Encouraging a lower standard of care
The Jobbing Doctor talks, with frustration, about doing a “Gordon Surgery”. In other words, his practice has jumped through the hoops to get the extra money from the government for doing extended hours.
I have been doing what I will call a “Crippen” surgery for several years. I started when Gordon was ensconced in Number 11 spending his day telling the inhabitant of Number 10 how to do his job. Now Gordon is in Number 10 spending his working day telling the inhabitant of Number 11 how to do his job.
Nothing changes.
My “Crippen” surgery runs from 6.00 pm until 8.00 pm, usually on Wednesday evening. I book 16 patients at seven and a half minute intervals. When I started in my current practice, the elderly partners (three over 65) all offered five-minute appointments. With all the experience of youth I was able to tell them that seven and a half minute appointments were essential if one was to practice proper medicine. They were a tolerant lot, and said I was very welcome to book patients at seven and a half minute intervals – provided I saw the same number of patients they did. Which is what, feeling self-righteous, I did. Now my younger, part-time, female hobby-doc partners tell the older partners that ten minute appointment are essential if one is to practice “proper” medicine.
Nothing changes.
Well, one thing does. The older partners told the younger, part-time, female hobby-docs that they are free to do ten-minute appointments if they wish, provided they see the same number of patients. And here is the change. They have stayed at seven and a half minute appointments.
Gordon Brown believes in pre-booked, ten-minute appointments and will not pay us the extended hours money if we do seven and a half minute appointments. I’m not prepared to fudge, or lie (some practices are, he said sanctimoniously) so my late evening surgery is now booked at ten-minute intervals. I will see twelve patients rather than the usual sixteen. I will enjoy having that little extra leeway. I may even be able to use some of the time to catch up on paperwork.
Thus, I can only earn the extra money by penalising my patients and forcing more of them to go to see nursey at the walk-in centre.
Crazy.
Labels: control freakery, extended hours, Gordon Brown, ten minute appointments
34 Comments:
You patronizing old sh!t. Nurses do not be like being called nursey and you know that. Were you one of my Doctors, I would be moved to violence.
Neither do they like being called "monkeys", "baggage handlers" or "the 5 GCSE brigade", pinky - yet the litany of abuse grows longer by the day, I'm afraid.
Curiously any reference to doctors as "greedy", "pompous", or "power crazed" tends to be met with incomprehending, or hurt indignation.
Crippen, I'd be interested to hear your opinion on this new "well note" idea. It seems a bit silly to me, and indeed in some ways achieves the opposite of what the government intends, by starting from the premise that people aren't capable of doing anything (although there are some things they can manage), rather than, as in the old system, that people are capable of doing things, although there are some things they can't.
"Curiously any reference to doctors as "greedy", "pompous", or "power crazed" tends to be met with incomprehending, or hurt indignation."
I presume you never read anything he wrote about Bacon then. Or Darziel. Or any of the other greedy pompous pricks he's attacked over the years who happen to be doctors. Selective amnesia? Perhaps you should see a nurse(y).
pinky said...
You patronizing old sh!t. Nurses do not be like being called nursey and you know that. Were you one of my Doctors, I would be moved to violence.
Tuesday, November 25, 2008 4:17:00 PM
the a&e charge nurse said...
Neither do they like being called "monkeys", "baggage handlers" or "the 5 GCSE brigade", pinky - yet the litany of abuse grows longer by the day, I'm afraid.
Curiously any reference to doctors as "greedy", "pompous", or "power crazed" tends to be met with incomprehending, or hurt indignation.
Tuesday, November 25, 2008 4:38:00 PM
+++
Hi girls! Good to see that you are coming up for the ground bait!
John
PS I couldn't remember, do I normally spell it "nursy" or "nursey"? Probably the latter, I think. Must get it right!
Difference is, anonymous, that Darzi and Bacon are attacked as individual sub-prime doctors, whereas 'nursey''s generic.
Ten minute appointments, well, good for Gordon Brown. My GPs' appointments are ten minutes anyway.
("Girls"?)
I don't really see how the "nursey" remark contributes to the post. "Nurse-led clinic" is more accurate and makes exactly the same point. Its only good manners.
