy house hunting

So about this time, I should be house-hunting. When the timetable for MTAS results came out, I planned myself two weeks of leave to try and buy somewhere to live. This week was when I'd find out if I'd been successful in round one of MTAS and I'd know roughly in which county to buy a house.

Dr Paul Clayton

+++++++++++++

The Ferret Fancier, once again, has accumulated a portfolio of leaked documents from management and the DoH, all which is essential reading:

Muck unearthed

Sniffing out the lies

Rectal seepage

MTAS dynamite

++++++++++++

Tin hats will be going on again at the GMC. Rita is back in action.

Have the doctors running Remedy UK realised that some of their senior colleagues might dispose of them by declaring them to be mentally ill?

Don’t be silly. It could not happen.




The A Team are Back - Rita Pal v General Medical Council The Judicial Review on their decision on Professor Rodderick Griffiths

"Any junior doctor whistleblowing under the GMC's Whistleblowing Protocol can be accused of being insane. They can also be accused of being inadequate at their job. This can be done without investigating the issues and without any evidence or verification. The director of public health is normally the first port of call for all whistleblowing concerns."

Read on here

++++++++++

Please send your recommendations for next week’s BritMeds to: thebritmedsATnhsblogdoc.wanadoo.co.uk


*********************
*********************

A couple of (I thought) minor errors, now corrected, in this week's BritMeds. I hope there are no more. It takes a fair time to read through all the recommendations and then assemble the whole post and, yes, a few errors creep in. A commentator styling himself as "A.N.O.N" has made some vitriolic comments, and couched them in a manner that I find aggressive and offensive. I have not had any complaints like this before. However, it may be I am wrong. If A.N.O.N's remarks are representative of a general feeling about the BritMeds, then clearly it is time to move on.

Health and safety at work

Greetings comrades. It has been a while since we spoke. Last year was the most successful year ever for our glorious health service. And now more good news from the Health Commissariat. Comrade Hewitt’s health and safety commissars will not rest until our health service is safe for comrade doctor, nurses, and patients.

Meanwhile, back at the coal face, Dr Crippen has just returned from a few days in his Windermere dacha to find there has been another initiative from those nice NHS Health and Safety at work people.

The following stickers have appeared in the Health Centre.




Where have they put them, you may wonder. Apparently, if you twist the top of a tap with a red roundel marked “H” in an anti-clockwise direction, hot water begins to flow. My colleagues and I are most grateful to the Health and Safety hot-tap nurse-specialist for this helpful advice.





There are, by my estimation, thirty-three hot taps in our health centre. I do not know how many there are in the whole of the NHS. I do not know how long it will take to apply the requisite stickers. I do not know how much the stickers cost. I do not know to what total the time-costs of the aforementioned hot-tap nurse-specialists will add up.

But this is health and safety. Better than wasting money on management consultants.

The Crippen Diaries 2007 (16)

Not quite Emergency Ward 10

Monday 16th April

Back after a gap.

The break in the diaries was due to the MTAS and MMC furore, which has not yet abated. Then, a week’s holiday in the Lake District and back to all the patients who have waited "until you finished your holiday, doctor”.

The first patient of the morning was Jim, a fit 79 year old. He was distraught. His wife had been admitted to hospital just before Easter for a routine hip replacement. She was a year older than him, and had maturity onset diabetes and ischaemic heart disease. She had held out against surgery on her hip until the pain, particularly the rest pain at night, became intolerable. The operation went well. She was up and mobilising. Then, early on Good Friday, Jim was phoned to be told that she had had “a bad turn” and was very unwell. He went straight to the hospital. When he arrived, there was no nurse at the desk. He saw curtains around his wife’s bed. Thinking that maybe the nurses were with her, he went straight to the bed. Opening the curtains, there were no nurses there. His wife was dead.

Jim has no criticism of the care she received. It was excellent. It was just unfortunate that there was no one at the door of the ward to meet him. It happens. There had to be a post-mortem. His wife had had an embolus, he was told. Fat embolus? Pulmonary embolus? He does not know, and neither do I. I will get some information in a few days.

Jim and his wife knew the risks. He is not bitter, but he is bereaved and he had come to talk, which we did. And he brought a carrier bag full of her medication. I looked inside. There was a pair of glasses, her reading glasses, in the bag. I offered them back to him. He did not want them.

An awful way to start the week.

++++++++++

The next patient was Eric a 27 year old fork-lift truck driver with hay fever. He was grumpy because I had kept him waiting twenty minutes. He was grumpy because he had paid a lot of money to the chemist for some anti-histamines which “don’t work”. He wanted to have “that injection” that gets rid of hay fever.

I don’t do “that injection” for hay fever. It is dangerous. And, to be perfectly frank, I was still thinking of Bill and looking at his wife’s glasses sitting on the desk. I suppose I should have thrown them away. I had thrown her drugs away. But glasses are so personal.

Eric seemed to think that I was not devoting all my attention to his hay fever. Eric was right. He left with some eye drops and a nose spray to complement his anti-histamines.

I threw the glasses in the bin.

+++++++++++++

David is 71 and lives alone. He is a widower. He has a daughter in Wales, to whom he is close. They see each other regularly. David is a retired quantity surveyor. He has, as he would be the first to admit, always been a worrier. He was very worried indeed today, visibly shaking. He said, “I think I have bowel cancer.”

The history was that, ten days ago, he suddenly found he had to strain to pass a large bowel motion. It hurt a little and then, when he looked down, there was blood in the bowl. The following day there was a little more blood but just on the paper. The next day he was back to normal. No blood. No change in bowel habit. Feeling well, apart from anxiety.

There was nothing to find on examination apart from a small pile. I bet that was the culprit.

He waited over a week for me to get back from holiday. He has not told his daughter as he does not want to worry her. I do not think this will turn out to be anything ominous but the one thing I cannot do, is the one thing David needs. A written guarantee that he does not have bowel cancer. I cannot give him that. They will see him quickly in the colo-rectal clinic. On this history, he will see the nurse rather than the doctor. Then he will have to wait several weeks for the follow up investigations.

Several weeks of worry.

+++++++++++++

Mrs Jones phoned. Her grumpy, elderly, independent mother, who lives nearby in sheltered accommodation is refusing to take her thyroid tablets. Mrs Jones wants me to sort this out. A classic general practice problem. I am not a health police officer. If someone does not want to take their medication, that is not my problem. Except it is, when it is an elderly patient. Or is that being ageist?

So I agree to meet the daughter at Mrs Jones’ flat.

Mrs Jones seems very well. She is not demented or dementing as far as I can tell. She does not wish to be examined and she is not prepared to have a blood test. The only abnormal behaviour is her refusal to take her medication. She has been on it for years. Why the sudden change of heart?

She will not come to any harm without thyroxine for a few days or even a few weeks, but it will catch up with her in the end. Maybe she has not been taking it for a while. There is no sign of a stockpile in the house. Her last blood test – about ten months ago, she is due another – was normal.

What do you do?

I have asked one of the district nurses to pop in next week and see if her persuasive powers are better than mine; and to try to get a blood specimen. Yes, I know, a bit of a buck pass, but I am not sure what else to do.

++++++++++


Tuesday 17th April

Alice is 56 and is widowed. She does not have any children. She works as a clerical officer for a large freight-forwarding company. I had seen little of her until she presented a few weeks ago with an ominous breast lump. All that needed to be done has been done except for the post-operative radiotherapy which starts next week.

She came in looking embarrassed and tearful.

She cannot afford the transport to the radiotherapy centre. It is a thirteen mile journey. A bus and a train and a walk. The cost to her is just over £10 a day. That is five days a week, for several weeks. She has been off work for a while and is now down to SSP (statutory sick pay) which is about £70 a week. She does not have much in the way of savings and does have all the normal household outgoings.

The NHS ambulance service used to provide transport but that has now been restricted to patients who are physically unable to use public transport. Alice is perfectly capable of getting on buses and trains.

Strangely, she is not angry about the situation. She is ashamed. She has applied for a grant for transport. I do not know anything about this, but it involved sending letters and reports to Preston in Lancashire. Alice gives me the name of a civil servant there who has told Alice that they have not given her the grant as they “have not received a report from your doctor.” That is me.

I have not sent a report because they have not asked me to. So I phone up said civil servant in Preston and, having spend several minutes negotiating the phone options, (“If you are really cross, press the hash key…) fail to get hold of anyone who knows anything about Alice.

At this stage, I call in one of the office staff and delegate what is rapidly becoming the task from hell.

The NHS is free at the point of entry, but you have to get there under your own steam.

There must be a better way.

++++++++++++

My secretary informs me that, whilst I was away, further diktats have arrived from the local mental health service, and hands me the following letter and document. Another form to be filled in before a referral can me made.

Both the covering letter and form make me fulminate with anger. Let us look at the letter first.

click to enlarge

It is not a letter at all. It is a circular. And it is anonymous.

Note the passive tense. “We are now required…”.

By whom?

Why?

The ethnic origin and marital status of patients with psychiatric problems are usually but not always relevant, but why is yet another data collecting task being imposed upon us. Why is the government collecting these data? Do they want to be able to tell the Daily Mail that West Indians are madder than the Irish?

Why is this relevant? Why has there been no discussion? What happens if a patient does not wish this data to be collected. It is one thing to put in a psychiatric history something like “Mrs Heaney was born in southern Ireland…”. That information is not easily extractable by the commissars. Now it has to be on the computer analysable tick-sheet on the front of the notes.

I hate it.

Next, look at the form that we are supposed to get the patients to fill in.

click to enlarge

It starts with a characteristic bit of dishonesty, so typical of this government.

“To help us make sure that the services we provide are unbiased and equally accessible to everyone, we wish to record the ethnic group and marital status of the people who use our services.”

Codswallop. Sounds good, maybe, but it is codswallop. Recording this data has no relevance to helping to provide an “unbiased and equally accessible” service. The psychiatric services are dire beyond belief, but are equally unavailable to all, without regard to race and marital status.

It is well known that immigrants and, in particular people of African and West Indian origin, get a raw deal from the psychiatric services. They do not have difficulty accessing it, but they often get second-rate care once they are in the system.

You will not solve that problem by counting numbers. You need to look at quality of care. And racial prejudice within the service.

What they might like to record is the number of patients who manage to see an NHS psychiatrist. Very few indeed. Most are fobbed of with a “risk assessment” by some over-promoted amateur whose skills start and end with their ability to tick boxes.

The only way to guarantee a psychiatric assessment where I work is to go privately. They will not be recording that though.

Then look at the categories.

Do we really need this kind of detail? Am I alone in finding it offensive? And if it is relevant, for example, to record details of British and Irish origin, why not Welsh and Scottish origin? Yes, I know about the definition of the UK and Great Britain and Eire and so on, but is this really relevant to a psychiatric history? If Irish origin is important, then so is Scottish and Welsh.

And just a minute. “Black background”? People born in Britain are British. Is this really about the colour of the patient’s skin?

And would someone tell Dr Crippen why it is that we are not collecting this sort of data on patients with asthma, or arthritis, or inguinal hernias? Why are we only collecting it on the mentally ill?

What is the real agenda?

Maybe I should move to Tunbridge Wells and start writing letters to the Daily Telegraph, but I hate and resent this. Data for data’s sake. Control freakery. Intrusion into the private lives of the mentally ill.

I hate it.


+++++++++++

Thursday 19th April

A desperately frustrating morning trying to get some help for David and Mary, his long-suffering partner. David is a Welshman. He works, when he does work, as a bricklayer and thus can earn good money. He is a keen snooker player and, in a different life when he was in Wales, had ambitions to play professionally. It did not work out.

His marriage broke down. He moved to England several years ago and now lives with Mary, who is a hotel receptionist. They have no children, but David has a ten year old son in Wales, whom he sees occasionally.

David suffers from anxiety and depression. To allay the anxiety, he drinks. To bury the depression, he drinks. The drinking makes the anxiety and depression worse, so he drinks more. You can argue about the definition of “alcoholic”. David qualifies on any definition you care to advance. He drinks gargantuan amounts. Sober he is delightful. Drunk he is foul tempered and frightening. He has never hit anyone. He never gets violent. He does not smash things. But who knows what will happen tomorrow.

The psychiatric services are playing pass the parcel with him. He has been under the care of the CMHT for over a year. They tell him not to drink. He is under the care of the alcohol team and they tell him that he drinks so much it would be dangerous to stop abruptly. They have suggested he changes from vodka to beer. They have offered him group therapy, but he cannot manage that. He is too anxious to do “groups”. He was about to have a ten week out patient supervised “de-tox” course, but when he turned up for the first session, they breathalysed him. He had not had anything that day, but the previous day’s intake was still showing. You have to turn up to “de-tox” sober so they would not let him in. He had breached his contract.

