The BritMeds 2007 (26)

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Warm the cockles with this:





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But we should be proud of the NHS – an American writes:

I think of myself as a pretty well informed person. Not so much when it comes to the issue of healthcare, but I know what's going on in our system even though I avoid doctors of all sorts like the plague itself. But seeing the things that are free in crazy socialized healthcare countries like Canada, France, England and Cuba, it was just astonishing. People would laugh at Moore when asked questions like how much it costs to have a baby in a hospital [answer: $0 in England] or the price of 30 pills opposed to a prescription of 120 [answer: the same under England's NHS].

Learning when England decided to change their healthcare system to a universally covered system was astonishing. It was 1948, just after World War II as most of England was rubble and bankrupt, they decided that no person should go without coverage. Good show.

Philly


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Or maybe not, for another American writes:

This confirmed the report of the Commonwealth Fund's International Working Group on Quality Indicators which found cancer survival rates were lowest in the UK and patients had the longest waits for elective surgery. “Roughly 40 percent of cancer patients never get to see an oncology specialist. Delays in receiving treatment are often so long that nearly 20 percent of colon cancer cases considered treatable when first diagnosed are incurable by the time treatment is finally offered”

Look before we leap into socialized medicine

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TOP LEVEL wanker of the week

An award granted to the writer of this

Read the extraordinary correspondence here.

Maybe it is all justified. Maybe. But foul mouthed ad hominen abuse is something one would more normally associate with drunken white van drivers.

You would not catch Tom doing this, however strongly he felt.

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The crux of the matter

This 'dumbing down' debate is an interesting one, and it certainly has the potential to get pretty emotional and messy. I felt the need to clarify my position as some people feel the strange desire to distort things in a way that stifles a proper discussion.

The ferret in trouble

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Help.

Dr Crippen is completly baffled. Can anyone explain what this is about?

And who is Oona? I don’t know her.

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MMR trouble approaching

Oh dear, Wakefield is back, this time with Patrick

Part 1

Part 2


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List of nursing diagnoses in Wikipedia

Read it quickly as it may not be there long. And share your thoughts.

This article is being considered for deletion in accordance with Wikipedia's deletion policy. Please share your thoughts on the matter at this article's entry on the Articles for deletion page. Feel free to edit the article, but the article must not be blanked, and this notice must not be removed, until the discussion is closed. For more information, particularly on merging or moving the article during the discussion, read the guide to deletion.

Wikipedia

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A new medical student

There is no doubt in my mind that applying to medical school was the single most coveted and stressful thing I’ve encountered in my life. A transitory paradise was reached April 26th 2007 – the day I got into Barts. For me this was fleeting – I hadn’t secured my place until I met my offer. From then on I was elated, knowing that all I had to do was turn up in September and start to learn medicine.

Unprotected Text

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Partial Birth Abortion May Soon Be a Reality In Northern Ireland.

…a process whereby a child is aborted (read “murdered”) as it is being born. If you think this is too horrific even for abortionists to stoop too, it has been going on in America for years.

Hidden Ireland


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More insight from across the pond

Socialized medicine? What are the pros and cons?
One only has to listen to the talking heads, read the newspaper, surf the net - particularly the medical blogs at any given time or work in the medical field to know that we are in a health care crisis in America.

It’s wonderful life

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Which bring me to this patronising effort from today’s Indy:

Obese people twice as likely to get Alzheimer’s

By Jeremy Laurance, Health Editor- Published: 29 June 2007

Britain’s obesity explosion could trigger a second even more serious epidemic - of dementia. Experts warned yesterday that our fondness for fast food and resistance to exercise was not only causing waistlines to bulge - it is also damaging our brains.

Obesity is bad for you. This is well established.

It increases your risk on winding up with all manner of nasty shit, like cardiovascular disease, diabetes, sleep apnea, gallstones, hernias, fatty liver disease, renal failure, osteoarthritis, stokes, that most people would much rather not have to deal with.

But clearly none of shit is scary enough to stop people pigging out at Maccy D’s, so now the ‘experts’ are wanting to tack going doolally-tap on to the list to make the whole business ever scarier.

Dumbing down dementia from the Ministry of Truth

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TIME TO ADDRESS THE FEMINISATION OF THE MEDICAL WORKFORCE

Indeed, The Witch Doctor would go as far as to say that along with the European Working Time Directive, and an ageing population, feminsation of the medical workforce is the thrust behind MTAS/MMC, Agenda for Change, the introduction of the National Practitioner Escalator, the Expert Patient, and indeed almost all aspects of NHS Modernisation.

There is a major problem!

The Witch doctor

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Andrew Wakefield and the death of the MMR debacle

More MMR trouble is brewing

Left Brain/right brain

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Simplicity is the key


Trevor Gay

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Surely not!

Dr Rant loves John Crippen. But occasionally he can be a bit of an old fart.

Dr Rant

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Most people agree that there are too many abortions already.

A doctors' representative body has voted in favour of a reduction in the number of physicians needed to approve abortion in the first 14 weeks of pregnancy. The British Medical Association approved a call for just one doctor to need to sign the form instead of two as at present. The association's annual conference in Devon, England, rejected a proposal that midwives and nurses should do abortions. [BBC, 27 June] Anthony Ozimic, SPUC political secretary, commented: "The call for abortion to be made more freely available in early pregnancy is inept. This would lead to even greater pressure on women, with less opportunity for them to reflect before making a decision, and therefore will lead to greater numbers of abortions. Most people agree that there are too many abortions already.

Catholic Action UK


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The DK and Dr Rant

Exactly what are your qualifications to give an opinion on health policy, DK? How about you shut the fuck up about things about which you are, frankly, ignorant, and stick to euro-bashing.

There's a good Devil.

The Devil is being a tosser

Dr Rant

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“Poor” old Patricia

Ministers Severance Payments.
Generally, 3 months of annual ministerial salary is payable when a minister ceases to hold office. Full details are set out in section 4 of the Ministerial and other Pensions and Salaries Act 1991 [PGA 1991 chapter 5], as amended. A Cabinet Minister’s salary is currently just under £140,000, so that severance payment is around £35k.

Quite why any Minister - never mind one who has proven to be an incompetent dolt in office - should pocket that sort of money while still taking an MP’s salary of £60,675 is beyond my ken.

Patricia Hewitt is also entitled to all the other MP’s perks - including the £22,000 “Additional Costs Allowance” a year available to nearly all MPs for accommodation which many use to buy flats in Central London. These flats - purchased using taxpayers’ money - are not returned to the taxpayer when the MP leaves Parliament.

The Wardman Wire

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Congenial well paid job for doctors on the dole

"RemedyUK are looking for doctors with local connections to either of these two constituencies to stand as candidates to highlight the threats to the NHS. If 'your' doctor fills that criterion and would like to find out more, do get in touch."

Vicky Ford

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Abortion reform

UK doctors have voted that women should no longer be required to obtain the consent of two doctors in order to have an abortion. Currently, two doctors must agree that continuing the pregnancy poses a greater threat to the woman’s physical or mental health than terminating it. This has been a serious barrier for many women,

Feminist philosophers

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The obese orthopod – BMI > 50

Fascinating story of orthopaedic surgeon who has gastric banding.

Chris Oliver

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The most selfish patient ever

Just how selfish would you need to be to think "That Dr McCann's a right selfish fuck. He might think that having his 4 year old daughter kidnapped, with no idea of whether she is alive or dead or having who-knows-what done to her at this very moment by some sick bastards, but what does he know about pain? I had my appointment for my ingrown toenail cancelled because of his slack attitude

Dr Rant

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What are the five worst things that Patricia Hewitt did?

For the last two years, the NHS has been in the hands of a complete and utter failure. Her tenure as Secretary of State for Health has been an unmitigated disaster for the health service. Just as she finished her role as Secretary of State for Trade and Industry by decimating the MG-Rover workforce, so shall her term end with large numbers of junior doctors, nurses and midwives seeking a job. So, what was so bad about her time in office? Here is Dr Rant's top five...

So much choice, but do you agree with Dr Rant?

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An auxiliary’s tale

I am currently on "nutter watch". This is a name I have given the shift myself, since I have had to seclude myself down on the far end of the ward, alone, to make sure a certain patient doesn't keep getting out of bed and wandering around.

Quite how she is still awake I have no idea. She's been given enough temazepam to knock out a small elephant.

The Oracle

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Congenial well paid job for doctors on the dole

We all wish to know what the GMC gives its workers after they have taken the £290 off us. Its more perks than a junior doctor gets really, isn't it? They all get free gym membership and a few other things. Indeed, I have today applied to the GMC as the NHS whistleblower.

How the GMC spends our money

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Exam results time

On another note, results came out on the 21st and were quite disappointing. I passed overall, but….

Short white coats

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LondonMedicGirl is a 24 year old, slightly ambivalent, female medical student at a London teaching hospital. She doubts her vocation weekly, if not daily

Yesterday I spent a considerable amount of my time actually working- I even decided to do a bit more work post-bath while I had hot chocolate! Admittedly I did also manage to watch a rather significant number of episodes of “Grey’s Anatomy” in between all that concientiousness, but still- WORK!!

LondonMedicGirl

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When should doctors do home visits?

I am quite happy to agree in theory that patients should only be visited at home if they are truly housebound or are terminally ill. That is certainly the view of our keen young partner. But in practice I am inclined to be a bit more accommodating about visit requests, perhaps thinking back to how things used to be. Some of my other partners feel this even more strongly than I do, and this is one of the sources of discord within the partnership.

A Fortunate Man

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Hello Doctor

So I sat in the Surgery of the Doctor's, waiting not so patiently. My appointment had been for 9.40, I was still sitting there at 10.30.

One Bear, One Blog

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Waiting

No news from breast screening as yet so I await my mammogram and suppose I'm in a state of limbo really, but as above, life does go on, you can't possibly be wallowing in your troubles every waking minute of every day. I did phone them to say as I work on the hospital site I could take a cancellation virtually at a moment's notice, so we'll see.

Lizzie

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Blogging doctor hopes to be MP

Well - he's finally done it. Gordon Brown has finally acheived his ambition and become Prime Minister. After 10 years brooding in the Treasury, he can now come out of the shadows and show us all what he is made of. I'm not "bovvered" - because we already know what he is made of. He says he will bring in lots of changes. Absolute rubbish. For those of us who work in public services, we know Gordon himself has been directing what we do from the very start of this Government. It is the Treasury-set PSA targets that we have had to work on. The centralised control has been via the grip on financing by targets and dictat from the Treasury.

Rachel Joyce

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MMC and MTAS

Training and the Royal Colleges

The petition

Dr Grumble


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More on McBitch

I swear on my life (and all the lives of the people I love) that I will never, ever become a vicious, sneaky bully like McBitch. And I swear that if I ever find out that someone I know is being bullied, I'll do everything in my power to rectify their situation and make sure they know it isn't their fault.

Hospital Phoenix

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Another day in the life…

Our overpriced, underdelivering, bungling, lying, hopeless "government" lurches through another day:

NHS fiasco leaves 4,000 jobs unfilled:

"The full extent of the junior doctor recruitment crisis was laid bare yesterday after figures showed that thousands of training posts have not yet been filled.

Wat Tyler

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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.

Magic answers

Over the next few weeks, I shall be returning from time to time to Patrick Holford. I had not heard of him until a few weeks ago when I came across his claims to enable people to say “no” to cancer, arthritis and heart disease.

Today, I notice that he has a banner advert on his site saying:

HEAR ABOUT HOW TO REVERSE DIABETES.

And so he goes on, plugging his books and his outspoken views on nutrition. It is a free world, but it angers me that GMTV gives him sofa space and thus lend his views the imprimatur of a television company.

“It was on the tele doctor, so it must be true.”

Do not get me wrong. I do not think that dietetic and nutritional advice is a waste of time. Far from it. Dr Crippen is a great believer in the importance of nutrition, and frequently refers patients for dietetic advice. There is an excellent dietetic resource on the internet. You will find no magic cures for serious illnesses there but you will find a wealth of sensible advice. I talk, of course, of the British Dietetic Association.

Diets, behaviour and learning in children

Reports in the media often tell us that changing a child's diet can improve their behaviour, improve their concentration, and even make them more intelligent.
Unfortunately there are no magic nutritional pills to take, but the evidence suggests that enjoying regular meals and a healthy balanced diet helps a child to have the best chance at optimal mental and behavioural performance. Regular physical activity or exercise is equally important - aim for at least an hour a day. The basics of a healthy diet are...

Diet and Autistic Spectrum disorder

Patrick Holford seems to embrace all the “treatment” modalities that the medical profession regards as quackery.

Get the definitive advice from here


Food Allergy – Fact or Fiction

You may not like what the BDA has to say, but it is true:

As many as one in five people believe themselves to be intolerant (or 'allergic') to a food. In act, less than 1% of the adult population have a true food allergy. With more people self-diagnosing a food allergy, there is a risk of unnecessarily cutting out important foods from the diet and risking nutrient deficiencies.

No magic answers anywhere on the British Dietetic Association website. The advice they give is rational and sensible and freely available to all. There always seems to be a problem with free advice.

It is not valued as advice for which you have to pay.

You may prefer to pay Patrick Holford £6.99 to teach you how to say “no” to cancer. Looking at his web site, at the rate he is going, I would not be surprised if soon he does not announce a cure for all known diseases. Patrick Holford must truly be a magician.

Madeleine McCann - two arrests in Spain

Previously unreleased McCann family handout of Madeleine McCann taken at 2.29pm on May 3 - the day she went missing from the family's holiday apartment (Kate McCann/PA)


The first possible good news although, sadly, there is no suggestion that Madeleine has been found.

Two people have been arrested in Spain on suspicion of kidnapping Madeleine McCann from the bedroom of an Algarve holiday apartment. An Italian man and a Portuguese woman were arrested in a dawn raid in the port town of Algeciras, in south west Spain. The arrest by the elite anti-kidnapping group of the Specialised and Violent Crime Unit of the National Police who were assisted by Portuguese detectives. The arrest took place at 5am this morning and detectives later spent several hours searching a house linked to the arrest. It is the most significant breakthrough in the hunt for Madeleine, four, following her abduction 56 days ago from the resort of Praia da Luz. (The Times)

The port town of Algeciras has a fast ferry service which means that Morocco can be reached in less than an hour. Mr and Mrs McCann, both doctors, had visited the north African country last month to promote the search for their daughter.

And now let us consider those appalling comments from a handful of unsympathetic and callous commentators in the light of this:

Kate McCann may quit as GP to fight child trafficking

THE MOTHER of Madeleine McCann may give up her job as a doctor to campaign against child trafficking and raise awareness about missing children. Kate and Gerry McCann, whose four-year-old daughter vanished in Portugal 45 days ago, are alarmed that child trafficking is not taken seriously enough.

Kate, 38, is now considering leaving her job as a GP to campaign full-time.

A family friend said: “They have come to realise that this is a major issue. If they can act as figureheads then that’s all well and good.

Kate said last week, ‘This is my job now. I can see this becoming my full-time career, with this whole issue of child welfare and opposing paedophiles’.”

Her plans come after meeting child welfare groups and politicians on trips to European capitals.

The McCanns hope to lobby politicians to create an international system that would alert police, media and the public within hours of a child going missing. In Madeleine’s case, border posts were not told until 12 hours after her abduction.

John McCann, Madeleine’s uncle, said: “We are at the stage where we’re feeling comfortable about broadening the issue. Criminal abductions of children are happening fairly regularly across the world. It’s horrible. It’s a political issue that’s low on the agenda but should be higher.” (The Times)

So much for the callous cynics

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Those who are sympathetic to Gerry and Kate McCann, and I am sure that is the overwhelming majority of people in the country, can keep themselves updated by visiting the Madeleine McCann website:

Find Madeleine McCann

The Crippen Diaries 2007 (26)

Not quite Emergency Ward 10

Monday 25th June

The first patient arrived with one of my minor pet peeves.

A water bottle.

What is this modern affectation for walking round carrying a bottle of designer water? And not only was the patient carrying the bottle of water but, several times during the consultation, she unscrewed the top and took a little drink.

She was otherwise normal and there was no indication of psychiatric pathology. What is all this about?

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David is a 56 year old bus driver. A 56 year old bus driver with piles. Awful piles. Piles make most people laugh, until they get an attack themselves. David has had them for years but they have never been as bad as they are now. At times he has difficulty sitting down.

They were so bad at the weekend that he took himself to the A/E walk-in centre. He was given some cream and some co-codamol tablets and told to “see your GP and get him to refer you to a surgeon.”

In the old days, they would have done the referral themselves but the dictates of the NHS internal economy are such that the PCT is refusing to fund such referrals unless they come from the GP. This is supposed to empower the GP as the gatekeeper to the NHS and is said to be something about “the money following the patient.” And of course the hospital cannot offer David “choose and book” and a “choice” of hospitals.

This is, in reality, another barrier to health care, another layer of bureaucracy for the patient to conquer. Of course, I do the referral. Back to the local hospital. David has no interest in going anywhere else. I changed the co-codamol to an anti-inflammatory tablet. Codeine is not great for people with piles.

And I had to sign David off work. He really cannot sit down at the moment. The acute attack will subside over the next few days, but there will be another, and another. David will not get to outpatients for three months.

He may need more time off work before then.


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Tuesday 26th June

For most of us, home visits are not the highlight of the day.

There is no problem when it is an acute severe medical problem, and no problem when it is someone who is terminally ill. In fact, visiting the terminally ill remains, in my view, the most important part of the job.

Today, I had two visits. Both classical modern visits. Both entirely appropriate and reasonable and yet both deeply frustrating.

Two elderly ladies, both widows, both with children who do not live locally and both with a collection of minor medical problems.

The hip aches a little more. A dizzy turn. Run out of the red tablets. Not opened bowels for three days.

Alice, the first port of call, had not opened her bowels for three days. This happens to her occasionally and, for someone of her generation, is worrying. She quite genuinely cannot get to the health centre, and I am happy to see her at home. But I am not happy to do a rectal examination on her with no one else in the house.

So I lay a hand on her abdomen, which is soft and non-tender, and I try to reassure her. Take a couple of senna tablets tonight, and that will probably sort it out. And then she tells me about her granddaughter who, like one of my sons, is doing GCSEs and a few minutes later I leave worrying about the lack of an examination that many would say is essential.

Barbara is a little older than Alice and her short term memory is not so good. “I don’t know, doctor, I just don’t feel well…”

I spent twenty minutes trying to disentangle something tangible from the ragbag of minor symptoms, but nothing emerged. So I checked Barbara’s blood pressure, which was slightly higher than it should be. She seemed to feel much better for the “laying on of hands”. I drove back to the health centre wondering what, if any, action I was going to take on a blood pressure of 184/96 in a lady in her late eighties.

Not much, I suspect. And that is probably wrong too.

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Thursday 28th June

A new day, a new Prime Minister and a new Secretary of State for Health.

I really do feel better about it all. I am as cynical as the next man, probably more so, but even so I am prepared to give them a chance.

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I referred John to the ENT clinic a while ago for an assessment of his chronic snoring. He has finally had a sleep study. He does not have sleep apnoea and does not need CPAP. The ENT surgeon has suggested he buys a SNORBAN gadget.

The cost £45 so John would like me to prescribe one for him.

I cannot. They are not available on prescription.

But are the any good? The ENT surgeon who recommended it is a sensible guy. I looked at the website.

SnorBan is a revolutionary patented mouthpiece designed to stop snoring. It gently holds the lower jaw forward causing the windpipe to open. This position allows air to pass down without vibrating the tissues found there - the cause of the noise - putting an end to snoring.

Use of the SnorBan mouthpiece improves oxygenation to the body and helps to eliviate day time fatigue.

OK, that sounds reasonable. I have no experience of SnorBan. Their spelling is a tad worrying. "Eliviate"?

But they say:

30 day unconditional 100% money back guarantee.

That sounds eminently reasonable, and gives me confidence. The only thing I do not like on the web site is the advert for a book

Download FREE e-book
'78 Ways to Live Forever'
(Just 4 stalks of celery a day will reduce your blood pressure)
NOW!

Still, I suppose it is free, though I don’t much care for salary.

David asked me if I thought it was worth paying this money for a SnorBan. I was not able to help.

Has anyone tried one?

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Gordon Brown to appoint Alan Johnson to the Department of Health

Alan Johnson

Gordon Brown is the new prime minister.

Really.

No definitive news as to cabinet appointments as yet (10.30 pm on Wednesday 27th June) but the word is that Patricia Hewitt has resigned to spend more time with her elderly parents in Australia. No crocodile tears about that.

And it seems that Alan Johnson is to take over at the Department of Health.

I hope that is true.

Alan Johnson has always struck Dr Crippen as a sensible, down to earth man and, by all accounts, he is good at getting on with people. He may have the skills (that Hewitt lacked) to get the doctors and nurses on side.

I hope that is true too.

As always at times like this it is fascinating to watch the orderly transfer of power in a democracy. To watch Gordon Brown leaving the Palace in the bullet proof Jaguar and minutes later watch Tony Blair carrying his own suitcase towads a Seven Series BMW and being redirected to a Vauxhall.

Gordon Brown has many advantages over Tony Blair. Not least, he will not have a Macbeth living next door. But what fun listening to Gordon Brown talking as though he was taking over from a rival political party. Perhaps he was.

Whatever Gordon Brown does, doctors must give Alan Johnson a chance. NHS BLOG DOCTOR believes he is the best possible appointment.

Oh! Dear, I felt a bit like this in 1997

Pay £6.99 to say "no" to cancer

Dr Crippen has made a great discovery.

It is now possible to say “no” to cancer. All you have to do is buy Patrick Holford’s book “Say no to cancer”. It only costs £6.99.

Actually, you do not even need to pay £6.99. You can have the book for free. Well, sort of. You get a free copy of the book if you join “100% Health”

100% Health sounds good to Dr Crippen. Better than 90% health that is for sure.

Best Deal – Save £50!

Yes I would like to join 100% Health today and receive your 100% Health newsletter for 2 years, that’s 12 newsletters, and the 10 special reports shown below, and I want to claim my free book for only £49.99. That’s a saving of £50 off the normal price.

Yummie!

Patrick Holford is clearly a very clever man. For, with his help, not only can you say “No” to cancer you can say “No” to arthritis and “No to heart disease” as well.

Wow!

And Patrick needs your support to continue the good work. He is asking for donations. Your gift, however large, will be gratefully received.

If you are in any doubt as to how clever Patrick is, he lists his qualifications:

Education and Qualifications

1973- 1976 B.Sc. Experimental Psychology, University of York
1995 Dip.ION Honorary Diploma in Nutritional Therapy
2004 F.BANT Fellow of the Association of Nutritional Therapists

Positions and Employment
1984 – 1998 Director of the Institute for Optimum Nutrition
1995 – 2005 Director of the Mental Health Project
1998 – 2005 Director of 100% Health Ltd
1998 - Director of Holford & Associates Ltd
2000 - Consultant to the Institute for Optimum Nutrition
2003 – Director of the Brain Bio Centre
2005 – CEO of the Food for the Brain Foundation

I understand the BSc from York. But can anyone help me with Dip.ION?

