Money money money

In his comment to my previous posting Neil80 pointed out “doing away with PCTs will surely mean more opportunities for Doctors to do nicely out of the system” This thought has obviously occurred to others, though, whereas Neil seems to regard the possibility with resigned distaste others appear to regard the prospect as a golden opportunity.

This article indicates to me that some are already  viewing commissioning as a potential gravy train and that even some hospital consultants want a piece of the action.  

I think it will be easy to spot those with ambitions to cash in on this. They will be the ones  unreservedly speaking out in favour of the whole concept.

Some of my colleagues only differ from prostitutes in one respect. There are some things prostitutes will not do for money.

Patients - Vascular Surgery

A picture worth a thousand words

Burn the heretic

A few thoughts on “Infection Control”

Do you remember the days when someone who “decontaminated” their hands in disinfectant twenty times a day or more was considered to have the psychiatric condition of Obsessive Compulsive Disorder? 

Do you ever wonder what are the consequences of repeatedly removing your normal skin flaura? Does it perhaps predispose to colonisation by pathogens. Might it increase the risk of infection to your patients, and you?

What do you suppose, bacteriologically, goes on in the warm, moist, unventilated, anaerobic environment inside those rubber gloves on your hands?

What confidence can you have in an infection control nurse who can not answer these questions, and appears not to understand the difference between a commensal and a pathogen?

Just wondering.

Patients - Urology

Why is this always funny when it happens to someone else?
I think that if there were a god she must be female.
Only a woman would put bollocks on the outside.

            

Top secret

You know how government officials are always leaving documents, laptops, disks etc lying around on trains, in toilets etc. Well one of the silly sods from the MOD appears to have lost a memory stick and it has come into my possession.

From what I found on this it appears that there is some good news, and some bad news. The good news is that our soldiers are definitely getting out of Afghanistan and Iraq very soon. The bad news is the exit strategy.

Cheaper sex

The price of a shag has been slashed by half. This price war was inevitable once they started selling Viagra over the counter though it is a shame to see diabetics, hypertensives and those with high cholesterol being discriminated against.

It also seems unfair to me that so much investment has been made in the treatment of impotence while those with the opposite problem, priapism, are totally ignored.

Fortunately I have discovered a 100% effective cure for this unwanted and distressing condition. If a patient presents to you complaining of excessive and inappropriate erections then take an aspirin tablet and put it in his shoe. That will make him limp.

Quote

What we have done for ourselves alone dies with us; what we have done for others and the world remains and is immortal.

Albert Pike 

Money money money

Further to my last post, I have been asked by Neil80  where I stand on the new proposals for the NHS structural changes. He points out that this may provide more opportunities for financially motivated doctors to milk the system.

PCTs already provide such opportunities. Also my main criticism of PCTs is that they take it upon themselves to dictate practice to the GPs, and even, indirectly also heavily influence the practice of hospital consultants. In my view they have acquired far too much power and for that reason I will not be sorry to see them go. The new commissioning bodies have the potential to be much more the servants of the GPs than the masters. I think it could work as long as this were realised, and, most importantly, the private sector should NOT be involved.

Any extra payments to doctors who involve themselves should be modest and proportionate. 

Management types justify the grossly excessive pay of medical directors by claiming that such pay is necessary to attract the right people.

I would argue the opposite. Those sort of financial rewards, in my view, attract exactly the wrong sort of people.

Money money money

The disproportionately high salaries of a minority of doctors has been highlighted recently as reported here.

There will always be a minority of calculating individual doctors whose career choices and motivation are mercenary, and who are able to milk the system for their own benefit. Look at Trust Medical Directors. Their clinical workload almost entirely dropped, no more on call and their days spent sitting on committees and telling their colleagues how to do their jobs. And for this they get an extra 50K+ on top of their consultant salaries. They usually manage to wangle themselves a CEA too despite the fact that the regulations state that these should not be awarded for work which is already remunerated.

I am sure there are some out there that are worth all this extra, but every Medical Director I have known or met has been arrogant, overbearing and none too bright. And before someone points out the obvious, it does not take much intelligence to use the current system to fill your own pockets at the taxpayers expense. What it takes is shameless cunning and a lack of integrity.

Catholic Ice Cream

I would like to say that the picture above is to draw attention to this incisive article.

That would be a lie however.

It is just an excuse to repost that picture of the nun in the stocking tops.