David wants and needs in-patient de-tox. There is no NHS facility that provides that in my area. Because David always smells of booze, the medical doctors are not interested. The psychiatrists are not interested either. David has never seen a psychiatrist, even though he is has been under the care of the CMHT for a year or more.

Two weeks ago, he took another overdose. We are not talking the teenage girl’s three paracetamol and an Alcopop. We are talking forty to fifty 40mg Citalopram tablets and seventy 50mg Campral tablets, all washed down with two litres (yes, two litres) of vodka.

He was taken to hospital by Mary and a mutual friend. He was not seen by a consultant psychiatrist. He was not seen by any of the psychiatrists. He had a “risk assessment” done by a nurse.

Take a look at it. Apologies for the quality of the scanning

click to enlarge

click to enlarge

What can one say?

Mood : low. (really?)

Regrets his actions and believes he would not repeat od/self-harm. (Really? Why should he stop now? How many tablets does he have to take for someone to respond to his cry for help?)

PLAN

Discharge ( ? plan)
Refer to CMHT for early appointment. (He is already under the CMHT)

+++++++++


I have printed the letter in case you did not believe it.

The NHS is free at the point of entry. I heard that somewhere. Can’t remember where. Maybe I read it on the back of a match-box. David cannot find the door.

David needs psychiatric help and in-patient treatment and de-toxification. He needs help with his anxiety and depression. He is not going to get it unless he goes privately. He is not even going to see a psychiatrist unless he goes privately.

Make no mistake, David is a difficult patient. I spoke to someone about him today. They said, “Oh God, he is impossible; he will not co-operate; he won’t stop drinking”.

So, bog off David, you are a pain in the ass.


PLAN?

Nothing.

Kelly Taylor - the right to die

Kelly Taylor

Poor old Kelly Taylor.

Like everyone else, I wish her well. She has Eisenmenger’s syndrome – incurable – and other medical problems.

We met her before here, when she launched a high court action for damages against her doctors, claiming they were breaching her human rights by refusing to kill her.

The media love cases like this and do not let facts stand in the way of their over-dramatised reports. What a hotch-potch of journalistic nonesense from the BBC who say that this is a court action to “compel” (sic) doctors to give her lethal doses of morphine”

Fortunately, Kelly has changed her mind and stopped the court action.

She is to experiment with non-drug treatments rather than continuing a High Court attempt to compel doctors to give her lethal doses of morphine. A Dignity in Dying spokesman said: "She has told us that she is considering advice to try non-pharmacological interventions that may result in reducing the pain and suffering she experiences. "She feels that she needs to have tried every avenue open to her before continuing her case in the High Court." Mrs Taylor now plans to experiment with treatments including physiotherapy. (BBC)

You mean she had not seen a physio before?

Kelly explains her illness, and her wish to die, in a video interview made before she had stopped the court action. The video may be seen on the BBC site here

As I say, I wish Kelly well, but it is hard to avoid the conclusion that this absurd court action is really her displacement therapy. It will be expensive. I wonder if she has legal aid? If she does, it would have been a lot cheaper for the taxpayer to provide decent private psychological support. The CMHT may already have done a risk assessment and discharged her.

We should all be grateful that Kelly does not live in Oregon or, worse, Switzerland.

Libby Purves joins the abortion debate

A teenager's brain

Maybe Murdoch has decided to ditch quality and go for sensationalism. Whatever the reason, The Times has been unashamedly going down market for years. It increasingly panders to the middle-class need for journalistic pap without the attendant shame of being seen reading something headed by the words “Daily Mail”.

A few days ago we were subjected to an extraordinary outburst from Caitlin Moran and today we find Libby Purves in hot pursuit as she jumps on the abortion band-wagon.

Caitlin Moran’s article was not to be taken seriously. She is capable of much better as evidenced by her wonderfully witty article yesterday in which she described her sex education.

But now Libby Purves seems to have taken leave of her senses

A crisis brought on by our selfish desires
Doctors’ opting-out of abortions was inevitable
An unprecedented number of doctors are opting out of terminating pregnancies, and the NHS struggles to cope. Ann Furedi, of the British Pregnancy Advisory Service, says: “Unless we can motivate doctors to train in abortion, we may face a situation in five years’ time in which women’s access to abortion is severely restricted.” Some doctors, she said crossly, take a “naive view” that there is now no excuse for accidental pregnancies, and think it low-status work.

Wrong, wrong and wrong.

A few doctors have always declined to do abortions on conscientious grounds, and it is their absolute right so to do. For the rest, it is more accident than design. When Dr Crippen was a gynaecology SHO, there were a few abortions on every operating list. They were passed down the food chain from consultant to registrar to SHO. The second thing my registrar taught me to do (after suturing episiotomies was abortions). "Right, Crippen the rest of these are yours, I’m going for coffee. Give me a shout if you need anything."

Nowadays most abortions are done outside NHS hospitals in private clinics working under contract to the NHS. So juniors often do not get the chance to “opt out” of the work. It is not there in the first place.

You cannot “motivate” doctors to do abortions by any means other than financial. No one enjoys doing them. Some are more troubled than others by them and no one seeks them out.

So who are the abortionists? Mostly trainee gynaecologists moonlighting for extra cash and, of course, the ever abused foreign doctors many of whom may be highly experienced but cannot get mainstream gynaecology jobs in NHS hospitals.

The increasing number of refuseniks is caused chiefly, say campaigners, by the cut in junior doctors’ hours. This means they no longer have to train in everything, but can pick and choose. And who, given a choice, would not gladly opt out of the one task in which doctors end healthy life?

No.

“Training” to do abortions does not take long. Any gynaecologist who can do an old fashioned D & C can do abortions. Training? Ha! Ha! See one, do one, teach one.

This does mean that occasionally there are problems – it is easy to perforate a uterus – and some of the abortionists are not as experienced as consultants and thus may perforate the uterus more often. That’s life. Can you really imagine Lord Winston popping in to the local Marie Stopes Clinic for an afternoon's abortions?

You do not find consultant gynaecologists doing abortion lists.

Richard Warren, of the royal college, told a newspaper yesterday that in the past abortion was “an accepted part of the workload” , but that it always was “difficult and upsetting work”, so more and more doctors now opt out. Another consultant said: “You get no thanks for it . . . who admits to friends at a dinner party that they are an abortionist?” She, and others, want it put in a core curriculum.

It is not difficult work. It is boring, repetitive, tedious unchallenging work. Upsetting? Maybe for some, but they will not be doing them anyway. Delivering babies requires more skills than performing abortions. We let midwives loose on pregnant women, so why do we not train up some abortion-nurse-specialists? That would solve the manpower problem and would save money to boot.

It is at this stage in the article that Libby takes leave of her senses:

These young doctors have a point: if they agree to do abortions they agree to do all of them, not just those undertaken for deep, serious, heartbreaking reasons. They must serve not only the rape victims, the abused, the desperate, the weak-minded, the sick and women who might be so damaged by birth that the welfare of their existing children would be torpedoed. No: once they’re signed up for it they must also serve the silly, the selfish, the careless and thoughtless.

“The silly, the selfish, the careless and thoughtless”

No, Libby, you cannot go there. If you do not believe in abortions, say so. What you are saying here is that you believe in some abortions provided always that you (you, Libby) think they are justified.

Read Emily’s tale again. A stupid indiscretion by an immature teenager.

“For your stupidity, Emily, I sentence you to give birth to a child against your will. Sentence to last eighteen yearsl with no remission. And may God have mercy on your soul." (Ms Justice Purves)

Well, on the unwanted child’s soul actually.

The old mantra of abortion campaigners — “No woman does this without deep thought and heartbreaking need” — is way out of date.

It is not a mantra. It may be overstated but, in my experience (yes, yes, I know I am a middle-aged male) the majority of women who have abortions do agonise about it, and a lot of them need support. And I have met far more women who have had, or requested, abortions than Libby Purves. Or Caitlin Moran. Or Emily, for that matter.

Plenty do it irritably, without a pang, after a drunken fumble with a stranger.

I hate that. Yes, women do have abortions after a “drunken fumble with a stranger” and most of them are enormously relieved to have the abortion and put it behind them. But do not trivialise their experience. It is the right decision for them, but that does not meant that it was necessarily an easy decision. And Libby, is a drunken conception going to be a bar to abortions?

Plenty do it because the time isn’t “right” for them, even by a factor of half a year.

Not plenty, Libby, but some. And who is to decide when the time is “right”other than the woman herself.

Even some mothers do it, as Caitlin Moran startlingly wrote last week, after less agonising than they put into choosing new kitchen worktops

Agreed. Caitlin going OTT

They know that the spirit of the 1967 Act is light years away from the 2007 practice: they know that without ever having debated or voted on it, we effectively have abortion on demand. Easier just to say no, and work on life instead. It would have been better, perhaps, if the spirit and letter of the 1967 Act (which I supported) had been more robustly followed, and couples given more reason to be very, very careful.

Every experienced lawyer in Britain knew that the abortion act sanctioned abortion on demand. It may or may not have been the enactment of David Steel’s spirit, but the “letter” of the law is unequivocal.

“The continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman”

Having a baby is always more risky, physically and/or mentally, than having an abortion. Ergo, abortion on demand.

But we should admit honestly that the change in medical education is only the final straw. We did this to ourselves with our worship of sexual impetuosity, our cowardly right-on attitudes to anything involving women, and our dubious backdoor introduction of casual, lifestyle abortion. We did this to avoid one misery, and brought on another.

There has been no change in medical education. There has been a change in venue for most abortions, meaning that it is easy for doctors not to do them.

• Our “worship of sexual impetuosity”
• Our “cowardly right on attitudes to anything involving women
• Our dubious backdoor introduction of casual, lifestyle abortion.
• There is, thank God, nothing back-door (or did Libby mean back-street) about abortions.

Oh dear, Libby, have you been holidaying in Tennessee? The message now from some educators in parts of America is that it's "worth waiting for." Sadly, as the nurses in Blount County, Tenessee are finding, most teenagers are off message. They are not waiting.

"The problem with teen sex in Blount County: Is there a problem with teen sex in Blount County? Most definitely, yes.

Blount County healthcare professionals (physicians and nurses) and public-health officials are alarmed at the large number of teens in this county who suffer the consequences of teen sexual behavior each year. Our county’s teens have a very high rate of problems arising from sexual behavior, and this rate is increasing."

Strange, is it not, that the "Right to Life" brigade are against abortion, but also against contraception and sex-education for children.

Libby Purves - would she approve?

Whether or not you teach young children about sex, by the time they are teenagers they think about it constantly. They need a road map. The way to reduce the abortion rate is to improve sex education. Children need to be taught about sex in primary school. They need to know that mummy and daddy have sexual intercourse, and they need to know why and how mummy manages not to be pregnant all the time. We need to throw away all those ludicrous “Janet and John” drawings of allegedly naked men and women whose genitalia have been removed. We need to ditch all that codswallop about birds and bees and storks. We need to teach young women not that abortions are shameful, but that they can and should be avoided. We need to stop selling Alcopops to teenagers. We need to look at our own drinking habits and make sure they can be safely emulated by our children.

What we must not do is punish women who have unwanted pregnancies by making them justify their abortions to Libby Purves.

Caitlin Moran and "pro-choice" - don't spoil it

Abortion is back in the news in the UK.

Emily, who writes the excellent “Doing it all again” draws my attention to an article published a few days ago in The Times, by Caitlin Moran entitled

“Why I believe abortion is part of being a good mother”

A provocative, journalistic title that would be more at home in the Daily Mail than in The Times. But let us first look at Emily's account of her abortion.

I don’t feel guilty about having an abortion. I felt at the time immense relief. I haven’t suffered the trauma that the anti-abortionists often cite.

On the night that changed my life, I was drunk. Not tipsy, absolutely roaringly, blacking out-style drunk. I can’t remember what I drank but I remember us all clubbing our pocket money together and standing outside the local off licence, trying to work out which of us looked old enough to buy the concoction of cheap drinks. I was one of them who went in with terrible fake ID. I got served with a shit load of booze with no problems.

Caitlin Moran now takes the argument further. Further than “necessity”; further than “ the lesser of two evils”; further even than “a woman’s right”. She is arguing that abortion is a virtuous act of motherhood.

“I would like to see a time where abortion is considered to be an intelligent, logical, humble, compassionate thing to do. I would like abortion to be considered as, perversely, one of the ultimate acts of good mothering.”

It is difficult to understand what agenda Caitlin is pursuing. She is an experienced journalist. If she is saying that woman should not be ashamed of having an abortion – and Dr Crippen would agree with that – then she fails utterly. Her stance is so extreme, and so gratuitously outspoken that she succeeds only in giving the militant “right to life” brigade a foothold.