I think that is a Diploma of the Institute for Optimum Nutrition. But who are they? I went to their website:

ION is based in South West London... map and was founded in 1984 by ……..nutritionist and author Patrick Holford.

Ah!

I have another problem with Patrick. A serious problem.

Patrick is a supporter of Dr Andrew Wakefield. And that makes me uneasy. So I started digging around in the nutritional and other "advice" that Patrick has gives on his site and in his books.

Oh dear!

Oh dear me!

Very soon I realised that I could devote a whole website Patrick Holford. Fortunately, someone has got there before me.

Holford Watch - The Truth About Patrick Holford, Media Nutritionist

This blog uses basic science to challenge the nutritionist Patrick Holford. Holford's website describes him as "a pioneer...Britains best-selling author and leading spokesman on nutrition and mental health". Holford's key qualifications include "being frequently quoted almost weekly in...newspapers"; he also claims to be "a vegan who eats eggs and fish". With all these credentials, there's obviously a lot to learn from watching the guy!

I was particularly impressed with Patrick Holford and some Fishy numbers

And then, as always when talking of autism, a visit to Left Brain/Right Brain, written by the father of an autistic child.

The death of the MMR debacle

Madeleine McCann has been missing for 54 days.

Madeleine McCann

Madeleine McCann has been missing for 54 days.

Dr Crippen remains appalled at the unsympathetic tone of some of the comments and emails that he has received. A few are downright spiteful.

There is continuing criticism of Gerry and Kate McCann for leaving Madeleine and the other children unsupervised in their holiday apartment. I do not know the full facts and I suspect that none of the commentators do either. I do know, as a father of four children, that over the years we have made the odd error of judgment in terms of child care. Fortunately, there have been no tragedies in our family. I do not know if Gerry and Kate McCann made an error of judgment. I do know that Madeleine McCann is a much loved daughter and, if Gerry and Kate McCann did make an error, they will have been living with that every day for 54 days.

There is an unpleasant stream of logic underlying these comments. Gerry and Kate McCann made an error. It is their fault. So we need not bother to hunt for Madeleine.

Gerry and Kate McCann are both highly intelligent people. They are acting exactly as I would. They are doing everything they possible can to keep Madeleine in the news for they know that that is the best strategy they have to find her. To maintain an international media campaign you need financial support. Such a campaign is beyond the means of a hospital doctor and his wife (who is not, incidentally, in full time employment – Kate McCann works as a locum. If she does not work, she does not get paid.)

Madeleine McCann

How can any decent person criticise two parents for fighting as hard as they can against all the odds to find their daughter?

The McCanns are wealthy people, they have no right to beg for money from those less well off than themselves. Nobody else could afford to give up their jobs for as long as they have. What about Gerry's patients? Presumably they are well down in the pecking order of concern. I reckon the majority of Middle England is now heartily fed up with the ongoing publicity, none of which has resulted in anything significant. (source)

What appalling remarks. Beneath contempt.

The search for Madeleine McCann has been going on for 54 days. Kate McCann is not regularly employed and so is not taking time off work. Gerry McCann is. He may have holiday outstanding. His hospital may have given him paid compassionate leave. I hope they have. If not, he may be taking unpaid leave.

What about Gerry's patients? Presumably they are well down in the pecking order of concern.

How can anyone say that? Women take six months off work for maternity leave. Are you really going to begrudge someone 54 days off work when their daughter has been kidnapped?

Next there are the commentators who say that many children go missing, but only Madeleine McCann gets this amount of attention. That is true. But it does not mean that Madeleine gets too much attention. It means the others get too little. It does not mean that Gerry and Kate McCann are doing something wrong by continuing to publicise Madeleine’s kidnapping.

I wish there were a way of finding all missing children. There is not. But just because we cannot do everything does not mean that we should do nothing.

Why should Dr Crippen and NHS BLOG DOCTOR single out Madeleine McCann for so much attention? Personal choice, certainly, and a personal choice I am perfectly entitled to make. We all have our favourite charities, and Find Madeleine McCann is one of mine. And yes, of course I am influenced by the similarities between the Crippens and the McCanns. Two doctors, one a consultant and one a GP, and both with a large family.

All parents are affected when a small child is abducted. We have been particularly affected by Madeleine McCann.

The most recent comment on Madeleine McCann came in today, and precipitated this article.

I wonder when the time will come that Dr.C has to rescind on his pledge to keep photo+bumpf on the front page? Of course, I sincerely hope she is found and that she doesn't need to stay in the public eye.

missbliss

The answer, Miss Bliss, is not for a very long time. Not, I hope, until Madeleine McCann is found and safely back with her parents.

Those who are sympathetic to Gerry and Kate McCann, and I am sure that is the overwhelming majority of people in the country, can keep themselves updated by visiting the Madeleine McCann website:

Find Madeleine McCann

How you can help?

If you have any information you can call:

• Portuguese Police direct on 00351 282 405 400
• Or British Police on 0800 096 1233

You can give also give information anonymously to Crimestoppers on 0800 555 111.
If you were in Praia da Luz or the surrounding area in the two weeks leading up to Madeleine's disappearance on Thursday May 3, the police may be interested in any photographs you took while there.

In particular they would like any pictures that have people in them who you don't know as opposed to scenery shots or pictures of just your own family. You can submit them to the police via the internet here.

Madeleine McCann must be found. It is not time to give up.

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Previous posts

Madeleine McCann - the website

Cast not the first stone

Madeleine McCann - the search goes on

Madeleine McCann - photo montage

Debate : Doctors for the rich, nurse specialists for the poor

If NHS BLOG DOCTOR has one mission statement above all others, it is to fight against the dumbing down of the NHS. This dumbing down most frequently involves the over-promotion of nurses into roles for which they are ill equipped. Roles that used to be filled by doctors.

In many fields of medicine the only way to be sure of seeing a qualified doctor is to go privately. Take yourself to the “free” at the point of entry NHS and most likely you will find yourself managed by some sort of “Health Care Professional” (HCP = there is no doctor available today).

This is two-tier medicine. Only the wealthy and the “great and the good” see doctors. The riff-raff get the cheapo-cheapo productions HCP.

The nurse-specialists usually counter this argument by saying that “we are just as good as doctors”. But now a new strategy has emerged. Oddly it comes from the normally excellent, multi-authored Mental Nurse column.

They are saying that the wealthy and the great and the good are now being treated by HCPs as well. (see here). Even if this were true, and it is not, would that make it any better? Put this into educational terms. Why not let teaching assistants take over at Eton and St Paul's? Bring the education in those schools down to the level of the sink comprehensives. That would teach the toffs.

I do not agree with the article, but I did however think it was important to discuss it and so I highlighted it in this week’s BritMeds.

Private sector quacktitioners

“So, nurse specialists for the NHS, doctors for the private sector. It’s great rhetoric, but is it actually true? Let’s get the bourbon biscuits out and have a look at the claim. As a bit of lazy research, I’ve picked up a copy of this week’s Nursing Standard and flicked to the jobs pages. So let’s see who’s recruiting nurse specialists and nurse practitioners. Well…....”

Mental Nurse still does not understand that private patients are referred to and seen by consultants and that NHS patients take pot luck. Look at the Lean Health video.

Mental nurse does not like that. He accuses me of not debating seriously. And now in the BritMeds comments he has a little sulk because I took the piss from the promotional video for “Lean Health Care”

Funny thing.

I try to inject a thoughtful, evidence-based approach to the whole nurse specialist/practitioner debate over on Mental Nurse, and Dr Crippen's approach involves hyperbole and cheap insults...

...yet I'm the one who's apparently not clever enough to do anything other than eat bourbon biscuits.

I did take the piss from it. I said

“A man with a beard and funny teeth explains how to make the NHS quicker and cheaper. The one-stop quacktitioner service. Of course it’s cheaper.”

Of course I took the piss from it. This odd chap is trying to dress up NHS cost-cutting in specious psychobabel. “Lean” health care. “Hospital at night”. “Teaching assistant”. “New Labour”.

Slogans and sound bites.

Spin.

I take back not one word. This is total toss-pottery. It is worse than that. It is fraudulent and dishonest. It is dressing up second rate medicine as something desirable.

“Lean Health Care”?

Crap.

This is fobbing off poor folk with second rate treatment. Do you think Tony Blair would see a quacktitioner if he broke his wrist?

And then mental nurse makes much of the fact that man with beard and funny teeth is an eminent doctor from the University of Warwick.

So what?

We are used to this sententious botty-wipe from the University of FormerPoly in Warwick. They specialise in it. We have already met another exponent of total toss-pottery from the very same centre of excrement:



So, come on Mental Nurse. What do you make of this bearded Telly Tubby? You seem to rate the University of Warwick and men with beards. What, precisely, is he saying? Go on, tell me. Explain it to me. And when you have done that, let us look at the over-promoted nurse specialist in the video.

As I have said before, I do not have a flair for languages so I do not speak “nurse”. Maybe you can help. Listen to Rachel Horley, Director of Learning and Support:

"The key to involvement is developing the learning capacity of everybody to recognise and realise the potential for involvement. The challenge for us is to find practical and creative ways of developing the capacity of everybody through learning and development opportunities both within formal learning and also in everyday work capacity."

Please explain what this means.

Mental Nurse, I shall continue to take the piss from over-promoted NPs who are put in positions of perceived responsibility and spout crap like this. And it is crap spouters like this who are being let loose on NHS patients.

I am fervently committed to decent health care for all, and it infuriates me that people without private health insurance are at the mercy of tossers like this.

Does anyone disagree?

Stinging jellyfish - best to pee on it?

Summer is upon us, and the holidays are approaching. A fun article in the Sun Journal

Stinging jellyfish. How best to treat yourself?

Myth: Peeing on the wound soothes a jellyfish sting.

Verdict: Sometimes. Sometimes, pee makes it worse.

Most of the authorities say it doesn't help, it might hurt, but there's no evidence it will end the pain. The best treatment is vinegar, an acid that deactivates stingers that haven't released toxin yet. Depending on the type of jellyfish, alkaline (like baking soda or urine) can deactivate stingers, too.

The downside: Sometimes alkaline activates toxin. Good chance of making your situation worse.

And also find out if :

• You can outrun a black bear by taking repeated right turns
• You need to wait an hour after eating before you go swimming
• Smoking cigars wards of mosquitoes
• Bees really die after stinging you
• Earwigs really like to crawl into your ears
• It is good to treat sunburn with butter

All good fun. Similar contributions - mythical, old wives tales or even true - welcome.

++++++++

Stinging Jellyfish – some serious medical advice can be found here.

The BritMeds 2007 (25)

Lean Health Care.

A man with a beard and funny teeth explains how to make the NHS quicker and cheaper





The one-stop quacktitioner service. Of course it’s cheaper.

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Chariots of Fire

Clearly, the Health and Safety Gestapo has gained a foothold in Hope hospital, and I fully expect to hear more of their lunacy in due course. I'll keep you informed!

The World’s gone mad.


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Dumb me down porridge

The following email has been sent to GPs by an Out Of Hours service:

"Dear Doctor

Further to a recent feedback meeting with our ECPs I am writing to advise you that at this early stage we would normally expect an ECP to be asked to accompany you on a visit to the prisons, rather than them being sent on their own.

This is because they need some further supervision and experience….

In the nick

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Oh dear

Wise words from Random Acts

Tom Reynolds


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Terror Tales

The wonderful Hospital at Night team have brought us yet more cost cutting dumbing down in the form of 'Safer Care Safer Training' and the 'developing of the role of nurse coordinator'. It really must be seen to be believed. There is an extensive 56 page document that outlines the so called 'competency framework' of these nurse coordinators. 'Competency' is really such a great way of introducing this marvellously termed 'safer care safer training' agenda, I wonder if the lambs skipping through the green pastures come as a free bonus item?

The Ferret

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The DK is having a bad hair day

Fucking statist doctor bastards with their fucking statist mindsets and their fucking illiberal views: listen to me very carefully (I would like to say this only once, but I've already said it many, many times).

SHUT THE FUCK UP. WE WILL DO AS WE PLEASE, YOU SHITE-BUCKETS, AND YOU WILL DO THE JOB THAT YOU ARE PAID FOR: PATCHING US UP.

FUCK. OFF.

We should ban doctors from speaking

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Bugger Off M'am

Dr Sally Winning, a psychiatrist and chairman of the BMA Scottish staff and associate specialists committee, said: "We don't want youngsters drinking on street corners."

There's a strand of social thought up there amongst the kilt-eaters and haggis wearers that is still very Puritan. That dreadful affliction caused by the fear that someone, somewhere, might be having fun.

Tim

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In the news

Perhaps the most important health news we have come across today is that the vaccine for the human papillomavirus (HPV) that causes cervical cancer has been approved for use in the U.K.

Life with leukaemia


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MASTURBATION

Temporary sexual pleasure with many dangers

says Tim

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There are idiots at all levels in the NHS

Another thoughtful post from Tom Reynolds

Random Acts of Reality

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Private sector quacktitioners

So, nurse specialists for the NHS, doctors for the private sector. It’s great rhetoric, but is it actually true? Let’s get the bourbon biscuits out and have a look at the claim. As a bit of lazy research, I’ve picked up a copy of this week’s Nursing Standard and flicked to the jobs pages. So let’s see who’s recruiting nurse specialists and nurse practitioners. Well…....

Mental Nurse still does not understandthat private patients are referred to and seen by consultants and that NHS patients take pot luck. Look at the Lean Health video at the top.

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Getting asthma right

An estimated 1 in 6 New Zealanders has a diagnosis of asthma. For some time there have been concerns that asthma is misdiagnosed and over-diagnosed..

Breath Spa for Kids

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Bowel Whispering

Bowel-whisperer Patrick Holford has some disturbing ideas about vaccination. If you pay a subscription to him, you can consult his special online reports on a number of topics. One of these reports is about vaccination. I'm accustomed to anti-vax denialism and general crankery but reading this report was like allowing my eyes to turn into two fists and pummel my brain.

BSK

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LEPERS AND WHISTLEBLOWERS - THE UNTOUCHABLES

Rita is on the war path again

The Whistleblower Diaries

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Nursing Research – the candy man cometh

I’ve never even heard of a “Penguin”, let alone a chocolate one. These are from the United Kingdom, and they used to have a bad joke on each wrapper!

Baffled American Nurse

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Work experience or more dumbing down?

"The 15-year-old son of two doctors performed a Caesarean section in an apparent bid to enter the Guinness Book of Records as the youngest surgeon.

Obesity and the Salt Connection

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Some must-read advice for everyone

If you are suffering from some serious illness like Hypertension ( Blood Pressure ), Diabetes or Chronic Kidney Disease, heart Diesease then keep yourself away from Ayurvedic, Homeopathic and Unani system of medicines. They are meant for small term illness and are not well in curing critical and long term diseases. You may fall into serious trouble if you skip this advice…

Aditya speaks

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AMERICAN DOCTORS DON’T LIKE YOU MUCH

Lawyers are making a mint in the USA at the expense of the medical profession due to allegations of malpractice. Doctors in the USA have had enough. They are looking elsewhere. Europe is the place! Now, we in the UK speak the same language as in the USA. Well nearly. So you would think these doctors would be swarming to the UK.

Not so.

Find out where they are going here

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Accomplia

But on Thursday, a committee advising the U.S. Food and Drug Administration voted to ban the pill after concerns about its psychiatric side-effects. The 14-member-panel heard testimony that Acomplia increases the risk of suicidal thoughts even in patients without a history of depression.

It is still being prescribed in the UK

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How much did the NHS supercomputer REALLY cost? Take a guess.

With the NHS "supercomputer" about to plunge into the crevasse, I've taken another look at the costings. How can it possibly be that they've been so hard to pin down?

The answer is here

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It’s those bloody NHS consultants again…

The relationship between the NHS and its consultants has always been poisonous. Bevan hated them and reckoned he only got them to go along with the NHS by stuffing their mouths with gold; Babs Castle hated them and tried to bludgeon them into giving up their private work; doubtless the 10 (yes 10!) Health Secretaries we've had since 1985 have all hated them. And we may be assured the feeling is entirely mutual….

Spanish Practices

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Find a utility bill or go away and die

Now I am on horrible tablets that I can't drink on, have constant headaches, can't walk very far unaided and might possibly have to wait weeks to see the neurologist. And Aunty Pat thinks the NHS is in a good state? I waited so long at A&E in a hospital gown with no pillow, no water even though I was thirsty, no pain killers and no chance of seeing a doctor that eventually I discharged myself on the grounds that I would me more comfortable and a lot warmer in my own bed. A health service which is the envy of the world? I don't think so.

I haven't even been able to register with my local GP since I moved house because I don't have a utility bill with my name and address on, since I share a flat, so have to go back to old house when I want to see a doctor.

Trixie

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Not all Nurse Practitioners are Bad

We’ve had nurse practitioners for seven years now, we had night nurse practitioners when they were just another word for night sisters. They may have started off by trying to prove that they could do a better job than doctors, but after seven years of being bleeped every time the on-call house officer was to do they are now firmly on the Doctors side. We usually have a coffee break together where we complain about the ward nurses.

Our NPs aren’t the sort that try and be Doctors, they haven’t replaced the Doctor at night. They’re not the sort that see patients or make diagnosis or management plans, some of them prescribe - but only really re-writting drug charts. If they find someone sick they will get an ECG, do an ABG and take bloods and most importantly get a Doctor. When I get there I have to assess the patient and make a management plan - the actual work of being a Doctor.

FtM Doctor

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Read the label

Here’s a reminder that one should read instructions and treat all medicines, including non-prescription ones, with respect. A 17-year-old athlete has died folllowing excessive use of an over-the-counter topical anti-inflammatory sports rub…

Black Triangle

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The beautiful game

Today I saw one of my favourite patients. We have known each other for many years and for some reason I always feel more cheerful after she has been to see me.

A fortunate man

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Lyme disease diagnosis

The Medical Defence Union (MDU) has told its members to remain vigilant for possible cases of Lyme disease. Lyme disease, caused by the bacterium Borrelia burgdorferi and transmitted to humans by the bite of infected ticks, can be hard to spot…..

Microbiology Bytes

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Does it make any difference?

Let those who claim that all political parties are the same and it makes no difference who we vote for make an appointment with their local GP and ask what they think.

The difference

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What hope is there?

My post yesterday concentrated on the petty attack by one blogger (doctor) against the grammar and punctuation of another (nurse) when the real fight was going on over on the other side of the Atlantic……

Life in the NHS

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The return of HJ

Dear old HJ used to be a regular commentator on NHS BLOG DOCTOR but then one day he disappeared. But he is alive and well, and commenting just round the corner (? bend) on anaesthetists

“Incidentally, your comment about 'consultant anaesthetists' made me laugh. Let's face it - for the vast majority of procedures, the anaesthetists job is that of a skilled technician, no more. It could be done by a well trained nurse. It's in their interest to make out that it needs a 'consultant' to do it.

HJ

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I am a big fan of using well trained specialist nurses. Often, they can do things as well or better than medics because they specialise in a technical task.

I recently received excellent treatment from a Nurse Practitioner. I was subsequently checked by a doctor who was much less informative. Whilst I am confident that the doctor was competent, he did make a minor criticism of the NP - a criticism I later discovered was clinically incorrect (albeit his error was minor).

HJ

Quite right too. Who needs a Gas Man? Please sent letters of support to HJ here


UPDATE UPDATE UPDATE UPDATE

Please be gentle with HJ. He tells me that "in fact, I have several friends who are doctors." Phew, that is all right then. But, however many medical friends HJ may have, not all comments are supportive of his views and he is getting angry:

HypoCrippen,

Don't go anywhere near your hypocritical, self serving, blog any more, you mean? A surgeon friend of mine reckons that for most purposes about 12 months of training is sufficient for most anaesthetic tasks. But then, what would he know compared to you? By no sensible measure should it take 12 years to train an anaesthetist for any task. Only someone oozing the worst pomposity and self importance of the medical profession - like you - would claim this.

Interesting that you don't actually challenge anything I say with any evidence - because you haven't any. It scares me that thanks to the NHS someone might actually have to put up with you as their GP. Scary.

I do miss HJ. I wish he would start commenting on NHS BLOG DOCTOR again, rather than hiding elsewhere! Or maybe he should try his luck at the Dr Rant Foundation.

Go on, HJ, I dare you. Have a go at Dr Rant.

++++++++

From large bin to small bucket

When our old Victorian asylum was starting to wind down, many people were full of optimism, looking forward to waving goodbye to the long, dim, corridors with high ceilings. Farewell to the stains, the smells and the memories of a dubious history. They envisaged a brave new world of shiny purpose built units. These new state of the art environments would benefit and uplift all of us, reducing stress and promoting well being. Oh, everything was going to be so much better….

Mental Nurse

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Darkness and silence

It seems counterintuitive that I should be happy when I’m starting my 4th go of chemo next week and have nearly exhausted the available cytotoxics, but I am, mostly, and when I’m not there is nearly always an obvious physical cause. There is no merit in this; I was born with a default state of happiness, I think.

Metastases in Auspicious Dragon

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We Do Not Have Adequate Provision of Allergy Services in the UK

There are so few clinical allergists in the UK and such a surge in need for them that it is hardly surprising that Jo Revill has a dramatic headline for her story: NHS Swamped by an Epidemic of Allergies. There are the equivalent of 26 fulltime posts in clinical allergy in the UK. I don't fully agree with her overview of the situation but you can understand the scale of the mismatched resources

Breath Spa for Kids

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Why I want "suspendeds"

My recent entry about seeing my first ’suspended’ - or, to be more accurate, my first dead body - prompted a bit of a discussion in the comments section. It’s been pointed out that some people, probably including myself, come across as far too eager to experience a ‘juicy’ job such as a resus or serious trauma. To some, it appears that we are almost willing people to die in order to give us the job we want. We are only happy when someone else is suffering…

Nee Naw

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Here we go round the mulberry bush

Yesterday, in agony, having not been able to sleep for several days, she took herself off to A&E. She had tried to get a GP appointment and was told there were none for two weeks. She then went to the walk-in centre, who told her to go straight to A&E. She saw a doctor, who told her the likely problem, and told her she'd need an X-ray. I happen to know that the X-ray department is in A&E Majors. What was she told? "Go to your GP and tell him to send you for an X-ray."

She can't get a GP appointment for two weeks.

This is crap, we all know it, and it goes on every day.

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

Tweety Pie

Hewitt is living in a fantasy land if she thinks that she has 'reversed the decline'. New Labour have frittered away billions on grandiose schemes which provide bugger all benefit to anyone except to the brain dead bureaucrats who are employed to shuffle the glossy bog roll around. Productivity and efficiency have been on the decline for years, despite endless meaningless statistics manufactured by the government that prove just how much better everything is.

Dr De’ath and the DK

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Kids today are fat.