Awww, Jayann - you took the wind out of my sails ;o)
Anyway, as Jayann points out, anonymous, there is a world of difference in rubbishing an entire group en masse as opposed to attacking wayward individuals.
The two examples you cite (Darzi & Bacon) are not criticised for being doctors (god forbid) no, they are criticised for being the architects of two naff projects, polyclinics and a consumer website, respectively.
One of the reasons Dr Crippen is so fond of abuse may be because he has NEVER been able to offer a shred of PUBLISHED evidence to back up his many alarm stories about nurse quacks - I suspect that this must be driving him mad given how desperately he clings to the 1% Oxbridge hypothesis.
Crippen always says he has the greatest respect for "nurses who nurse" - it's just nurses who are used as doctors (whether because they're forced to by government targets or whether they choose to) when they're not qualified to do so. The nurses at the polyclinic will mostly fall into the latter catagory.
it seems people have a rather upsetting tendency to pick up only on the slightest criticism. Understandably nurses find the label 'nursey' upsetting. BUT, as PK points out, Dr. Crippen has always had great respect for nurses who nurse. Whilst nurses find these labels irritating, it must be equally frustrating for doctors to have to put up with people who are not medically trained trying to do their job.
pinky, the a&e charge nurse, etc. If you can muster the energy to scroll down a little you will see several examples of Dr. C defending nurses in a number of ways.
Surely by now you all know the following:-
nurse = highly trained professional doing crucially important job for which he/she trained viz nursing
nursey = highly trained professional who for reasons of pride/arrogance combined with a breathtaking lack of insight is pretending to do a job for which s/he is not trained.
It's an abbreviation, used to sum up the all pervasive trend within the NHS (and elsewhere) for "nursey" to demonstrate the Peter principle by pretending to be "doctor"
No offence intended.
John
a & e charge nurse, :)
What an incredibly simplistic view, Dr Crippen.
I am not trained in IT but someone has to sort out computer problems (log in codes, printer not working, no sticky labels for path samples, security cards for locums).
I'm not trained as a telephonist either but the phone rings at least 1,000 times a day in our department guess who gets to pick it up 9 times out of 10 ?
And guess what, I didn't train as an administrator either, but if a receptionist doesn't turn up for a night shift who do you think is expected to sort out the front desk ?
Or if a locum doctor needs a time-sheet signing who do you think they make their way toward ?
I could go on but I'm sure you get my point.
Nurses take care of lots of stuff but the extent of the non-nursing component of our job from booking/arguing with hospital transport to rolling round on the floor with a disturbed psychiatric patient (or piss head) seems to have been woefully underestimated in your cosy, and archaic formula.
None of this prevents gormless looking doctors approaching me just about every single shift to ask where the portable otoscope is (sorry, forget to mention portering duties as well).
The silent answer in my head is "it's where the last f**king doctor left it" but of course in reality I interupt my nursing duties to hold the doctors hand while we silently walk round the department looking for it.
Nowadays I pull colles fractures, slice abscesses, stitch up wounds, inject antibiotics, etc, etc - it's all just grist to the nursing mill.
If I don't do it (or somebody like me) then patients simply wait longer and longer and longer.
You know, exactly the way things used to be in A&E until a very sizeable population of patients complained that enough really was enough when it came to the abysmal standards of care many of them received.
What's this 1% thing? Is it a reference to doctors being brighter than anyone else? Perhaps this will help the nurse...
http://neatorama.cachefly.net/images/2007-08/iq-range-occupations.jpg
See they are! And diagnosis is difficult. So the bright, trained people should do it. Not blinking nurses.
And, nurses should not be pulling Colles fractures or incising abscesses. Shame on your department.
Thank goodness I've had all my family now...
http://news.bbc.co.uk/1/hi/scotland/edinburgh_and_east/7747646.stm
What about THIS one?:
"...the younger, part-time, female hobby-docs..."
So - because women, in British society, bear the brunt of the burden of unpaid caring duties (like children - SOMEONE has to care for the things), and work part-time in order to try and balance work and family life for their families' needs - they are to be seen as 'hobby docs' in the worldview of Crippen, who thinks the highest form of life is the male medical doctor, and all else are pond life. I have to agree - this level of arrogant ignorance about people's lives, and his obvious contempt for so many patients and (in his worldview) 'lesser' colleagues must compromise his ability to be an effective GP.