One need go no further than the first comment under the article from KC:

Sex Causes Pregnancy, and pregnancy produces kids.
Don't want Kids. Lock your Legs Down.
Practice Oral Birth Control and Just Say NO!
IT IS REALLY VERY SIMPLE AINT IT!

Tell that to a scatty teenager who has had too much to drink!

There is a temptation to fisk Caitlin Moran's article, to take it apart paragraph by paragraph. It is not worth it. With its cod philosophy and bogus Buddhism, it is too silly for words.

“Women never speak publicly about their abortions with happy, relieved gratitude, in the same way that they would about a vital job promotion….

Last year, I had an abortion, and I can honestly say it was one of the least difficult decisions of my life. I’m not being flippant when I say it took me longer to decide what worktops to have in the kitchen….I was just too tired to do it all again. I didn’t want another child - in the same way that I don’t suddenly want to move to Canada; or buy a horse…

Ultimately, I don’t understand anti-abortion arguments that centre on the sanctity of life.”

Enough.

I have seen and helped a large number of women to have abortions. For some the decision has been easy. For some it has not. Of the many who find it “easy” at the time, a fair number go on to have psychological problems at a later stage.

Women have the right to control their own destiny and the right to control their own bodies. It should be their decision, and their decision alone, when to have an abortion. And they should not feel ashamed of it.

But let us not trivialise the issue.

By all means disagree with the anti-abortion lobby, but to purport not to “understand” the sanctity of life “argument” suggests intellectual and moral bankruptcy.

Few would argue with Emily’s decision to have an abortion. More might argue with Caitlin’s. They should not. It is none of their business. It was her decision, and her right to make that decision.It is not for me, or you, as a doctor, or a friend, or a family member, or a passer-by to impose our views upon a pregnant woman.

Caitlin Moran fuels the “right to life” campaign. She trivialises abortion, she demeans women, and by her extremism, she damages the very cause she purports to support. As the BBC reports today, there are fewer and fewer doctors prepared to work as abortionists.

Experts say the decline in the number of NHS doctors willing to perform abortions has also declined because they are able to "pick and choose" the areas they train and specialise in - and very few opt to carry out terminations when they can choose other areas such as fertility medicine. (BBC)

Caitlin Moran is a savvy, experienced journalist. She should know the effect an article like this is likely to have. So why has she written it? Her judgment must have been clouded.

I do not believe she is intellectually and morally bankrupt. I believe that Caitlin Moran is racked with guilt.

The BritMeds 2007 (15)

The BritMeds are published a little earlier this weekend as Dr Crippen is away tomorrow.

This week’s selection is dedicated to the Secretary of State for Health who, as a result of yesterday’s story, will henceforth be referred to as Filthy Patricia.

Despite the holidays, a bumper crop of nominations and recommendations have come in over the few days.

First, the best news of the week. Remember Cardiac Arrest? The television medical drama that made ER seem like Watch with Mother? The TV drama that introduced us to the wonderful Helen Baxendale as Dr Claire Maitland? The DVD has finally been compiled and is available from Monday.



Order your copy here today

+++++++++

I now draw your attention to Dr Aubrey Blumsohn, who writes the “Scientific Misconduct Blog”.

Dr Aubrey Blumsohn

Several of his excellent articles have been recommended, in particular, The mission of a University: Burger Flipping, Tenure, Berkeley and British Petroleum

What happens to a University’s academic agenda and reputation when a big company, like British Petroleum moves in?

For anyone wondering what these sorts of partnerships mean for a university without an academic compass…it is worth remembering what happened to Professor Ignacio Chapela at Berkeley in 2004 when he tried to pubish a Nature article showing that genetically modified corn had contaminated native maize in Mexico - stepping on the toes of a Berkeley-Novartis agreement.

And then Aubrey moves on to Batman and Drug Regulation in the UK

Who is this?

Thank you to the Bitter Pill Blog for pointing out the uncanny resemblance between the Right Honorable Andrew Burnham Minister of State at the Department of Health, and the psychiatrist known as the Scarecrow who works at Arkham Asylum (and has developed fear-inducing toxins) in the recent movie Batman Begins.

++++++++++

The horrors of female circumcision are still with us in Europe, never mind in the developing world. The author of A Changing Life lives in both England and France, and has just written an article on “The Incredible Melting Condom”

But her main concern is the outrage of female circumcision, and she so she has translated an article from a leading French Blogger :

I’m 30 years old of Senegalese descent and I live in Paris. I have a well paid job which allows me to live comfortably. I live with my partner in the south of the city. When I was 4 my mother had me circumcised. It ruined my life.

The full article is in “My path to renewal”. Those who wish to read it in the original French should look at "Excision: le chemin de ma reconstruction"

++++++++++

Financial incentives and delighting patients. Is the is the best new way to improve health care?

++++++++++

More tales from the annals (or should it be anals) of Filthy Patricia.

Money is so tight at the Potters Bar Community Hospital that there is not enough money for basic equipment, according to a source. Do you really want to know where the nurses are going to get their rubber gloves?

++++++++++

Wendy Fox, 38, lives in south Yorkshire but lived in Lime Avenue, Leftwich, with her parents Keith and Rosalind Mottram and brother Steve. She is now suffering from Lyme Disease, is paralysed from the waist down and has been wheelchair bound for six years. Her heart and liver are damaged.

She is suffering from Lyme Disease. Is the medical profession taking enough interest in this condition? Some even deny its existence?

++++++++++++

"A rise in the number of obese patients on wards could be causing thousands of NHS nurses to seek treatment for back pain, according to experts.

But then some good news:

All that is necessary to curb the growing incidence of obesity is to tell the truth about what causes it! - Obesity is NOT caused by overeating.

+++++++++++

Recently MPs awarded themselves a 66% pay rise. While overworked and grossly underpaid nurses got an insulting 1.9%. How is it the Government can afford to give themselves payrises and not key workers? I feel the nurses fully deserve it

Please sign the following petition now:

We the undersigned petition the Prime Minister to Give Nurses a Payrise in line of that of MPs.

+++++++++++++

"Its important for doctors to be controlled by fear so no one challenges our authority. Only Field Fisher Waterhouse know where all the skeletons are hidden and how many doctors lives we have ruined. No one else should ever know" GMC's Unpublicised Regulation

"Your powers are weak, whistle blower

Some sage advice from Rita to any doctor who is thinking of whistle blowing about experiences in the NHS.

+++++++++++

If you have nothing to hide, you have nothing to fear… UK Liberty looks at medical confidentiality.

++++++++++

Another little health care cut from Filthy Patricia. Why? Probably because she is frightened of independent advice given by independent professionls. She cannot control what they say.

Big mouth strikes again says:

When I was deciding whether or not to have back surgery, I relied heavily on BestTreatments and its sister site, ClinicalEvidence.com. Both sites come from the British Medical Journal, and they’re rare in health sites in that they don’t have an agenda, they’re not trying to flog you stuff and they don’t reprint pseudo-scientific bullshit. Instead, they take a simple formula: here’s what we know works, here’s what might work, and here’s stuff that there’s no evidence for whatsoever.

And now, they’re disappearing behind subscriber-only walls because the Department of Health isn’t willing to fund them any more.

+++++++++++++++++

News of Filthy Patricia’s plan to give all British Women the “right” to a home birth reaches the USA in “British Battle Royal”


+++++++++++++++++

A psychiatrist from the Maudsley writes:

Being black in Britain is bad for your mental health

I have had problems being a psychiatrist since the first day I worked in the Maudsley hospital. The Maudsley is in south London, and every day I saw more and more young people of African and Caribbean origin developing serious mental illnesses.

As a young black man I identified with them, found it disturbing, and vowed to do something about it: so I started research in the area. Unfortunately, that made things worse rather than better; partly because the statistics are so chilling, and partly because of the response to them.

++++++++++++++++++

Oh dear, this writer is worrying about Dr Crippen’s mental health:

I enjoy reading the NHS Blog Doctor because he's passionate. I feel for him though because I suspect the stress that results when he looks in vain for evidence of caring or logic or good management or good customer service in New Labour's NHS will drive him to an early grave…

++++++++++++++++++

The Girl with the Blue Steth has a thought or five

++++++++++++++

"More people in this country are dying than is necessary - this proves it. England is an international disgrace. In the developed world, only North Korea and Turkey, I think, are worse."

Says Aangirfan

++++++++++++++

There's been a degree of frantic bleating about the fact that call charges from hospital bedside phones are going up. Admittedly, the amount - 160%, from 10p to 26p a minute - is pretty eye watering, but it's not as if there are no alternatives.

The Welch Family are cross about it discuss alternatives.

+++++++++++++++

In the BritMeds, Dr Crippen occasionally looks at how others see us. Here is a characteristic article from the USA

All we need to do is look at the UK and Canada where medical care is of mediocre quality, where waiting times are frequently deadly (I've read that the UK's health system actually instructed hospitals to increase waiting times to save money!), and where citizens come to the US for important medical care when they need it urgently and they can afford it. A newly-released poll from England should cause even more worry as we see our elected representatives dip their toes in the dirty water of socialism.

You many not like that. I don't like it. Because of pride, certainly, but also because it is an exaggerated description of the failings of our healthcare sytem written by someone who probably has health insurance and has not a clue about the complete absence of care from which, for example, blacks on the south side of Chicago suffer. It hardly makes a British Citizen feel proud. But we do have problems, that is for sure and, sadly, much of his article is based on the following from the Daily Telegraph.

More than two thirds of doctors says they would not recommend medicine as a career as morale in the health service reaches an "all-time low", according to a survey published today.

More than half of the 14,000 doctors who responded said they felt morale at work was "poor" and in the case of junior doctors "terrible".

And how does Filthy Patricia and her crooked, malodorous, dishonest, mendacious little shit-bag commissars deal with that? Out comes the "sword of truth and trusty shield of fair play":

A spokesman for the Department of Health said the Healthcare Commission's latest NHS staff survey indicated that staff remained "generally satisfied".

+++++++++++++++

Dr Rant, as usual, does not mince his words about Filthy Patricia in “Killing Babies – the ultimate choice”

++++++++++++++

Mother of Many says A HOME BIRTH.............NOT A CHANCE!

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And here is another one. Why do we keep hearing stories like this?

A WOMAN who suffered from an undiagnosed illness for 30 years is fighting for treatment. Annette Miller, 50, of Windsor Road, Hebden Bridge, became ill with flu-like symptoms while she was studying for her A-levels. She never recovered and was told by doctors she was suffering from ME, or chronic fatigue syndrome. It was only last year that blood tests revealed she had the rare bacterial infection Lyme disease.

Can anyone explain why the medical profession seems unable to take control of problems of ME and Chronic Lyme Disease?

++++++++++++++++

So infatuated is New Labour with imposing market "solutions" on everything from education to climate change, that it has actually managed to create a series of market failures. Nowhere is this more apparent than in housing. Its policies have helped drive house prices beyond the reach of most people, put large numbers of people in housing debt and added to homelessness. Even the banks are pointing out how bad things have got. Today the Halifax revealed that public sector workers such as teachers, nurses, and firefighters cannot afford to buy homes in seven out of 10 UK towns.

A World to Win

++++++++++++++++++

Patterns and trends in prostate cancer incidence, survival, prevalence and mortality.

We know already the the UK medical profession is not good at lung cancer. It seems now that the same applies to prostate cancer:

There were wide differences in survival across Europe, with rates in the UK well below the average, but all European rates were far below those in the USA.

+++++++++++++++

If you have this

Some doctors providing out-of-hours care are being replaced with less qualified nurses and other workers, according to a poll. A survey of 50 primary care organisations found that 19 had already cut the number of doctors they employed out of hours, replacing them with cheaper staff.

Then you get this

Two days later, her condition had deteriorated and she called the local GP out-of-hours service complaining that she had been vomiting a "black tar-like substance" and that she had severe pain, dehydration and constipation. The nurse who took the call said her case was not serious enough to call out the emergency doctor, and advised her to take laxatives for the constipation.

The coroner said the nurse had "totally failed" to deal with the case. "Had Ms Christian been seen by a doctor at this stage ... it is surely inevitable that she would have been admitted," he said. Even at this stage it was likely her life would have been saved, he added.

More dumbing down. Dr Crippen says keep paying your private health insurance – if you can afford it.

+++++++++

Curly is a well-meaning but naïve blogger who says:

This is simply ludicrous, such iniquities ought not to exist in the National Health Service, if a drug being appraised by NICE (National Institute for for Clinical Excellence) is available on prescription in one part of the U.K., then it ought to be available in every other part of the U.K. The decision to prescribe and pay for certain treatments should be in the hands of specialised consultants, not the offices of technocratic executives. I know that our Member of Parliament, David Miliband reads this blog, (sometimes for light relief) but this is a very serious matter, which I am sure he will do his utmost to resolve.

Of course he will, Curly.

