Linguistic abuse of the mentally ill

Another look at the careless use of language that so often offends the mentally ill

... we thought back to the books we were brought up with. Little Black Sambo; Noddy always being chased by golliwogs and so on. We also took it all for granted but it was not quite right. It was not right at all; engrained stereotypes, the thoughtless use of words and pictures with their subtle, insidious undertones….

The Guardian, Tuesday 24 November 2009

The National Dumbing-Down Centre

Courses: we have offered our university-accredited courses in minor illness management since 1997. You can attend the two-day Pharmacology course or the three-day Clinical Skills course, or combine the two and then go on to complete our six-month Certificate.

This three-day course runs from Monday to Wednesday and comprises seminars on the assessment and management of minor illness. Practical, focussed and intensive, it covers all the important facts.


Introduction

• Minor Illness Management for Non-Doctors
• Tips on clinical examination
• Sore throat, earache and cough
• UTI, D&V and musculoskeletal pain
• Rashes and mouth problems
• Infections and antibiotics
• Communication and change management

Why on earth bother to go to medical school for five years when, for a mere £450, you can learn all this is three days?  And who is running these courses? The "National Minor Illness Centre".  A grandiose title but, on closer inspection, one of dubious significance notwithstanding the use of the NHS logo which is proudly displayed on their website. This is not a nationally recognised organisation at all. It is a handful of GPs and nurses in Luton trying to make money.

It takes all sorts.

They have some clinical questions on their website.

• Should children with conjunctivitis be excluded from school? 
• What medication should be stopped when a patient had D & V? 
• Which patients with shingles should be treated with antivirals medication? 

If you have not been to medical school, you may not know the answer to those questions. But don't worry. Dr Gina Johnson and Dr Ian Hill-Smith or, if you like that sort of thing, their nursey will tell you - but only if you send them £25. 

There is one thing on their website that I like. This picture:

Is this meant to illustrates the level of expertise that trainees from the "National Minor Illness Centre" will be exercising? Do you want to expose your children to them?


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See also The Jobbing Doctor's "How dumb can you get?"

And the Ferret discovers that it is getting even worse in Australia

The Australian Government is also trying to replace GPs as the cornerstone of Australian medical practice, in a way that draws striking parallels to what the Labour government has done here in order to usher through the privatisation of the NHS....And, interestingly, there is a push for another change – namely, that all practitioners working in primary care, irrespective of their qualifications and expertise, be now called “doctor”. Such a collaborative model readily brings to mind the sovietisation of health care.

What value a medical degree?

Why the NHS is failing.

Any more good ideas?

My drug-sodden old friend Wat Tyler at Burning our Money has just explained in a few hundred words how NHS resources are being squandered. Read

Earning your pharmacist an honest crust

Tyler may not know, but will not be surprised to hear,  that these pharmacist "reviews" are laboriously transcribed onto paper and then sent to the family doctors who put them, unread, into the bin.

Anal grammarians and eating placentas : Robert van Persie

A short piece in the Guardian again today, this time about the alleged mystical healing powers of placentas and Robert van Persie's alleged trip to Serbia for some implausble alternative medicine. Let's just hope that the Quacktitioner Royal does not take this one up.

I've already had a couple of gleeful emails from some like-minded anal grammarians asking me why I want timorous souls to be thrown away. Just for the record, I wrote:

But, if we timorous souls are not prepared to eat placentas, can they be put to any other use before they are buried in the garden or thrown away?

This was changed by the sub to:

But, if more timorous souls are not prepared to do so, can they be put to any other use before they are thrown away?

Gawd! I make enough mistakes of my own, without that schoolboy howler being inserted above my name.

ADHD - should nurses take over diagnosis and management?

In the United States, approximately 9% of the school-age population is diagnosed with ADHD. It's the most commonly diagnosed behavioral condition in children today. Twice as many boys are diagnosed with ADHD as girls.

Concerta

The race continues in the USA to get 5 million children on psychoactive medication for behaviour problems. Drug companies in the UK are not allowed to advertise directly to the general public but the internet means that is only a theoretical restriction. In the USA, the makes of Concerta have a highly sophisticated pitch aimed directly at parents. Listen to the soothing guitar music as the virtue of medication is extolled to all who care to browse.

Dear God, what are we doing to our children? And now, in the UK at any rate, much of the diagnostic work is passed down to the nurses.

The letter about the little girl arrived, not from the paediatric consultant, but from the nurse "specialist"...