Unless he's not a real GP - but has been writing this blog to wind people up- for reasons unknown.
Ooooooh! Just love the vitriol. Let's take a look at this comment.
What about THIS one?:"...the younger, part-time, female hobby-docs..."So - because women, in British society, bear the brunt of the burden of unpaid caring duties (like children - SOMEONE has to care for the things), and work part-time in order to try and balance work and family life for their families' needs - they are to be seen as 'hobby docs' in the worldview of Crippen, who thinks the highest form of life is the male medical doctor, and all else are pond life. I have to agree - this level of arrogant ignorance about people's lives, and his obvious contempt for so many patients and (in his worldview) 'lesser' colleagues must compromise his ability to be an effective GP. Unless he's not a real GP - but has been writing this blog to wind people up- for reasons unknown.
They are "hobby docs". Their main priority is their family and they will always subjugate the needs of their family to the needs of the practice. They all have husbands but, when one of their children is ill, it is never th husband who takes the day off work at short notice. It is always them. They in fact are the sexists; they take it for granted that hubby's job is more important than theirs. I've got 4 children and both my wife and I work full time and have always managed a balance that has meant that we have done our jobs properly. It has not been easy. For some of the time I (and many like me) have had to take the greater part of the burden of our child care - not that I mind doing it, I don't. But pleeeeeeeeeese don't give me this sexist feminist crap suggesting that only wimmin can do child care.
I do not think, nor have I ever said, that MALE doctors are superior. But what you need to get your tiny mind round is the fact that the pendulum has swung too far as wimmin now make unrealistic demands of their employers about child care. If they can't do the job, they should leave and do something else.
Then you descend into abuse:
"his obvioius contempt for so many patients"
Talk me through that if you would, with examples.
Finally, I write the blog to let of steam. It you want to take it all 100% seriously, and take every word at its face value, well, that is a matter for you. Maybe you should get out more.
John
John wrote:
"They all have husbands but, when one of their children is ill, it is never th husband who takes the day off work at short notice. It is always them. They in fact are the sexists; they take it for granted that hubby's job is more important than theirs"
Ian wrote:
And you're telling Anon to 'get out more'?
Seriously - how do you get such a warped view in which to construct these 'arguments'?
If I huff n puff a little will your straw man fall down?
You're a misogynist John, just admit it.
John's arguments also tend to follow the Peter Principle by employing the same laborious argument to its highest level of incompetence without realising its futility.
It's a shame he ruins a valid argument - nurses are going thru a hiatus of change as the P2K grads roll into senior clinical roles (having been carried by traditional nurses for several years who are since retired or higher in the hierarchy leaving an ever dwindling number of nurses who remember traditional nursing) to be supervisors to new grads - but supervisors who perhaps don't realise what they don't realise.
Personally, overall - it's better for nursing - but not good for medics who, not only can't find the otoscope, but cannot for the life of them seem to remember where they left 'their nurse'.
There's as much good as there is bad about the changes in nursing but following another generation it will be a forgotten issue as a new status quo will establish from which we'll make change new change.
I do agree that much of health care is becoming 'protocol' driven and I wondered, John, if you could support me in ridiculing this protocol driven tool that some have been hammering since 1990 - the Mini International Neurospychiatric Interview (MINI). A medically constructed tool for the differential diagnoses of psychiatric conditions. No nurse was involved in the construction of this tool so it has to be good I guess - and especially since its use has been validated by Prison Guards -
Seven individuals participated in the interviewing, including the warden (RR), four corrections officers, and two psychologists. One of the authors (DWB) held two 120-minute training sessions in the use and administration of the MINI."
http://www.jaapl.org/cgi/reprint/32/2/158
"Our experience with the MINI was successful in many respects. We were able to show that this highly structured diagnostic interview could be taught to and administered by a variety of correctional personnel, including those without mental health experience."
2 hour Psychiatry training no less (and, specifically, no more) - for Correctional Officers to become diagnosticians!
At least it takes 5 O levels a whole weekend to become a Nursey to wipe bums.
I wonder if John has any idea what training for a "crucially important job for which he/she trained" actually entails nowadays?
