Thought for the new year.

The best anti-depressants on the market are not made by Pfizer, GSK or Lilly. They are made by Cadburys, Fullers, and Harley Davidson.

Happy new year.

How much!?

Other bloggers out there have commented on the media tendency to doctor bashing, and the usual inaccuracy involved. Well the Independent is joining in today having a go at NHS Consultants. Apparently the average salary of an NHS Consultant is £120,900 pa. That is news to me and all the colleagues I have shown this article to today. Now I know we have a pretty good rate of pay but none of those I asked gets more than the top increment of £100,446, and many of them do not even get that. Still we would not want accuracy to get in the way of a good story now would we?

Herbal medicine

There is a commonly held belief that herbal remedies are somehow safe because they are “natural”. There is also some confusion between homeopathy and herbalism which reinforces this view. Homeopathy is of course totally safe as it does not have anything in it, but that does not stop some people believing it works. For possibly the most extreme and deluded view on what it is effective for look at this, and weep.

Herbal products however often contain active pharmacological substances some of which can be toxic. You would think therefore that those who favour herbal medicine would approve of measures to make the practice safer. Testing to ensure quality and safety of herbal products is to become mandatory next year, although there will still be no requirement to show efficacy. 

These are fairly basic and desirable requirements I would have thought, but the advocates of herbal medicine disagree. They feel that the standards applicable to pharmaceutical products should not apply to them. They feel they should continue to be able to dispense potentially toxic substances, with little or no efficacy and potentially serious side effects without regulation.

If you read the comments to these two articles (1) (2) it is clear that there is a great deal of utter ignorance and stupidity out there. The usual ill informed views are peddled, including the accusation that this is all a conspiracy by the pharmaceutical companies, and doctors are all in their pay.

Now I know the pharmaceutical giants are not without fault, and I will be posting in the near future on one of their nastier practices. But by and large they deliver the goods. In just 100 years their products have transformed the practice of medicine and contributed enormously to the huge increase in life expectancy. An increase not found in the days when CAM practices were all there was to give patients. 

And at least I know if I take a modern drug what is in it, what is not in it, it’s exact strength and how it might react with other medication I might be on. I know the company has spent millions on testing it and that they are not allowed to promote it for conditions for which it has no license. 

Which is more than you can say for herbal medicine.

Cosmetic surgery?

In one of my previous posts I commented on some of the medical conditions now treatable on the NHS that were perhaps not quite what Bevan had in mind when he brought the NHS into existence.

To the list of these conditions I think can be added the operation of hymenoplasty, an operation to restore  a ruptured hymen, in order to convey the illusion of virginity. My use of the word illusion is quite deliberate. You can restore the anatomy but virginity, once gone is gone forever.

This is not an uncommon procedure in the private sector, with a typical cost of £4000, but it is also increasingly being done on the NHS, most commonly on moslem women who need their husband to believe in the wife’s virginity on the wedding night.

Before my stance is misinterpreted I have to say that I am entirely in sympathy with this procedure being done on the NHS. I disagree totally with those who feel that this is a purely cosmetic procedure. Bearing in mind that many of these women live in a situation where “honour killing” is a very real threat, even in the UK, I think there is a strong argument that this is in fact a life saving procedure.

Honour killing is a strange term. I don’t see much honour in a group of armed men targeting and murdering a single defenceless woman. Is there a similar sanction against a man who is not a virgin on his wedding night? Presumably he is taken to one side and told he is a very naughty boy.

Research

It is many years since I published any research and the thought of ever having to do any again fills me with loathing, usually. But here is a project I wouldn't mind getting involved with.

Quote

“A man is not finished when he is defeated. He is finished when he quits.”