There are apparently many things to blame for the fat kid crisis. Things like computer games, television adverts for fast food, and the fact that most of them are utter lazy c…

I am livid

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Nurse blogging at your own risk

For some reason Dr C has it in for nurses in a big way and sadly, if he can’t get you on content he will now resort to your spelling and punctuation inadequacies. No doubt he would have a field day with me, because though I am better educated than most, for some strange reason I am kind of grammar blind! I am not sure that my inadequacies with the comma and semi colon would ever have kept me out of medical school or indeed stopped me from becoming a doctor.

Julie @ Life in the NHS

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MTAS and MMC

Dumbing down the doctors

At the moment most paediatric wards have up to seven specialist paediatric senior house officers (SHOs) - doctors with up to four years' experience. Most could be replaced under Modernising Medical Careers. In future, trainee doctors with one or two years' experience will spend four months in paediatrics before moving on to another specialism, and would not necessarily have any interest in that area of medicine.

Socialist Courier

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Shuffling the deck chairs

So, MTAS is heading towards August 1st and across the UK there are about 15000 junior doctors who have no idea what job they will be doing, nor in which speciality, in which hospital, or even which region they will be doing it. The better qualified they are the less likely they are to have been offered a job.

Dr Rant

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There’s no business like SHO business

Since the recent conclusion of 'Britain's Got Talent', 'Any Dream Will Do' and 'The X Factor', the interminable boredom of Big Brother has prompted the executive team at the Dr Rant Foundation to devise a new prime-time television extravaganza. It will hopefully also help to solve some of the heartache caused by the MTAS junior doctor jobs fuckwittery that has recently caught our attention.

Simon Cowell has already given his backing to our new show that will be open to the 10,000 experienced junior doctors who will be jobless in August.

Dr Rant

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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.

Cloud cuckoo land : part time doctors

Dr Sarah Blayney

It is customary for old farts to decry youth from a perceived moral high ground which can best be defined as “you young people do not know how lucky you are.”

Dr Crippen spent five precious years of his life working 100 to 120 hours a week with overtime pay rates that were derisory. It was ridiculous. Absurd. No one should have to work in that fashion. But there was an upside. Experience. Experience that benefited both doctors and patients.

Common sense, legislation, and the European Working Time Directive have put an end to that. Junior doctors hours are to be reduced yet further. Some junior doctors, like Dr Andrew O'Brien, know there is a real problem with lack of experience.

Ten to fifteen years ago, the average orthopaedic surgeon would have had approximately 36,000 hours hands-on experience before he was appointed to a consultancy. Dr Andrew O’Brien, a specialist registrar in orthopaedics will have had approximately 8000 hours experience when he becomes a consultant. (UK surgical training crisis)

The recent BMA survey, as reported by the BBC, says:

Newly-qualified women doctors outnumber their male counterparts by almost three to two, a survey suggests.

The British Medical (BMA) found that 58% of doctors who graduated in 2006 were female compared with 51% in 1995.

It is right and proper that women can pursue a career in medicine. But at what stage do we decide that the needs of medical training can no longer be subsumed by the needs of working mothers? It may not be politically correct, and there will be a torrent of angry comments, but Dr Crippen thinks the pendulum has swung too far.

Dr Sarah Blayney does not share Dr Andrew O'Brien's insight. Sarah is 24 and in her first year of work after graduating. She works at Arrowe Park Hospital, in the Wirral. She feels that the current system left doctors with very little choice or flexibility:

"The training jobs as they stand are all or nothing. You either do all the hours or don't get the post. I want to pursue a career in hospital medicine, which will mean me committing to a minimum of five years of fairly hefty on-calls. "

At the moment I am 24, single and am enjoying life. But in four or five years time my situation may have changed and I may not want to work those hours."

She said flexible working would be particularly relevant to female colleagues wanting to start a family, but said male colleagues were also interested in changing their hours. For example, some wanted to take time out to travel, she added.

"It should not need to compromise training. Doctors appreciate that they need to put the time in. It's about having more flexibility."

Sarah lives in cloud-cuckoo land. She wants the job but she is not prepared to do the hours. If you want to be a hospital consultant you have to train for many years during which you will work long hours. But Sarah does not see it like that:

"I want to pursue a career in hospital medicine, which will mean me committing to a minimum of five years of fairly hefty on-calls. At the moment I am 24, single and am enjoying life. But in four or five years time my situation may have changed and I may not want to work those hours."

Well, bully for you Sarah.

You need to grow up a little. You can’t expect to pop into the hospital to do occasional clinics at a time of your own choosing in between school runs, parent-teachers association meetings and back packing holidays. Life is not like that. Being a hospital consultant requires commitment, dedication and long hours. There is generous provision for paid maternity leave. What more do you want? Get a child minder like everyone else does. If you won’t do the hours, you can’t have job. Get a part time appointment in the Family Planning Clinic. Just because you are a girlie, you can’t expect medical training to be turned on its head.

But just a minute. Sarah Blayney works at Arrowe Park Hospital, in the Wirral. That sounds familiar. Is that not where Sue and Dave, two of NHS BLOG DOCTOR’s oldest friends, work?

It is too.

Sue and Dave must have sent Sarah a copy of the most frightening NHS document that Dr Crippen has unearthed. Getting a picture of the night at Arrowe park hospital is a blue print for medical care without doctors.

Maybe Dr Crippen has been unfair. If 70% of junior hospital doctors are going to be on maternity leave or back packing holidays, we may yet have need of Sue and Dave.

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And see Dr Rant's take on this

Good news! The Fat Doctor is back

Good news.

The Fat Doctor is back.

"Famine-resistant doctor, pastor's wife, mom to one son, companion to two dogs, Diet Cokehead, TV junkie and frustrated writer approaches middle age with as little grace as possible....."

Always one of my favourite medical websites, and much missed. Kindness and compassion. No vitriol here.

Take a look at The Fat Doctor's recent posts:

Thirty eight reasons to lose weight

1. Live until 85 without debility.
2. Play with Son without getting winded.
3. Clothes from regular stores!
4. No cankles.
5. Swimsuits without embarrassment.
6. Want a tummy tuck eventually: Pannus be gone.
7. Avoid embarrassing Son when he is old enough to be teased.
8. Airplane seatbelts.....................

Teensy Problem

This morning, while peeing and contemplating all of the rest I plan to get this weekend, I glanced into the tub and saw a little mouse. It furiously pawed at the sleek wall of the tub trying to get out. Three hours later, it hadn’t made any progress and had pooped. A lot. I admit, mice scare me.

Lazy Eye

As a doctor, I know I’m lucky. My child is able-bodied, intelligent and, perhaps most importantly, humorous. As a mother, I’m very concerned about his lazy eye. He’ll be three in August, and I know we need to jump on this early.

Welcome back, Fat Doctor.

But...er...what is a cankle?

The Summer Solstice and SAD syndrome

On the Summer Solstice, which occurs on June 21, the Sun is at its highest path through the sky and the day is the longest. Because the day is so long the Sun does not rise exactly in the east, but rises to the north of east and sets to the north of west allowing it to be in the sky for a longer period of time.

After the summer solstice the Sun follows a lower and lower path through the sky each day until it reaches the point where it is in the sky for exactly 12 hours again. This is the Fall Equinox. Just like the Spring Equinox, the Sun will rise exactly east and set exactly west on this day and everyone in the world will experience a 12 hour day. (source)

Or, to put it in more simple terms, soon the nights will be drawing in. The best of the year has gone.

The Crippen children fall about laughing when I say things like this. Their summer holidays have not yet started and for them the summer is yet to come. But, once again, I am in the hinterland of SAD syndrome. The children are similarly amused on 21st December when, in the gloomy depths of mid-winter, I perk up and announce that soon the days will be getting longer.

I am not really mentally ill (I hope) and SAD syndrome does not seriously affect my life. Some are not so lucky, and have real problems. But it does affect me a little.

I can remember as a small child being baffled when my grandmother said, as she frequently did, “the nights are drawing in/out”.

“So what?” I used to think.

Now I understand and with each year, as I get older, it becomes more and more important.

It must be a feature of age.

"Tarts" cancer jab will "ruin lives"

Expensive at the point of entry

"Gardasil is almost 100% effective against Human Papilloma Virus, the main cause of cervical cancer, which can be fatal, and genital warts. It is now being prescribed in Britain , with calls for the 'wonder drug' to be administered wholesale to school-girls.

Cervical cancer charity Jo's Trust has called for a nation-wide programme of vaccination in secondary schools to be launched by the end of the year, even though no tests have been done on girls of that age and long-term side-effects are as yet unknown.

The use of the vaccine which prevents cervical cancer has been condemned by a Christian prayer and lobby group."

Stephen Green, National Director of Christian Voice, said today:

'The best way of not getting cervical cancer and genital warts is to stay a virgin and marry a virgin. Why don't these officials want young people to do that? Why don't we raise their expectations and ours and treat them with some respect?' (Christian Voice)

Madness.

I saw Alice, a sixteen year old girl, this morning. She is not a tart. She is a schoolgirl. She has not been able to have a Gardasil immuisation because of prudery and government delay (Patricia saving pennies again) and now she cannot even get contraception.

Yesterday afternoon, after school, Alice had intercourse with her boyfriend. The condom split.

This has not happened to her before. She went to the local chemist to get the “morning after pill”. The well known high street chemist that she visited charges £25 to provide one levonorgestrel pill. (Levonelle 1500)

Alice is a school girl. She is hard up. She did not have £25 and nor did her boyfriend. Together, they could only raise £11.

Alice’s parents do not know she is sexually active. In fact, they think she is not. She was nervous about coming to the family doctor because I know her parents. And her sister. However, she is a sensible girl, and realised that it was essential that she got the morning after pill so she set off to school very early this morning and was waiting at the door of the surgery when I arrived.

In 2006 there were approximately 194,000 abortions in the UK, nearly five percent more than the previous year.

Contraception is supposed to be free in the UK. Chemists are allowed to sell the morning after pill without prescription to make it easier for young girls like Alice to get help.

And it is easier.

If they can afford it.

Utter madness.

The Crippen Diaries 2007 (25)

Not quite Emergency Ward 10

Monday 18th June

A funny day, illustrating the best and the worst of the government’s protocol driven NHS.

Dorothy is in her mid-seventies. She is a spinster and now lives with Mavis, her younger sister, who is a widow.

Dorothy has a collection of medical problems, none of them acutely life threatening, but the combination of osteoarthritis, osteoporosis and COPD makes her life difficult. Her bone pain is reasonable well controlled with analgesic patches and she struggles on. She is prone to getting urinary tract infections. No obvious reason why. Ultrasound and cystoscopy normal. The difficulty with her urine infections is that she does not get much warning in terms of pain on passing urine. She just becomes incontinent. So she has a small supply of Trimethoprim at home and, when problems arise, Mavis gives it to her twice a day for three days and that usually solves the problem.

Mavis had started the Trimethoprim on Saturday but unfortunately Dorothy had not responded and was now both incontinent and unwell. I arrived to find her in bed, and wet. She had a temperature, she was clammy, slightly dehydrated and confused. Not just slightly confused. Away with the fairies. We had a surreal conversation about double glazing. I hope she did not think I was the salesmen.

So, hospital for Dorothy.

I phoned ambulance control on the doctor’s number, listened yet again to the choices, and pressed “1” for admissions. Nothing happened. I tried several times over fifteen minutes and there was no response. Finally I dialled 999. Very pleasant and calm young lady insisted on getting the address and phone number before taking any details. When she had done that, I apologised for coming through on the 999 line, and said it was not an emergency. She laughed and said “Yes, the ordinary line is down, several doctors have had to do this today”.

I explained the problem with Dorothy and specifically said again that it was not an emergency, and I did not need a full para-medic blue-light ambulance. “I’m sorry doctor, it is already on its way, you came through on 999.” I asked her if she could not put a call through to them to say it was not an emergency, and an ordinary ambulance within two hours would do. I did not want to pull a paramedic crew off the M1 motorway to ferry a confused old lady to hospital.

At this stage, the door bell went. An advance paramedic had arrived, with kit, ahead of the ambulance. Extraordinarily, the paramedic was a patient of mine. I know him well. He was cheerful and relaxed. He offered to put a drip up on Dorothy. I said it really was not necessary, and he was fine with that. Then the ambulance crew arrived. They did an ECG on her, and off she went.

The first thing to say is that the response time for ambulances has improved beyond recognition over the last few years and I have no doubt that if Dorothy had had a heart attack, and slipped into VF, this sort of response would probably have saved her life. But she had not had a heart attack, did not need paramedics and did not need a drip or, frankly, a domiciliary ECG.

No harm done. My paramedic patient said they were having a quite day. We had a long chat about how wonderful it would be for both of us if we could predict which days were going to be quiet, and which were going to be busy.

All suggestions welcome.


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


Tuesday 19th June

I had Tom, a medical student, with me today. I enjoy having medical students. It slows you down quite a lot (a few more gaps) but it keeps you on best behaviour. All GPs have to cut corners from time to time. When you cut a corner with a medical student present, woe betide you if you cannot justify yourself.

The students usually arrive with a “brief” from the medical school. Tom’s brief today was to “discuss with the GP the problems posed by ‘frequent attenders’”

We had talked about this briefly the day before. We agreed that the term “frequent attender” was being used pejoratively. It was not referring to people with serious illness needing regular medical follow up.

Looking down the list of patients, I saw that Ernest was due in. Ernest is a frequent attender. He is in his late sixties. He has well controlled hypertension and no other identifiable serious medical problems. And yet he comes in at least once a fortnight, with a variety of physical symptoms. I phoned him and told him I had a medical student with me, and would he mind seeing the medical student first. Ernest is a nice chap, and would always be helpful, but he sounded positively delighted at the prospect of relating his problems to someone new.

Tom spent half an hour with him. He came back and presented the history of “griping right sided abdominal pains which had been going on for twenty four hours; no vomiting; slight nausea, but then I am often a bit nauseous, said Ernest, I think it is my hiatus hernia, but these symptoms are different, I think it all came on after that ham the wife bought at the corner shop yesterday, and when I opened my bowels this morning, my motions were rather like pellets, and I had a buzzing in both ears, which did not settle until I had a cup of tea, and then I noticed that my tongue was a bit coated…..and so it went on.”

I examined Ernest’s abdomen, and then said that Tom and I would have a brief discussion as to what should be done. We went back to my room. Tom talked of blood counts, amylase, cancer markers, plain abdominal X-Rays, ultrasounds and so on. I talked about patients who close their eyes when you palpate their non-tender abdomen, about multiple disparate symptoms making serious diagnoses less likely, about the absence of red light symptoms such as weight loss, blood in motions or urine, or persistent change in bowel habit. Ernest had none of these. He had all his routine bloods checked three months ago; normal. A chest X-Ray six months ago; normal. A barium enema two years ago: mild diverticulosis but nothing else.

Is it time to re-investigate him?

We went back to Ernest and told him that we did not think there was anything too serious going on, that he should have a light diet and plenty of fluids and we were confident that it would all settle down. As always, we safety netted. If you are not right in a week, I want you back, and we will investigate it further.

Ernest was satisfied and off he went.

Tom was less satisfied. How can we be “sure” that there is not something serious underlying all this? We can’t. I don’t think there is, but I can’t be absolutely sure. However, if there is something going on, Ernest will be back in a few days with the same symptoms. More likely, he will be back in two or three weeks with a collection of different symptoms.

And so we skate on over ever thinner ice.

+++++++++


Thursday 21 June

I was phoned in the middle of surgery by the psychiatric SHO at the local hospital. Elizabeth has had Parkinson’s disease for over ten years, and is on a shed load of appropriate medication. She has also failing short term memory. She was admitted acutely a few days ago after a fall. A few cracked ribs. The orthopaedic team asked the psychiatrists to assess her for possible early dementia.

The psychiatric SHO needed some background medical information, details of her medication, and asked about her other medical problems. He was very pleasant. After a couple of minutes talking he asked,

“This diagnosis of Parkinson’s disease; is it a proper diagnosis, or did you make it?”

Now it is certainly true that Parkinson’s disease is both underdiagnosed and overdiagnosed and therefore, by definition mis-diagnosed. Oddly enough I am aware of that.

After a long pause, I said “I think I know what you are getting at but, on reflection, do you think you might have phrased your question a little differently?”

Another long pause, and then he said, “Oh God, I didn’t mean it like that…”

Hmmmm

This will be a useful experience from him when he comes to write his 150 words on “mistakes I have made and how I learnt from them” in the next MTAS form.

+++++++++++

There is another wave of VLCDs (Very Low Calorie Diets) in my area. They seem to come in cycles and are usually run by pyramid selling companies. You pay a huge sum of money – about £60 a week – to buy some tins of powders. Powder which, incidentally, you can buy generically in high street chemists for a few pounds. But if you buy them on the high street, you do not get the dolly bird and the PR. And the dolly bird has a garage full of tins of powder. The more she sells, the more she earns.

All the usual fatties are coming in, just as they did five years ago.

It is the tantalising promise of four stone weight loss within a few weeks. And if you stick to the diet, and keep washing the soiled knickers, these diets work. Of course they do. If you are close to starvation, you lose weight. Most do not stick it out. The odd ones that do then develop a complex about their loose skin which is suddenly four sizes too big. But they soon grow back into it once they go back to their normal habits.

I am enormously sympathetic to patients with weight problems but this is not the way. And the VLCD diet companies usually want the patients to get their doctor to sign medical disclaimers. We will not do that. And so I had a very difficult consultant with a patient who accused me of “not understanding” and of “being obstructive.”

"You're young and strong and you won't need it,"

Two of these will not suffice

Please read this.

And then would someone, somewhere explain to me why such ignorant cruelty is tolerated in the NHS?

I am ashamed.

Doom, Manhunt 2, Duke Nukem and British Censorship

Having admitted that I like motor racing, I might as well go on to make a full confession. I used to play video games. Not for a while now, but years ago I downloaded Doom from the internet (you could not buy it over the counter) and jolly good fun it was too. I do not think I was psychologically damaged by it, but who knows. I also had a copy of something called Duke Nukem but I never managed to get that running properly.

The British Board of Film Classification has recently decided to ban a new game, Manhunt 2, because of its “unremitting bleakness and encouragement of casual sadism.”

Rockstar Games trail the game in the following way:

One chance. They took your life. Time to take it back. Manhunt 2. Coming Summer 2007.



Today, The Times reports:

David Cooke, the director of the BBFC, said that the board preferred to ask for cuts rather than order an outright ban, but that was impossible in this case. “Manhunt 2 is distinguishable from recent high-end video games by its unremitting bleakness and callousness of tone in a game context which constantly encourages visceral killing with exceptionally little alleviation or distancing,” he said.

“There is sustained and cumulative casual sadism in the way in which these killings are committed and encouraged.”

The board said that the game was worse than its predecessor, Manhunt, because of the “sheer lack of alternative pleasures on offer”. Sue Clark, a spokeswoman for the board, said: “The only thing [the main character] does is go around and kill people extremely violently. When he gets out of the mental institution he [tries] to find out who he is, but that just involves killing more people.”

Sounds like Doom to me.

As I recall, Doom was unremittingly bleak and callous and the game involved constant visceral killing. And didn’t I take my teenage children to see the most recent James Bond film, Casino Royale, during which Bond was sat naked in a chair with no seat whilst a sadist whipped his scrotum?

That film was not even an “18”. It was good "all round family entertainment."

Has anyone in this country watched The Sopranos? The best TV drama to come out of the USA in ten years (and American TV series drama is now as good as it gets) but full of sex, violence and sadism.

Back to Manhunt 2. David Cooke goes on to say

“The game presented a range of unjustifiable risks to adults and children”

This is where I part company with David Cooke. This is Mary Whitehouse redux.

"Behave yourselves!"

Who is Cooke to say what represents a risk to me? Who is he to prevent me playing a game that is available in many other parts of the world?

I shall now have to find a legal way to track down a copy of the game. I have friends in the USA. Maybe they will mail me one. It is not illegal to own the game in Britain, but it is illegal to supply it.

When I get hold of a copy, I will review it.

Meanwhile, I guess it’s back to something that has sanitized “acceptable” violence like Walking with Dinosaurs on the BBC.

God, I hate censorship.

Pomosexuality

I have learnt a new word today.

As so often on matters like this, I seem to be a late arrival. It must be my conventional education. That word is “Pomosexual”, a word used to describe "PostModern sexuality".

The mainstream definition of the word Pomosexuality refers to the fluid nature of our sexual orientations. While it is convenient to sort everyone into a handful of different groups - homosexual, bisexual, heterosexual - Pomosexuality argues that these words and categories cannot do justice to the complexity of human sexuality. Like many other things in life, sexual orientation isn't a black and white, either/or experience for many of us. (Emerging Women)

This is a subject to which the always excellent Aphra Behn has averred without ever, to my knowledge, naming it.

I self-identify as queer. I am in a relationship with a transsexual, (a fact I hadn’t meant to talk about this early on in this space, but - hey). I am not straight because my partner… well, let’s just say I’m not straight. I’m not gay: I’ve had partners of both sexes. But I’m not bi either. Bi-sexuality suggests that you will have sex with people of either sex, but it says nothing about having sex with people who are intersex or transgender or any of the other spaces in between.

Queer as folk. No. Queerer than that (Aphra Behn)

What does Pomosexual really mean? Whilst we await the judgement of the Oxford English Dictionary, I think for the time being it means anything you want it to mean. It means “anything goes”.

And why not?

Fatties do better after heart attacks

Cardiac Rehabilitation Clinic

Some doctors will admit to a little schadenfreude that health freakery does not confer cardiac invulnerability. There is nothing more depressing for the family doctor than trying to advise a slim, trim, lycra clad, non-smoking, gym-visiting middle-aged vegetarian, who has just has his first heart attack, on life style changes.

So much easier to help the flabby lounge lizard who is three stone overweight and has not taken exercise since TV remote controls were invented.

Now we hear that fatties who have heart attacks may have a better prognosis than the the health freaks. Various theories are suggested.

(The) differences in body chemistry caused by obesity might play a role. For instance, levels of blood platelets, which can affect clotting, are lower in obese patients, while levels of fat in the heart tissue, which might have a protective effect, are higher. Another theory is that the higher levels of endogenous cannabinoids in obese people might be key. There is a growing body of evidence to suggest that these chemicals have a protective effect during a heart attack. (BBC)

Counter intuitive research findings like this are a constant source of pleasure. But I shall not be rushing to put all my post-heart attack patients on a diet of Mars Bars and McDonalds.

Why do fatties seem to do better? I am not sure I buy into any of the chemical theories advanced above.The truth is probably more mundane.

The life time risk of heart attack is predominantly a function of the hand of cards you are dealt at birth. The fatties may have been lower risk at birth, but have brought the disease prematurely upon themselves. The thinnies were probably always high risk and, had they not looked after themselves, would probably have had their heart attack even sooner. Given that they were high risk from the beginning, and already have excellent lifestyles, there is not much more they can do but keep their fingers crossed.

It's abortion again : "pro-life", "pro-choice" & contraception

Iain Dale has stirred up a hornet’s nest by highlighting the recently announced UK abortion figures under the headline “Abortion Figures Shame This Country!”