Hi Mr Ian
Now you have told us more about yourself, I always see you lying on Bondi Beech with a can of Fosters in your hand. But I digress....
You said:
"Seriously - how do you get such a warped view in which to construct these 'arguments'? If I huff n puff a little will your straw man fall down? You're a misogynist John, just admit it.
++++++
It is said to have to revert to the dictionary, but may I remind you that a misogynist is:
"a man who hates woman; or who acts from a hatred of women"
You are falling into the knee jert stereotypical last ditch of the intellectually moribund feminists who assume that anyone who disagrees with anything they say is ipso faco a misogynist.
I have news for you. In this modern world, child care is a father's responsibility just as much as the mother's. You may not agree with my views on child care as an equal responsiblity - that's fine - but holding such views does not make me a misogynist.
Don't be silly.
John
Oh Hi fake doctor John.... I don't usually receive a response but I guess you were right - Groundbait... mutter mutter...
If the best you're going to do is pick the weakest part of my argument, please don't flounce around with it like some meaningful moral victory.
And in this modern world... Nurses no longer play handmaiden to doctors and are capable of doing significantly more than you would permit them to do.
So are we in the same world together now?
And I'm no longer beachside after 4 years - I've moved outback. It's not bad either as I only have to put up with a psychiatrist clinic once every 5 weeks for 6 hours. The rest of the clinical practice is mine.
Quick mate - slap another protocol on the barbie...
'Tis beautiful.
actually, Dr C has a point.
We call it patriarchal indoctrination.
I have met and worked with the specimen many times within the NHS. "Mommies" get the special treatment that amounts to significantly more time off, and increased workloads for those of us who have the misfortune to work with them.
While I agree that mothers do need some support, they end up far too often being a burden on their colleagues who hav to pick up the slack, put up with the endless baby blabber and have to cover at least 10 hours a week because "mommy" had to leave early for some baby emergency. Good for mommy that she can do it. bad fr the poor schmuck like me who has t pick up her slack at no extra pay.
Thanks for that soopermouse
+++++
Oddly, my 15 year old daughter was off school yesterday with a temperature and ear infection. So we both went to work, with her tucked up with fluids, nurofen and a phone. My health centre is only a mile away, so I popped home during visits. My wife phoned her a couple of times. I came home for a late lunch. My wife made sure she got home earlier than usual ( just after 6.00 pm) and so on.
It's a fudge. It's a compromise. Yes, it is stressful. But we both feel it is not right to take time off work for this. When the children were younger and had viral infections, I used to fill them up with calpol and take them into work to sit in our coffee room crayoning. They flatly refuse to do that now, and prefer to stay at home.
Are we bad parents?
John
soopermouse - there is no point being made here other than the point that John always seeks to gain moral ground by diminishing the value of others rather than espousing any virtues of his own (save for the nauseating amounts of righteous 'effort' he puts into his patients care while everyone else around him fails - which he then contradicts in his subsequent posts anyhow).
Yes, paternal care is a good change and power to the blokes that do it.
But after a gazillion generations of women taking primary care giving roles to babies while men were quite happy to remain hunter-gatherer - it's a bit much to ask it all to turn around in a generation or even two.
Consider the vote for women and the right to work - once women were "given" (by men) their naturally given right - it still took 5 or 6 generations to realise women were still getting paid less than men doing exactly the same job.
It's taken about 8 to get it mostly right (just the top 2% old boys network fat cats to go and women have equality in the workforce).
Now, in not quite two generations of the 'metro-man', he wants to gripe about a woman being discriminatory by not letting the man be the child minder by creating a hyperbole of emotive argument based on what? -
Comments like: "Their main priority is their family and they will always subjugate the needs of their family to the needs of the practice. They all have husbands but, when one of their children is ill, it is never th husband who takes the day off work at short notice. It is always them. They in fact are the sexists; they take it for granted that hubby's job is more important than theirs."
Utter unsubstantiated bollocks. Or hyperbole - presenting a remotely possible situation into a fact.
They in fact are the sexists; they take it for granted that hubby's job is more important than theirs.
Completely and conveniently ignoring several hundred years of female suppression where it was ordained - by the men - that the man 'work' and the woman 'care'.
I don't recall any male suffragettes tying themselves to railings and demanding their right to stay home and be an equal parent. they simply changed how it works - cos they can.