In fact I have now bought some Federici ice cream, and it is really nice. Very tasty.

But not as tasty as the nun in the stocking tops.

Obesity Virus?

I have read some fucking shite in my time but this tops it all

Mystery Object (3) answer

Perhaps this one was too obscure. The object in the last post was a phimosis dilator. The pointy end was inserted into the meatus of the phimotic prepuce. The screw device was then operated opening the jaws of the dilator to stretch out the phimosis. Now, how many of you are squirming?

Mystery Object (3)

                        OK that last one was too easy. Any guesses on this one

Mystery Object

This is an antique medical artefact the modern version of which would be recognised instantly. It would be about 9 inches long and is made of cedar with a cedar and brass insert. Any guesses as to what it is. If there are no correct guesses I will reveal on Wednesday.

Faith & Reason

I see the pope has been pontificating in Westminster Hall. Trying to play the victim he portrays the catholic church as being suppressed, marginalised and silenced by the secular majority in Britain. What a gross and vile distortion. Where is the evidence for this?

He also said we should “seek ways of promoting and encouraging dialogue between faith and reason at every level of national life”. 

I think in response I will quote a far better man.

“Those who believe without reason cannot be convinced by reason”

James Randi

Patients - Trauma

Communication

My call for anecdotes has been answered. This comes from a contributor who claims not to have been directly involved, and that the story goes back some years, so the story could be apocryphal. Still I like it.

The story concerns a patient with a severe acute lung condition who found himself tracheostomised, and ventilated in an ITU for many weeks. Though mostly conscious and orientated he obviously found it difficult to communicate. One of the ITU Consultants, Dr P, felt particularly for this aspect of ITU patients’ care and spent some time one to one with the patient. He then found out about a new type of tracheostomy tube which had an auxiliary air inlet, directing a small amount of gas upwards from the tube, the object being that the patient could then phonate and speak. This excited Dr P and he sent off for one. He spent much time with the patient explaining to him what was going to be done and what should result.

The great day arrived and the tube was changed, and the gas supply attached. Dr P sat attentively by the patient waiting to hear the patient’s  first words for many weeks. The patient looked at Dr P. After a few unsuccessful attempts he got the idea and the words came, garbled but comprehensible. “Why don’t you fuck off and leave me alone”

Quote

 ‎"I love the Pope. I love seeing him in his Pope-Mobile, his three feet of bullet proof plexi-glass. That's faith in action..." - Bill Hicks

Identity

One of the things that make other medical blog sites out there interesting is the clinical anecdotes. The small but profound accounts of another doctor’s minor triumphs and disasters. The stories that we can identify and sympathise with. Those aspects of a doctor’s work that are intensely personal and human. 

It may have been noticed that I do not post such anecdotes. This is not because I do not have any such stories to tell. I have probably as many as any of my colleagues and occasionally I am tempted to recount them, but I always resist this temptation.

If I were to start down that path I would inevitably start giving away personal details, my speciality, my location and my history. As sure as night follows day it would not be long before I was identified.

This is something I would rather not happen. This is why I do not respond to comments on my blog that appear to me to be putting out feelers. I give no feedback to personal questions. The only facts I have given are that I am a currently practising NHS Consultant and have been qualified for over 30 years. There is an assumption amongst some readers that I am male, which I will neither confirm nor deny.

Remaining totally anonymous is something I value highly. It gives me an extraordinary level of freedom to express what I think and believe. It means I can reprint statements and articles that got the original authors into hot water. I can make criticisms of the highest on the medical landscape. I am able to criticise hospital managers, including my own if I wish, and voice my opinions of their actions. All without fear of suffering what happened to these unfortunates. (1) (2) (3) (4)

On a broader field I can post something like this without fear of this happening.

I am in real life an obscure and unremarkable individual, and I would like it to stay that way. 

Post 100

Well, this is my one hundredth post since starting my blog back in April. I was not at all sure where it was going to go back then, what would I find to write about? who on earth would be interested? Would it be a damp squib and fizzle out?

Six months down the line I think it is true to say that the blog has acquired a certain flavour, not necessarily to everyone’s taste. As to finding stuff to write about, a fellow blogger told me at the time, “there is always something to write about”, and he was right. So who reads it. My stats programme only gives me data since the beginning of July but since then I have apparently had 8313 page views, many of them from overseas.