I infer from what he writes that Iain is of the disturbingly named “pro-life” persuasion. As always, however, he puts his considered views moderately:

In an ideal world there would be no abortion, but we do not live in that world and never will. Those of us who adopt a pro-life attitude must recognise that we cannot roll back the clock and shouldn't try to. We have to be pragmatic, but that does not stop us trying to understand why the abortion rate in this country is so much higher than in most others, and then doing something about it. The question is, what?

It is hard to see even the most rabid member of the equally disturbingly named “pro-choice” persuasion taking offence at that statement but, of course, lots do. Read through the comments under Iain’s article. It is not possible even to mention the subject of abortion without the extremists from both sides started a pitched battle.

Dr Crippen, as I have argued many times before, is from the

..I really do not like abortions but on balance until we can come up with something better it seems to me it is a woman’s right to do with her body as she pleases and so reluctantly but nonetheless unequivocally I support her right to have an abortion

school of thought. Sorry if that is a bit wishy-washy.

I have just read a fascinating book (as above) entitled "What Roe v Wade should have said". Any one interested in abortion law - and the issues here apply just as much to the UK as they do to the USA - will be fascinated to read Roe v Wade being "re-heard" by eminent jurists of all political persuasions. The book is written by Jack Balkin who is an eminent Professor of Law in the USA, and who has his own website, Balkinization.

Iain Dale asks what we should do about the abortion rate but does not offer any answers. The answer is easy and obvious. Better sex education, starting in primary school. Sex education in schools must be compulsory; no right for parents to withdraw their children from it. And better and free availability of contraception and contraceptive advice for children of all ages.

How has the government fared on this?

Ann Weyman, Chief Exexutive fpa said:

"As this audit reveals, contraception is an ailing, fragmented and chronically underfunded public health service. The fact that some Primary Care Trusts (PCTs) found it acceptable to spend just 18 pence on each woman's contraception is simply beyond belief.

"Since the audit was finished the situation has only got worse. Many PCTs used the Choosing Health[i] money allocated to contraception services for other purposes. Consequently more contraceptive clinics have closed and services have been cut. Clinics provide specialist training for doctors and nurses, so their closure will deeply affect services in the future as the number of trained staff shrinks.

"Investing in contraceptive services actually saves the NHS money. Research carried out for fpa by the University of Newcastle shows that investing in longer acting methods of contraception - the IUD, the IUS, injections and implants - would save the NHS £500 million over 15 years. Nevertheless the audit shows that 20% of PCTs have restricted women from having these methods.

"This audit should act as an alarm call to all PCTs to evaluate their strategic approach to reproductive health care," (Anne Weyman, fpa)

Patricia Hewitt has thus “saved” a few pounds by reducing contraceptive services. She is unlikely to have saved her job.

The strangest thing about the so called “pro-life” brigade is that they are usually as opposed to sex education and contraception for young people as they are to abortion.

Odd.

I wonder where Iain Dale stands on that one?


+++++++++++

A fascinating and, for the "pro-choice" believers, a challenging moral conundrum from The Difference Magazine

...at what point of maturity do embryos acquire the necessary "factors of form, function or behaviour" to merit their protection from needless destruction? At present, the creation and use of human embryos for research is not permitted beyond 14 days in vitro. In order to be consistent, should the time frame allowed for human embryo research be extended to 24 weeks to match that for abortions, should the time frame for abortions be reduced to 14 days to match that for in vitro experiments, or should some other compromise be reached?

See Undignifying Research

Motor racing safety

Dr Crippen’s father was involved in motor sport and so I have always been a fan of grand prix motor racing. I can remember, as a small child, Jackie Stewart winning his first world championship. I have vague memories of my father telling me of the catastrophe at Le Mans when a car went into the crowd. I remember Taffy Von Trips, Bandini, and Jim Clark. All tragedies that would not happen today.

In the Canadian Grand Prix two weeks ago we witnessed what was without doubt the worst and most terrifying accident I have ever seen, and I have seen a fair few. As it was endlessly repeated, I had to avert my eyes. I knew that I had seen a motor racing driver die and seeing it once was once too much. Then the news came through that Robert Kubica had survived. Not only had he survived, but he was unhurt. Since then, secure in the knowledge that he had not been hurt, I watched and re-watched the crash, fascinated. It is a tribute to Jackie Stewart, who was the first driver to insist on improvements in safety, and to the engineering technology that has been developed, that a man can walk away from a crash like that. This technology will gradually spill over into the cars that we drive and will benefit us all.

And hasn’t motor racing once again become fascinating? Lewis Hamilton has brought an implausible degree of talent to a sport that was in danger of becoming processional. Is Lewis the Tiger Woods (Tiger probably has other things on his mind just at the moment - Tiger and Elin Woods just celebrated the birth of their daughter, Sam) of Grand Prix racing? I do not know the answer to that question.

Lewis Hamilton

Already the British press are building Lewis Hamilton up into the first billion pound British sportsman. There is a long way to go before he matches the genius and consistency of Tiger Woods but, whatever happens, it is going to be an exciting motor racing season. More exciting than the likeable but worried Fernando Alonso was expecting.

Whatever the outcome of the world championship, and British bookies are making Lewis Hamilton the favourite, we can watch the season unfold secure in the knowledge that motor racing as a sport is now safer than boxing, and far more exciting.

Girls just aren’t turned on by man-boobs

If someone gave you £3.6 million, what would you spend it on? We have all passed the odd minute daydreaming about that one.

More interestingly, if you had £3.6 million pounds to give to the NHS and could decide what it was to be spent on, what would you go for?

• A hundred and fifty nurses for a year?
• A thousand hip replacements?
• A hundred and fifty midwives for a year?
• Three thousand cataract operations?

A bewildering choice. The government has just been in the happy position of spending £3.6 million on the NHS and they have chosen to spend it on NHS Choices.

"NHS Choices is a service that aims to put you at the centre of your healthcare. It’s been developed to help you make choices about your health, from lifestyle decisions about things like smoking, drinking and exercise, through to the practical aspects of finding and using NHS services should you need them. There’s already a lot here, but the range of information NHS Choices offers - and the uses you can put it to - will expand as the service grows." (So sayeth Patricia)

I have just spent ten minutes looking around NHS Choices and, as you would expect, I hate it. It is utterly dishonest. The last ten years has been about removing patient choice, not increasing it.

The lifestyle advice the site gives is trite and patronising, and at times downright offensive. The Zimmers are featured:



It there anyone who does not find this video nauseating and patronising? It is an advertising gimmick. What does it have to do with the NHS?

Then we have matey “right-on” health care advice to the “youngsters”.

Do girls fancy you?

Take our scientific Pullability Quiz to find out what girls really think of you.

The Crippen teenagers mouths gaped open in disbelief. Has no one told the government that teenagers hate being patronised?

And then there is this deeply offensive advert:

Girls just aren’t turned on by man-boobs

Probably true, but the large number of teenage boys who suffer from this condition (and it is often transient due to a hormone surge) need sensitive and careful handling. They do not need to be made to feel sexually repulsive by the government.

Ask the sex doctor.

Dr Anne Edwards offers advice about how to have a fulfilling love life

Dear God, why do we have to patronise older people in this fashion? I suppose we should be grateful for small mercies. We have at least been spared a video of The Zimmers getting a leg over their groupies.

So it goes on. And on. And on.

Another £3.8 million of taxpayers money that could have been spent on real health care. It is all PR and presentation. Flummery with no substance. Meretricious nonsense.

Is this a good use of taxpayers' money?

It is not even a very good website. How on earth did they manage to spend £3.6 million on it? Did they put it out to tender? I shall ask a professional web-designer. I bet he could have produced something better for £36,000 never mind £3.6 million.

You wouldn't treat a dog like this.

Physicians do not know much about surgery, haematologists do not know much about cardiology, psychiatrists do not know much about orthopaedics and GPs, well, they do not know much about anything. And yet, we all went to medical school and so, before we became specialists, we were doctors. We had learnt how to analyse problems and how to know our boundaries. Those five years were not wasted.

Another email arrives, this time from a Consultant Psychiatrist somewhere in the West Country. Her teenage daughter, who is herself about to go to medical school, fell off a horse last week and hurt her shoulder.

I had a look, and although I am but a humble psychiatrist, I knew it was a bust clavicle. Palpable lump, point tenderness, severe pain. Pretty obvious diagnosis. Sling and rest is all that is required but I am a psychiatrist. Better go to A/E and get it done properly. She should probably have an x-ray, just to confirm.

So far so good. I take daughter to the minor accident unit. Seen by an Nurse Practitioner, who carefully examines her, and diagnoses '?acromio-clavicular joint strain'

Oh well.

Off to x-ray. Nice radiographer chats to soon to be medical student daughter and points out the fracture to her.

“Cor!” says daughter.

Back to see NP. He looks at x-ray, gives daughter a sling and gives good advice about rest, mobility etc. I smell a small rat.

“How long do you think the fracture will take to heal?” I ask.

“Oh, it's not broken,” he said. “It's just a strain”.

Could I have I look at the film?” I say.

He in turn now smells a rat. “Do you know about X-Rays?” he asks. I say I am a psychiatrist, but I learnt a little about them at medical school. We look at the film. I point out the fracture.

“Oh, that's just a line on the film” he says, ignoring breaks in the line of the cortex, the increased density in the overlapping ends etc. etc.

“OK”, I say, “well, we'll wait for the report from the radiologist” and we leave. Daughter is impressed. "I never knew you could be tactful, Mum."

Now, this is all rather trivial really, but it illustrates a more important point. A poor examination gave a false diagnosis, which was then adhered to despite evidence to the contrary. We can all be guilty of this. But doctors are trained carefully, and have the knowledge to move on from this position of error. I have lost count of the number of times my teachers said 'Never make the facts fit a theory. Your theory must fit the facts.'

This NP, who was in charge of the unit, had obviously never gone through this process. It's not his fault. He is being used in a role for which he is simply not qualified.


In this case, no harm done. But what happens when he sends a child home with a sore throat, pyrexia and dribbling because he does not know of the significance of dribbling in a child who cannot can swallow?

I would not want this NP treating my daughter. Frankly, I would not want him treating my dog, which brings me on to the interesting case of Dr Susie Macleod who is an experienced veterinary surgeon in Hertfordshire. She employs a number of highly experienced veterinary nurses. In 2004 she set up a separate clinic seven miles away, entitled the Health4Pets clinic. This establishment was staffed wholly by veterinary nurses, with no resident veterinary surgeon on the premises, although there was regular communication by telephone with the main practice and webcam pictures could be transmitted between the premises. The clinic's main function was to furnish facilities for the vaccination of small animals by veterinary nurses at considerably lower cost than the charges made by practices where veterinary surgeons carried out vaccinations.

And why not indeed? Sending “nurse specialists” out into the community to manage asthmatics and elderly patient with heart failure and COPD is known to provide huge financial savings and free up doctors and hospitals for more important work. Why not apply the same cost savings to veterinary medicine?

The Royal College of Veterinary Surgeons were not persuaded. On the contrary. They considered that Susie Macleod’s behaviour constituted disgraceful conduct.

Section 19 of the Veterinary Surgeons Act 1966 makes it a criminal offence for anyone to undertake veterinary work unless they are fully qualified veterinary surgeons. Veterinary nurses are allowed to carry out certain limited procedures provided the animals concerned

are under the care of the veterinary surgeon and the treatment in each case is carried out by the nurses under the direction of the veterinary surgeon.

Susie accepted the following facts:

• a. she was not present at the clinic when the vaccinations were carried out;
• b. she had never examined the animals;
• c. she had never read the animals’ medical records;
• d. she had never discussed the animals with their owners or agreed to take on their care;
• e. she did not know of the animals’ presence at the clinic or their condition;
• f. she had no discussion with the nurse administering the vaccine about the animal or its proposed treatment;
• g. she had no knowledge of the animals at allSo what defence did Susie mount to these agreed facts?
  

Read the next bit carefully. You many have heard it before. Susie placed some emphasis, however, in her submissions to the Board,

on her provision of “protocols” to the nurses which they were strictly enjoined to follow. In each case the nurse had a sheet on which she was required to fill in details about the individual animal, ticking boxes as she went, with instructions to refer the case to a veterinary surgeon on making certain findings about its health or condition.

She went on to argue that…

a veterinary nurse could carry out booster injections, so long as it was under veterinary direction, which she interpreted as extending to the system whereby she gave standard directions to the nurses by means of the “protocols”.

And what did their Lordships think of that?

"Their Lordships also consider, however, that the treatment carried out by the veterinary nurses in vaccinating the animals cannot be said to have been done under the appellant’s direction. The appellant argued that her “protocols”, consisting of instructions to the nurses and forms which they had to complete, constituted sufficient direction to them. Their Lordships cannot agree. They do not wish to attempt to define in detail the circumstances in which treatment is carried on under the direction of a veterinary surgeon, for those circumstances may vary widely. The concept does, however, connote an element of immediacy and potential control of the treatment which was wholly lacking in the carrying out of vaccinations at the Health4Pets clinic.

…..At its hearing the Disciplinary Committee was advised by its legal assessor that disgraceful conduct in a professional respect is conduct which falls far short of that which is expected of the profession. Their Lordships consider that that was an appropriate definition and that the Committee was correctly advised...

…their Lordships have no hesitation in upholding the decision of the Disciplinary Committee that the appellant was guilty of disgraceful conduct in a professional respect. The detailed findings made by it and the expression of opinion contained in its judgment that the appellant’s actions were capable of jeopardising animal welfare give sustainable grounds for reaching its ultimate decision, and their Lordships are of opinion that that decision fell within the ambit of sustainable conclusions."

The Veterinary Profession is not dumbing down. It is not going to allow protocol driven tick-sheet veterinary medicine to be practiced by unqualified “veterinary care professionals.”

Susie Macleod was reprimanded for disgraceful professional behaviour. We can be sure that she will not in the future be letting her nurse specialists loose on animals.

The question for doctors, patients and the NHS is obvious and I will not labour it. But the next time the cardiac nurse quacktitioner pops in to treat grandma’s heart failure, or the next time you visit a quacktitioner run walk-in clinic, try to forget that it is illegal to treat a dog in this fashion.

++++++++++

The full version of:

Susie MacCleod v The Royal College of Veterinary Surgeons is available here.

Attacked by the illiterati

I reproduce in full (and uncorrected) a splendid piece from someone who styles himself as an “Advanced Practitioner” – whatever that is. Cheaper than a doctor, I warrant.

I'm sure you've all heard of him, Dr Crippen the man who hates Midwives, Nurse Practitioners, Nurse Specialists, but loves District Nurses. He dislikes the fact that some nurses have extended skills and knowledge that tresspass (sic) into the medical domain. Is this because he feels threatened by advanced practitioners and not by by DN's. (sic) Is he aware that DN's (sic) are extending their roles to include physical examination and diagnosis?

Dr Crippen, i (sic) assume (sic) is a man probably approaching retirement age who was trained in the days when doctors were thought to be gods with omnipitant (sic) powers and still believes that nurses are doctors (sic) handmaidens.

So let me open your eyes Dr Crippen, (sic) we are professionals with extensive knowledge who have not been to medical school as we do not proclaim to be doctors. (sic) We are independent practitioners working not just in secondary care or primary care walk-in-centres, but in many GP practices throughout the UK. Are all those other doctors wrong or misguided? Maybe they are secure human beings and professionals who understand that times are a changing.

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Independent practitioners of what?

Yes, I am a great fan of district nurses and no, I do not feel threatened by them. Nor am I threatened by the monstrous regiment of quacktitioners that has been let loose on the general public. The only thing that is threatened is the patients' health.

Please feel free to criticise me in any way you like. I have but one request. Your spelling, your use of commas and apostrophes and your general grammar are embarrassing. All doctors have passed “O” level or GCSE English. Could I suggest you get one of them to glance at your copy before you publish?

How the hell do you expect doctors to treat you seriously when you are verging on illiterate? I hope to God you do not write up drug charts.

I still have more years than I would like before retirement and during those years I shall continue, undaunted, to wage the war against dumbing down in the NHS, against allowing the development of a system in which the poor folk are seen by non-medically qualified “health care practitioners” whilst the rich, and the great and the good, continue to see doctors.

I shall be publishing a piece tomorrow upon which I would particularly like your comments.


++++++++

PS I trained at a time when doctors were treated as God. Capital "G" and singular.

The old lady's friend

Distalgesics

Distalgesic (Cosalgesic, Coproxamol) is a compound analgesic. Each tablet contains Dextropropoxyphene Hydrochloride BP 32.5mg & Paracetamol BP 325mg (for those in the colonies, paracetamol = acetaminophen). Dextropropoxyphene is an opiate like drug. It may have addictive properties. It can be prescribed alone or in combination with paracetamol.

Compound analgesics are illogical and dangerous. If you need two pain killers, better to prescribe them separately so that you can adjust the dose of each independently. A classic case of do what I say, not what I do, for all doctors prescribe compound analgesics, usually combinations of paracetamol and codeine, such as Co-codamol. (paracetamol 500 mg + codeine 8mg or 30mg).

Two paracetamol four times a day provide excellent analgesia, and are a good starting point on the analgesic ladder. Patients may truly need something stronger than paracetamol but, in many cases, they are only benefiting from the placebo effect of something perceived to be “stronger” than over the counter preparations.

Despite theoretical objections, there is not much harm in a compound co-codamol type of analgesic, and Big Pharma has obliged with a plethora of preparations, all gift wrapped and heavily marketed.

Distalgesic probably slipped through on the bandwagon with no one noticing. It was an instant success and soon had a devoted following. Part of its success was due to its easily swallowable torpedo shape. The drive towards economic prescribing brought the arrival of Cosalgesics (cheaper) and then, horror, the truly generic “Co-proxamol” – which meant the pharmacist could dispense whatever formulation he had in stock. Patients travelled miles to find a chemist who stocked the original “Distalgesic”

Its success was baffling. All the research showed that dextropropoxyphene was not a particularly good pain killer even in combination with paracetamol. It was even said that two paracetamol were just as effective as two Distalgesics. All well and good in the laboratories, but try telling that to the patients.

Then more disturbing data began to emerge.

A review of all dextropropoxyphene poisoning episodes in a stable representative population during the past 10 years showed that Distalgesic accounts for most overdoses, and it has become an increasingly popular component of self-poisoning coktails. Sudden respiratory depression due to dextopropoxyphene potentiated by other common ingested agents is the main danger, and at least one-third of patients take a potentially lethal dose (20 tablets of Distalgesic and alcohol or benzodiazepine)…..

….consequently Distalgesic has become the ingested agent principally responsible for self-poisoning deaths over the age of 12 years. This rise to prominence has paralleled a pronounced increase in prescriptions for the drug. (source)

As a practice, we made a policy decision twelve years ago to stop prescribing co-proxamol, and to change all patients on it to something else. The first part of the task was easy. The second was not. We were staggered by the difficulties we encountered.

We rapidly became convinced of two things; for some people – for whatever reason, be it psychological or physical, and despite what the research scientists say – Distalgesic is a potent and effective painkiller; secondly, Distalgesic is addictive.

The Committee on Safety of Medicines finally decided to withdraw Distalgesic in all its forms in January 2005, but agreed it should be a phased withdrawal “to allow users an opportunity to adopt suitable alternative pain management strategies" (a.k.a break their addiction.)

Even after ten years we still have a handful of (mostly) little old ladies who are devoted to Distalgesics. Is it better to leave them be? Iain Dale certainly wants his mother left alone (and postulates that the drug was only banned because David Kelly committed suicide with it).

As all GPs know, patients can be very determined about their perceived "rights" to medication. A Mr de Quincey writes from the Lake District:

Hi, I was taking opium for several years, I have multiple spine and other joint problems and terrible nerve pain. I was very satisfied with opium, I was able to manage my pain and stiffness and continue to work part time, I took it only when needed at low dosage levels. Imagine my surprise when my doctor informed me that all his patients were to be instructed that opium was being discontinued, and I was taken of it. I tried to argue that it worked for me and that I was responsible with my medicines and did not drink, but the doctor insisted and told me he would be struck off if he continued to prescribe it for me.

Actually, the real email was from Helen Jones-Gill and was for the attention of the Department of Health (full text here ). Dr Crippen has naughtily substituted one little word. Apologies, Helen.

But Helen Jones-Gill email demonstrates that, if Distalgesic was to go, something new was needed. Enter Tramadol. This is currently a much in-vogue drug. No one seems to know where it has come from. Most doctors have not got a clue what is in it or how strong it really is or what side effects it has. But it seems to help and the punters like it, so doctors are now prescribing it in shed loads.

Tramadol originates from Germany. It is a synthetic opiate like drug. It may have addictive properties. It can be prescribed alone or, guess what, in combination with paracetamol. Where have I heard that before? Maybe they should call it Tramalgesic.

Here we go again.

Read this - and call a taxi

Safer than an ambulance?

A new comment has just arrived on the article I wrote some time ago entitled "Read this or die".

The story told in that article was true in every word. The patient died and might not have done had it not been for the obstructive inteference of a foolish, protocol-bound ambulance driver. The article now elicits this response:

Well. Dr C clearly thinks along the lines of Kenneth Clarke the ex-Tory Minister who described Ambulance staff as "glorified taxi drivers". I find Dr C's comments patronising, insulting and ignorant....

Oh dear. I was not patronising anyone. I was giving a true example of the dangers of dumbing down. A primary school playground response of "Well, GPs are really bad too", even if true, is not helpful.

Let us assume for the sake of the discussion that we have the worst GPs in the world. Is that a reason to allow ambulance drivers to put patients' lives at risk by playing at doctor?

Only yesterday we had trouble with an ambulance crew. My partner had assessed a patient, discussed him with the hospital physicians, arranged an admission and called an ambulance. The ambulance driver arrived, carried out his mickey mouse medical "assessment" and then told my partner, in front of the patient, that he did not see why an admission was necessary. My partner did not have the time to explain paroxysmal atrial fibrillation, atypical angina and early heart failure and merely said that he would call another ambulance crew if this one would not do as they were told.

Ambulance drivers are put under pressure not to take people to hospital. Their reluctance to take patients in at the request of a doctor is both arrogant and dangerous.

Doctors.net currently has a lot of correspondence on this very topic. I wish it could be seen by the general public. Ambulance crews are valuable, and have an important role at the scene of road traffic accidents but, in the domestic environment, when the problems are medical rather than truamatological, they often apply inappropriate protocols to problems they do not understand.

Safer to call a taxi.

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

And read more on this topic in The Death Rattle

The Britmeds 2007 (24)

Anatomy of the twaterati

…this piece is about the growing phenomenon of that oxymoron- a doctor who doesn’t see patients- a non patient-contact doctor. (NPC) It’s spectacularly easy to be the best doctor in the world when you are not seeing patients.

One of Dr Rant’s finest

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Am I going to die, doc?

How can we explain the paradox that men are hypochondriacs who won’t go to the doctor? As a GP I often see men who claim to have a serious illness but are so reluctant to visit me that their opening gambit is: “I’m only here because my wife insisted.”