I've got 4 children and both my wife and I work full time and have always managed a balance that has meant that we have done our jobs properly.
This is like the shared Drink Driver role - I'll drive to the pub and you can drive back missus.
When the little Crippen juniors were pattering the floorboards I'll bet you a Fosters beer on Bondi Beach that dear 'doctor' John was a typical old fashioned male role model and wasn't to be seen in pinny and doing domestic chores with his kids.
He would have been the 'active parent' in the later years of their lives around 15 onwards - and most his parenting skills came from his wallet.
It has not been easy. For some of the time I (and many like me) have had to take the greater part of the burden of our child care - See above - shared drink driving.
And onto my favourite...
not that I mind doing it, I don't.
Mind? MIND?
He fathers the children but it's ok - he doesn't mind caring for them when he absolutely has to? I wonder if Mrs Crippen minded giving birth to them? Or if her maternal decisions were made only because she absolutely had to?
But pleeeeeeeeeese don't give me this sexist feminist crap suggesting that only wimmin can do child care.
Of course - this is all plain inflammatory and John has merely had a shit day cos his female Nursey picked him up for some mistake he made at work today and he just wishes she'd stay the fuck home and raise kids.
As for my views on equal parental responsibility - it's irrelevant John as I, nor you, are arguing that point.
John, you are a traditionalist - which is why you staunchly argue for old style nursing and blame it for the failures of health care. How can it be that you don't argue for the lack of old style parenting as being the failings of moral values?
Pick a principle and stick to it will you please.
Mr Ian said...
soopermouse - there is no point being made here other than the point that John always seeks to gain moral ground by diminishing the value of others rather than espousing any virtues of his own (save for the nauseating amounts of righteous 'effort' he puts into his patients care while everyone else around him fails - which he then contradicts in his subsequent posts anyhow).
there are so many internal contradictions there that it is hard to analyse; I only “diminish” those taking part in the dumbing down of the NHS, primarily the nurseys (and, most certainy, the GPwSIs)
I am not quite sure what you mean by “righteous effort” but whatever you do mean (do give examples) why is it nauseating?
Yes, paternal care is a good change and power to the blokes that do it. But after a gazillion generations of women taking primary care giving roles to babies while men were quite happy to remain hunter-gatherer - it's a bit much to ask it all to turn around in a generation or even two.
I don’t want to turn it round. I see it as a shared and equal partnership
Consider the vote for women and the right to work - once women were "given" (by men) their naturally given right - it still took 5 or 6 generations to realise women were still getting paid less than men doing exactly the same job. It's taken about 8 to get it mostly right (just the top 2% old boys network fat cats to go and women have equality in the workforce).
Sure, I agree with that 100%. And it’s still not right in some areas, though it is better than it was. In other areas, the pendulum has swung too far. For example, do you really think that Lady McCartney should have had such a pay day?
Now, in not quite two generations of the 'metro-man', he wants to gripe about a woman being discriminatory by not letting the man be the child minder…
I said nothing of the sort. That is entirely your construct
…by creating a hyperbole of emotive argument based on what? - Comments like: "Their main priority is their family and they will always subjugate the needs of their family to the needs of the practice. They all have husbands but, when one of their children is ill, it is never the husband who takes the day off work at short notice. It is always them. They in fact are the sexists; they take it for granted that hubby's job is more important than theirs."
Utter unsubstantiated bollocks. Or hyperbole - presenting a remotely possible situation into a fact.
It’s not bollocks where I work. Our part time female doctors do PRECISELY that, and it causes a lot of resentment
They in fact are the sexists; they take it for granted that hubby's job is more important than theirs. Completely and conveniently ignoring several hundred years of female suppression where it was ordained - by the men - that the man 'work' and the woman 'care'.
I don’t need a history lesson. I know what happened in the past. But that is not a reason for going to the opposite extreme
I don't recall any male suffragettes tying themselves to railings and demanding their right to stay home and be an equal parent. they simply changed how it works - cos they can.