Richard M Nixon

Language

One or two people in the past have criticised me for my choice of language. In fact it appears that I have been using one of the most versatile and expressive words in the English language.

http://www.youtube.com/watch?v=Q23sodJ0SIg

A rock and a hard place

There is no doubt that patients’ lifestyles influence their state of health. Their dietary habits, alcohol consumption, smoking and sexual practices are the main, but not only factors in this. To doctors this is of limited relevance. Certainly we should adopt a preventive role in advising our patients of their lifestyle practices that can potentially impinge on their health, but even this has it’s limits. While no-one would argue that we should encourage our patients to stop smoking, how many doctors would advise patients to give up horse riding (128 deaths/yr per 100,000 participants) or other risky sports.

By the time patients present to us with the consequences of a lifetime of bodily abuse however lifestyle becomes unimportant when it comes to treatment options. At this stage we simply have to treat to the best of our ability. This is crystallised by the GMC good practice guide at para 7; “You must not refuse or delay treatment because you believe that a patient's actions have contributed to their condition.” and “You must not unfairly discriminate against them by allowing your personal views to affect adversely your professional relationship with them or the treatment you provide or arrange.  This includes your views about a patient's age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.”

So what do you do when your Trust proposes to engage in precisely that sort of discrimination as is happening here, and is going to require your co-operation to apply it. To co-operate puts you in breach of GMC good practice guidelines, while to defy puts you most definitely in the firing line as far as your employer is concerned.

The GMC does seem to have this covered as they state; “If inadequate resources, policies or systems prevent you from doing this, and patient safety is or may be seriously compromised, you must follow the guidance in paragraph 6.”

So what does it say at paragraph 6? This is where suddenly the crystal clarity suddenly deserts the GMC and they are a little more wooly” you should draw the matter to the attention of your employing or contracting body. If they do not take adequate action, you should take independent advice on how to take the matter further. You must record your concerns and the steps you have taken to try to resolve them.”  Firstly you are supposed to stick your head above the parapet and start making a fuss. And when, inevitably, your expressed concerns are ignored then what. Then all of a sudden it is for someone else (unspecified) to advise you. What a cop out. The logical next step of course is whistleblowing but as I have pointed out before this is likely to have catastrophic repercussions, despite the presence of legislation supposed to protect you. 

And when your Trust turns on you like a rabid psychotic dog, because you have followed GMC guidelines, just how much support do you suppose you will get from the GMC?

Ring fencing

Despite the promises of the new government to ring fence the NHS budget it now appears inevitable that financial cuts are on the way. And not small cuts either. Although various figures are being predicted there is no doubt that we are talking in the region of billions of pounds, possibly in the region of 10% of the whole NHS budget. (1) (2) (3) (4)

In fact financial difficulties are nothing new for the NHS and Trusts have been quite imaginative in how they have managed to extract extra funds directly from the punters to help balance the books. Parking fees for example, and the rip off that is patientline.

In addition there is the use to which charitable donations are put. I remember when donations from the League of Friends and WRVS were used to buy amenities for patients. TVs, radios, hair dryers, that sort of thing, to make patients’ stay more comfortable. These days these donations are increasingly used to buy essential medical equipment, that should come out of the Trust budget. In addition whereas in the past premises for these charities were provided free of charge by hospitals, many Trusts are now charging rent, and if the charity can’t afford the rent they find themselves replaced by private sector commercial traders.

Increasingly desperate Trusts are even asking already hard pressed staff, especialy nurses, to do extra unpaid work.

Yet in spite of all this difficulty the NHS are still able to fund “pastoral services”, estimated by the National Secular Society to cost the NHS in the region of 40 million pounds a year. Even the most cashed strapped Trusts still seem to find money for these services. That 40 million would pay for a lot of extra nurses, or support staff to enable the nurse to concentrate on nursing duties.

I have no doubt that some will misconstrue this as a suggestion that pastoral services should be removed from the NHS altogether, but it is not. I am simply questioning who should be paying for it. If we are charging rent on the charities who actually give all their profits to the NHS, is it too much to ask that the religious institutions pay their own way?