Women in Times

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

I do not have an answer to this

The UK Missing Children Website sports a number of missing children. While the rest of the world is concentrating on Madeleine Mccanne, I am going to feature a different missing child every few weeks. This is because I believe that just because Madeleine is a doctors' child and commands the attention of all the medical blogs does not mean other children are less important, especially children from the ethnic/black community who have never got as much publicity nor has the Pope ever offered to hold his hand out to their parents.

Another missing child

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

Fear

I have always had a horror of goiters and been troubled by bad dreams of getting one. I have nothing against the goitered, so if you happen to have one and are reading this, I don’t mean to be insulting; I’m sorry for your troubles and that, I just have an unholy fear of them, and this is why:

One day, when I was a little girl....

Problem child bride

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

Meanwhile…

A & E services at the hospital where Kezia was first diagnosed with leukaemia are being axed and replaced with an "urgent care centre". What I imagine Dr Crippen would term "dumbing down".

Life with leukaemia

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

More lives at risk

The sentiments of the people below are those representative of the United Kingdom. NHS Cuts have been evident for many years now placing patients at risk. The public has attempted to protest but most issues are not taken up in the national papers. Even if they are, they remain a flash in the pan. The main issue is this, if something isn't done now, the effects will be extremely serious.

I loved the idea of gatecrashing an NHS Trust board. I can imagine all their faces.

NHS Exposed

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Fat children should be put down

Children's charities have expressed concern after medical experts were reported to have called for obese children to be 'put down'. "It would be in the best interests of the child," one expert is reported to have said.

UK Daily Pundit

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Stop being ill, say doctors

DOCTORS have better things to do than treat ill people, according to a new report from the British Medical Association.

The Daily Mash

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

Taking the shilling…

When my oldest child was born - 15 years ago… gulp! - my partner and I made a conscious decision that, I’m glad to say has born dividends and has, so I’m convinced, rewarded my son, and his younger sister, who came along later, with something very precious and yet also something that money can’t buy.

That something is good health, and the decision we took was simply that when he became ill, as children invariably do from time to time, we would look to the NHS for help only when it was absolutely necessary; that we wouldn’t be the kind of neurotic parents who go running to the GP to demand a cocktail of potions and lotions at the first sign of a sniffle.

The Ministry of Truth

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

General Medical Council Regulation Handbook : How To Ruin A Poor Medical Doctor , Using The Civil Burden Of Proof (Volume 1 Chapter 1)

Before Lord Justice Tuckey, Lady Justice Arden and Lord Justice Lawrence Collins

Judgment April 30, 2007

Abolish the GMC

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

How independent is The Independent?

Hay fever: the cure and the catch
By Jeremy Laurance, Health Editor
Published: 12 June 2007

A once-a-day pill for hay fever that could transform the lives of sufferers is being denied to thousands of those most severely affected because of the cost. The pill, which is dissolved under the tongue, is the first oral vaccine developed for hay fever. But the majority of NHS trusts have failed to fund it.

The Ministry of Truth takes a look…

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

This doctor may be unwell

“I have been inspired by Patrica Hewitt…”

Thick as two short planks

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

Soaking the rich

NURSES face a £300-a-year bill to park their car at Glasgow hospitals - despite plans to slash proposed charges. Union leaders say nurses are angry over plans to introduce £25-a-month permits at four major sites in the city.

As revealed in yesterday's Evening Times, the compromise follows a health board review of the charges, being introduced on July 29, following protests from patients, staff and visitors. Staff earning £10,000 to £30,000 a year can apply for a £25-a-month permit, while those on less than £10,000 will be charged £5 for four weeks.

Eveningtimes

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


Sicilian volcanoes

Mount Etna

John Dawson has been walking the Sicilian volcanoes. What has that got to do with medicine, you make ask? A lot. If Dr Crippen did not escape to the Lake District from time to time, he would not cope and if you want a guide for the Lake District, after Wainwright, it does not get better than John Dawson

John was lucky enough to be up on the Fells on Christmas day when there was a cloud inversion

The Scafells peeping through a cloud inversion

Spend a few minutes looking at John Dawson's photographs, which can all be seen at:


John Dawson’s Lake District walks

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Mr Hunnybun has dyslexia

A day at the pharmacy

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21 Ways to catch cancer

The following article is by a guest writer Martin Weatherall, an advocate in the harmful effects of electro magnetic radiation (EMR). This article comes from his work detailing sources of EMR from dangerous antennas in the area of Woodstock Ontario. Having being effected by EMR himself Martin put together the following list of cancer causing points. I was surprised just how many I get exposed to on a daily basis.

I’m a fish

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Time to abolish NICE

What Nice is doing, therefore, is giving a spurious appearance of rationality to what are, in fact, cruel and stupid decisions. And in doing so, it is involuntarily giving legitimacy to those decisions.

Stumbling and Mumbling


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

Telephonic auscultation

Some years back, I developed a chest infection. I knew it was a chest infection. I’ve had them before, and I knew this was another one. I was feeling too rough to get down to my GP’s surgery, so I phoned up, explained my symptoms to him over the phone, and demonstrated my rather spectacular cough. He agreed it was a chest infection. He said he would phone a prescription for antibiotics into the pharmacist’s, and get them to deliver the prescription to me. So far, so good but unfortunately…

Funky Mango’s Musings

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Holford Watch - The Truth About Patrick Holford, Media Nutritionist

Dr Sarah Jarvis v Patrick Holford

Dr Crippen thought Patrick sounded fairly benign and was beginning to fell sorry for him when Sarah went on the attack. But why does the mainstream media give so much sofa space to these people?

Who do you think won the debate ?And make sure you look at the comments.

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

Topless cardiac arrest

Dr Wonderbra believed that Gossard Wonderbra was an essential accessory to every female junior doctor. Discussions had gone on in the doctors mess two weeks before stating the serious problem with the new sports bras that just did not hold the essentials while running…to a cardiac arrest

Dr Wonderbra


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Dr Rant’s teaser

Do you believe it? Is it true?

A prize for the first commentator to name the names


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

Here's a rare thing: an honest doctor who admits to mistakes!

Most of the time, they are patients whom I think I've done all I possibly could for, so I can accept it. But there are always the others. Six months ago, I was performing a thyroid operation on a teacher my age and damaged a nerve that led to her vocal cords. This woman can no longer talk and has had to give up work. The only way I can live with myself is to try to do all I can for her and understand what I did wrong and do better next time. Being sorry is not enough."

Obesity and the salt connection

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I Never Knew My Nice Glass Of Wine At Home Was Killing Me

After a stressful day Judith Heath would regularly open a bottle of wine to share with her husband over supper. As manager of a busy GP surgery she found the alcohol helped her to unwind.

When Judith, 56, and her boss fell out she began drinking more. Instead of one bottle Judith started drinking up to a bottle and a half every evening.

Alcoholic’s anonymous review

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Midwives go to the Devil

The two midwives should have all of their orifices filled with cockroaches and then they should be placed in the stocks for three days. If they survive that, then….

The DK takes on the nursing profession and has a formidable opponent in the ever robust A & E Charge Nurse.

Make sure you read the comments

The Devil's Kitchen

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Who needs doctors?

Know more than your Doctor: the online "bog-standard medical course" for the general public courtesy of the Daily Telegraph.

As the NHS continues its slow collapse, this course in its daily bite-sized pieces will prove perfect for patients, relatives, funeral directors, lawyers and news readers.

Knowmore

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Mental doctor banned for faked CV
By Daniel Knowles

Doctors applying for work at the troubled Springfield Hospital face tougher checks after a locum employed there was suspended by a medical watchdog for faking his CV.

Local guardian

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MTAS and MMC

No time for celebration

The fancier has been lucky enough to secure employment for August this year, however there are many who have not yet been so lucky. Remedy Uk is running a list which contains all the junior doctors who are staring unemployment in the face at the moment.

It's hard to sum up just how traumatic this year has been for everyone involved, and this trauma is not yet over for the majority of candidates, it must seem that it will never end. It has been five months of uncertainty so far, and this will stretch towards eight months for many. And this stress has been all added on top of working in some pretty demanding roles as it is. I am quite sure that this has been too much for some people to take, the emotional and physical drain has taken its inevitable toll.

The Ferret

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Philip Smith was the junior doctor who famously heckled and questioned Patricia Hewitt on Question Time



He now describes in detail the disillusionment felt by many junior doctors this year.

The really ridiculous thing is that I voted Labour in power in 1997, my first ever vote. I’m from a working class background, my parents never attended university, I went to a comprehensive school, fought for my life in intensive care twice in the last ten years because of my Crohn’s disease and even wrote a book encouraging people like me to go the medical school. The Labour government betrayed me and my generation of doctors over tuition fees, now for many unemployment beckons. All I ever wanted to be was a doctor. I’m sure there are thousands of doctors just like me that feel the same but whose lives have been ruined by this fiasco. This is a national disgrace and something that should not be allowed to be hidden under other bad news. Shame on you Patricia – ‘this is your legacy, this is Tony Blair’s legacy – leave now!’

Dr Philip Smith

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Tested to destruction

I used to be a doctor; intelligent, self-aware, able to assess my abilities, ready and willing to address my deficits, self-educating, self-regulating...

Now? I'm a rat in a cage, an experimental object, unprotected prey to the confused, conflicting agendas of anyone who puts their hand up.

Dr Rant

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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 Crippen Diaries 2007 (24)

Not quite Emergency Ward 10

Monday 11th June

The repercussions of the press presentation of stem cell surgery for dry macular degeneration continue. A lot of patients are coming in to ask about it.

George had just been to the hospital eye clinic. He said that he had asked about the surgery, and been advised it was not available locally. So he wanted me to refer him down to London, to Moorfields. Sadly, it is not available there either.

The he asked me if I would prescribe some more I-Caps for him. The hospital specialist had started him on them and said they might help.

I know three things about I-Caps. They are not available on prescription, they have been heavily and successfully advertised and they are expensive. As they cannot be prescribed, and as I cannot imagine the eye specialist paying for George's I-Caps himself, there can be only one explanation. The manufacturers of I-Caps must have kindly given the hospital a free supply of the drugs for distribution to the patients. Such generosity. I really must stop being rude about Big Pharma.

Let us change the subject completely for a minute, and look at two happy, smiling people with white teeth.

A picture of good looking people with very white teeth

I do not know why they are so happy. Maybe they are pleased with their dental cosmesis. But back to the topic under discussion.

Expensive or not, I-Caps must be good because Chris Steele recommends them. And Chris Steele is a doctor. A famous doctor. He is famous because he is sometimes on telly.



Not only does he appear on telly, and in his own web site, but he also appears in the I-Caps advert. If you click on his name in the advert, the following pops up:

Dr Chris Steele is the resident GP on ITV’s This Morning programme. In 2006 he ran a feature about common eye conditions and mentioned his mother had recently had some treatment.

She was advised by her Ophthalmologist that she should consider taking I-Caps, a dietary supplement which contain the antioxidants Lutein and Zeaxanthin.

Antioxidants are important and can contribute in helping to maintain eye health.

Great stuff, Chris. I hope mum is well. Did she take the tablets?

Despite Chris, and his mum, Dr Crippen is still not sure why I-Caps work. Fortunately, there is an option in the I-Caps advert entitled “why I-caps work”. Heavens, they must have seen me coming. I clicked on it immediately. This is what it says:

• High potency vitamins and essential minerals including zinc
• Lutein and Zeaxanthin – natural carotenoids found in the macula
• Contains the important vitamins A, C and E
• Provides raised serum concentrations of Lutein, which can be related to increased macular pigment density
• Sustained release formula for greater absorption and less stomach irritation
• Best-tolerated zinc source with one of the highest levels of absorption

I am embarrassed. I must be stupid, because I still do not understand why I-Caps work. I must have missed something. I just hope the patients do not miss out because of my ignorance.

Fortunately, those nice people at I-Caps have managed to persuade eye clinics to give out free samples. That is how George got his. And because he got them from the eye “specialist” he knows that they must be good. Sadly, I cannot prescribe them for him. But he can buy them himself from, for example, Eyecare Plus:

ICAPS Eye Vitamins 3 x 60 tablets : £39.40
Bundle contains sufficient for 3 months dosage

What a bargain.

+++++++++++


Tuesday 12th June

Amanda is fourteen and arrived today with her mother. Amanda attends one of the local private schools, a school which is always high in the league tables, and prides itself on academic excellence and “value added” as well.

Amanda has not been doing very well academically and the school have raised the question of “dyslexia” or, as Amanda’s mother puts it, “mild” dyslexia. From the medical point of view Amana is fit and well, and excels at sports. If she were in a comprehensive school, she would I suspect be in the higher academic streams. But she is not in the comprehensive school. She is in the private school and has been deemed to be "struggling".

Amanda’s parents are professionals, and not short of a few bob. They want to have Amanda assessed by an educational psychologist to see if this diagnosis of “mild” dyslexia is correct. I suspect it will be. It nearly always is. I cannot recall a private psychological assessment for dyslexia reaching the conclusion that the child shows no evidence of the problem.

“She’s very intelligent, doctor, but she is dyslexic.” I struggle with this concept.

A layman’s definition of intelligence – and I happily admit to being a layman on this – is “the ability to understand and process information.” Just as it is no longer acceptable for children to fail exams, it is no longer acceptable to label them as being of lower intelligence. Instead, we sub-divide intelligence into a number of categories and look at each one individually. Let us suppose that Amanda is very poor at analysing data presented to her in words and is labelled as dyslexic. Surely this means that one area of her intelligence is poor or, in to put it in simple terms, she is not as intelligent as she might be.

Because we have the label “dyslexia” Amanda will be given extra time for her GCSEs. Why do we not identify all children who are, for whatever reason, less intelligent and give them all extra time to do their exams? Indeed, taking this to the logical conclusion, we could assess all children’s global intelligence and give them examination times inversely proportional to their IQ.

Why not?

Why should it just be middle-class Amanda who gets preferential treatment?

What happens to all these children with “mild” dyslexia when they leave school? Will they be prepared for the realities of life? You do not get “extra time” in the real world.

++++++++++


Thursday 14th June

Andrew is in his late thirties, and still plays an occasional game of veteran’s rugby. I keep suggesting that it is time he took up golf but he will not hear of it. A few weeks ago, in an end of season game, he hurt his back during a tackle. He does not have a previous history of back trouble. He told me today that the pain was so bad that he took himself to an osteopath who told him that he had a problem with a displaced lumbar vertebra. This sounds serious to me. The only context I have come across displaced vertebra is after a visit to that nice Mr Pierrepoint. It took the osteopath three sessions to get the vertebra back in place.

Andrew is still in pain, though better than he was. The history and signs were suggestive of residual sciatica. Not much to be done. Reassurance and analgesia. But what do osteopaths mean by saying that a vertebra has been “displaced”?

+++++++++++

The community pharmacist has identified all out patient who are on atorvastatin rather than simvastatin. Simvastatin is about four times cheaper. One of my partners has been struggling with the right form of words to use when explaining to the patients that their medication is being changed. She has hit on a winning formula. She is telling patients that “simvastatin is the industry standard.” To the extent that it means anything – the vague suggestion that simvastatin is the “industry standard” because it is better – it is dishonest. But in fact it does not mean anything at all. It is pure Blairspeak - from the land of “cotton rich” and “organic” and “corn fed”.

I have started saying to patients that I am changing them to simvastatin because it is four times cheaper. This has the merit of honesty. Surprisingly, most patients accept that. A few do not. Tough. It is time everyone learnt the cost of health care, and this is a small start.

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

I had to do a medical report today on a women who is in her mid-thirties. The company who are employing her asked for details of “all consultations with the doctor over the last year” – that was easy, there had only been one for contraception; for details of “all certified absence from work in the last three years” – even easier, none; and for “a summary of all significant past medical problems.”

She had not had much. Two children. A fractured wrist. That was about it. Except, when she was twenty, she was treated for a gonoccoal throat infection. An unexpected finding on a throat swab when she was a student. She had presented with a persistent sore throat, which was not responding to OTC aspirin.

Is this a “significant” medical problem?

Medically it is not a big deal but not perhaps something that women want on their medical c.v. which, with computerisation, can be accessed by the world and his wife. In the old days, I might well have “lost” a page of the untidy Lloyd George notes. You cannot do that with a computer. Even if I took it off, there is an audit trail.

I phoned her and told her that I would have to put it on the medical report. She laughed. She really was not bothered.

Perhaps I am turning into an old prude. It really is not a big deal. But I would not want it on my medical summary.

I put “severe throat infection” on the medical report. Why should I trouble her company with details of the bacteriology?

+++++++++


Friday 16th June

The morning started badly. I was seeing the third patients when I heard screaming and shouting coming form the reception area. There were a lot of swear words mainly starting with “f” or “c”. I excused myself and went outside. There were already two of the younger female doctors there, trying to persuade an incandescently angry middle aged woman to calm down.

What had happened?

Mabel is in her mid-forties. She had arrived at reception shortly after 8.00 am and asked for an appointment to see a specific doctor. That doctor is away on holiday. “She is always on effing holiday…” started Mabel and from there it got worse. She was offered an appointment to see one of the other doctors at 10.00 a.m. That was not good enough. Mabel wanted to be seen immediately. She was not prepared to wait an hour and a half and she was not prepared to come back.

The receptionist stood her ground. There were no appointments free until 10.00 a.m. and in any normal sphere of life the offer of an appointment within two hours would be regarded as good service. Not in the NHS. At this stage, Mabel completely lost it. Her language became appalling.

The two female partners who had come out finally managed to calm Mabel down, and took her off to a consulting room. Why had she demanded an immediate appointment? She wanted a prescription for some co-codamol which she takes from time to time for low back pain. She has suffered from low back pain for years. There are no abnormalities to find examining her. She has had physiotherapy – unhelpful. She has had an X-Ray and an MRI Scan – both normal. The orthopaedic consultant who saw here suggested more physiotherapy. It did not work the first time when we had arranged it, and it did not work the second time.

Mabel lives alone. She is unmarried. She stacks shelves in a local supermarket. She smokes too much. She drinks a bit but not excessively. She is lonely and sad and does not cope with life. It is easy to “medicalise” people like Mabel, to conjure up some sort of psychiatric diagnosis but she is not psychiatrically ill. She is a sociopath who is unable to cope with life. She has often been difficult in reception before, but never like this.

We spend far too long at lunchtime discussing what to do about Mabel. The two female doctors who dealt with her felt guilty about letting the reception staff down. They do not want to give the message that abuse works and will get you an appointment. Mabel’s foul language was such that, in the absence of mental illness, we would normally remove a patient like this from our list. Mabel is not mentally ill. She is in the no man’s land between “mad” and “bad” an area where the NHS normally does not go.

We decided in the end that we would discuss it with the staff. I went off to talk to two of the senior receptionists. You may think they are battle axes.

I said, “Do you want us to chuck her off?” We talked a little. One of them said, “Mabel doesn’t have much, does she?”

So Mabel was reprieved.

Cloning Val and Ursula

click to enlarge

"Organisational Structures in the Belfast Trust"

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

Another email arrives, this time from an Irish nurse, currently working in Belfast.

Dear Dr Crippen

I work for the new Belfast Health and Social Care Trust, which is the recently merged trust covering the whole of Belfast, and all facets of both healthcare and social services.

I couldn't help but laugh at the latest structure chart that has just been sent out (attached).

We are now approaching the same number of directors/co-directors/associate directors as we have nursing staff in the trust - it's getting beyond a joke and just another example of where UK healthcare is going wrong.

We even have a Director of 'Patient Experience'...what on earth?!?!

I worked for a while as an occupational health adviser for a large high street retailer, which is far bigger than the Belfast Trust. We made do with 8 directors.

How times change!

+++++++++

Valerie Jackson clone

How times change indeed. Take a look at the first flow chart. The Co-Director RHT reports to the Co-Director BCH who reports to the Co-Director Education who reports to Olive, the Co-Director Standards, Governance & Performance who reports to the Senior Manager Service, Planning and Development who reports to Valerie Jackson, Director of Nursing and Patient experience.

Ursula makes the tea.

click to enlarge

And what, pray, IS a Director of Patient Experience? Dr Crippen would be grateful for suggestions.

Valerie Jackson clone

But our Val is a busy girl. In her spare time, she is also Director of Older People, Medicine and Surgery and sits on top of another ponderous hierarchy.

Ursula still makes the tea.

click to enlarge

I have only excerpted two charts from the document. There are many more. Those interested in self-flagellation may wish to download the whole “Organisational Structures in the Belfast Trust” document from here.

Val and Ursula clones work in an NHS Trust close to you.

Those who do download the main document may find it confusing. Help is at hand. There is a longer publication, entitled "Freedom of Information Act Publication Scheme" in which all is explained. Do not worry if you do not know what a "Publication Scheme" is; the first part of the "Pulication Scheme" includes a chapter on "What is a Publication Scheme."

This splendid fifty-one page document is available here.

A letter from the PCT

Andy and I were at medical school together. Andy is a country GP now. He is only recently an ex-rugby player. He is well over six foot tall and has huge hands. He swears like a trooper with a vocabulary that would surprise the DK. He is happily married with two teenagers and like most of us was, until recently, a happy family doc. He is one of the kindest people I know.

He has just sent me an email.

It illustrates better than anything I have seen exactly what this government has done to the medical profession, and to the NHS. Well meaning protocols, written by over-promoted semi-literate fools are bringing the British medical profession to its knees. This is why doctor’s morale is rock bottom. We cannot work in this environment. This is the new world of of clip-boards and protocols, of rules and regulations, of hospital-at-night and health care professionals.

There is no room for doctors.

I toyed with presenting the email cynically, as a “good news from Stalin” announcement, or whatever. Instead, I am merely going to remove the swear words and present it verbatim. Note particularly the illiterate letter from the PCT with its bizarre verbal neologism. NHS protocols are often written like this.

I have no further comment. Make of it what you will.

Hi John,

I am going effing bonkers. As you know, I look after a residential home for people with severe congenital physical and mental handicaps. Some of them, obviously, are female. I do not perform smear tests on them. I know, I know, many handicapped people are sexually active and it is important to give them the same preventative medical care as anyone else. But these young women are not sexually active and, frankly, for most of them their spastic contractures would make penetrative sex of any sort impossible.

I took the decision not to do the smears. The patients are mostly not competent to weigh up the issues themselves in order to give or withhold valid consent. I have thought about this carefully, and I have had long talks with their carers and families before reaching my decision. They have never been sexually active, the chances of any of them developing cervical cancer are negligible and the prospect of inflicting a vaginal examination on them is unthinkable.

Even to attempt the examination on these largely uncomprehending patients would be traumatic and degrading, and anyway it would be impossible to complete a satisfactory vaginal examination because of the flexion deformities.

So, as I say, I decided that these women should not have smears. I documented that decision in the medical records and noted that it had been fully discussed with the families and carers, all of whom were in agreement.

I wrote to the PCT so that they can avoid sending repeated reminders for these women and their carers to fret about.

And that is the end of the matter. Or so I thought.