It is clear from comments to the posts that the whole spectrum of agreement/disagreement has been expressed to my views. This is inevitable and any disagreements I may have had with commenters should not be taken personally. I have only ever rejected one comment, and that, not because I disagreed with it, but because it was a long, pointless and boring ramble. For those who have contributed with your comments, thanks for your contribution, whether I have agreed with you or not. You may have noticed now that comments moderation has been lifted.

Like all blogs I have acquired a small band of registered followers. Thanks particularly to you for the reassurance that I am not wasting my time.

To end with a small gripe. When I started I invited anyone with an interesting NHS relevant story to send it to me if they would like it aired. In six months I have had only one. From hearing my colleagues grumbles I know there is no shortage of such stories. Why don’t you send them here instead of just grumbling? You can have total anonymity if you wish. A contact link can be found on my profile page. Any contributions or suggestions will be most welcome, though I obviously can not guarantee to post your contribution.

I have found writing this blog to be cathartic, educational, and mostly great fun. I wonder if I will still be here six months from now.

The devil finds work for idle hands to do

You may have noticed that I have been very busy today with several posts in one afternoon. There is a good reason for this. While my hands are keeping busy on the keyboard they can not be occupied with other unclean practices. This is especially important in view of the fact that I keep finding myself drawn to that picture of the nun in the stocking tops.

Wanking

In my second post on the mystery object I included a link at the end to a page of tips on how to stop your youngsters wanking, and at the same time turn them into gibbering wrecks. The page is obviously tongue in cheek and I found it hugely funny. The thought that anyone today could have such an attitude is clearly ludicrous. Oh no it isn't. Courtesy of pharyngula here is a link to a video showing that the view that wanking is a heinous sin for which you will burn in hell is alive and well. Where else but the USA.

PS, if you don't want your youngsters being tempted in this way don't let them see the picture below of the nun in the stocking tops.

Not banned, yet.

I thought I would also post these two, in similar vein as I expect they will be banned too.

Banned!

This advert for ice cream has been banned in the UK by the advertising standards authority. Apparently it might offend some catholics. Meanwhile the head of the catholic church, a man who has protected and shielded the worlds biggest paedophile ring, is about to be feted by the high & mighty at the UK taxpayers expense. To add insult to injury Peter Smith, the catholic archbishop of Southwark, has described those who might express their opposition to this visit as "crackpots and lunatics." The words pot, kettle and black spring to mind. Posting the advert is not the only protest I can make. I am going to buy some of this ice cream

Quote

Silence never won rights.  They are not handed down from above; they are forced by pressures from below.  


Roger Baldwin

Working time directive

There has  been a lot of comment lately about the perceived effect of the EWTD on training of specialists. Particularly from surgeons, there still seems to be considerable support for the conditions endured by doctors of my generation. This is odd. I remember thirty years ago my colleagues being almost unanimous in condemning the onerous hours we worked. Now these same people seem to have changed their minds and seem to wish to impose the same torture on those now in training. They even seem to have convinced many trainees that a return to the bad old days is desirable.

There are one or two things I would point out to todays trainees. The first is this article.

Secondly I would point out that many doctors over the years have struggled hard to consign to history working conditions for doctors that verged on paid slavery. These people endured it and felt that you should not have to. Do not be so willing to throw away what has been achieved for you.

Third, you assume that longer hours will mean better training. From experience we oldies know full well that the extra hours will mostly consist of covering the work.

Todays trainees have no experience of the conditions that they now seem to be clamoring for. Conditions that they have been brainwashed into believing will make them better doctors. I have no doubt that if the clock is turned back it will not take long before they realise they have been had.

Be careful what you wish for. You may get it.

Book burning

I see Terry Jones did not burn his korans after all. I think on balance that was right,  though I have some reservations. On principle I think that burning books as a concept is disturbing, from nazi Germany to Fahrenheit 451. On the other hand it was being used as an example of freedom of expression, of which I totally approve even if I disagree with, or am offended by what is being expressed.

His motivation, "my god is better than your god" was childish and provocative but the reaction he got in some Moslem countries was monstrously excessive and ridiculous. It is clear that many in these countries, with their hysterical demands for Jones' arrest and punishment, do not understand the essential freedoms enjoyed by the citizens of western democracies. Nor do they understand the restraints placed on democratic governments. Jones was not proposing to do anything illegal, and was simply going to destroy what was his own property.