+++++++++++

In HRT PANIC FINALLY LAID TO REST? the author wonders why Dr Crippen is so “indecisive” about HRT.

Because, as I take responsibility for my patients. Because I live in a world of penumbra and indecision. Oh to be a teenager again! If you are interested in HRT, this is what I said.

Compare the two articles and make up your own mind.

++++++++++++

Dr Crippen has just been up there, and is thus obliged to mention the “Save West Cumbrian Hospitals” which is asking : Is the government about to axe the careers of 8,000 junior doctors ?

It is depressingly the same where ever you go in the UK

+++++++++++

Finally, I am just back from a week’s holiday, and cannot face dipping into another week of MMC and MTAS. Normal service will be resumed next week.

So let us end with a few words from Dr Michelle Tempest:

Thought of the week has to be dedicated to NHS staff, who continue to suffer from the unresolved problems regarding doctor specialist training and the lowest level of morale ever reported since the NHS began.

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Please send your recommendations for next week’s BritMeds to: thebritmedsATnhsblogdoc.wanadoo.co.uk

Filthy Patricia

Tracey Emin's bed

When I am on holiday, particularly if I am walking in the Lake District, the cares of the world really do lift. I did not think of Patricia Hewitt for a fleeting second. The failings of the NHS and the education system normally, as a doctor with four children ever on my mind were, for a moment, forgotten.

Back to earth with a jolt this morning.

A glass of orange juice and The Times. The former was delicious, the latter was disturbing. First, on page 12 of the news

School helpers ‘are taking A-level classes as head teachers exploit cheap labour’
Unqualified school helpers are being used as cheap labour to teach A-level and GCSE classes in subjects about which they know nothing when specialist subject teachers are on leave, a union claims.

In the very worst cases, an untrained assistant was required to teach A-level English for an entire term, while another was put in charge of a GCSE maths group.
Other instances include former dinner ladies and prison officers replacing qualified supply teachers.

Government reforms to teachers’ working conditions in 2003, supported by the NASUWT, brought about a reduction in teachers’ hours and specified that teachers would not have to cover each others’ classes for longer than 38 hours a year — or an hour a week.

Instead, classroom assistants and cover supervisors, who are not teachers and who are paid about £13,000 a year, would be given a far greater role.

A spokesman for the Department for Education and Skills said that official guidance made it absolutely clear that cover supervisors do not teach.

“We have record numbers of teachers in our schools with over 35,000 more than in 1997. We have also removed many administrative tasks from teachers and overseen a doubling in the number of support staff to help free up teachers’ time to do what they do best — teach,” he said. (The Times)

We are used to this in the NHS. Doctors replaced by nurses, Consultants replaced by GPs, midwives replaced by “maternity care assistants. And when the government is challenged, they lie. They duck the question. Compare the final paragraph above with Hewitt’s response in the Guardian when she was asked to explain the lack of obstetric care:

Huge progress has been made since Labour was elected - there have been almost 2,500 more midwives and 44% more students entering midwifery training since 1997, and an additional 1,000 midwives will be qualifying over the next few years. Under Labour, the budget for maternity services has increased from £1bn to £1.7bn. As the chancellor announced in the budget, an additional £8bn is being invested in the NHS this year alone.

In the NHS we call these cheap substitutes "health care assistants". In education they are "teaching assistants". We are moving towards a generic job description of the UPA, the Universal Professional Assistant, who will be tasked to take over any professional job. The only condition of employment will be complete ignorance of the job to be undertaken. The pay will be commensurately low.

This is why Dr Crippen educates his children in the private sector, which does not use teaching assistants. He also has private health insurance so that he can be treated doctors rather than by nurses and ambulance drivers. And also, he now realises, so that he may avoid certain hospitals.

I made a cup of coffee, tried to put teaching assistants out of my mind, and turned the page. All was well until I reached page 31. Come with me now to Good Hope Hospital in Birmingham.

Good Hope Hospital, Birmingham

Hospital ‘orders’ reuse of sheets
Cleaners at an NHS hospital have been told to turn over dirty bed sheets rather than use clean linen. Good Hope Hospital in Birmingham advised its staff to “top and tail” used sheets to cut the £500,000 annual laundry bill.

Posters instructing staff that this procedure would save 0.275 pence for every sheet re-used were pinned on cupboards and doors leading to the A&E and maternity departments. A health worker said that new patients were being given the same sheets as the previous occupant. (The Times)

When questioned about this policy, a anonymous “hospital spokesman” confirmed that it had been the policy, but that it had now been stopped. Good Hope hospital had 36 cases of MRSA in the last ten months of 2006.

There are so many things that could be said. "Ms Emin has finished with her bed now", for example. Dr Crippen thinks that it is one of the most filthy and unforgivable practices of which he has ever heard.

And all to save 0.275 pence a sheet.

Patricia Hewitt speaks to the Guardian

Patricia Hewitt has taken the unusual step of replying personally to a recent article in the Guardian on maternity care in the UK. She probably did not write the article herself but it must have been initiated by her and will have crossed her desk before it went out.

That a Cabinet minister, responsible for one of the most important government departments, should be replying personally to articles in a newspaper is a sign of desperation.

That the reply should be so breathtakingly duplicitous both demeans her office and calls her probity into question. I suppose we should be used to it by now. As the ageing Greek commentator pointed out a few weeks ago, Hewitt is already up there in the pantheon of great political liars.

“Classics of the genre, you may recall, are such as these:

I am not a crook.
- Richard Nixon, 1974

I'm a pretty straight kind of guy.
- Tony Blair, 1997

The NHS has just had its best year ever.
-Patricia Hewitt, 2006

Staggering falsehoods, every one of them; statements so diametrically at odds with the truth that they seem almost to warp the fabric of space and time around them." (Mr E)

Hewitt’s article was published yesterday in the Guardian.

Of course we must do more for mothers-to-be. And we will

Many women are denied the maternity care they prefer. We will give them choice, says Patricia Hewitt

Thursday April 12, 2007 The Guardian

Your article claims the NHS has "too few midwives to achieve even the basic levels of care for families" (Birth care promise is unattainable, April 7). This is untrue.

The UK remains one of the safest countries in the world in which to have a baby,

[Like so many things that Hewitt says, the superficial truth masks a lie. Yes, the UK is indeed “one of the safest countries in the world in which to have a baby.” It is safer, for example, to have a baby in the UK than it is in Chad, where the maternal and peri-natal mortality rates are particularly high. But we should be right at the top of the list. What Hewitt does not say is that the maternal and peri-natal mortality rates in the country have been rising. And that is shameful.

The National Patient Safety Agency, which is part of the NHS, has reported on this recently. Go to their site here, and click on the link to:

The Confidential Enquiry into Maternal and Child Health (CEMACH)

The link does not work. The CEMACH report has disappeared from the NHS. Why might that be, Dr Crippen wonders?

And could someone explain to Dr Crippen why this report is confidential?

Fortunately, confidential or not, the CEMACH report is available here. Those not wanting to read it in full may like to refer to a recent article, with up to date figures, by Sophie Goodchild, Jonathan Owen and Ian Griggs in The Independent:

Record numbers of women are being harmed or dying as a direct result of childbirth in what doctors are labelling a "crisis" in maternity care. There has been a rise of 21 per cent in deaths of pregnant women in the care of NHS maternity services. Deaths over the past three years now total 391, up one fifth on the comparable period, and 17,000 women have suffered physical harm while on labour wards.

Figures obtained from the National Patient Safety Agency (NPSA) reveal that over the past three years, 17,676 mothers have been injured on maternity units. Serious cases include women with perforated bowels whose injuries are so severe they have needed temporary colostomies.

The UK now has one of the highest rates of maternal mortality in Europe, with 13 deaths per 100,000. Britain ranks below countries including Poland and Hungary, and is above Bulgaria, Bosnia, Belarus, Romania, Armenia and Albania.]

and 80% of women are satisfied with the maternity care they receive.

Not according to The Independent:

A survey of nearly 5,000 women's experiences of maternity from the Healthcare Commission, to be published to coincide with Mother's Day later this month, is also expected to highlight a lack of satisfaction among patients with medical care during labour and delivery.]

Of course, more needs to be done if we are going to deliver our manifesto commitment that, by the end of 2009, every woman will have choice over where she gives birth and what pain relief to use, supported by a named midwife throughout her pregnancy. That's why last week we set out how, for the first time, women and their partners will be guaranteed this choice.

[We are back to Alice in Wonderland here.

`Have some wine,' the March Hare said in an encouraging tone.

Alice looked all round the table, but there was nothing on it but tea. `I don't see any wine,' she remarked.

`There isn't any,' said the March Hare.

`Then it wasn't very civil of you to offer it,' said Alice angrily.

There are not enough maternity units. Hewitt is closing them down. There are not enough midwives to provide a safe service in hospitals, never mind at home.]

Your piece quoted selectively from research, suggesting that "more women want midwives they can trust than wish to be able to make choices about their care". Of course mothers-to-be want doctors and midwives they trust. But we also know they want to be given a say over the care they receive. Women want a range of options - from consultant-led care in hospitals, to midwife-led units and home births - and their choice will depend on what's best for them and their baby.

We know that more women would choose home births if the choice were available. Where the NHS locally employs enough midwives to support genuine choice, 10-12% of women choose a home birth compared with only 2-3% nationally. That's a lot of women currently denied the option they would prefer.

[Dr Crippen does not want, on this occasion to reopen, yet again, the debate about the safety of home births as opposed to hospital births, but it is dishonest of Hewitt to purport to offer “all” women the “right” to a home birth without discussing safety. If she means that only a highly selected group of women, alleged to be low-risk, are to be offered a home birth subject to the availability of a midwife prepared to conduct it, she should say so]

High-quality services that support genuine choice must not be the sole preserve of the articulate middle classes. That's why tackling inequalities in maternity care is at the heart of our approach. We know that providing more ante- and post-natal services in the community, including through Sure Start and Children's Centres, helps improve access to care - and outcomes such as low birth weight - among hard-to-reach communities.

[Experts are warning that 10,000 more midwives are needed to prevent a further rise in blunders and deaths. They say there is also a shortage of trained obstetricians, desperately needed now that doctors perform more Caesarean sections, largely because of staff shortages. More than one in five births in Britain are by Caesarean section, a figure significantly higher than World Health Organisation guideline of 15 per cent. (Independent)]

Under Labour, the budget for maternity services has increased from £1bn to £1.7bn. As the chancellor announced in the budget, an additional £8bn is being invested in the NHS this year alone. Labour's investment and reforms, and the hard work of NHS staff, will deliver the quality and choice of maternity care all mothers want, and deserve.

[An increase from £1bin to £1.7 billion over ten years is a little over 5% a year, and thus barely keeps pace with inflation. In terms of the real money that is needed to expand the service, it is next to nothing.]

++++++++++

Patricia Hewitt’s reply might be acceptable from a government which had been in power for ten weeks. They have been in power for ten years. The time has passed for more promises of more action to be taken in the future.

After ten years, the people of this country are entitled to ask not what will be done, but why it has not already been done.

We are desperately short of midwives

We are short of medically trained obstetricians

We are short of maternity units.

We may be doing better than Chad, but more mothers and babies are dieing during or shortly after labour since this government came to power.

This truly is new labour.

++++++++++

Comments may of course be made below as usual, but please comment under Patricia Hewitt's article in the Guardian (here)

Great Gable and the Great War Memorial Tablet

Great Gable seen from Wasdale

A glorious day for walking. Clear sky, cool and sunny. We decided to do Great Gable, not from Wasdale as illustrated above, but from the Slate Mine on Honister Pass. Sadly, although visibility was excellent, with the sun came haze and so it was not the greatest day for photographs.

The path up from the slate mine

The purist will say tackling the Gables from this starting point is cheating, as you have won a thousand feet before you get out of the car. But we have been up Gable a fair few times, and this was an ideal day for a family walk across from the Slate Factory, looking down on Haystacks and Innominate Tarn, around which Wainwright’s ashes are scattered:

“All I ask for, at the end, is a last long resting place by the side of Innominate Tarn on Haystacks, where the water gently laps the gravely shore and the heath blooms and Pillar and Gable keep unfailing watch. A quiet place, a lonely place, I shall go to it, for the last time and be carried: someone who knew me in life will take me and empty me out of a little box and leave me there alone.

And if you dear reader, should get a bit of grit in your boot as you are crossing Haystacks in the years to come, please treat it with respect. It might be me…”

(Wainwright)

Open cut mining on the slopes opposite

This walk provides spectacular views over Buttermere, Ennerdale and Wasdale.

Looking down over Buttermere and Crummock

The Gables come into view

We followed Moses Trod and then, after a quick glance down at Wasdale, up Great Gable. On the summit there is the famous Great War Memorial Tablet, now nearly sixty three years old.