I have just received a letter from the PCT saying that:

“national guidance now states that women cannot be ceased from cervical screening on account of learning disability, however profound that disability is. The only circumstances in which women can be ceased from screening are when they have sufficient competence to be able to consent to be removed from the programme”

All these women will now receive regular letters instructing them to book smears and if they do not, they will be sent reminders. Each time a letter arrives, the protocols in these institutions dictate that a ‘best interest meeting’ has to be convened – relatives, carers, therapists and the family doctor will all have to provide their views.

The whole process will be repeated at frequent intervals

I am no longer permitted, as the family doctor, as an experienced medical professional, to make a clinical decision, despite the GMC guidance on ‘do no harm’ and ‘make the patient your priority’.

The protocol dictates that the default position is to assault these vulnerable patients unless a vast swathe of people can regularly make the case against.

I give up.




Andy

Midwife ‘ignored pleas as baby died’

Iain & Heather Croft

A distressing headline in today’s Times brings me, once again, back to midwives and my inbuilt antipathy towards them.

The story in The Times is heartbreaking. An increasingly desperate couple begging and pleading with midwives to get medically trained help for their dying baby.

They arrive at the hospital, in labour, and are told there are no beds and are then taunted by some staff who say “There’s no room at the inn, you’ll have to go home.”

A midwife tells the mother she is not in pain and that she is a “silly girl.”

Later, the husband recounts:

“I asked several times if my wife could be seen by a doctor and we were refused. The midwife kept saying to her that her pain was not real. She said ‘no pain, no gain. This is what you have to go through, this is what it’s like’. . . . At some time she said to my wife, ‘You are a silly girl. You don’t deserve this baby. I’m going to take it off you’."

The husband was told to monitor the baby’s heart-rate himself, and to trigger an alarm button if it fell below a certain level.

He said: “It did drop three times and I pressed the button each time. In the end I had to go out into the corridor to bring her back in to look at it. She kept telling us not to be so fussy.”

A postmortem examination, which Mr Croft said staff tried to “bully” him out of having, showed that the child died from asphyxia.

The case is still being heard. A verdict has yet to be reached. What ever facts are finally proven, the actions of two midwifes, however reprehensible, cannot be held automatically to apply to the whole midwifery profession, any more than the actions of Harold Shipman were representative of all family doctors.

And yet, and yet….

A few months ago, in British midwives want mothers to suffer, I wrote:

Midwives were the first nurse-specialists I encountered when I trained as a doctor. I developed an immediate antipathy as did most medical students. I hated the way they patronised the patients. I have never understood why, because a woman is trying to deliver a baby, it is assumed by midwives that she can be addressed by her first name. I hated the way women were made to feel guilty if they asked for pain-relief during labour. I hated the way that, if they did ask for pain relief, a pethidine injection was rammed into their thigh without so much as a by-your-leave and without discussion of the pros and cons. I hated the way that women who asked for epidurals were treated disdainfully. Time after time, I saw midwives delaying calling the anaesthetist for the epidural until it was too late."

Is this just misconceived prejudice? Do midwives tend to patronise women? Do they tend to belittle labour pains? Do they treat the mother as a failure if she requests pain relief?

Perhaps not all midwives are like this but, in my view, and sadly, enough of them are to justify my antipathy.

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

How do doctors approach the management of pain in childbirth?

Dr Andrew Doughty, the British anaesthetist who pioneered the introduction of epidural analgesia for childbirth said in 1978:

"It’s most impressive effect is to bring tranquillity and humanity to the delivery suite as well as happiness and dignity to a woman on one of the most important occasions in her life"

How do midwives approach the management of pain in childbirth?

Louise Silverton, RCM Deputy General Secretary, said: "Epidurals provide effective pain relief but, where there is no clinical indication that they are necessary, they can significantly raise the likelihood of other interventions such as Caesarean section occurring."

True, but is not maternal choice the most important indication for an epidural ? Apparently not, according to the midwives.

Sue Macdonald, the chairman of the RCM committee, said:

"Epidurals have become a kind of norm for a lot of women. Sometimes women think, 'I just want to get rid of the pain, how fantastic'. "

Why is a representative of the Royal College of Midwives criticising a mother who “just” wants to get rid of the pain?

Is this what the Royal College of Midwives prefers? Another mother's story reported recently:

The pain was so unbearable I begged for drugs, so Andrew went searching for the midwife. He was told she was "on a break". When she reappeared 10 minutes later, she refused to give me pethidine, but agreed to gas and air, which was useless but at least stopped me howling. The pain was relentless and I felt as though I might black out – I kept waiting for it to pass as a contraction does, but there was no respite.

Twice more he approached her, pleading for help. Twice she categorically refused to give me an epidural, claiming I wasn't even in labour, and, again, didn't lift the sheet. Had she done so, she would have seen that I had dilated from one to 10 centimetres in just over an hour and a half – a process that naturally takes place over 12-14 hours in first-time mothers – and that the baby was crowning and the sheets beneath me were soaked in blood.

Later, after the babies birth, the midwife continues to do as she pleases:

She was holding a bottle of milk. I implored her not to feed my daughter, but she ignored me, and proceeded to push the teat into my baby's mouth as tears streamed down my face. I returned to the ward shortly before midnight and held my precious baby all night. After two days, and barely able to walk, I asked to be discharged as the filthy bathrooms and rude staff had become too awful to endure any longer. (Full story here.)

Are midwives really as know-it-all and arrogant as that?

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”

"Negligence is not really an issue for us". Breathtaking.

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

I do, as I freely admit, have an inbuilt antipathy towards midwives and I know that, once again, I will be criticised for expressing it. But, as I have said before, if you could access the comments on Doctors.net.uk on midwives you would know that my feelings are shared, to a greater or lesser degree, by many doctors. I merely express in public what many others will only say in private.

The story in today's Times is yet another example of midwives allegedly being arrogant and unsympathetic. We shall have to wait for the case to be decided but, sad to say, it has the ring of truth.

Irritating voices - you choose

St Ruth

It is extraordinary that the largest purchase most of the population makes, that of the family house, is in the hands of firms staffed by people with no moral code, the professional skills of failed used car salesmen and the dress sense of a hair dressers’s assistant.

The estate agents.

Had HIPS included a properly drawn up Housebuyer’s Survey, a survey upon which the putative purchaser could have sued, the estate agents would have been introduced to the concept of honesty. And HIPS would have facilitated the introduction of electronic conveyancing, currently in its infancy.

It was not to be.

HIPS have been emasculated, and the shell that is left can be avoided by a little room naming creativity. Private industry has invested millions in staff training in preparation for HIPS, and it is all going to be wasted. The government may get away with this sort of incompetence in the NHS, but not in the private sector. Wait for the writs.

Once again, Ruth Kelly is in trouble.

And then, the most awful thought. We know Patricia Hewitt's days are numbered. Gordon may punish St Ruth by moving her to health. A nightmare too awful even to contemplate. For one unexpected reason. Dr Crippen has consistently said that Patricia Hewitt has the most irritating voice in politics.

Now, I am not so sure. I have today been listening to the lugubrious tones of St Ruth. It is a close call, but I think she may be even worse than Patricia. If she is moved to the Department of Health, I do not think I will be able to cope.

See what you think:

First, listen to Patricia lying about how much she enjoys her job:



Then, listen to St Ruth lying about government housing policy:




Readers, I fear I may have misled you. And so, on to the NHS BLOG DOCTOR poll

Who has the more irritating voice?
	Patricia Hewitt
	Ruth Kelly
Free polls from Pollhost.com

UK Lung patients let down by NHS

Bronchoscopy

The recent survey by the thoroughly excellent British Lung Foundation has been picked up by the media and given an airing.

The way the media and the government have dealt with the public reaction to the survey exemplifies so much of what is wrong with the NHS and, in particular, this government’s approach to health.

A problem has been identified. Lung disease is common in this country. It is the “British disease”. We have the expertise, some of the best expertise in the world, and yet:

Death rates from respiratory illness in the UK are almost double the European average.

True.

...the UK has one of the worst records on respiratory disease in Europe, with a "postcode lottery" for care and a shortage of specialist lung doctors in some areas.

True

So far, so bad. The answer to the problem is simple. More resources. More doctors who specialise in respiratory diseases. But that is not the New Labour way. That simple solution does not fit in with their blueprint for tackling health problems. This is how they do it.

First, generate unreasonable public expectations:

People with lung disease need not suffer, if only the correct treatment were provided.

More than half of those who answered the survey said that they lived in fear of an attack of breathlessness, while a third said that they could not play with their children or grandchildren because of the effects of their illness. Some said they could not run, dance or even take holidays, while 16% said that their breathlessness stopped them having sex with their partners.

I’m sorry, guys, but having lung disease means being short of breath; it means not being able to play football; it may make sex difficult. Having lung cancer means dying. Having your legs amputated means no more ballet dancing. Even if treatment throughout the country were perfect, people with COPD would still be breathless. The government likes to promulgate subliminal propaganda suggesting that under “New Labour” there is a right to perfect health; a right to have all suffering allieviated.

There is a reason for that. If the public are persuaded that they have a right to perfect health the corollary is that if people still have lung symptoms, then the medical profession has failed.

Secondly, we must bring those lazy, incompetent doctors to heel.

“A spokesman for the Department of Health said GPs were already given incentives to encourage them to spot and treat people with COPD...

Here we go again.

Huge sums of money will now be wasted on paying GPs to submit lists of patients with COPD, asthma and lung cancer. For most well organised practices like mine, that means pressing a button on the computer, printing out a list of names and sending it to the Department of Health. Thank you, that will be £10K in target payments to boost the coffers.

Thirdly, we must tell these incompetent doctors how to do their jobs

...and national guidelines were being drawn up.”

Soon, at a cost to the taxpayer of millions, a glossy brochure from NICE will arrive on the doorstep of every doctor in the UK. This will contain an idiot's guide to treating lung disease, tell ing us, for example, that all patients with sleep apnoea should have sleep studies, and all patients with lung cancer should see an oncologist.

Good idea. Wish I had thought of that. Last year the government told us that people with depression should have "talking therapy". Where are the "talking therapists"?

Fourthly, we must have a (insert you favourite disease) week.

The focus group orientated government love this sort of thing, so we are going to have "Breathe Easy Week". One week of the year during which we all think of lung disease. Soon all the weeks in the year will be gone, each one allocated to a fashionable and socially acceptable medical condition, but we will still not have one for schizophrenia and elderly ladies with urinary incontinence and faecal soiling. Sorry girls, there is not going to be a "Shitty knicker's week".

So there we have it. The government's blueprint for all (fashionable) disease problems:

• Make the public believe that they are entitled to perfect health
• As health is not perfect, doctors have failed, therefore
• Pay GPs to make more diagnoses, and then
• Issue protocols enabling monkeys to treat the disease, and finally
  
• Have a disease week, with flag days and bring-and-buy sales
  

The continuing obsession with process and PR, and with guidelines and protocols.

I do not need guidelines telling me how to diagnose sleep apnoea. I need a dedicated clinic which can perform sleep studies and provide CPAP on a reasonable time scale. I do not need some silly bloody hand-patting lung cancer nurse specialists to see my lung cancer patients; I need chest physicians and radiation oncologists who take an interest in lung cancer. (See "A tale of two cancers")

It gets worse.

We may have some of the best respiratory medicine expertise in the world. Enjoy it whilst it lasts, for it will soon be gone. It will be gone because, to save a few pence here and there, we are eating our seed corn.

What do I mean by that?

We have three excellent chest physicians locally. Ten years ago they had a senior registrar, two middle grade registrars, a research registrar and four SHOs. There were also pre-registration housemen scurrying around the wards looking after the day to day care of the patients.

If you have a chronic lung condition, yes, you need the expertise of the consultant at the top of the pyramid, but what you really want is the young, lean and hungry medical registrar who is genuinely interested in emphysema because he is doing an MD on it; who is questioning orthodoxy, who is driving his consultant mad by saying “why don’t we do it this way, why have we not tried that, have you seen that new paper in the Brazilian Journal of Respiratory Medicine…. and so on.” A busy medical "firm" with enthusiasm passing up the chain, and experience passing down.

It has all gone.

Old fashioned senior registrars do not exist. There are no registrars on the firm at all now. There are SHOs, but they are inexperienced. They did not do the same hours as house-officers did ten years ago, and so have not seen the same number of patients.

The clinics are run by nurse specialists. These nurses have neither the training, nor the experience to do the job the registrars of old did. They do not question, and they cannot think and analyse in the same way. They are protocol bound. The old fashioned teaching and learning institution, the medical "firm", has gone.

When the current generation of experienced consultants retire, there will be a void in medical expertise that will never be filled.

How to make Gordon Brown laugh - it's that photo again

I am beginning to feel like Private Eye which prints, almost weekly, that wonderful picture of Andrew Neil in a vest with some totty young enough to be his granddaughter.

Actually, I don’t need much encouragement to print this photo...but today’s excuse came from another brilliant spot by Iain Dale.

Delicious!

The BritMeds 2007 (23)

The end of immunisations

Now, massive litigation could force companies to leave the vaccine business, threatening the future of one of medicine's greatest achievements. On June 11, in an unprecedented action before a federal claims court, lawyers for 4,800 autistic children will argue that vaccines caused autism. If successful, these claims could exhaust the pool of money currently set aside to compensate children who have been hurt by vaccines…

Big Pharma may pull out of making vaccines…then what?

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

Exam psychopathology

Post-Exam Personalities. You know, the weird social hierarchy that you see when you come out of the exam hall: in one corner you'll have the Nerds and the Hypertalkers laughing about how easy it was and how they BLATANTLY scored the bonus half-mark by quoting the alternative name for the radial groove, in another corner…..

Cambridge Angry Medic

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

Holford Watch - The Truth About Patrick Holford, Media Nutritionist

This blog uses basic science to challenge the nutritionist Patrick Holford. Holford's website describes him as "a pioneer...Britains best-selling author and leading spokesman on nutrition and mental health". Holford's key qualifications include "being frequently quoted almost weekly in...newspapers"; he also claims to be "a vegan who eats eggs and fish". With all these credentials, there's obviously a lot to learn from watching the guy!

Holford Jumps on the Wi-Fi Broadband Wagon - and gets it badly wrong.

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

Tempting angels

…temporary nursing staff employed by the NHS. They are more expensive than permanent staff, may well not be properly trained or even qualified, and are difficult to manage on the wards.

Yet the NHS routinely employs thousands every day. Costing taxpayers millions and taking risks with patient safety.

Burning our money

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

She’s back, and she has a job

……I did not deserve a job any more than those 10,000 unemployed doctors. That I was merely lucky. That it could have just as easily been me facing career oblivion.

I have not won, I have just survived.

Trick Cycling for Beginners

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

A rash decision - cleverer than Dr Crippen

Although I think I am pretty calm about child illnesses (and so I should be as Molly has been in hospital three times), Meningitis is something you dread having to deal with. The glass tumbler test reassured me but, for my own peace of mind, I needed a doctor to tell me Zach was ok. I called out of hours; I got a nurse specialist who diagnosed his rash over the phone as a heat rash.

Emily at Doing it all again

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

A Fortunate Man

I have already mentioned the depression questionnaire which we are now obliged to administer to patients when we make a diagnosis of depression (on pain of losing some of our annual QOF payment). I have mixed feelings about this. On the one hand I dislike being forced to do things inflexibly, it is one more thing to remember, and the questionnaire may be difficult to administer if the patient has a poor command of English or lower than average intelligence……

Questionnaires and QoF

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

Consultants want a means-tested NHS

Senior doctors are to propose that health care should be paid for through a compulsory NHS income tax. Hospital consultants will next week argue that the present centralised system funded through general taxation is "unsustainable and dysfunctional".

A motion to be debated at a British Medical Association conference will suggest a means-tested system similar to those used in France and Germany.

Daily Telegraph

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

You all thought that John Le Carre’s ‘The Constant Gardner’ was fiction did you?

Officials in Nigeria have brought criminal charges for the drugmaker’s alleged role in the deaths of numerous children who received an unapproved drug during a meningitis epidemic, The Washington Post reports.

Pfizer faces criminal charges in Nigeria

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

The Devil and Mrs H

The DK secured a personal interview with Patricia

Devil’s Kitchen

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

“Hospital” at night

A consultant reports:
I have put in writing my objections and await our first death. I am gutted that what I thought was a good piece of planning, governance, considering the juniors comments, improving working practice and safety - has been over turned by someone who knows nothing about the set up and looks at a piece of paper."

The Ferret

++++++++++++++
Update

So, I have a job

Hospital Phoenix

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

Suspended patients

Every time I’ve been out on the road with Steve, I’ve told him that I want to see a suspended patient (otherwise known as a cardiac arrest, or a dead body, depending on how long they’ve been like that). Every time the MDT (ambulance computer) rang with a new call, I’d jump up and down and go “Is it a suspended? Is it? Is it?” and of course, it wouldn’t be; it would be “old woman fallen over” or “cut toe” or suchlike.

New Naw

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

Junior hospital doctoring at its best

Oncalls are all about the NHS conspiring against you. It’s about dropping your bleep in the loo accidentally. Its about thanking God that it was an unused toilet. It’s also about trying to fish the thing out and then presenting a plausable less laughable explanation to switch board. It’s about tripping over the urine bag in a cardiac arrest. It’s about looking over the operating theatre at the most wonderful dark haired surgeon and catching your eyelashes on your contact lens. Its all about watching the contact lens fly aerodynamically into the patient’s open abdomen. It is true there is a patient out there shopping in Tescos with a contact lens in their abdomen. Either that or suction in theatre actually worked.

24 Hour Dash

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

Statins and Why Patrick Holford Is Breaking My Heart: Part 2

Patrick Holford regularly accuses scientists, doctors and the pharmaceutical industry of withholding or distorting research findings. In a promotional video for Food is Better Medicine than Drugs Holford casts himself and co-author Jerome Burne as Woodward and Bernstein figures battling against omnipotent forces.

The other side of the story

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

Dumbing down doctors before they get to medical school

I am a physics teacher. Or, at least I used to be. My subject is still called physics. My pupils will sit an exam and earn a GCSE in physics, but that exam doesn’t cover anything I recognize as physics. Over the past year the UK Department for Education and the AQA board changed the subject. They took the physics out of physics and replaced it with… something else, something nebulous and ill defined.

The vague and the stupid… a physics teacher begs for his subject back

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

Stringing up doctors – the GMC

If you are British and you are tried for an offence, you will not be found guilty unless unless the evidence points to your guilt 'beyond all reasonable doubt'. Despite this, many innocent people have been locked up or even hanged.

Dr Grumble

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

Nuggets in the mud

The minute by minute preceedings of the Commons Health committee may not have immediate appeal, but Potentilla has been paying attention.

The problem with doctors is that they tend to think they have more important things to do. But these things do matter. They matter to us, to our patients and to our profession - especially those that follow behind. The challenge here is to try and extract the interesting bits without unfairly making the participants to look idiots.

Dr Grumble with help from Potentilla

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

Music to medical ears

These days there are so many protocols available that one has to be very knowledgeable in order to decide which protocol to use, however if you are that clever that it is likely that one wouldn't need the protocols in the first place. Hence protocols are useless, QED. This my paradox of the protocol, and it means that if someone relies on protocols to manage patients; then are they really expert enough to be independently managing patients?

The protocol paradox

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

Worried about Wi-Fi?

“…I’m in a dash, but I thought you deserved these two brave rebuttals of the peripheral criticisms that the ubiquitous electromagnetic radiation scaremongers have received.

Jasper Carrott of all people on BBC2 (funny how despite being such a massive source of electromagnetic radiation they still have such a thing about beating people up over the subject)……..”

Bad Science

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

All well and good, Mr Brown, but who was the Chancellor of the Exchequer?

Gordon Brown team criticises Blair/Hewitt NHS reforms

Oona King, the former MP who is blogging as she tours the country with the chancellor, wrote that reforms could be "testing" for both staff and patients.
She added: "Some of the change in the NHS has been a triumph (the reduction in waiting-lists, the largest hospital building programme since 1945) and some has been a fiasco (reform of junior doctor training and the heavily-criticised GP contracts)."

The Brown Campaign

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

Would you rather live to be old or die before you become old?

Four out of 10 old people in hospital are malnourished because the Department of Health can't be arsed to spend enough on nursing auxiliaries to make sure everyone gets help to eat.

Salt connection

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

Glaxo, Top Ad Spender, Didn’t Publicize Avandia Risks

GlaxoSmithKline Plc was the drug industry’s top advertiser last year [2006], promoting its asthma and diabetes treatments to patients and doctors. Information the company didn’t make well known is now drawing more attention.
London-based Glaxo knew its Avandia diabetes pill posed a risk for heart and circulatory complications as early as 1999, when the medicine won U.S. approval. The cardiovascular concern wasn’t widely disseminated until May 21 [2007] when a Cleveland Clinic Foundation analysis reported that Avandia may cause a 43 percent higher risk of heart attacks than other drugs.

Seroxat Secrets

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Camidoc in the news again

We looked here at Penny Campbell’s tragic death in “Mother died after eight GPs failed to spot septicaemia”.

Now, in another case, a doctor who worked 24 hour shifts for Camidoc has been struck off.

From Hackney

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

Why Pro Abortion Doctors and Midwives Have To be Stopped

The BMA has backed abortion on demand in Britain and backs plans to use midwives and nurses to carry out abortions instead of doctors. The BMA also have control over the medical profession in Northern Ireland. Isn’t it time that the Northern Irish doctors had thait own board and association as a professional body?

Hidden Ireland

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

Doctors refuse to treat terminally ill patient unless he agrees to give up meat

Heard the one about the surgeon refusing to treat a terminally ill patient unless he agrees to give up meat? You soon will do.

UK Daily Pundit

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

Bush names anti-gay surgeon general

"Dr. James Holsinger has demonstrated in the past that he harbors religious-based prejudice towards homosexuals," said Jamie McDaniel, coordinator of Soulforce Lexington, the local chapter of a national organization that opposes the use of religion to oppress lesbian, gay, bisexual and transgender people. . .

Undernews

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

Harold Shipman is still with us

The Medical Defence Union (MDU) has opposed certain measures in government’s response to the Shipman Report.

Dr Peter Schutte, Head of Advisory at the MDU and Treasurer of the Faculty of Legal and Forensic Medicine, warned that the repercussions of the Harold Shipman trial were still being felt in the profession.

Legal medical news

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

As others see us :

Put another feather in the cap of Socialism. Now, patient in the U.K. will have to quit smoking for four weeks before surgery. You see, since smokers' generally take longer to recover from surgery, they cost the system more. With socialized medicine, they cannot simply charge for the extra time. So they refuse care instead. I'm sure this will, as one commenter said, extend to requiring one to go on a diet before surgery.

The Joys of Socialized Medicine

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

Agency nurses

The House of Commons Public Accounts Committee today warned of the dangers of increasing use of agency nurses within the NHS. In a trend being replicated throughout the UK economy, decent, secure jobs are being replaced with temporary or agency work, and nurses and patients are paying the price…..