I've got 4 children and both my wife and I work full time and have always managed a balance that has meant that we have done our jobs properly. This is like the shared Drink Driver role - I'll drive to the pub and you can drive back missus. When the little Crippen juniors were pattering the floorboards I'll bet you a Fosters beer on Bondi Beach that dear 'doctor' John was a typical old fashioned male role model and wasn't to be seen in pinny and doing domestic chores with his kids. He would have been the 'active parent' in the later years of their lives around 15 onwards - and most his parenting skills came from his wallet.
How little you know. I’m beginning to get a picture of you. You have adopted the Aussie “Crocodile Dundee” male stereotype and simply cannot understand the possibility that a male might, for example, change a nappy
It has not been easy. For some of the time I (and many like me) have had to take the greater part of the burden of our child care - See above - shared drink driving.
And onto my favourite... not that I mind doing it, I don't. Mind? MIND? He fathers the children but it's ok - he doesn't mind caring for them when he absolutely has to?
I stick by that. I don’t mind doing it. Changing nappies and routine child care is not intellectually challenging but it needed doing, and so I did it. Didn’t mind as they were my children. Would not care to do it for other children though.
I wonder if Mrs Crippen minded giving birth to them?
Well, the process of child birth is not much fun for the woman (or the helpless by standing man) and she did not enjoy the process much, though she liked the outcome and that made it all worth doing.
Or if her maternal decisions were made only because she absolutely had to? But pleeeeeeeeeese don't give me this sexist feminist crap suggesting that only wimmin can do child care. Of course - this is all plain inflammatory and John has merely had a shit day cos his female Nursey picked him up for some mistake he made at work today and he just wishes she'd stay the fuck home and raise kids.
Not at work today. Did have a bad day yesterday, though. We don’t have any nurseys in our practice, only nurses, and they are excellent.
As for my views on equal parental responsibility - it's irrelevant John as I, nor you, are arguing that point.
John, you are a traditionalist - which is why you staunchly argue for old style nursing and blame it for the failures of health care.
I am a traditionalist on nursing. Absolutley right. I was around when it was done properly. And you have not expressed yourself clearly. I think you mean that I blame many (not all) of the ills of the NHS on the lack of traditional nursing care. And I do.
How can it be that you don't argue for the lack of old style parenting as being the failings of moral values?
Because those are two entirely different issues, Mr Ian. Now I know that as a nursey you will have difficulty multi-tasking and so I will try and put it in clear protocol terms.
Old fashioned parenting where women did all the work without support BAD
Old fashioned nursing where nurses cared for patients GOOD
Modern parenting where the man and woman share the workload GOOD
Modern nursey nursing where the nurses carry clipboards, pretend to be doctors and don’t touch patients BAD
Can you cope with that?
++++++++
And now I have to stop for, although it is my day off, I have to go to Sainsbury, do the shopping, and prepare the evening meal. You see? A modern man. Or, maybe, nought but a domesticated capon. Take your pick!
John
Actually Mr Ian, here's the thing I learned back when I was a wee babe : the child who doesn't cry doesn't get fed. To apply that to the situation we're talking about, I can guarantee you that most women I know will not even for a second consider asking their male partners to do something around the house or some healthcare. They just assume that their partner wouldn't, because that is how they were raised and indoctrinated.
It's not that Men gave women rights, women took it. It's time they did it again. don't shut up and do everything yourself, ask for your partner to take some fuckign responsibility
Actually Mr Ian, here's the thing I learned back when I was a wee babe : the child who doesn't cry doesn't get fed. To apply that to the situation we're talking about, I can guarantee you that most women I know will not even for a second consider asking their male partners to do something around the house or some healthcare. They just assume that their partner wouldn't, because that is how they were raised and indoctrinated.
It's not that Men gave women rights, women took it. It's time they did it again. don't shut up and do everything yourself, ask for your partner to take some fuckign responsibility
Yes there are more female part-time/fixed term docs and some of them (some of the ones I've encountered) do prefer to work that way, not to be partners. Some of those and some full-time young mother women docs don't, I'd say, give as much time and thought to their patients and to the practice. Otoh, some do, and very much so. And some men part-timers, fixed-termers, locums, and partners, are the same!
However
being a burden on their colleagues
I agree some most certainly do, and it's the single childless, men and women, who tend to be expected to pick up the slack, work unsocial hours, and so on. And yes, this is about patriarchy.
You all sound like sociology text books or even worse Rousseau.