UNVEILING THE WAR MEMORIAL TABLET

Great Gable, June 8th, 1924

W. T. PALMER

On Whit Sunday the Club completed its task of a permanent and magnificent memorial to members who fell in the Great War. In October, 1923, the title-deeds of 3,000 acres of high mountain had been handed over to the National Trust. The rocks, buttresses, and recesses of Lingmell, Great End, Allan Crags, Green Gable, Great Gable, Kirkfell and other peaks east and west of Sty Head Pass had been secured, as Dr. Wakefield (the new President) declared, to us and our children for ever.

Geoffrey Winthrop Young, a veteran of the Piave front,pronounced the following eloquent tribute to the fallen:

Upon this mountain summit we are met to-day to dedicate this space of hills to freedom.

Upon this rock are set the names of men-our brothers, and our comrades upon these cliffs-who held, with us, that there is no freedom ot the soil where the spirit of man is in bondage; and who surrendered their part in the fellowship of hill and wind, and sunshine,that the freedom of this land, the freedom of our spirit, should endure.

This bronze stands, high upon the crowning glory of our free land, as a sign between us and them; our covenant that those to whom in the time to come we, too, shall be but as these names,or as less than these names, still hold their freedom of this splendour of height, still breathe its fearless health, the inspiration of its faultless pleasure free still, amid these untrammelled forces, to perfect their own vision of what is beautiful, interpret for themselves their own discovery of what seems true.

By this ceremony we consecrate a twofold remembrance; in token that these men gave their mortality of manhood for a redemption of earthly freedom, this rock stands, a witness, perishable also in the onset of time, that this realm of mountain earth is, in their honour, free. In token that their sacrifice bears witness still, beyond death, to the imperishable ideal of spiritual liberty, we commit to-day, not in bronze, but in unalterable faith, our thought of their triumph in the spirit to these spaces of power and light.

By this symbol we affirm a twofold trust: that which hills only can give their children,the disciplining of strength in freedom, the freeing of the spirit through generous service, these free hills shall give again, and for all time.

The memory of all that these children ot the hills have given-service, and inspiration, fulfilled, and perpetual-this free heart of our hills shall guard.

The Great War Memorial Tablet in 1924

The Great War Memorial Tablet 12th April, 2007

However many times I see this Tablet, I never fail to be moved by it.

And then it was the scramble down to Windy Gap, harder on the knees than the ascent, up to Green Gable and then a gradual walk back to the mine, taking in Brandreth and Grey Knotts on the way.

A great day out.

Brit Blog Awards 2007

Dr Crippen is flattered to find that NHS BLOG DOCTOR is one of five blogs shortlisted for the Metro Brit Blog Awards political blog of 2007.

Dr Crippen in The Guardian

A Dr Crippen article on the difficulties of treating back problems in General Practice appears in today's Guardian.

Who will take over from Patricia Hewitt?

'Après moi le Deluge'

An important question was posed over the weekend by the ever fascinating Aphra Behn. Who will get the health portfolio after Gordon’s coronation?

Dr Crippen has to admit here to having an incorrigible weakness for political gossip and political personalities. I am hopelessly addicted to political diaries, biographies and Guido. I find the Westminster soap opera infinitely more enjoyable than the Archers, whom I leave to Mrs C.

I have been mulling over two questions.

First, and fascinating in its own right, what will happen to Patricia Hewitt? Some fantasise about the elderly Greek commenter's suggestion coming to fruition. (It involved an aeroplane engine - those who missed it may read it here).

It may be hard for doctors to believe, but Patricia is still highly thought of by the Labour Party. She is currently fronting the Blair answer to WebCameron (New Labour – the movie) with an intense and meaningful video in which she says she feels "genuinely humbled" to be the Health Secretary. Take a look again at “Hi, I’m Patricia Hewitt”.



Those of us working within the NHS struggle to get through the video without feeling ill. But, believe it or not, the focus groups like it. This is sincerity; sincerity as only Patricia can do it. She will not be returned to the back benches. Such a demotion would be seen as a condemnation of the last ten years of New Labour health policies. It is not Patricia’s fault that she cannot open her mouth without sounding patronising. It is a congenital, possibly genetic problem. But it is still a problem of which the public have had an adequate sufficiency. Gordon will want to protect the public from further exposure to her, and so she will be moved to a position where she can be seen but not heard. The Crippen money is on Leader of the House.

Who will get the "Oh f**k, not health" portfolio?

It is obvious, really. It has got to be Dave “the boy” Miliband who, despite being the worst blogger in Britain (see here) is not without ability.

Why does Dr Crippen think it is obvious?

The thought process goes like this. Gordon will need to punish Miliband for allowing the speculation about a leadership challenge to continue. Of course, Miliband has denied it more convincingly than Heselitine used to deny he was going to challenge Margaret Thatcher, and he has not yet been caught installing phone lines à la Portillo, but he is still biding his time.


He may calculate that he cannot win and decide not to challenge. But Gordon will still need to slap him down, and what better way to do that than by giving him the health job? Too important to turn down, but a political graveyard.

So, it’s Miliband for Health. You heard it here first.

Unless…unless…there is always an “unless” in politics. Miliband may do the same calculation that Dr Crippen has done. In which case, with the Reidian experience of “Oh f**k, not health” in prospect, he will have nothing to lose by standing for the leadership. If he does, there is an outside possibility that he might win. In which case he will be appointing the new Health Secretary.

Dr Crippen suggests he offers the job to Gordon.

Menopause, HRT and the PMJ

Bray

Here we go again.

HRT is back in the news and, if the PMJ (People’s Medical Journal) is to be believed, it is time, once again, for doctors on the front line to change our position on HRT.

We have always known that HRT may increase the risk of breast cancer and it is likely that that risk, though still low, is higher than originally thought. It used to be said, however, that HRT decreased women’s risk of heart attacks and strokes and so, even allowing for the breast cancer, it was a good overall bet. Then, in 2002, the Women’s Health Initiative in the USA published a landmark meta-analysis of HRT (see here) which concluded:

Compared with the placebo, estrogen plus progestin resulted in:

• Increased risk of heart attack
• Increased risk of stroke
• Increased risk of blood clots
• Increased risk of breast cancer
• Reduced risk of colorectal cancer
• Fewer fractures
• No protection against mild cognitive impairment and increased risk of dementia (study included only women 65 and older)

Hard to sell that to the customers. There was an immediate and radical change in HRT prescribing. The drug that had been near compulsory in the 1980’s (“if your GP won’t prescribe it, make sure you see a specialist” screamed all the women’s magazines) suddenly fell into disfavour.

Family doctor’s still prescribed HRT but did so now with an air of reluctance, and lots of caveats and warnings. Not for more than five years…you must stop it when you are 55…there are better things for osteoporosis prevention…and so on and so forth. Lots of “gut feeling” here, not much science. We could not get an agreed policy in our practice of ten doctors. In particular, two of the female partners had entrenched and disparate views, one continuing to put women on HRT willy-nilly and the other taking them off it. If our normally cohesive practice could not agree, nationwide there must have been confusion and erratic prescribing.

Dr Crippen has always been cynical about trends and fashions in medicine. Just as he worries now about putting the world and his wife on statins, he worried then about putting the wives of the world on HRT, even though the menopause experts were saying it should be in the tap-water.

The sad fact of the matter is that I did not have a clue about the validity of the claims made for HRT ten years ago, and I do not have a clue about the current state of knowledge. So, I try to steer an uncertain middle course, and probably thus make everyone unhappy.

Time to call in the specialist. If you, Crippen, are telling your patients that you do not know the definitive answer about medication, then kindly sent your patients to someone who does. Good idea. But first, before I make the referral, I have to ask the patient if she wants to go on HRT. Does that not rather beg the question? Certainly it does. But if I refer a patient to a menopause clinic, to a menopause “expert” they will prescribe HRT. They always do. They are believers. HRT is their stock-in-trade. Dr Crippen has never known a menopause expert not to recommend HRT. They even give it to women who have had breast cancer. You do not believe that, do you? But it is true.

HRT is big business for Big Pharma. There are a lot of menopause clubs and societies to which the menopause “experts” belong. And they meet regularly in “congenial environments” to discuss the pros and pros of HRT.

Now the PMJ reports some good news on HRT.

U-turn on the risks of HRT as experts say it CAN cut heart disease

A new study disputes health scares over Hormone Replacement Therapy, saying the treatment used by millions of post-menopausal women may reduce, rather than increase, the risk of heart disease.

British experts said the revised analysis of the Women's Health Initiative Study virtually reversed the 2002 warning that led millions of women to stop HRT or not start it.

Dr John Stevenson, an HRT expert from London's Royal Brompton Hospital, launched a furious attack on the original researchers and warned that women who stopped taking hormones would go on to suffer heart attacks and other illnesses they 'didn't deserve'. He said:

"This is a U-turn of dramatic proportions. These conclusions are at complete variance with the widely-publicised 2002 results on which our guidance on prescribing is based. We are astonished that a study which made such a claim for the dangers of HRT is now showing just the opposite. It is an affront to science, adding insult to injury for the thousands of women in the UK alone who abandoned HRT."

Strong stuff indeed. The original study, quoted above, is dismissed in “a furious attack” as “an affront to science.”

What does the American Woman’s Health Iniative actually say? The report, Postmenopausal Hormone Therapy and Risk of Cardiovascular Disease by Age and Years Since Menopause, should be read in full, but in summary says:

1. Risk of heart attack from hormones may not be increased in women who start the hormones less than 10 years after menopause, but there is increasing risk in women who are more distant from menopause
2. Risk of stroke from hormones does not depend on when a woman starts hormone therapy; strokes are increased regardless of years since menopause
3. Risk of death from any cause appeared to be reduced in women who were 50-59 years at the time they started hormones in the two WHI trials

There may be a little good news here for those wanting HRT, but Dr Crippen would not describe this as a “U turn of dramatic proportions”.

Let us therefore go to the original source which is in one of the most respected medical journals in the world, the Journal of the American Medical Association (JAMA) .

Objective To explore whether the effects of hormone therapy on risk of cardiovascular disease vary by age or years since menopause began.

Conclusions Women who initiated hormone therapy closer to menopause tended to have reduced CHD risk compared with the increase in CHD risk among women more distant from menopause, but this trend test did not meet our criterion for statistical significance. A similar non-significant trend was observed for total mortality but the risk of stroke was elevated regardless of years since menopause. These data should be considered in regard to the short-term treatment of menopausal symptoms.

JAMA. 2007;297:1465-1477.

Read the first sentence of the conclusion carefully. The trend observed “did not meet our criterion for statistical significance.”

I cannot reconcile that with the outspoken statements attributed to Dr John Stevenson in the PMJ. Dr Stevenson has been in the news before. Three years ago a Swedish study of breast cancer survivors taking HRT was stopped prematurely as too many women in the trial developed recurrent cancer.

British menopause experts were more relaxed.

Experts have moved to reassure former breast cancer patients taking HRT, after researchers said it could raise the risks of a new tumour.

A Swedish study of breast cancer survivors was halted early after cancer came back more often in HRT users. However, consultants treating women for severe menopausal problems said that other, unpublished, research had found no evidence of an extra risk.

Dr John Stevenson, from the Royal Brompton Hospital in London, and a past chairman of the British Menopause Society, said:

"We have some patients whose symptoms are so severe that their quality of life is very low. We explain the possibility that HRT may increase their risk of breast cancer recurrence, and they choose HRT. Provided the patient makes an informed choice, that is right for them."

A spokesman for the Department of Health said that the general advice was for women with a history of breast cancer to avoid HRT - and had been for some years. (BBC)

What does a GP do if an eminent consultant recommends a course of treatment with which the GP disagrees? Does he tell his patient, thus undermining the consultant? Does he prescribe drugs which he considers to be inappropriate? When a GP prescribes a drug he takes responsibility for that prescription and for any problems that may arise. It may go to mitigation to plead that prescription was on the recommendation of a learned Professor, but that would not absolve the GP if there were to be a disaster.

Dr Crippen is a believer in freedom of choice, and has no problem with women who have had breast cancer taking HRT if they understand the risks. Dr Crippen will not himself be prescribing it for them as he personally does not understand the risks and, despite his libertarian views on freedom of choice, struggles with the idea of prescribing on the basis of “unpublished research.”

Returning specifically to Dr John Stevenson, his full c.v. is displayed on the internet, and is impressive:

Dr John Stevenson

Dr Stevenson is a highly respected endocrinologist with particular expertise in the cardiovascular risks of both HRT and the menopause. He is a Consultant at the Royal Brompton, in London.