Radical Healthcare workers

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

Tragic death behind the arras

At the bottom of my Protopage list are the irritating blogs that I just can’t quite bring myself to delete

Polonius

+++++++++++

Blogging from an NHS Waiting Room

It seems that in order not to breach the waiting time target, clinics like these are quadruple booked. 200 patients were booked in this afternoon with no increase in the four doctors usually on duty as when there are 50 patients. I've been handed a copy of the complaint form to fill in - they have a ready supply. Yet most people around me declined the form, preferring to moan rather than write. The receptionists were shaking their heads even as we arrived; “its mad this clinic - just look at it - well if you want to wait...”. The concerned mother in me felt we should - how otherwise will we know if Jem's finger bone is back in one piece? ... So the patients get seen, after 2 -3 hour waits, by doctors who are exhausted and the hospital gets to tick its box for no breach of waiting times. Discretion and discernment have gone for the doctor and clinic manager, replaced with frustration and anger from patients.

Iain Dale

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

Christ is in our midst

When I was sixteen years old I asked God to give me a serious illness, a cancer, so that I would suffer for His love and glorify Him through my pain. I made this prayer for a long time. But my elder told me that this was egotism and that I was coercing God. God knows what He is doing. So I didn’t continue with this prayer. But you see, God did not forget my request and He gave me this benefaction after so many years!

Hand Maid Leah

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

Scientific Misconduct

The basis for these problems lies in the increasingly special relationship between the pharmaceutical industry, a network of powerful colleagues, the government and these very organisations which purport to deal with matters of "integrity" and "professionalism". When those who regulate, those who are regulated and those who scrutinize the regulators become one and the same, alarm bells should be ringing.

Speaking of teeth and of suicide, the story is told of the French academic who found himself facing those four doors. He decided to commit suicide. However he decided first to compose his own epitaph:

Attendre quo de soi la vétusté triomphe, C'est absurde! Je vais au devant de la mort. Mourir a plus d'attraits quand on est jeune encore: A quoi bon devenir un vieillard monogomphe?

Find out what it means here

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

Medical complaints

Doctors have claimed their morale is at an all-time low, but Patricia Hewitt insists the NHS is improving. Is she right?

According to Dr Fielden, "The profession is angry. It is angry with managers, with employers, but most of all we are all angry with the government for a woeful dereliction of duty - towards patients, towards the profession and towards the future."

He is calling for an end to the "political meddling" that has "brought the NHS to its knees".

Ann Robinson

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

“The operation was successful, the patient let us down by dying!”

A look at Patricia Hewitt’ management of the NHS

Dr Rant

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

WE CONSULT MUM AHEAD OF DOCTORS

British mothers handle twice as many health enquiries as the NHS Direct helpline…

Marie Claire

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

THE MTAS/MMC week

Next stop, rock bottom

….my partner has not been offered a job in either of the other two areas where she had interviews. As well as I know her, and as much as I would like to think that I can empathise with her situation, I can't even begin to imagine how she's feeling just now.

I've been there through it all: The decision to go back to study medicine as a mature student, turning down an offer of funding and a place to do a PhD at Cambridge in favour of Medicine; the six year degree course (including a pre-medical year); the daily struggle to live on a combination of part-time cleaning jobs, bursaries from charitable trusts, hardship grants from the University and student loans whilst studying extremely hard; finals

Citizen Blog

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

UK Doctors, will you please help this man

“Plans to revolutionise the way patients are admitted to hospital have been attacked as ‘Stalinist’ by Britain’s leading surgeon. Bernard Ribeiro, president of the Royal College of Surgeons, said the system would destroy the professionalism of the NHS and put people’s care at risk.”

The Witch Doctor

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

No time for celebration

All of us know people who have quit medicine or are quitting, or who have decided to end their days with the NHS and flee for greener grass overseas. At my lowest ebb I have had thoughts of quitting medicine, even though it is the only thing I ever really wanted to do, but we do all have out limits of endurance. I don't know how much longer I could have lasted before breaking.

The Ferret

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

WHO IS SANDY LEITCH AND WHAT IS HIS ROLE IN MMC?

Well, Sandy Leitch has no direct role in MMC at all!

The Witch Doctor

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

A sick system

Patricia Hewitt promised to learn from the MTAS fiasco, but junior doctors are finding that the situation is as hopeless as ever.

Alex

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

And you thought there was freedom on information…

The DoH is again using the Freedom of Information act to with hold anything that would expose their rank incompetence. They seem to use a different loop hole every time, it does rather make a mockery of the government's pretence at openness and accountability. They claim it is in the public interest to have a administration that can conduct all its important business 'frankly and freely' behind closed doors.

DoH Incompetence

+++++++++

The house of cards collapses

It seems that our ivory tower dwelling dictators are beginning to feel a little bit of constructive revolutionary heat warming their tootsies. About time too.

Professor Rubins's limp excuses did not convince Remedy Uk, who have responded convincingly to his limp brand of apologism. In fact PMETB have been shown to be up to their neck's in it:

The Ferret

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

And finally, we looked at the worst doctors in Britain

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


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 Crippen Diaries 2007 (23)

Not quite Emergency Ward 10

Monday 4th June

“I’m not a tablet person, doctor” is one of those expressions best avoided when you are seeing your doctor. It tends to make us giggle.

This morning, when Mr Jones started the consultation with that very sentence and kept a straight face and looked quizzical, waiting for the follow up. There is always a follow up, usually a request for half a dozen forms of medication. But Mr Jones did not want medication.

“…so I have been taking St John’s Wort.”

“Is that not a tablet?” I asked.

“Ah, yes, doctor, but it isn’t a “medical tablet” if you know what I mean.”

I nodded to signify that I knew exactly what he meant. Actually, I had not got a clue. Clearly, he felt that it was advantageous for a tablet not to be “medical”. God knows, enough people are poisoned by medically approved medication that has been tried and tested and subjected to all sorts of safety investigations. Think of the damage that people could do with untested medication!

I think perhaps Mr Jones meant a tablet unencumbered with the necessity to see a doctor. The Health Food shop he visits makes it so much easier and seems much more “whole-meal”.

“And you GPs are doling out far too many of these SSRIs. I mean, I know you wouldn’t give them out unnecessarily but, well, some doctors do and so, well, I thought I would try the St John’s Wort first."

Mr JOnes was digging himself into a hole. The logistics are complex. Does he mean that he thinks I would dole out SSRIs unnecessarily? Or that St John’s Wort is better? Or that he is not really depressed?

I spent a long time going through his problems. Balance sheet of life pretty good, but he cannot face getting up in the mornings. Small tasks have become mountains. He has become a desk tidier. I find this quite commonly. Slightly obsessive people who cannot get on with life until their desk is tidy and, whatever they do, it never quite is. So they put their life on hold. Like some dieters put their life on hold until they have lost that stone in weight. They never do lose it and so gradually become reclusive.

I think Mr Jones is depressed, and would benefit from antidepressants. So does he, which is why he came. He is going to go away and think about it some more and I will see him again at the end of the week.

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

A really difficult visit with the District Nurse to see Rhoda, an elderly lady who lives round the corner from the practice. Rhoda is a good old-fashioned name which has not yet had a renaissance. You do not come across babies called Rhoda.

We are trying to get Rhoda into sheltered accommodation, and she is resisting. Well, not resisting, more refusing point blank. Which is a shame. She would manage well in ground floor accommodation with wide doors, low shelves and easily accessible lavatories and a sit-down shower with lots of grab rails.

She lives in a two bedroomed house. A good old fashioned “two up, two down”. There is no lavatory downstairs and she can no longer get upstairs due to her osteoarthritis. So she has a commode. She is a widow and has no children. There is a niece somewhere who makes an occasional “something must be done” visit (“I mean, it’s not right, doctor, she needs looking after”) usually just before Christmas. People like to tidy-up the family outliers before the Festive Season gets in full swing. It makes the turkey more digestible.

Medically, apart from her osteoarthritic hips and knees, she is in good shape. She had a left total hip replacement five years ago, and so her left hip is not too bad. But she hated it in hospital and will not go back. Another new hip and two new knees would help, but she is not interested. She has her cats, and her television, and her cigarettes. The commode lives in the kitchen-dining room and is not emptied as often as one would like. A resource issue. The nurses go in. There is a “carer” who goes in as well Monday to Friday. But a “spot of diarrhoea” on Sunday morning after the nurses have visited will still be there on Monday.

Cigarettes, cats and commodes are not a happy combination. Rhoda is oblivious. Rhoda is completely compos mentis. She owns the house, and has lived there for nearly fifty years. I don’t blame her for not wanting to move.

I am sure the neighbour thinks I am negligent for not “doing something” but I do not know what to do. As so often, when I leave the house, the neighbour comes out and solicitously asks, yet again, what is going to be done.

Some people seem to think that doctors as “authority” figures have the power to “take people away”. We do not.

Rhoda would be a little better if the neighbour popped in and emptied the commode from time to time. But it is not for me to ask that, and why should she? The district nurse asked her about it once. Braver than I.

She said she would, but she is allergic to cats.

++++++++++


Tuesday 5th June

Once I get more than fifteen minutes behind, which I do most days, I routinely apologise to patients for keeping them waiting. Some of my partners do not. They take the view that we are doing the best we can, it is not our fault that we run late, and so why should we apologise? I take the view that a quick “Good morning, sorry to have kept you waiting…” does no harm and oils the wheels. For the overwhelming majority of patients, there is not an issue. Mostly, they say “not a problem” and smile.

A few, a very few, are grumpy. They show this in various ways; an unsmiling “yes, you are very busy this morning” is the mildest. Some ostentatiously look at their watch as they come in. Very occasionally they will make a comment, or a “helpful suggestion”, about the appointment system.

I do not know how to solve the time keeping problem, other than by giving patients half hour appointments. What a luxury that would be. But if I only saw fourteen patients a day, the system would collapse. So it is eight to ten minute appointments, and we do our best.

I was running twenty minutes late this morning when Douglas arrived for his appointment with his wife, Phyllis, in tow. Douglas smiled at my apology. Phyllis said nothing, but scowled and looked at her watch. Douglas had come for a review of his BP and heart failure. To review patients with heart failure, you have to examine them, and then there was the prescription to update, and then the form to fill in to check Douglas’ chemistry and cholesterol.

I had used twelve of my ten minutes, but was on the downward slope of the consultation. That which needed doing had been done, pleasantries exchanged, and the date of the next consultation arranged. Douglas was standing to leave when Phyllis said, “I could not get an appointment for my doctor today (she sees one of my partners, and she is on holiday) so could you just do my prescription whilst I am here.”

Phyllis is on Tamoxifen for her breast cancer (in remission), two drugs for her osteoporosis and one drug for her BP. “Just” doing her prescription takes thirty seconds; press a button and wait for the print out. Providing her with a proper medical service means a few questions about the breast cancer and checking for side effects of Tamoxifen (rare, but occasionally serious), taking her blood pressure and arranging appropriate blood tests, if necessary, for chemicals, calcium and cholesterol.

“Have you made an appointment?” I asked, knowing full well she had not. In fairness, she said she had tried, but there was only one slot left with me, and Douglas had booked it. Phyllis looked disgruntled.

So I pressed the button and gave her the prescription, and made her an appointment for her own doctor in two weeks time.

“Can’t you take my BP now, so that I don’t have to come back?”

So I took it, and it was normal. But I still told her I wanted her to see her own doctor in two weeks as she needed blood tests.

“Can’t you just write out the form now?”

Lines in the sand are always arbitrarily drawn. I drew my line. “No. I have done what I can, and I am already running late.”

Phyllis huffed and puffed and left. Douglas delayed a few seconds, wrinkled his nose, and said “Sorry, Doc” and then he was gone too.

Every family doctor in the country has an experience like this every day. It is why we run late. It is why, at times, we are grumpy. It is why some patients say, “Oh! I don’t like seeing Crippen; he never gives you the time.”

A commonplace trivial event. Difficult to put into words the stress such an event causes.

++++++++++


Thursday 7th June

I had to play the car key game this morning. They weren’t where they should have been and I wasted ten minutes looking for them, then five minutes looking for the spare ones, the another five minutes finding the spare door keys…and so I started ten minutes behind

Angela is forty seven. She has had a “bit of a cough” for longer than she can remember - years - but over the last few weeks she has found that she is wheezing a bit when she breaths out and has been a bit hoarse. She smokes ten cigarettes a day. She is otherwise feeling well, fit and active. She is not losing weight. She is not short of breath. She has not been coughing up blood. She has no history of asthma. Her older brother and her mother both died of lung cancer. Both were heavy smokers. Listening to her chest, there is a localised coarse expiratory wheeze on the left which more or less clears on coughing. Her peak flow is normal.

She says she is trying to stop smoking. I ask her if she is worried that she might have lung cancer. She laughs, and then says ‘yes’.

She probably hasn’t but she certainly needs a CXR. She can have that today, but it is currently taking between two to three weeks to get CXR reports. Angela can’t believe that. Of course, if the radiographer spots anything ominous on the CXR (and they usually do spot pathology), she will get the radiologist to report it much more quickly. So no news is usually good news, but that is not the way it should be done.

Angela will now worry for two weeks.

++++++++++

I had the first worried parent coming in to ask about the dangers of Wi-Fi. There will be more. She works in an office were there is Wi-Fi as does her husband. They have just installed it at home and the two children are constantly exposed at school.

I do not know the answer.

My gut feeling is that, like the “dangers” of mobile phones and electricity pylons, this is a load of nonsense. I do not believe there is any danger at all. If there is, the Crippen household is likely to be amongst the first who are stricken as we have an electrical toy shop.

This lady has in the past also worried about the risks of MMR, mercury in immunisations and diary allergy.

As always, I try to reassure her and, as always, I fail. She says she is going to sell her Belkin Router. I ask her how she could possibly do that if she thought it was emitting dangerous radiation. She paused and said, "Oh well, I will throw it away."

I wonder. I suspect the router is more likely to end up on eBay than in the Wheelie-Bin.

+++++++++++

Friday 8th June

Eric was first diagnosed with macular degeneration in his early seventies. He is nearly eighty now, and the problem has progressed. He visits the local hospital eye clinic every six months, queues for two hours, sees the most junior doctor of the day, almost always one he has not seen before. The consultation takes two or three minute. Eric’s memory is not as good as it was. He always has some questions and either they are not answered or Eric does not remember the answer.

So, every time he goes to the clinic, he comes to see me a week later, to ask me “what they found” and “what they said”. Eric hears all the reports about new drugs that can treat macular degeneration, drugs which are subject to the post-code lottery, and wonders why he is not getting them. He blames the government. It is not the government’s fault. Eric has “dry” macular degeneration, a condition for which there is no treatment. The drugs, such as they are, are for “wet” macular degeneration.

I am not altogether sure why the hospital keeps seeing Eric. There is nothing they can do. He is already registered as partially sighted. The trip up to the hospital is a bit of a charade.

Eric is now at the stage that reading is difficult. He manages, sort of, with a magnifying glass and what is left of his peripheral vision but his wife says he only really makes out the headlines, and those only with difficulty.

I saw that Eric had made an appointment today which was surprising as he had not recently been to the hospital eye clinic. He came in with a copy of yesterday’s Times. He wanted me to refer him for the “new” treatment for macular degeneration and, yes, this was treatment for “dry” macular degeneration. I had also seen the article.



The headline, which Eric had been able to make out, said “Cure for most common form of blindness” and below the headline was an entirely gratuitous picture of, presumably, a mother (or is it meant to be grandmother?). Take a look at the article (here), and read the second paragraph:

A team of British doctors said that a groundbreaking stem-cell treatment for age-related macular degeneration (AMD), which affects a quarter of people over 60 to some degree, should become widely available. The condition is responsible for the blindness of 14 million Europeans.

Eric said he would go anywhere, go privately, pay however much it cost to have this treatment.

It sounds like a genuine breakthrough. It sounds exciting. Who knows what may be possible in years to come. But Eric had forgotten about the first paragraph. He would not have been able to see it himself. His wife would have read it to him, but the visual memory of the headline and picture is what stuck in his mind. The first paragraph said:

“A routine operation to restore the sight of people with the most common cause of blindness will be available within a decade, scientists believe.”

Eric may live to take the benefit of this treatment but it is not available yet, neither on the NHS nor privately.

Sometimes I hate journalists. Why do they put up these dishonest, provocative headlines? Headlines that people with failing vision can read.

It is both irresponsible and cruel.

The scum of the British Medical Profession: name and shame them

It takes five years to train a doctor at a unit cost to the taxpayer of approximately £250,000. The young men and women who emerge from medical school have a duty to the county to behave themselves, to conduct themselves as mature and responsible professionals and, in particular, to embark upon proper postgraduate study to obtain additional qualifications to enable them to become senior doctors.

There are always a few rotten apples. They will be ruthlessly weeded out. Remedy UK has now decided to “name and shame” this flotsam and jetsam of the medical profession. Here are but a few:

Dr Manish Chand
I work as a registrar/senior SHO in Poole with lots of experience having completed a teaching hospital BST rotation in London.
First class distinction at BSc
Postgraduates prizes,
Several first author publications and have presented as first author all over the world. I am a tutor at an Oxford college.

Unemployed

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

Dr Elena Hunter
3rd year SHO applying for Radiology in Oxford,
Part1 MRCS
Multiple audit and evidence of dedication to Radiology.
6 months as an anatomy demonstrator at Oxford University
I am tied to this region by my husband’s number in Surgery and we have a 6 month old daughter. I have just come back from maternity leave.

Unemployed

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

Christine Tjen
CMT ST1 applicant
Currently a Foundation Year 2 doctor.
BSc (1st class hons) from a medical school where only approx 30% of yr are selected to do it, have a publication, attended international conference for a poster presentation, several audit.
Passing MRCP Part 1 at the earliest opportunity.
Strong ties with family/important people in my life

Unemployed

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

Dr Keval Patel
BSc in Human Anatomy (2'1)
MRCS part 1+2.
ALS, ALERT, BSS, trauma radiology, etc
FY2 in a London surgical rotation applying for ST1 general surgery in London/KSS. Wife to support.
CV strong points include: 3 x publications (2x 1st author)
poster presentations (internationally & locally)
lots of audits
lots of courses (ALS, ALERT, BSS, trauma radiology, etc.)
I thought not too bad for 2nd year out of med school (ICSM), not good enough for MTAS though!

Unemployed

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


Dr Benjamin Taylor
Applied for ST3 Clinical Oncology (London/KSS, Eastern, W-Mids, Severn).
All 4 first round interviews (round 1a). No offers.
House on market today - moving back in with family.
MRCP
1st class honours BSc
competitive London Medical rotation (not London graduate)
currently SHO in major tertiary referral Oncology Hospital

Unemployed

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

Dr Alex Liddle
SHO at St Thomas's
2004 graduate from Imperial.
BSc
I got my MRCS in full last year, aged 25.
I've publised and presented internationally.
My jobs have been Royal Surrey, Charing Cross (prho), St Mary's A+E, General, ENT, orthopaedics; St Thomas' cardiothoracics.
Universally excellent feedback and references.
Prize at medical school, captain of rowing, audit, all the courses.
Don't know what more I could have done to make myself more attractive to the shortlisters.

Unemployed

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

Dr Stephen Ohanlon
wannabe ENT ST3
MA physiology from Oxford
Medical degree from Cambridge
MSc in Surgery from Imperial
Teaching physiology in a Ugandan medical school
Mess President
MRCS
DOHNS.
National audit, published, first author
Publication of original research in Laryngoscope, first author
Over 100 tonsillectomies and grommets

Unemployed

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

Dr Leesa Parkinson
MBBS with distinction.
BSc (1st class)
PhD (submitted, viva awaited)
ST2 ACCS(EM) ST3 GP in Scotland and NW
1 yr EM, 6 months Elderly Medicine
6 months Orthopaedics
ATLS, ALS, APLS
MCEM Part A
International presentation of research
EM appropriate audits
Prizes both at and since medical school including
I'm told I have very good references and interview technique also.
House and home in Scotland, which I dearly love, but may have to go on the market.

Unemployed

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

Dr Veronica Roberts
ST3 in T&O.
Graduated 2001, with prizes at Med School
MRCS(Eng) at first sitting
All required courses: ATLS, AO etc
3 years experience as SHO in T&O (inc paeds)
Presently working on my MD as Research fellow
Publications in peer-reviewed journals all as first author
International and National presentations (most as first author)

Unemployed

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

Dr Adrian Clarke
Applied for ST2 anaesthetics.
BSc, MRCP, ALS, APLS, ATLS.
6 years post grad experience. Sitting Primary FRCA this year.
Audits and posters presented at national level.
Plenty of evidence of suitability for career.
Numerous other tasks - RCP associate college tutor, mess treasurer etc etc etc.

Unemployed

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

Dr Aswinkumar Vasireddy

BSc Honours
MRCS (Eng) completed
Originally short-listed for ST3 Trauma & Orthopaedics in L/KSS & Eastern deaneries. No offers. I have dependents to support.
Merits throughout medical school.
4 national prizes.
3 articles. Numerous international and national presentations (oral + poster) - most relating to Orthopaedics.

Unemployed

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

This sickening and ever lengthening list of failures goes on and on, and can be read in full here at Remedy UK. Thank God for the BMA. You won't catch them having anything to do with riff-raff like this.

Who do you think you are?

Idle sods. Ten years of training, post graduate experience and qualifications, and huge educational debts does not mean the bloody country owes you a living.

You can parade details of your fancy first class honours degrees and your poncey post-graduate jobs as much as you like. It does not cut any ice with me. Get real, get out there, role up your sleeves and get your hands dirty. Get a real job.

You each cost the country £250,000 and you blew it. Frankly, I think you should have to pay that back as well as your piddling little loans.

And don’t come all this mawkish crap about family commitments. God, you bloody women will be demanding maternity leave next.

You have not got a job.

Computer said no.

You are unemployed.

Tough titty.

Stop moaning and bog off to Australia. There are plenty of jobs out there for scum like you.

Gordon Brown to promote Patricia Hewitt

Rejoice, rejoice

The health service is at the end of its best year ever, and has moved from deficit to credit. Yes, folks, it is making a profit.

I can only conclude therefore that, contrary to my predictions, when Gordon Brown takes over, Patricia Hewitt will be staying at the Department of Health. Or maybe, having solved our health care problems, she will be promoted. A new Chancellor of the Exchequer will be needed.

I really was at a loss for words after I listened to Patricia on the Radio 4 Today programme yesterday morning. Fortunately, other bloggers were far from speechless.

• The Devil was able to secure a personal interview with Mrs Hewitt.
  
  
• Wat Tyler provided a characteristically pithy analysis of "profitable" (sic) healthcare

Princess Diana documentary : Channel 4 is right to proceed - update after the programme

The People's Princess

Channel 4 is under fire for insisting on screening the forthcoming documentary on Princess Diana, against the wishes of the Royal Family.

Channel 4 says:

“For ten years conspiracy theories, claims and counter-claims have obscured what actually happened that night. Did the photographers chase Diana to her death in the Pont d'Alma tunnel? Were they too busy taking pictures to call the emergency services and did their presence hinder those services? They had witnessed and recorded one of the most terrible and iconic moments of the 20th century. But for ten years that night has plagued their lives..