Men and women act differently because they are different. It's got something to do with being 'indoctrinated', but the hereditary factor is just as if not more important in generating differences in behavior. It is interesting to note that it appears that the behavioural differences between the sexes are even more pronounced in modern civilizations.
Don't look at the house without considering the foundation it stands on.
Anonymous (at 3:36) any evidence to back up your concerns - thought not.
By the way, the real "shame" is not that A&E nurses now offer a few little extras (and pretty good they are too, in the main) - no, it was the disgraceful standard of care that existed because large swathes of NHS patients waited, and waited, and waited, and waited..............(and not just in A&E either)
Back then elderly patients, say, were often stuck in a busy waiting room until their name mysteriously rose to the top of a never ending queue [after all, you are unlikely to die from a colles fracture).
Then when your name was finally called (hooray) you might have been treated by an SHO who had only ever reduced one or two fractures before, and there was a fair risk that they might lack confidence (perhaps because of an inadequate haematoma block last time, or lack of familiarity with Biers block procedure, etc, etc).
Now it is customary for a nurse to request an x/ray at triage - scandalous, eh, tantamount to the end of civilisation as we know it.
How would somebody with only 5 GCSEs ever understand this sort of stuff ?
To make matters worse somebody like me comes along and manipulates a fracture into a better position, FFS.
All I can say in my defense is that ALL patients are offered a choice (doc or quack) - in other words nobody is ever treated by a nurse unless they want to.
Curiously several doctors have consented to the ENP experience (as customers in A&E) including my own GPs wife funnily enough - no complaints from any of them so far.
quick A&E CN - I think after your nursey post John may need resus. Give him to the FY1.
Don't know where to start on Crippen's rants since I last posted. Haven't got time right now to fisk.
However, I could NOT let the 'am I a bad parent?' comment go by. He took his sick kid to work? In a doctor's surgery? To "colour with crayons?"
That is irresponsible on so many levels - and destroys his claim of him 'putting work first'. A sick kid in a doctor surgery, belonging to the doctor. Either he's had to compromise his patient care (I know how compelling the needs of sick kids are!) or he's compromised his kid's welfare.
Either way - his comments about the 'hobby doc' females, in light of his admission, further stink of hypocrisy.
Indeed, Mr Ian - I have no doubt Dr crippen would prefer to wait for a consultant rather than have one of the hoi polloi press the defibrillation button ;o)
"..being a burden on their colleagues ...
I agree some most certainly do, and it's the single childless, men and women, who tend to be expected to pick up the slack, work unsocial hours, and so on. And yes, this is about patriarchy."
But you then have to address the flip side of this. Women, with or without children, pick up the vast amount of slack on the country's unpaid caring burden (saving the welfare state billions). Women comprise the vast amount of people having to care for children, for the elderly, for sick husbands or sick adult children, acute or chronic.
Crippen himself some time ago was criticising families for NOT taking on elderly relatives enough (harking on the idealised 'Asian' family in contrast) - never mind that his claims do not seem to be backed up by what we know about modern life (women still have the bulk of unpaid care duties in all ethnic communities, including British.)
Crippen seems far removed from the real world of flexible working practices and the demise of the breadwinner wage (so women go out to work to financially support the household because men don't earn enough), of female headed households were women are compelled by the state to work to financially support their children, but where they also have child care responsibilities, so that their work is necessarily part time and - different from most GPs, even the part time ones - low paid.
I am a part-time academic, working that way as a female head of household while trying to full-time care a young disabled adult (up until recently, also another child who even now not quite an adult, but who has just entered the workforce). I'm not a 'hobby academic' just because I work part-time. I'm committed to my work. The family are poor. Crippen could not exist on our family income, even with our very meagre welfare payments. If I gave up work- we'd be homeless soon enough.
It's really quite cringe-making to watch the various pronouncements on this blog and realise how removed from the world Crippen is. Whatever he protests, his views about women in particular are creepily atavistic.
On the subject of 'hobby docs', i.e. part-time, I recall that Crippen admitted that he is indeed a 'hobby doc' himself, yet still earning in excess of £100k! But hypocrisy is what we come to expect of this much maligned character, who spouts so much nonsense about subjects outside of medicine about which he knows very little.
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