He is currently:

• Chairman of the charity Women’s Health Concern
• Executive Committee member of the British Menopause Society
• Fellow of the European Society of Cardiology
• Member of the Scientific Advisory Board of the National Osteoporosis Society (UK)
• Non-US Section Head, Cardiovascular diseases in women (reproductive and post-reproductive age), Women's Health, Faculty of 1000 Medicine

And in the past he has been:

• Chairman of the British Menopause Society
• Treasurer of the UK Bone and Tooth Society
• Executive Committee Member of the International Menopause Society
• Executive Committee Member of the European Menopause and Andropause Society
• Member of the Medical Research Council (UK) Advisory Board

He has been happily married to Bonnie, previously a Nursing Sister, since 1977. They have 3 children. The family is completed by Paddy (a large flat-coated retriever), Gizmo (a Persian cat), Mopsy (a Dutch rabbit) and Maximus (a Guinea Pig)!

He sees private patients in London, Woking and Guildford.

Dr Crippen will bumble on steering his uncertain course through the middle ground. He will cautiously recommend HRT to women with significant menopausal symptoms and will do his best to give a thumbnail sketch of the pros and cons. He will not be saying that HRT reduces the risk of heart disease and, when the PMJ article is waved under his nose, as surely it will be, he will say that it is too early too tell. He will continue to say that HRT slightly increases the risk of breast cancer. And he will neither recommend nor prescribe it for women who have had breast cancer.

He will, on request, refer women to menopause “specialists”, but will continue to advise that such a referral always results in a prescription for HRT.

And finally, Dr Crippen’s heart will continue to sink when patients arrive with their copy of the PMJ carefully folded to display the medical pages.

+++++++++++++

Those who have missed some of the PMJ leading articles on HRT and the menopause may care to look at some of the following – chosen with care from the hundreds that are available. Try a little exercise for me. Think about your own views and beliefs on HRT and then try to reconcile them with all the PMJ articles below. All in a day's work for a GP.

• Thousands facing new HRT stroke fears
  
  
• Blood clot warning for women on HRT
  
  
• HRT alternatives 'could damage your health' warning
  
  
• HRT link to premature deafness
  
  
• Cancer risk of popular HRT drug
  
  
• Jane Seymour and her HRT dilemma
  
  
• Tiny magnet that soothes the misery of menopause
  
  
• Long term HRT increases Breast Cancer risk
  
  
• Why the HRT generation has a fun-filled life
  
  
• New study disputes HRT risk

NHS BLOG DOCTOR supports REMEDYUK

The MTAS March

There is an old story that, some years ago, a group of hospital doctors decided to join together to form a national organisation to look after their particular needs and interests. They were wondering what to call the organisation. Given that it was to be a national association of doctors, they decided to call it the British Medical Association but, after a little research, they found that that title was already being used by someone or other.

It would be unfair to accuse the BMA of not supporting the junior doctors in their struggle against MMC and MTAS – they did indeed put their name on the full page advert in The Times – but it has to be said that the BMA is perceived to be pro-establisment, part of the “great and the good” of the medical profession and of course it represents all doctors, including those responsible for MMC and MTAS.

Hospital doctors desperately needed their own organisation, and so RemedyUK was born. It was born of necessity out of the carnage of MTAS. RemedyUK now goes from strength to strength. It will represent the junior doctors in the struggle to save their careers in a way that the BMA cannot.


Dr Crippen hopes that RemedyUK will not just be a “one-issue” organisation. He hopes that, even after the MTAS debacle is sorted out, RemedyUK will go on to have a life of its own and will continue to represent the wider interests of all hospital doctors.

For far too long, “junior” hospital doctors have not been taken seriously. The media talk of “GPs and Consultants” and then, as an afterthought, “the juniors”. The “juniors” are doing this, and the “juniors” are doing that - but the prefix “junior” means that from the outset they are not taken as seriously as they should be.

There may be some validity in describing the newly qualified 22 years old houseman as a “junior” but the use of the term is absurd when applied to a 35 year old senior surgical registrar.

We need an initiative to re-brand the “junior” hospital doctors. GP trainees were re-branded as GP Registrars because the general public thought they were seeing medical students. We could do the same with hospital doctors. Once they are into higher professional training, maybe they should all be called “registrars”. Let us omit the word “junior”.

MMC and MTAS caused outrage. This was not a few angry, militant young doctors. This was a unified medical profession. Take a look at the video below.



This quietly spoken, dignified Consultant Paediatrician is on the first demonstration of his life. This is not Dave Spart. This is not a rabid militant. This middle-aged doctor is not used to manning the barricades. What the public must understand is that if men like this are taking to the streets to demonstrate, there is something wrong. Something badly wrong.

Not only was it the medical profession, but it was their wives and families.

Mums4Medics is an ad hoc lobby made up of the parents and significant others of doctors affected by the current crisis in post-graduate medical training.

We have come together because we understand better than most lay people the dedication and commitment of junior doctors and their fears for patient care and the future of the health service they have chosen to dedicate their working lives to. And it’s no longer enough for us simply to provide a shoulder to cry on

Back to practicalities. RemedyUK need your support. They also need your money.



They have instructed Leigh Day & Co, one of the leading medico-legal solicitors, to investigate the possibility of legal remedies. That is expensive.

The BMA membership rates are between £189 and £280 a year, depending on how long you have been qualified. Many doctors pay that subscription annually with no thought of the value for money. Apart from the BMJ, what do you get from the BMA?

RemedyUK is actively working for hospital doctors. It has been hugely influential in overturng MTAS and is now working hard to stop the fudge and cover up that may be introduced in place of MTAS.

RemedyUK believe that the Government cannot continue to recommend sticking plaster solutions for a fatally flawed MTAS process. These recommended solutions do not rectify the fundamental problems with the selection system. Implementing these changes at such a stage in the process will only serve to disadvantage different groups within the profession.

RemedyUK believes that the only fair solution is to stop the flawed MTAS process and implement a solution that is transparent and fair for all.

Our views are supported by our members, with over 80% supporting the cessation of MTAS and 80% supporting a legal injunction to achieve this. Only 23% support a revised MTAS scheme with 70% preferring a return to the deanery application system. 1340 people responded to our survey. Over 70% of these respondents were applying through MTAS and 56% held interviews for round 1.

View the full results here.

How much money can you spare RemedyUK?

Dr Crippen suggests that every doctor who reads this sends £25 to RemedyUK. Or more if you can. Your donation, however large, will be gratefully accepted!

If every hospital doctor in the country sends them £25, they will be financially viable within a few weeks. If, through lack of interest, inertia or “MTAS fatigue” you send them nothing, they will go under.

You can send them money via the internet by clicking here.

Do it now.

The BritMeds 2007 (14)

The normal form of words is, "I am grateful to Dr Michelle Tempest for drawing my attention to this video…” but somehow, in view of the content, it does not sound right.

“Hi, I’m Patricia Hewitt…”

A prize for any British Doctor who gets through this without throwing up.

"A full range of birthing choices, huh? If only one could simply giggle and chuck the glossy Maternity Matters document in the bin along with Patricia Hewitt."

A brilliant article by Alice Miles

The Junior Doctor says this.

Few things can make a doctor’s heart sink more in clinic than a patient brandishing a newspaper clipping.

So at least well known journalist Ben of BadScience has insight.

What does a good employer do if one of his employees gets breast cancer? Why, he sacks her. You don’t believe it? It’s true, and you really will not believe who the employer was.

"Unlike Heather Mills, and many others, I have no recollection of having two legs. I have - as far as I am concerned anyway - always had one leg. This is me. This is how I have always lived."

Mum has age related macular degeneration... I think she may be suffering from Charles Bonnet Syndrome (CBS).

Read a bizarre conversation here.

Pfizer drug distribution deal triggers market investigation

BBC soap opera is portraying tonsillitis as a “life threatening illness”.

Dr Rant asks “What’s new, pussycat?”

The Mental Capacity Act comes into effect, bringing with it back door euthanasia

Here is a frightening question. How many members of the Committee on the Safety of Medicines (CSM) have ties with Glaxosmithkline? The answer is here.

In “We know what we know…” Kevin Leitch says, “I like doctors…by and large…” read on.

Forgive me for going a bit crazy but for once I've got very little to moan about. I love Spring, it is by far the best season, and it makes me so happy. On top of that, today is officially my last day of obs and gynae. Fingers crossed I won't have to go near it again in the future.

Another medical student put off obs & gynae.

Between 18 and 20, a woman is like Afrca : wild, naturally beautiful and full of mysterious, fertile deltas.

Wait until the Junior Doc gets to Afghanistan.

The pathologist tries to convey the pleasures of cutting up dead bodies.

In Cambridge, the Angry Medic takes time off from revision to watch the new Dr Who

Tom Reynolds finds "another teenage boy has been stabbed on my patch."

New Naw meanwhile orders one chow mein and a cardiac arrest

We turned up at one of those warden controlled flat complexes that seem to exist in another dimension to the real world. They really are quite surreal. I don't know what drugs the architects take but they must be good.

Why do I do this job moans about architecture. Dr Crippen thought all warden controlled flat complexes were like that.

SHP is now personally financing the NHS

“having to make all phone calls on my mobile at my own expense because replacing the broken phone in my office isn't budgeted for.”

"The NHS is administering only about half the amount of radiotherapy needed to treat British patients properly"

That is the Welfare State we're in for you.

Patricia Fuckwit appeared on the Radio 4's Today program to unveil her latest fuckwitted scheme that aims to deliver more care in patients' homes. Every deluded, dishonest sinew that belonged to Ms Fuckwit was needed to grind out the propaganda for this latest ideological campaign.

Dr Rant is on the rampage again.

The MTAS and MMC week

Listen to this as you read on.

It has been a challenging time for Remedy UK recently. The Review Group's most recent fudge is not acceptable, and we have been hard at work to find a solution which we think is fair and equitable.



Remedy UK goes from strength to strength, and has instructed top medico-legal solicitors, Leigh Day & Co to act for it.

The Psychiatrist asks, “Have spin doctors spun doctors?”

The disheartened docotor meets some mendacious serpents

Dr Grumble is still doing battle and feels “like those stupid people in the fairy tale who were unable to see the emperor's clothes”

The Ferret Fancier has unearthed the MTAS parrot sketch

Hospital Phoenix divides the great and the good (ha! ha!) of the MMC into animals with backbones and without backbones

++++++++++++++

Please send your recommendations for next week’s BritMeds to: thebritmedsATnhsblogdoc.wanadoo.co.uk

The BT Home Hub

Dr Crippen is away from home, staying in a wonderful house, wonderful except for its internet connection. Say hello to the BT Home Hub.




Internet access fine. E-mail in, fine. E-mail out? Not possible. Why should this be? A few minutes Googling found whole communities of unhappy users of this piece of kit.

Those scoundrels at BT will not let you send emails unless you have an account with them.

Still, the view is good.

Dr Crippen is censored

A nurse e-mails me from the Diana, Princess of Wales Hospital in Lincolnshire.

She brings worrying news:

Dear Dr Crippen,

I would like to say how much I enjoy your blog particularly your views on nurses. I am a nurse but I agree with you, I have no desire to anything more than what I am. The trend towards specialist nurses is a way for the NHS to save costs while giving some of my colleagues an elevated opinion of themselves, which in my experience isn't much.

By the way, my Trust blocks your blog, can't think why.

Take care.


Best wishes



Name withheld

The nurse did supply her name, but asked to remain anonymous. And if what she says is correct, who can blame her. She might be sent of to the Gulag

Heavens. This is getting very Stalinist indeed. Has anyone else found that NHS BLOG DOCTOR has been blocked by their trust?

Maybe it is not true.

So, an open letter to the Chief Executive

Andrew North, Chief Executive

Dear Andrew

I am told by a member of your staff that the Trust has blocked access to NHS BLOG DOCTOR on their computers.

Surely this cannot be true!


Best wishes,




Dr John Crippen

Ashamed to be British

Hundreds queue to join a new government funded dental practice in Vladivostok.

Remember the old Soviet Union?

This sort of queue was commonplace. Sadly, this is not an historical picture from the old Soviet Union. It is a picture taken today in England. And not from a poor part of England. From one of the posh, middle-class home counties. Hampshire to be precise.

However, the comparison with the old Soviet Union is apposite. For it is New Labour Stalinist controls and targets that have driven British dentists into the private sector. Doctors have been putting up with controls and targets for ten years. Unlike doctors, British dentists have no difficulty making a good living in private practice outside the NHS.

New Labour imposed a contract on the dentists. Its rationale is cost-cutting. It does not give dentists time to practice proper professional dentistry. They are compelled to continue "amalgam bashing" working in what they refer to within the profession as "dental filling stations".

And what happens to the few remaining NHS dentists?

Dentists are being forced to take holiday to avoid treating patients because the NHS has run out of money. The scandal reveals how the Government's reform of NHS dentistry has failed patients and dentists just a year after the controversial shake-up.