The Guardian, Tuesday 17 November 2009

Sick certificates

King Andy's guide to faking a sickie

It has always suited governments to encourage the long-term unemployed to "discover" an illness and move on to incapacity benefit. The move is easily made, as GPs are a "soft touch" for a sick certificate. But while this move to incapacity benefit may please the government by providing a short-term "fix" for high unemployment figures, it creates an insidious long-term problem...

The Guardian, Tuesday 3 November 2009

Myalgic encephalomyelitis (ME) : science, quackery & mental illness

The militant wing of the Myalgic Encephalomyelitis (ME) brigade broke out the champagne when a recent article in Science reported that a retrovirus had been found in 67% of ME patients compared to under 4% of the general population. Sadly, the study only involved just over 100 patients and is thus inconclusive...

The Guardian, Tuesday 20 October 2009

Public Stools

Garderobe

A smartly dressed, middle-aged lady came in and sat down. Let's call her Angela. Angela was a child of the 60s, the decade of female emancipation. But, while other girls of her age were letting their hair down at Woodstock, Angela was still at school....

6 October 2009 The Guardian

The illusion of choice

Last week, my ageing motorcar started making an odd noise. The service manager told me I needed a replacement camfleugal pin. He gave me a list of 10 suppliers. Which one did I want them to use? I don't know much about camfleugal pins. I told him to get it from where he normally gets them. The illusion of choice is important. Patients who need to go to hospital are now offered a "choice" under the government's much publicised "Choose and Book" (CAB) system. But how does CAB work in reality?

cont...

The Guardian 29 September 2009

GP boundaries

Last week GPs were mystified when the health secretary Andy Burnham announced plans to abolish practice boundaries, which will leave patients free to register with any GP of their choice, regardless of where they live. But has the government thought this through? GPs are morally and contractually obliged, when medically necessary, to visit sick patients in their own homes: the elderly; the infirm; the terminally ill. It is the government that has previously insisted on predefined areas. It might be frustrating for a patient to find he cannot register with a particular doctor because he lives a couple of miles outside the doctor's area, but if you do not stick to the boundaries, a couple of miles soon becomes 20, and before long the doctor has patients in Manchester, Birmingham and Southampton. How are they all to be visited at home then?

There is a more insidious agenda.... (cont)

Roast swan and port

 

BMA House

Dr Crippen: Is the BMA right to want to ban alcohol advertising?

I joined the British Medical Association almost accidentally, as did most doctors. I wanted to receive its journal, the BMJ, and, when I was a student, the association offered a good value "membership and magazine" deal, so I signed up. And you know how it is with direct debits; you never get round to cancelling them. But the BMA is not my "trade union", it does not consult me about my views and it is not authorised to represent my views.

The BMA's image is that of elderly medical crustacea who meet weekly to dine on roast swan, washed down with vintage port, before issuing yet another diktat about how less privileged folk should live their lives. The latest is that they want to ban alcohol advertising.

There are four teenagers in the Crippen household. Last week, yet again, we had the alcopops conversation. Yet again, I explained that if any of them were to drink a glass of neat alcohol, they would find it repugnant. Alcopops are a way of wrapping up alcohol to make it appealing to young, credulous teenage palates.

My 16-year-old son disappeared off to the small cupboard in the garage and ^­ returned clutching one of my two remaining treasured bottles of 1983 Chateau Palmer. "This," he said, "represents a transparent attempt by the French wine industry to disguise alcohol in such a way that it will appeal to credulous, middle-aged, jaded palates. This bottle is probably worth over £100. Why don't you sell it? At least alcopops are cheap. And," he giggled, "unpretentious on the palate."

Thus, as parents, we journey down the long and tortuous road of hypocrisy. I'm not a wine expert but there is no doubt that vintage Chateau Palmer slips down a treat, and I treat my remaining bottles with reverence. How can one compare alcopops to vintage wine? Vintage wine is "important". Alcopops are cheap and nasty.

But this cuts no ice with teenagers. Why should it? It's all booze. It's all alcohol, packaged to appeal to each and every age. A common problem I see professionally is teenage drinking. I am not convinced that stopping advertising and increasing prices is the answer. Setting a good example might be.

The medical profession itself does not have a good record as regards alcohol abuse. Perhaps, therefore, we speak with special expertise. The BMA's "roast swan and port" image is unfair, but I am uneasy that they chose, without consulting their members, to adopt such a prescriptive, parental role to society.