…For one night the press photographs became the most expensive ever, but when Diana died they became worthless. Those who possessed them were hounded and for some their careers destroyed. The photographers have never felt able to tell their side of the story... until now.

The balance between freedom of speech and prurient intrusion into people’s private lives is not easy. Dr Crippen's first reaction to this documentary was that it should not be shown, but I have changed my mind. The unexpected death of the then most prominent member of the Royal Family is a matter of legitimate public interest. Princess Diana was a skillful manipulator of the media. That was the game, her game, and it was a game she mastered. She would expect to be pursued by journalists. On many occasions she welcomed the pursuit.

The journalists were blamed for her death. They were scapegoated. The public outcry was led by the very people who bought the tabloid pap from which the paparazzi earned their living. If any one is to blame, it is not the journalists. It is the prurient general public. It is right that we hear the journalists' side of the story.

I sympathise with the Princes, but they do not have to watch the programme.

Let us not forget that for many years, the public blamed Mrs Parker-Bowles for the death of Princess Diana. Had there not been a “third person” in the marriage, who knows what might have happened. Currently, the Prince of Wales is employing some of the most sophisticated media advisers in the world to re-brand the Duchess of Cornwall. As anyone who saw the unctuous "documentary" on her last week, it is clear that the Prince is manipulating a receptive media to make his second wife “acceptable” to the public as a future Queen of England.

This odd, introverted socio-pathic family cannot expect the media only to present issues to their liking. Princess Diana is and always will be in the public domain. They must take the rough with the smooth.

From the medical standpoint, Princess Diana’s tragic death raises a much more important question. The question being, to lapse into jargon, whether the ambulance service should “scoop and run” or “stay and play”.

Princess Diana had sustained catastrophic internal chest injuries. In particular, she had ruptured her pulmonary vein, the vein that takes blood back from the lungs to the heart. It is likely, whatever treatment she had received, that she would not have survived.

A passing doctor was with her within a minute or two, and a fully equipped trauma team was there within fifteen minutes. They “stayed and played”. It was nearly two hours before she was in the operating theatre of a Paris Hospital. Predictably enough, it has been argued that had they “scooped and run” she might have survived. Maybe so. But if they had “scooped and run”, and she had died in the ambulance, the counter argument would have been advanced.

The issue is discussed in detail in:

Death Of A Princess, Did Princess Diana Have To Die?:
A Case Study In French Emergency Medicine

What happens in the UK?

There is an increasing amount of “stay and play” carried out by paramedics well versed in play techniques, but not well enough trained in diagnosis.

Ten years ago, the BMJ reported:

This debate over scoop and run or stay and play serves only to perpetuate the winging of the pendulum. There is likely to be no single answer for the care of the critically injured. Each patient needs individual assessment of his or her needs. Paramedics have been restricted by protocols, which are often inflexible, because their training has not been broad enough to allow more flexible guidelines. Doctors have also tended to overestimate the skills of paramedics.

The involvement of doctors at accident scenes, however, continues to be mostly on a voluntary basis through the BASICS (British Association for Immediate Care) schemes.

We looked at BASICs a while ago. A well-meaning lot, but you have to giggle. What other country would dumb down on site traumatology to a group of amateur volunteers?

GPs are universally hopeless in traumatological “blood, artery, spurt” situations, but they do have diagnostic medical skills. Paramedics have practical skills, but do not have real diagnostic skills and so often underestimate the need for accurate diagnosis. When called to a domestic medical emergency by the family doctor, paramedics can be a real problem. Dr Crippen has had one patient who died as a result of “stay and play” when he had instructed the paramedics to “scoop and run” but was ignored.

Paramedics increasingly now make decisions about who should and should not be taken into hospital. This is all part of the NHS cost cutting and, dear God, they do get called to some nonsense. Even so, sometimes they get it badly wrong. If you are going to “stay and play” you need more skills than the average ambulance brings to market.

Like many family doctors, Dr Crippen has reached the stage that, if he were taken suddenly and seriously ill but was still compos mentis, he would get a family member or friend to drive him to the nearest hospital rather than take his chances with an ambulance full of paramedics who wanted to “stay and play”.

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Follow up at 10.00 pm Wednesday 6th June
This was a responsible and important documentary. It was not primarily about Princess Diana or Dodi Al Fayed. It was about the photographers who were subjected to an authority instituted and media supported lynching. Locked up without charge for over two days. Two years later they were formally cleared. Mohamed Al Fayed pursued an action against them for breach of privacy and was awarded derisory damages.

It seems most likely that the cause of this accident was mundane. A drunken chauffeur driving too fast in a built up area.

Having seen the programme I am convinced that it was reasonable and appropriate for it to be shown. It was carefully edited with nothing prurient or too intrusive. My only criticism is that the photographers, for all their faults, should not have had to wait ten years for their story to be told.

From the medical point of view, I still do not know if "stay and play" was superior to "scoop and run" but I suspect the latter would have had more chance of success. It would be interesting to hear Tom Reynold's views on that.

Last chance to download Patricia Hewitt

Looking good on eve of 60th Birthday

I see today on the Department of Health website that the public is being offered what may be their last chance to download a high resolution picture of Patricia Hewitt.

It appears that a £29bn facelift has rejuvenated the Secretary of State.

Get your download now whilst supplies last.

The BMA gets desperate

Click to enlarge

The above advert appears in today's Times and, I daresay, in other papers too. For the first time in living memory the BMA proposes to consult its members. They must be desperate. And still, even now, the letter is handed down from the Olympian heights of medical "old fartdom".

They just don't get it, do they?

One of NHS BLOG DOCTORS spies at the BMA was able to send in a copy of the first of many proposed drafts of the letter. This is what might have gone out, before Professor Kumar got hold of it.

Dear Colleague

I am writing to you at a time of real crisis for the survival of the BMA. The executive has spent many hours quaffing port at BMA headquarters and have been most distressed by the recent problems. Due to changes in the training application process, thousands of “junior doctors” are unemployed.

I would like to tell you that the BMA tried to help, but sadly that is not the case. Of course, we launched an immediate investigation and although we now have some idea as to what a junior hospital doctor is, we have not been able to locate one.

The BMA now has major concerns about its dwindling income from standing orders.

We hear every day that talented junior doctors have cancelled their direct debits as they feel their careers have been blighted by the inactivity of the BMA.

We took a clear and united view that the right way forward was to state our own opinions on MTAS and MMC without consulting the juniors.

In view of the recent High Court action, and some limited movement by the Government, the BMA continues to work for the best outcome possible for all the doctors affected by the shambles.

Actually, that last paragraph was written by a committee. I have just read it through and I do not know what it means. The first and third clauses do not connect and, by the way, I forgot to mention Remedy UK. There. I have said the words I was trying to avoid. Remedy UK is composed of some nasty young men and women who disgraced the profession by taking to the streets. Personally, I blame the parents, some of whom I am advised were on the demonstration too.

Our members will understand why, in view of this disgraceful behaviour, we supported the government in the court case. It was necessary to destroy Remedy UK. Sadly, in that, we failed. Remedy UK lives on. It seems we may have misjudged the mood of the profession and so we have now offered a small sum of money to Remedy UK, twenty (or was it thirty?) pieces of silver, as a patronising gesture to these misguided youngsters.

Over the coming weeks we will promote even more forcefully – and I would stress the word, “forcefully” – the interests of the BMA.

Neither I nor any members of the BMA executive have ever met a junior hospital doctor, nor do we know any. We are therefore arranging to consult the juniors via some electronic contraption which is, I am told, in line and we will be using the tried and test MTAS software to help with this consultation process.

Please note that we continue to purport to speak for and on behalf of the juniors although we have not been able to find a single one to sign this letter. In any case, it carries more clout with my signature under it. We could of course (honestly) have found fifty, a hundred, two hundred or more junior hospital doctors to sign, but that would have been an empty gesture. Who listens to the juniors. This letter needed to be signed by someone with clout. Someone who knows best.

Here at the BMA our concern is always for our membership. And I mean all our membership, not just the desiccated old farts who rule the roost. We care about the juniors too. May I remind you all that a case of good claret now costs upwards of £500 and so each case is the equivalent of two junior doctor’s annual subscriptions.




Mr J. Iscariot

XXX

Lazy GPs demand more money

I would not normally bother with an article in the People’s Medical Journal, but I have had so many emails about the one in today’s PMJ that I cannot resist a response.

GPs want to charge £20 an appointment if they have to open their surgeries in the evenings and at weekends. Their call is a response to proposals that they should extend their hours to justify salaries which have soared in the past three years.

No they don’t. This is merely one suggestion made by a GP for discussion at a forth coming conference.

A group of family doctors from across the country will table the demand at a British Medical Association conference. The charge would apply only to routine appointments made in advance and not to out-of-hours emergencies, which would still be handled by local primary care trusts.

Why is this such a bad suggestion? At present I work from 7.45 am until 6.00 pm, except on one day when I do a later evening surgery until 8.00 pm. If some patients wish to see me outside those hours for routine medical matters (I am not talking about emergencies now) why should they not pay extra for the privilege? I doubt in any case that I would be prepared to do it. The day is long enough as it is. And if I did do it, I would be charging more than £20 per consultation.

In fact, there are many working people who would be delighted to pay for the convenience of a late night booked appointment with their doctor. Private GPs do this all the time -and charge a great deal more than £20. My practice does not have private patients and, like all GPs in the NHS, we are not contractually allowed to offer private services to NHS patients.

But the idea provoked fury from patient groups and politicians. Critics say it would undermine the founding principles of the National Health Service - and could put lives at risk if patients delay seeking help.

Bollocks.

At no time was the underlying principle of the NHS that people should be able to see a doctor at any time of the day and night for any condition however trivial. And this would not put lives at risks. This is not meant to be for emergencies. It is meant to be an additional service for routine consultations.

Michael Summers, of the Patients Association, said: "It is a scandal and wouldn't be tolerated in any other country."

Michael Summers is espousing the characteristically naïve and selfish attitude held by a number of patients that is destroying the NHS. His ludicrously unreasonable demands cannot be met by doctors, which is why we have NHS Direct and all the other HCP led dumbed down nonsesne. "Wouldn’t be tolerated in any other country?" Michael Summers needs to go and live in the USA for a few weeks.

The call for paid consultations comes as GPs head for a showdown with Gordon Brown over surgery hours. New GP contracts agreed in 2004 saw 90 per cent of family doctors opt out of providing care in the evenings, at weekends and on Bank Holidays in exchange for a small salary cut.

It was a ten percent (approx) pay cut to contract out of Out of Hours work. It was a gross miscalculation by the government. They underestimated the burden and costs of the Out of Hours cover that GPs were providing virtually for free. Now the realities are biting home. Doctors are an expensive commodity.

But other elements of the contracts have allowed their pay to jump by almost two thirds, to an average of £106,000.

Our pay has not jumped by two thirds. It has risen by between twenty and twenty five per cent over three years. Average pay has gone from approximately £75,000 to £100,000 for a full time GP.

Mr Brown, who has promised to make the NHS an 'immediate priority' when he takes over as prime minister, is expected to order GPs to justify their salaries by opening their surgeries in the evenings and at weekends.

This government has been in power for ten years. What does he mean, making the NHS “an immediate priority”? As opposed to what he has been doing for the last ten years? He talks as though he is taking over after ten years of Tory misrule.

However overpaid the PCP may think doctors are, morale in the health service, particularly in general practice, is at an all time low. Not surprisingly, GPs think that they are worth £100,000 a year, and they can justify every penny of the recent pay rise because it has been generated on a piece-rate basis for hitting QoF data targets, set by the government. Yes, it has mostly been a waste of time, and the money could have been far better spent, but the government did not listen. You cannot tell Alan Milburn, John Reid or Patriacia Hewitt anything. They already know it all.

And, by the way, whatever happens, you cannot “order” GPS about in this fashion. The use of the word “order” comes from a rabble-rousing PCP journalist, but is irritating nontheless.

But Mr Summers, vice-chairman of the Patients Association, said: "The conditions that people suffer from out of hours are just the same as those they suffer from during the day. Why should they have a second-rate service?

Precisely, Mr Summers. Do you really think it is good economics for the tax payer to underwrite the cost of providing doctors to treat ingrowing toe nails and hayfever at ten o’clock at night? It is an absurd waste of money.

"I have been campaigning for some time for the out-of-hours service to be overhauled. People will die otherwise."

Geoff Martin, of the pressure group Health Emergency, said: "This is desperate stuff. Forcing people to pay undermines the whole principle of being able to access primary healthcare as and when you need it.

"It will put more pressure on the ambulance service and accident and emergency departments, because people will pick up the phone or get in their cars."

Yes, indeed. I agree with Geoff Martin. People will call an ambulance for utter trivia (as they did here) because ambulances are “free”. So idle, selfish, naïve people will save £20 by calling the ambulance. And they might ask the ambulance to stop on the way at the takeaway to pick up their Pizza. Why not? They were coming anyway.

And finally, a comment from the PCP forum:

Well, if I had to pay £20 I would expect a longer appointment than 5 minutes and a whole lot more attention than I get now. Online forum

If people had to pay £20 per consultation, doctors would have much more time to spend with patients as they would no longer be seeing the flood of inappropriate, time wasting nonsense that deluges the out-of-hours service.

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It is a tragedy that people’s minds are closed to the cost and value of health care.

It is damaging for doctor's morale to live with the constant media tirade condemning us as lazy and overpaid. The general public has little understanding of the real cost of professional training and expertise and will not be happy until doctors are underpaid. Health care is perceived to be a commodity that should be freely available. Because it is freely available, it is assumed to be "free" and so it is unacceptably vulgar to suggest that doctors should be well paid.

The health service is failing ergo doctors are over paid. The health service is failing because the demands make upon it by an unrealistic general public are unsustainable.

The “free at the point of entry” mantra is so entrenched that rational discussion is impossible. The NHS has never been “free at the point of entry”. The government pretends it is, for it dare do nothing else, but increasingly the only way for patients to get decent medical care from doctors, rather than from amateurs, is to pay for it.

If we were to introduce a “fee at the point of entry” system, properly safety netted, there is a real chance that the NHS could be saved. An NHS where everyone had access to doctors. Instead, we are moving to a system where only the rich will see doctors. The riff-raff will have to put up with “health care practitioners.”

A view from the other side

Desiderius Erasamus

In regione caecorum rex est luscus

A reader draws my attention to a new and exciting blog.

Insight from the dumbed down on dumbing down.

The BritMeds 2007 (22)

The irrepressible Amateur Transplants

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A great cartoon

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Disagreeing with the GMC

The message from the wider trans trans community is simple and there for all to see - thanks for saving our lives Dr Reid. The honest, spiritual truth is plainly clear: in their eyes, Dr Reid still holds, and will always hold the title as a world renowned psychiatrist whose warmth and compassion for real patient centred care of his patients.

Dr Reid has a strength that cannot be brow beaten by a clear jealous intent of other professionals who have no other power than to simply follow the leader of the pack, and with all might can only simply maintain what is a somewhat Stalinist grasp of a failing NHS treatment resource for transsexual people.

The Angels are standing shoulder to shoulder with Dr Reid

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700 days

The life of the average NHS chief executive

Dr Grumble

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Best year ever…for dead babies

Stakeholders - your NHS continues to deliver (get it?!) the finest patient-centred care through innovative working practices!

Any bugger can deliver your baby - after all WOMEN HAVE BEEN DOING IT FOR MILLENNIA!

Best year ever takes a look at...the NHS


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Abortion: A Barrier to receiving Communion?

Catholic politicians must not cooperate in sustaining through legislation “the unspeakable crime of abortion” and to do so creates a barrier to their receiving holy Communion, says a Scottish cardinal on the approach of the 40th anniversary of passage of the law that made the taking of unborn human life legal.

He calls for action from those in the health-care industry, urging support for “medical professionals who are unwilling to cooperate in the slaughter … on our universities and medical schools to teach that all human life deserves protection … on our hospitals to end testing procedures designed only for targeting and killing the weak and infirm.”

A fascinating blog from a Roman Catholic priest

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It’s those lazy GPs again

“If Tesco can open till midnight every night, why can't our GPs open till midnight every night?”

Dr Rant explains

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Naked Men

It's been an absolute age since I last went to someone in the process of being sectioned.

For those of you not well versed in English law as it pertains to mental illness a 'section' refers to a part of the Mental Health Act 1983. Most often it is used to describe admitting someone for mental health assessment against their will. The section that I most often come across is the police using Section 136 which enables them to remove to hospital the naked man running down the street screaming that he is off to kill the aliens who are putting thoughts in his head.

A good story from Tom

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Free marketers like Wat Tyler want Big Pharma to be allowed to advertise directly to the patients, as they do in the USA



And what is wrong with that? (Thanks to Dr Grumble for the tip)

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To Hell in a Handcart

A medical newsround from….

…Dr Rant

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It is always worse for doctors…

When I blogged previously about our plans to get the surgery done, I was surprised to see another blogger talking about what a difficult decision this must have been. Which made me feel quite a fraud - I have to admit that I really didn't find it that difficult to decide that I'd prefer my son to have a minor, low-risk operation than to go through his childhood with a squint. While I did have the odd fleeting moment of "Oh my god, what if this ends up being one of those stories you read about in women's magazines where the mother talks about how she wasn't worried about it beforehand and then it all went horribly wrong...?"

Good enough mum

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Rita is going to have a rest

Today, I was introduced to the power nap phrase by a work colleague. Apparently, these seemingly harmless powernaps are taken by house wives to improve their cognitive function.

NHS Exposed

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Thank you from the UK

Hi, and thank you for giving grieving people the chance to have a say. the following is from my blog .And this is how i feel . Its about my 10yr old daughter who lost her fight for life after a bone marrow transplant. The doctors had given her a 95-98 % chance of survival but she really got no chance of survival. Its about what she went through till the very end. I want to share it with every body out there.

The Grief Blog

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It’s official : nurses are now too clever to nurse

All nursing courses become degree level. This gives the RCN confidence to demand higher wages for nurses, yet again. Being the RCN the pleas are ignored. Nursing student numbers go down. Universities in an attempt to bring the courses into line with their other courses make them even more academic. Mentors complain about a repeat of Project 2000, especially those that did Project 2000 in the first place.

A letter from the future

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Black Triangle

Thalidomide

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This is why we need a front end charge, a “fee at the point of entry”

You know it’s going to be one of those nights when you’ve only been in work for half an hour, and you’ve spent at least fifty percent of that time trying to explain to someone why a woman who has caught her finger in a child’s pushchair why she isn’t going to get an ambulance any time soon. The conversation went a little like this…..

Nee Naw has one of those nights

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The end of the BMA?




"Greater love hath no man than this, that he lay down his friend for his life".

"Et tu, BMA : the end of the Ancien Régime and the rise of Remedy UK"

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Is health care better in the USA than in the UK?

Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives.

A frightening tale of criminals checking out of jail and into hospital, crooked doctors and poor hospice availability.

US health care costs sore. Are they getting value for money

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Watch out! There is a spy about (1)

Drug companies are paying nurses to visit hospitals and doctors’ offices in the U.K……..

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Watch out! There is a spy about (2)

Internet Spying by Drug Companies Said to be "for the good of the patient"

On May 30, 2005 the Financial Times (London, UK) newspaper reported that drug manufacturers GlaxoSmithKline, Pfizer, and Johnson & Johnson are considering the use of proprietary computer software to monitor web logs, commonly known as blogs, news groups, and patient online forums for mention of the companies' pharmaceutical products in internet postings.

Spying on the medical bloggers.

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Madeleine McCann – the seamy side

I spotted over the last few days newspaper outrage that the only named suspect in the McCann case had asked for advice about media representations and was accused of trying to "cash in" on the story. This hypocrisy comes, of course, from the very same newspapers that have been hoping to sell additional print copies based on their extensive coverage of the story.

Currybet

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Some common sense on dieting and nutrition

A major cause of increasing obesity is certainly the campaign against it -- as dieting usually makes people FATTER. If there were any sincerity to the obesity warriors, they would ban all diet advertising and otherwise shut up about it. Re-authorizing now-banned school playground activities and school outings would help too. But it is so much easier to blame obesity on the evil "multinationals" than it is to blame it on your own restrictions on the natural activities of kids

Food &Health Skeptic

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Diabetic drug may be a killer….

GlaxoSmithKline took another hit yesterday amid signs that doctors in the US were avoiding its blockbuster diabetes drug Avandia after a study linked it to increased risks of heart attacks and death.

Obesity and the salt connection

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The Blair police state

The Fixated Threat Assessment Centre, which is run by Scotland Yard and whose staff includes psychiatrists and police, can authorise the indefinite detention of people it identifies as mentally unstable and potentially dangerous.

“There is a grave danger of this being used to deal with people where there is insufficient evidence for a criminal prosecution,” said Liberty’s Gareth Crossman. “This blurs the line between medical decisions and police actions.”

UK Liberty

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Female circumcision

I’ve always known that I had been circumcised. As far back as I can remember , I have always known that I had been mutilated. I have even always known that it was my clitoris which was cut, even at the time when I didn’t know what it was for.

Approaching the reconstructive operation

A French blog – the article can be read in the original French:

Excision: le chemin de ma reconstruction

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A Cambridge medical student approaches exams


Encouraging words from the tutor

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Your mother is hiding in the wardrobe

Nurses sometimes tell lies. This is a shocking admission.

Mental health nurse

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Want to volunteer for the OSCEs?

So for the past two days I’ve been a simulated patient for the 3rd year OSCEs. This is my second time doing this, and it’s definitely a different experience being on that side of the bed. Yesterday I was the patient for a neck exam (“This patient has come in today because of a suspicion of an overactive thyroid. Perform an examination of the neck, focusing on the thyroid gland.”), while today I was the patient for cardiovascular system exam (“Please perform an examination of the cardiovascular system, leaving out abdomen, peripheral pulses, BP, etc” [it’s only a 5 minute station – how much can you really expect to get done?). It’s always fun to notice the slight differences from student to student, whether it is because they were taught by a different demonstrator, learned little tricks during practicing, or just practiced differently. You can also almost always tell who has practiced, and who hasn’t (which is funny, because they knew exactly what was going to be on the exam because they were told so weeks in advance).

An exciting new discovery: An American medic in Britain


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Dissatisfaction

Last week I had one of those consultations where there is a sudden and unexpected change in direction, and things rapidly become very sticky.

A fortunate man

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How others see us…

ANY NATIONALIZED HEALTHCARE SYSTEM WHICH ALLOWS THIS IS.... SICKO.

The Astute Blogger

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More from our friend Professor Joseph Chikelue Obi

Celebrity Wealth Warning from Professor Joseph Chikelue Obi about selflessly campaigning for long lost children from Ethnic Minority Communities (especially those whose Parents are not Senior Medical Doctors who sadly lost just one of their very many Home Alone Children while carefully lunching away at a Highly Fanciful Foreign Restaurant)

Abolish the GMC

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