The research comes after official figures showing the number of adults seen by an NHS dentist has dropped by 69,000 in the last year, with 11,000 fewer children now getting NHS care.

Patricia Hewitt can’t admit to her mistake and refuses to listen to the thousands of dentists and patients who have told her that the new dentist contract isn’t working, whilst we have to watch on as fewer patients get treated through the NHS and the morale of dentists sinks to an all time low. (source)

In 1999, at the Labour Party annual conference, Tony Blair pledged (see here) that everyone would have access to an NHS dentist within two years.

Blair cannot even get his own teeth fixed.

The state of British dental hygiene is already a standing joke in the USA. Take a look at the website of Fulloseus Flap, an American dentist.

William Kelly, 43, extracted part of his own tooth, leaving a black stump.

Does Fulloseus Flap have any answers? He says:

Terrible treatment these British folks are receiving from their socialized government National Health Service. The government taxes the people exorbitantly, promises them basic dental care and then screws the patients and the dentists.

So, what is the solution?

Well, not the recruitment of Polish dentists to do work “that British dentists will NOT do.” Does this sound familiar?

The solution: privitisation of British dentistry with government vouchers for the poor and indigent. And…. a little chairty form the British Dental Association until privitisation kicks in fully.

"Negligence is not really an issue for us"

This baby will die in minutes if not delivered - and it can't be delivered at home

Hewitt is determined that it shall be every pregnant woman’s right to have a home delivery. It is portrayed as a matter of “choice” but soon there may not be any choice. So many maternity units are being closed that there will be no alternative other than to have a home delivery.

A “right” to a home delivery is as safe and as sensible as giving parents the “right” to insist that their children have their tonsils out at home on the kitchen table. That is the natural way to do it. That is what doctors used to do a hundred years ago, so why not now?

The independent madwives are ecstatic.

There is not a single insurance company in the country that is prepared to cover independent madwives to do home deliveries. So what do the madwives do?

They work without insurance.

Private midwives have been working without indemnity insurance since 2002, when the last company willing to provide cover pulled out. Despite this, their numbers have grown from about 40 in 2002 to 200 at present, with up to 4,000 babies a year delivered privately. (The Times)

The madwives thus show the same disregard to safety as people who drive cars without insurance. Car drivers can go to jail for driving without insurance. Soon, the madwives may follow.

Independent madwives now tell mothers-to-be verbally and in writing at the first meeting that they are not covered for claims.

Annie Francis, spokeswoman for the Independent Midwives’ Association said:

“Most clients understand you can’t insure against things going wrong during childbirth, only against negligence, and negligence is not really an issue for us”

Let us consider the case of Beatrice Carla, styled by the newspapers as a “new age midwife” and see if Annie Francis’ statement that “negligence is not really an issue for us” can withstand close scrutiny.

Beatrice Carla, 56, is fighting to save her career after facing 27 charges, amounting to five counts of professional misconduct.

An expert panel heard claims that the independent midwife:

• HAMPERED paramedics' attempts to resuscitate the baby, so she could apply olive oil to its feet.
  
  
• STUCK her finger into the baby's mouth to apply a herbal remedy when a paramedic was giving resuscitation.
  
  
• BOTCHED attempts to use a lifesaving "bag and mask" device to resuscitate the baby.
  
  
• FAILED to perform basic resuscitation techniques when the baby stopped breathing.

Carla had been asked to assist a pool birth at the mother's home. But the labour started to go wrong when the umbilical cord became wrapped around the baby's neck.

Medics managed to save the baby's life but it suffered severe brain damage.

Carla - who was advised at the hearing by Chris Warren, treasurer of the Independent Midwives Association - told the hearing in Edinburgh she attempted to use a "bag and mask" device designed to resuscitate babies.

Carla faces further charges over

• the temperature of the water
  
  
• failure to react to a longer than average labour
  
  
• failure to document numerous clinical details which could have helped in the ongoing care of the baby.

Carla denied the allegations over the birth on the grounds that they could not be proven. She said: "Insufficient evidence has been given to prove that my practice fell below the base standard. There is no correlation between extensive record keeping and adequate care.”

Chris Warren said:

"We have grave concerns that some women may choose to birth alone if independent midwives are stopped from practising. We focus on the women and their views are respected. The NHS has a lot of rules and some women can't get the care they require. Even if the wishes of a mother impair the safety of a birth, we will accept that.”

The article concludes:

Many independent midwives and their clients follow an "alternative" lifestyle and the use of homeopathy and herbal medicine is common. A full care package, including ante-natal, birth and post-natal care can cost up to £2500

The full article can be found in the Sunday Mail

Hewitt is pushing women towards home-deliveries. She marches under the banner of "choice" but the real agenda is cost-cutting. Dr Crippen believes that any woman electing to have a home delivery is taking risks with her own life and with the life of her baby. The baby does not have a choice. The time will come that brain damaged children will take legal action not only against the madwife, but against their own mother.

Remember, when a madwife walks in at your door, science and common sense fly out of the window. As this desperately sad article shows, even the avoidable death of a baby does not sway those with entrenched views.

Obstetric care in Great Britain

Dr Jonathan Crippen

A Modest Proposal for preventing the children of poor people in the United Kingdom from being a burden on their parents or country
by Jonathan Crippen


It is a melancholy object to those, who walk through the hospitals in the great towns, when they see the labour wards crowded with beggars of the female sex followed by three, four, or six children, all in rags, buying the cards that must be scratched and importuning every passenger for alms. These mothers instead of being able to work for their honest livelihood are forced to employ all their time to beg sustenance for their helpless infants.

It is agreed by all parties, that this prodigious number of children in the arms, or on the backs, or at the heels of their mothers, and frequently of their fathers, is in the present deplorable state of the kingdom, a very great additional grievance; and therefore whoever could find out a fair, cheap and easy method of ridding society of these children would deserve so well of the publick, as to have her statue set up for a preserver of the nation.

As to my own part, I have turned my thoughts for many years, upon this important subject, and maturely weighed the several schemes of our projectors which I have always found grossly mistaken in their computation. I propose to provide for them in such a manner, as, instead of being a charge upon their parents, or the parish, or wanting food and raiment for the rest of their lives, they shall, on the contrary meet their maker peacefully at birth.

There is great advantage in my scheme, that it will prevent those voluntary abortions, and that horrid practice of women murdering their bastard children. There only remain an hundred and twenty thousand children of poor parents annually born. I shall now therefore humbly propose my own thoughts, which I hope will not be liable to the least objection.

I have been assured by a very knowing obstetrik physician from the New World colonies of my acquaintance that a young healthy baby shall most likely survive when delivered by a learned physican and yet, when birthed at home by a midwife, may well perish before the moment of first breath.

I do therefore humbly offer it to publick consideration, that the hundred and twenty thousand children, already computed, born to poor folk shall birth at home to be delivered by the midwife and thus most likely shall not survive this method which we calleth New Labour. The children of gentlefolk shall meanwhile lie in the hospital to be attended by the physician at ye regional centre of expertise and shall survive and shall suck plentifully at their mother’s breast.

To this end, I have appointed Mistress Sheila Shribman lately of Cambridge University, an administrator of renown for eleven years in Nottingham and reeve of children’s health, unqualified in the skills of the obstetrik, but well qualified in the ways of the committee and who doth spinneth well for the government and who shall oversee the cull of the children of the poor folk for she herself doth have no professional experience of birth of children and doth therefore not knoweth when the midwives maketh tits of themselves. And meanwhile the physicians, learned in the ways of ye obstetrik care shall minister to the wives of the great and the good and also to the wives of the merchants who, though not of noble birth, joineth the private health insurance companies and therefore can pay the learned physicians to delivereth their babies.

I have already computed the charge of nursing a beggar's child (in which list I reckon all cottagers, labourers, and four-fifths of the farmers) to be about two thousand guineas per annum; and I believe that few of their children will survive the administrations of the midwife and, if they do, may yet drowneth in the birthing pool even though all shall singeth ten green bottles and eateth of the placenta. And the children shall not grow to purchase the cards that shall be scratched and Camelot shall no long prosper.

And yet, despite all, all shall still be happy for, verily, it was their free choice to entereth into New Labour.

And Master Brown of the Exchequer, a man renowned for the stealth tax, who credited not the dividends, shall be further pleased, in discoursing on this matter, to note the reduction in the benefits of the child and rejoice that the poor folk of this kingdom having of late lost their children shall no longer scroungeth from the state but shall enter into gainful employment and the babies of those who boomed shall not survive to collect the much diminished pensions.

I think the advantages by the proposal which I have made are obvious and many, as well as of the highest importance. For first, as I have already observed, it would greatly lessen the number of benefit scroungers, with whom we are yearly over-run, they being the principal breeders of the nation, whereas the maintainance of an hundred thousand children, from two years old, and upwards, cannot be computed at less than a thousand pounds a piece per annum, Master Brown’s stock will be thereby encreased five hundred and fifty thousand pounds per annum as the constant breeders, particularly the Papists who taketh not the morning-after potion shall no longer have children to maintain.

Many other advantages might be enumerated.

I can think of no one objection, that will possibly be raised against this proposal, unless it should be urged, that the number of people will be thereby much lessened in the kingdom. This I freely own, and 'twas indeed one principal design in offering it
to the world.

But, as to my self, having blogged for many years with vain, idle, visionary thoughts, and at length utterly despairing of success, I fortunately fell upon this proposal, which, as it is wholly new, so it hath something solid and real, of no expence and little trouble, full in our own power, and whereby we can incur no danger in disobliging England. After all, I am not so violently bent upon my own opinion, as to reject any offer, proposed by wise men, which shall be found equally innocent, cheap, easy, and effectual.

I profess, in the sincerity of my heart that I have not the least personal interest in endeavouring to promote this necessary work, having no other motive than the publick good of my country, by relieving the poor, and giving some to the rich.

++++++++++++++


Patricia Hewitt has announced that all pregnant women will have the "right" to a home delivery. I was wondering how to react. I cannot improve on the above article first published a couple of months ago. I have edited it slightly. Apologies to those who have read it before.

Complaints procedure at the Department of Health

On 9th February 2007 in an article entitled “Who WILL clean up the shit in the NHS” I published a letter written by a patient to Patricia Hewitt. The letter catalogues a long and depressing list of examples of failure of care at all levels.

If you have not already done so, read the letter in full here.

I now quote two excerpts from the letter:

How is a 62 year old woman expected to retain any dignity or respect in a ward full of 60 to 80 year old men? I was admitted last week to the Renal Department of St. Elsewhere’s Hospital for surgery and found myself in a ward full of men. This is the second time in a year that this has happened. I thought mixed wards, which are especially embarrassing for older patients, were being discontinued. Having been given “bowel preparation” medication, I was expected to go through the ward, clutching my clothes to me as best I could, dripping vilely, out to the toilet (more on that later). I consider this absolutely disgusting treatment and totally embarrassing.

Having been given the bowel preparation medication, I was not prepared for its violent action and was still dressed in my own clothes (they have had to be dry cleaned or thrown away). After being in the WC for about 15 minutes, I pulled the help cord and a nurse came. I asked if she could help me as I had no clothes not soiled and she returned with a washcloth, towel and gown, and left me to get on with it. She did not check back. I had to try and clean myself and the floor and toilet while my body was still emptying itself. I was in there for about an hour without being able to move. When I eventually emerged, the shift had changed and the night staff were on duty. No-one had wondered where I was or come to see if I was OK. I could have passed out for all anyone knew.

Yesterday, Mrs E.N. brought me a copy of the reply she received from Hewitt. Well, not from Hewitt herself of course, but from Sally Greenbrook of the Department of Health’s “Customer Service Centre”.

This letter epitomises everything that New Labour is doing to health care. First of all there is the spin. Greenbrook works for the “Customer Service Centre” not the complaints department. Then comes the lengthy statement of policy, summarised in the first paragraph

“mixed sex accommodation is not acceptable.”

Then, after lots of policy flannel, come the lies.

“99 per cent of all NHS Trusts provide single sex sleeping accommodation.”

No they do not. That is a lie. Except technically it may not be a lie because the word “exclusively” has been omitted. Let there be one single sex ward only, and the hospital joins the 99% even if all the other wards are mixed.

“You have raised concerns about cleanliness in hospitals” says Sally Greenbrook.

Mrs BN lost control of her bowels, covering the floor, herself and her clothes in shit. She was left alone to clean it up herself. This was indeed a matter of “concern” to her.

Then comes the government's second favourite strategy (after dishonesty). Bury the complaint in “process”. Two pages of boiler-plate text about how to complain (via the appallingly named PALS service).

Finally, disown the problem.

“The Department of Health is responsible for setting guidelines and issuing policy to local healthcare Trusts, but plays no part in investigating specific complaints”

There is logic to that statement, but there is a middle ground. The letter is a disgrace. The DoH is washing their hands of the complaint. Note that in the three pages they do not even bother to name the hospital.