The Guardian, 15th September, 2009

Gordon brown is genuinely lovely...

There have been some appalling rumours, originating from the blogosphere, but now circulating widely  in the main stream media as well, suggesting that Gordon Brown is so seriously mentally ill that he has had to be treated with mono amine oxidase inhibitors. (MAOIs).

A generation ago, MAOIs had some currency. They were mainly used second line if tricyclic antidepressants had failed. They were said to be particularly good for depressives with severe anxiety related symptoms and social anxieties. They were not used often, even twenty years ago, for they had potentially dangerous side effects (high blood pressure crisis)  if combined with certain foods. And it's not just "cheese and chianti"; the list is much longer and includes many commonly available "over the counter" medications.  They are virtually never used now. I have only ever had one patient who took them.  I would never initiate them, and I have not prescribed them for over twenty years.

4.3.2 Monoamine-oxidase inhibitors


(MAOIs)

Additional information interactions (MAOIs).

Monoamine-oxidase inhibitors are used much less frequently than tricyclic and related antidepressants, or SSRIs and related antidepressants because of the dangers of dietary and drug interactions and the fact that it is easier to prescribe MAOIs when tricyclic antidepressants have been unsuccessful than vice versa. Tranylcypromine is the most hazardous of the MAOIs because of its stimulant action. The drugs of choice are phenelzine or isocarboxazid which are less stimulant and therefore safer.


Phobic patients and depressed patients with atypical, hypochondriacal, or hysterical features are said to respond best to MAOIs. However, MAOIs should be tried in any patients who are refractory to treatment with other antidepressants as there is occasionally a dramatic response. Response to treatment may be delayed for 3 weeks or more and may take an additional 1 or 2 weeks to become maximal.

Withdrawal


If possible MAOIs should be withdrawn slowly (see also section 4.3).

Interactions


MAOIs inhibit monoamine oxidase, thereby causing an accumulation of amine neurotransmitters. The metabolism of some amine drugs such as indirect-acting sympathomimetics (present in many cough and decongestant preparations, section 3.10) is also inhibited and their pressor action may be potentiated; the pressor effect of tyramine (in some foods, such as mature cheese, pickled herring, broad bean pods, and Bovril®, Oxo®, Marmite® or any similar meat or yeast extract or fermented soya bean extract) may also be dangerously potentiated. These interactions may cause a dangerous rise in blood pressure. An early warning symptom may be a throbbing headache. Patients should be advised to eat only fresh foods and avoid food that is suspected of being stale or ‘going off'. This is especially important with meat, fish, poultry or offal; game should be avoided. The danger of interaction persists for up to 2 weeks after treatment with MAOIs is discontinued. Patients should also avoid alcoholic drinks or de-alcoholised (low alcohol) drinks.




Other antidepressants should not be started for 2 weeks after treatment with MAOIs has been stopped (3 weeks if starting clomipramine or imipramine). Some psychiatrists use selected tricyclics in conjunction with MAOIs but this is hazardous, indeed potentially lethal, except in experienced hands and there is no evidence that the combination is more effective than when either constituent is used alone. The combination of tranylcypromine with clomipramine is particularly dangerous.

Of course, the fact that they are rarely used now is not proof that Gordon Brown is not taking them but the chances that he is taking them are so low that I believe they can be discounted.


Gordon Brown is a poor communicator and, particularly after his disastrous appearance on YOU TUBE, there has been much speculation about his mental state, not least from Tory blogger Iain Dale. Brown is in the public eye and being the object of such speculation comes with the territory. And, as David Owen showed in Disease, demented, depressed, serious illness in heads of state, high office is no guarantee of health or sanity.


As we approach a general election the knives are out and the Tory spin machine moves into a higher gear. The image of a mentally ill prime minister taking drugs with dangerous side effects is too good to miss. What, though, is the other side of the story?  Indeed, is there another side of the story?  Possibly. In a thought provoking article, the DK reveals some inside information from a source close to the prime minister. The DK is no cuddly left winger and the fact the he publishes this information very much increases its credibility. So get the Kleenex out and read:

...although his politics are not mine, Gordon Brown is genuinely lovely...


The Devil's Kitchen

I do not believe for one moment that Gordon Brown is taking MAOIs, and I think this is a smear too far.  But I worry about what marriage has done to the DK. Is connubial bliss turning him into an old romantic?  Put the Kleenex away. Gordon Brown employed Damiann McBride and Derek Draper as professional smear merchants. Live by the sword, die by the sword.