I confess to a sense of bemusement seeing the hatred and vitriol exchanged between the exponents of two different views as to the nature of the great fairy at the bottom of the garden. My bemusement is tempered with despair that there are people who would be happy to kill for the sake of their delusions.

In the end I think he should not have received the publicity he has. He should have been ignored completely and allowed to burn whatever he wanted that was his to burn. Be it a koran, a bible or the latest Jeffrey Archer. He should have been left in his obscurity and nobody should have taken any notice.

Mystery object - answer

Well I had a number of suggestions for what this was, all of them more or less right.

The mystery object is described on the website where it is offered for sale as; “an internally spiked, male anti masturbation device.”

Such things have been around for a long time. The picture above is a similar device from about the year 1900. Back then masturbation was regarded as a huge social evil and risk to health, and supposedly sane and normal people went to great lengths to discourage the practice, including applying devices like this. I am not at all sure what sort of person would buy the modern one, available today for about £100, but since the spikes are designed to discourage erection I can not imagine any sane man consenting to have this applied.

Thankfully today we have progressed a little in our attitudes. As Woody Allen once described masturbation “It’s safe sex with someone you love.” 

However for those of you who still feel that discouraging wanking in youngsters is the best way to produce well balanced, stable, happy and healthy adults then this page should give you a few helpful tips.

Mystery object

Occasionally while randomly surfing the net you find yourself led down alleys that in retrospect you might have preferred not discovering. Once embarked down one of these paths you can find yourself impelled by a horrible fascination and curiosity until an area of ignorance you would rather have retained is lost forever. This is one of those areas. Any guesses as to what this object is. I will post the answer tomorrow. No prizes.

Quote

The only thing wrong with being an atheist is that there's nobody to talk to during an orgasm. 


Unknown

Book Burning

If I were to ask you who Terry Jones was you would probably think of this Terry Jones, of Monty Python Fame.

There is however another Terry Jones who, until recently, enjoyed a well deserved obscurity as the Pastor of a tiny church in Florida called The Dove World Outreach Centre. If you look at this site it is clear that the DWOC is nothing unusual across the Atlantic. There are thousands of such small, and not so small, churches across the USA pushing this type of unsubtle evangelism, usually headed by some foam flecked ranting pastor of borderline sanity. Some of these have become big names, and acquired considerable wealth, such as that execrable fraud Benny Hinn.

So why has Terry Jones and his DWOC suddenly shot to prominence. On his site he makes no effort to hide his islamaphobia, promoting his book “Islam is of the Devil”, (yours for just $12.95) and he has announced that on September the 11 he is going to publicly burn a number of copies of the Koran. The purpose of this apparently is to "make a statement to honour those murdered on that day,"

Pastor Jones has considerable support from like minded individuals across the USA, who have been incensed by the proposal to build a mosque on the site of the twin towers. What strikes me most about these people is the sheer hypocrisy. Such hatred and antipathy from those who follow a religion supposedly grounded in forgiveness and tolerance. 

I have no particular love for islam, or christianity. I view all religions with deep but equal contempt. But the reality is that Pastor Jones’ actions are likely at a stroke to undo much painstaking work by American and British servicemen to secure the hearts and minds of the, mostly muslim, people of Iraq and Afghanistan. It will make the soldier’s job harder and more dangerous.

Pastor Jones can not, and should not be stopped in his intended stunt. It is his right to express his views, and he is at liberty to do as he pleases with his own property.

Perhaps though there is one way in which Jones can be made to reflect. I don’t know his Email address as his site for some reason is off line. I suspect his site has crashed. But if and when  I can, I think I will email him to remind him of what it says in the bible at Judges Ch 6. V31.;

If he whose altar has been destroyed is a god, let him act for himself!" And perhaps I will also inform him that, in the interests of balance, if he goes ahead, then on the day that he is burning korans I will burn a bible. Or I would if I had one.

Next CMO

I have commented on another blog that the next CMO is likely to be a prize twat and Jobbing Doctor seems to be of the same view, though he is a little more civil about it. But then I had another thought.
Can anybody apply?

Patients-Nephrology

Rebellion

I feel in a rebellious mood this morning. A desire to shake the establishment to the core and express my dissent. I am going to assert my independence and freedom of thought. Yes I am going to do it. I am going to put two fingers up. I am going to wear a long sleeved shirt to work today.