What could they have done? How about this:

Dear Mrs E.N.

The Secretary of State was sorry to hear of your recent experience in St Elsewhere’s Hospital.

She has passed your complaint directly to the Chief Executive of the hospital for immediate investigation. A copy of your letter has been kept on file at the Department, and the Secretary of State will be informed of the outcome of the investigation.


Yours sincerely

Short, to the point, and honest. Of course, the problems should never happen in the first place, but at least it would give the impression the government was taking an interest. See what you think of the full reply:

Click to enlarge

Click to enlarge

click to enlarge

An anaemic old man

Iron deficiency anaemia

Gordon Brown, the Chancellor of the Exchequer, is in the news today as more and more information is revealed about his fraudulent dishonesty. He was warned time and again that the dividend credit stealth tax he introduced in 1997 would endanger the pensions of millions of British citizens, now in late middle age, and too old to make radical changes to their pensions. It was the sort of characteristic dishonesty that has become the trade mark of this government.

The Chancellor of the Exchequer

The NHS has also been subjected to a stealth assault over the last ten years. The government makes much of health care being “free at the point of entry” or “free at the point of need." Trouble is, New Labour’s Health Commissariat, NICE, is redefining “need” and dumbing down the quality of the care.

We looked last week at the government’s refusal to make Tarceva available to NHS patients with lung cancer, despite its routine use in the USA and Europe. As the GP on the front line I have to pick up the pieces. I have to counsel and support the dying patient who cannot access a drug that is available only to someone with private health insurance.

For the poor folk, the NHS may be free at the point of entry, but cross the threshold and the store is empty.

Blair and Hewitt make much of targets, of turnover, and of the numbers of patients “successfully treated”. Hospitals are obliged to discharge patients as soon as possible. A successful event is defined, more or less, as discharge from hospital or from the clinic.

I am trying to investigate a 71 year old man who has a boring and unexciting medical problem. He is a bit anaemic and he has microscopic traces of blood in his faeces.

He is symptomatically well. No weight loss, no change in bowel habit, bit of arthritis in the knees for which he takes ibuprofen and that is about it. We would not know about the anaemia except that he had a blood count done when he had a recent cholesterol check. Let’s call him Bill. In the old days, pre-1997, I would have referred him to the hospital and the consultant would have taken ownership of Bill, and of Bill’s problems.

Now, it goes like this.

Top of the list of causes of anaemia is bleeding from the gut. Persistent bleeding from the gut may be the first sign of cancer. If Bill was my father, I would want him promptly and thoroughly investigated. It is a bit of a toss up where to start, but the history of taking ibuprofen means the top end is as good as any. Bill had an endoscopy three weeks ago.

That sounds quick and easy, but it was not. I referred Bill to the local gastroenterologist. He did not meet the criteria for a TWR referral, but I marked the letter “urgent”. He had the endoscopy six weeks after referral. It took a further three weeks for me to get the report, which was normal. Bill’s blood count had, during that period, dropped a little lower. The endoscopy report said “if symptoms continue, suggest a barium enema or colonoscopy”.

Bill does not have any symptoms, so the advice is silly, but then the gastroenterologist did not actually see Bill, or even talk to him. He had the endoscopy done by a nurse-specialist. You get what you pay for.

I referred Bill to get the “other end” done. That was a five week wait. He was then seen by the colo-rectal nurse practitioner who did a flexible sigmoidoscopy, which was normal. She then sent Bill for a Barium Enema. That took another three weeks to be done, and a further ten days for the report to arrive. This “event” thus took nearly nine weeks.

Blair and Hewitt will have Bill’s three visits to the hospital catalogued as three completed “successful events”. Normal endoscopy, normal sigmoidoscopy and normal Barium Enema (a few diverticulae, but nothing else)

The clock has now been running for eighteen weeks.

Three “successful events" for the government and I still do not know why Bill, still feeling well, is anaemic. I still own Bill and his problem. No one at the hospital has taken responsibility.

His blood count has dropped a little more.

What other causes of low grade gradually worsening anaemia are there? Dozens, but undiagnosed malignancy it still at the top. It maybe he has got an early pancreatic malignancy. I ordered an ultrasound in between the endoscopy and the barium enema but it has not been done yet, and anyway the pancreas is not easy to visualise on ultrasound.

A CT scan of his gut would be helpful, but I do not have direct access to CT scanning. So I spoke to the gastroenterologist who was, as ever, friendly and helpful. He said he would see Bill personally. Bill has an appointment with him in three weeks time. That will make it a total of twenty one weeks. Maybe the consultant will order a CT scan. Who knows? But if he does not find something wrong in his part of Bill’s body, he will send him back to me, and I shall have to start again.

You will never hear of Bill. Tarceva is often in the news. Journalists like that kind of story. Elderly men with low grade anaemia are not newsworthy.

It would not be like this if Bill had private health insurance. Walk down the medical yellow-brick road and the gastroenterologist would have him into the private clinic. He would do an endoscopy, a colonoscopy, an ultrasound and a CT scan within a few days. He would find an answer. And if he did not, he would get a colleague to see him. Ten years ago, Bill would have been able to have something similar on the NHS. Not any more.

What Gordon Brown has done to your pensions, Hewitt and her predecessors have done to your health care. But you will not hear about it, even under the Freedom of Information Act.

For, you see, Bill’s treatment is a success story of the modern NHS.

To boldly go where no man has gone before...

We are moving on into the afternoon now, but nonetheless Dr Crippen feels obliged to draw your attention to news just released in America by my colleague, Dr Charles.

Prime Minister Tony Blair will be undergoing a routine colonoscopy to promote awareness of the test for the prevention of colon cancer. A similar public awareness campaign took place here in the United States when Katie Couric bravely went on television live during her own colonoscopy.

"That was fun"

It is estimated that only 54% of eligible British citizens actually receive the test, which involves the insertion of a flexible tube equipped with a fiber optic camera into the large intestine to look for abnormalities of the colon and rectum, including polyps and cancerous lesions. Chief among the reasons sited by Brits for not getting the procedure done is the preparation. It involves the administration of a potent laxative the day before the exam to completely clear the large intestine of stool. Essentially, patients have moderate diarrhea for a whole day. The second most common excuse was simple fear.

"I aim to change the way in which my people view colonoscopy," Mr. Blair said in a press conference given at a National Health Services clinic in Northern Ireland. "Far too many put off the testing for reasons that are inimical, really."

Detailed report here.

Patricia Hewitt resigns

In an unexpected statement made earlier this morning, too late for the Sunday newspapers, the Secretary of State for Health, Patricia Hewitt, announced that she was stepping down from office for personal reasons.

After the usual exchange of letters, the Prime Minister said:

I know that all who have worked in the NHS will be grateful to Patricia Hewitt for the sterling service she has provided. Most of all, countless users of the NHS will appreciate the many health care improvements for which she has been responsible. She leaves the NHS in a stronger state than it has ever been.

Her successor has not yet been named, but an announcement is expected from Downing Street later in the day.

The Devil goes mad

There is increasing concern amongst medical bloggers about the health of one of the most admired non-medical bloggers, the Devil's Kitchen.

It started with sofas. The DK has taken to sitting on sofas at 18 Doughty Street and regailing all who will listen with his right-wing political views.

Now, no longer the anonymous blogger of yesteryear, the publicity seems to have gone to his head:




DK, help is available. Please contact NHS BLOG DOCTOR or Dr Rant as soon as soon as possible. Do not be frightened. We are your friends.

The BritMeds 2007 (13)

This new law is straight out of the Nazi handbook. This law is not about the wellbeing or care of the patient, this is about saving money, just as the German law was to begin with, and then used to remove the physically impaired from society altogether - legalised murder.

PJC looks at the Mental Capacity Act

British Doctors say “end NHS fertility treatment”

This doctor envisages "your bog standard NHS hospital transplanted onto the moon's surface."

A study report that claims that tough guys recover more quickly from serious illness and injuries.

“The best year ever” looks at the recent introduction of Advanced Avaiation Practitioners.


In Me and the Big Bruiser, Dovegreyreader looks at nursing at it used to be thirty years ago at Great Ormond Street

Experimental Shrimp struggles through the NHS

It’s “lockdown time” at Cambridge University. The medical students are trying to revise for exams, and the Angry Medic is struggling

Standing in the courtyard of the Sri Mahalakshmi Hindu temple in east London, a dozen jobless doctors are eating dhal, rice and potatoes off paper plates. Wrapped against the cold in anoraks and sweaters, they come here each evening when the temple serves free food. They eat in the gloom before slipping away to damp, squalid lodgings where many sleep three to a room.

The NHS continues to discriminate against foreign doctors

A patient is admitted with a serious illness, starts steroids, and then says :

I have discovered that having a serious illness can be extraordinarily life-affirming.

If you want a good GP, move to Merton

92% of the population trust doctors. See how politicians compare here.

A DOCTOR who peppered his CV with lies to get hospital jobs across the country has been struck off.

“Pole to Polar – the secret life of a manic depressive”

My brain has been racing and I’ve been full of ideas- the most fixed one being a desire to go to Paris, right now. I am not to be trusted with my bank card at times like these.

A medical student scrubs up for surgery…and ends up having an anatomy viva:

Fertility controversy:

One of Britain's most successful fertility doctors today won permission to mount a High Court challenge over the legality of search warrants used by a watchdog authority to raid his clinics.
Mohamed Taranissi argues the warrants were obtained by the Human Fertilisation and Embryology Authority (HFEA) on the basis of "incomplete and misleading" evidence.

(see the Infertile World online )

Ill-advised comments says

Doctors who breach patient confidentiality must be dealt with, but Patricia Hewitt was wrong to single out Muslim GPs in this area.

Lucia is not letting her own leukaemia treatment stop here working for other young people with cancer:

Lucia Pasqualino will be wearing funky fuschia at the May ball she is hosting to raise money for a charity supporting children with cancer. Lucia, 17, of West Park Drive, Blackpool, has become something of an ambassador for the charity Clic Sargent in the two years since she was diagnosed with childhood acute leukaemia. (full report here)

Lucia says:

Is it wrong for me to think RMCH is worse than birmingham? For more about this campaign visit here. I would love a unit like in UCLH but it's unlikely as the Christie already has a TCT unit for age 16+.

A mother with a sick child agonises in “What a quandary”

If private health care did not exist then the NHS would go in to meltdown as it would not be able to cope with everybody but if you go for the private option then you are made to feel that you are queue jumping in some way...

Psychiatric patients often get ignored by physicians. In a revealing post, SHP recounts how a mentally ill patient with TB is treated:

The chest physician says that we can arrange a follow-up appointment after a few months of treatment "if we think it is necessary". He also advised us that the TB nurse-specialist might "pop in from time-to-time." I don't know what all of this is indicative of. The rise of the quacktitioners? The usual substandard treatment of psychiatric patients by the rest of the medical profession? The way TB is treated these days? Is there really no necessity for patients with TB to be seen by physicians?

A senior medical student is on edge. It’s OSCE time again. Not much changed here since Dr C was at medical school, expect we talked of “short cases”

Its that time of year again, as we approach the end of the module, examinations loom. Yes ladies and gentlemen its OSCE time (well it will be in a few weeks.)

Retirement with no problem? Not if you need a blood test:

“2 weeks time is the earliest we can do”…”What???!!!” “Oh and then it will be 10 days before the results are back”.. “But my husband could be dead by then!”.. “Sorry best we can do”

I don’t want to have to use the NHS if I am ill, say most British doctors.

Do birds commit suicide? How would the NHS treat a suicidal bird? Answers here

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The MTAS/MMC week

The Templeton/Black email is still reverberating around the medical blogosphere and has now been picked up by the main stream media. Professor Templeton does not have much to say.

The medical student who was recruited as an adviser to MMC resigned and wrote a damning letter to the CMO on 31/3/2007.

"This man has veritable balls of titanium and I salute you", says the Ferret Fancier. Read the letter in full here.

But this was the second letter. The first letter, which the FF has also unearthed, was written on 18 March. Crock of Shit did not resign until 30 March. How much did this letter affect him?

What a comprehensive assassination of MMC. As he says, they are downgrading what should matter and deliberately churning out propaganda while only attempting a token consultation. Alan Crockard resigned on 30/03/2007, I wonder how much this letter had an effect.

Read the full first letter at The Ferret Fancier

Frontpointsystems, which has consistently provided up to date analysis of MTAS and MMC turns to A Question of Ethics.

I am sure that my outspokenness on here has put off a few potential clients but there is only so much I can compromise on.

Have my towel says :

So in summary, don't expect the best treatment from August 2007, you used to be able to say that the best candidate got the job, now you can't even say a good candidate will get the job. Spend your savings on lottery tickets as it's