Going to the Devil

I rise briefly from my slumbers to spring to the defence of the Devil, whose most recent post has caused a furore and even resulted in one of his devoted followers saying:

A blog too far for me I'm afraid. I though most of your rants were good but the standard recently has been dropping and this is one is just shite. Deleting your RSS feed from Firefox.

Poor, timorous soul. It is precisely this sort of balanced writing that first attracted me to the Devil's Kitchen. Long may it continue.  Connoisseurs of the Devil, like Dr Crippen, have long known that it is instructive to look at the time of publication of the DK's articles. Those written in the early hours of the morning, when the DK is well into his second cup of Ovaltine, are particularly rewarding.


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And see the always reliable Daily Mash

Swine flu immunisations

The government's chief commissar for immunisations, Professor David Salisbury, has said that nurses have a "duty" to be immunised againstswine flu. A poll by nursingtimes.net showed that 30% of respondents would refuse to have it. If the government is surprised at the number of nurses who will not have the immunisation, just wait to see what happens when they offer it to doctors. On the facts available to date, I will not be having it. Nor will my family. I will not be the only doctor taking this view.

In 1976, after a swine flu outbreak at Fort Dix in the US, a vaccine was hastily manufactured. It had to be withdrawn a few weeks later as it was causing serious neurological problems. Science has moved on since then, you may say. That could not happen now. But, if governments have confidence in the safety of the vaccine, why has Kathleen Sebelius, the US Secretary of Health and Human Services, felt it necessary to sign a document making federal officials and vaccine makers immune from lawsuits related to any ill-effects from the vaccine? Why has the UK government sent letters to neurologists asking them to be on the alert for neurological complications caused by the immunisation?

I did trust the government when it introduced an emergency vaccination programme for smallpox. But smallpox was a deadly disease and the vaccination was tried, tested and proven. The swine flu immunisation is being rushed out. It is of uncertain efficacy. It is to be given to prevent a disease which, as yet, is mild. The second wave of swine flu may be worse. I do not know. But I do know that, if the virus mutates to a more virulent form, the immunisation may in any case not work. We are in the run-up to an election. The government has to be seen to be doing something.

Every year, like obedient sheep, thousands troop into their local health centre to have a "flu immunisation". You may have had one last year. Did it work? I am amazed that there has not been a public outcry of people saying, "Excuse me, I had a flu jab last year and I still got swine flu."

Millions of trusting citizens may have the new swine flu immunisation. If something goes wrong, as it did at Fort Dix, we could have a major medical disaster.

The Guardian, 8 September 2009

Time for a blogging break...

 

Dr Crippen takes a break

Dr Crippen is signing off for a while.

I'm not going to stop writing but blogging is time consuming and other opportunities are on the horizon. A general election is looming. NHS BLOG DOCTOR has not endorsed any political party but regular readers will be aware how disillusioned I am with this government (for which, optimistically but naïvely, I voted in 1997). The damage it has done to the NHS is, I fear, irreparable.

Political doctrine and political allegiances do not matter. It is the blind pursuit of political doctrine that is destroying the NHS. New Labour has much to answer for, but the roots of the malaise go back a generation to the early days of Thatcherism.

All our NHS really needed was the funding it is now getting. But instead we have gone along the lines of private business and, with that, vast amounts of money are being squandered on commissioning and billing and measuring and bonuses and, bizarrely, even advertising and PR.

Our government, to its cost, worships markets. Even the baled-out bankers are regrouping and once again are spinning the roulette wheels of the flawed money markets. And in the NHS, private providers, despite their very poor track record, are still the order of the day. The NHS as we know it is doomed.

Why is the NHS being privatised?  Dr Grumble

What matters is the provision of a reasonable standard of health care for all UK citizens without regard to their status or income. We no longer have that. We have a two-tier standard of medicine just as we have a two-tier standard of education. What should the government do for the NHS? The Jobbing Doctor elegantly sums it up in one word:

Whenever I am asked what I think that the Government should do about the NHS, I generally say "Less".

Here we go again...The Jobbing Doctor

It is time for a break from regular blogging. Time for retrenchment. My close colleagues, Dr Grumble and the Jobbing Doctor, both of whom I commend, will continue to tell you how it is, how it was, and how it should be.

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Does anyone know from which Lake District mountain Mrs Crippen took the snapshot?