Quote

The great pleasure in life is doing what people say you cannot do

Walter Bagehot

Colleagues, Neurosurgery

NHS reforms

The NHS is going to be alright. The solution was blindingly obvious and it is nice to see our present masters have seen this and are going to make everything better.

Cowardice

I think that this article from The Onion strikes a chord with more people than would care to admit it

Wikileaks

I have been asked to say where I stand on the present Wikileaks revelations, and have given it some thought. Trying to articulate my standpoint I find that one of the comments to a previous post does the job perfectly and I will simply quote that contributor.

""They too were done under that Free speech banner, but could've caused chaos on a global scale that would've perhaps even caused lots of killings and heartache everywhere, or damage to the trust between allies, or enemies" - I simply do not accept such rationalisations as a good enough reason to argue against the likes of WikiLeaks.

All of the conditions that you describe (global chaos, killing, heartache, loss of trust, etc) - all long predate Wiki.
For far too long we have trusted leaders (such as Blair) when the record shows time and time again that a healthy skepticism would have been far more appropriate - for example, remember all that tosh about WMDs - the 45 minute strike capability, etc?

In my opinion political factions might develop a more creative approach to solving various conflicts if there was MORE rather than less openness.

If we look back at the 'cold war' for example, we can see that paranoia was driven by secrecy, and all for what, eh - for the Russians to be hosting the 2018 world cup (sobs silently)

the a&e charge nurse

Comments

I have no objection to those who disagree with me making reasoned arguments in my comments and until now all comments submitted have been unmoderated. But there is always one who abuses the privilege and my resident troll has been getting steadily more abusive and strident. So much so that his last two comments have been deleted.

For the time being therefore I have reimposed comment moderation, because I can. Apologies to everyone else. Please don't be put off.

Yet more defiance

This is the now famous picture drawn by the Swedish artist Lars Vilks for which many believe he should be murdered. I have reproduced it because the more people reproduce it, the more targets there are for this vile intolerance. Then the true absurdity of the overreaction becomes more apparent. The picture is now widely available on the web on many sites and blogs. It has received far far more publicity than if it had been ignored.

What are they going to do, kill us all?

More Defiance

Regular readers will know that I have a soft spot for the ice cream manufacturers Federici , not only for their rather nice ice cream but also for some of their advertisements, which, rather gently in my view, mock catholicism. A (very small) number of complaints have resulted in the advertising standards authority banning two of their adverts, bans which can only be considered as a gross, excessive and unjustifiable restriction of freedom of expression.

Well Federici have refused to sign an undertaking not to run further advertising which might offend catholics and are challenging the ban. Good for them and I hope they win. If you agree then you can communicate your views to the ASA here.

And then we might get more pictures of the nun in the stocking tops.

Defiance

A few posts ago I repeated a quote that was a little rude to the French. This film clip should make amends. One of the finest pieces of cinema ever made.

Prostate Cancer

Prostate cancer has been getting an increasing profile lately. Apparently among the reasons why many men present late with this condition are;

1. An innate tendency among males to ignore symptoms of any kind which might indicate something serious, while at the same time making an oscar worthy performance over anything actually trivial, such as flu.

2. A knowledge among men over what will happen to them as part of the examination for any complaint below the waist. This latter might possibly be addressed by a new blood test for prostate cancer, as featured here.

CEAs again

The ball keeps rolling in the direction I have previously predicted, and frankly advocated. And also as I have previously predicted the rank & file of Consultants are making very little protest.
Perhaps I will change the name of the site to Dr Nostradamus.

Working time directive

I have posted before on the working time directive and the working conditions my generation endured that masqueraded as training. To those who think I am exaggerating (my on call room was a hole in't ground covered wi' a tarpaulin) have a read of another's experience. And another.

In the same post she also talks about the involvement of doctors in torture and what they could possibly have been thinking to allow themselves to do this. I think here she misses the most likely motivation, To quote from another of my previous posts

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

Quote

Deer aren't capable of that kind of thinking. All they care about is, what am I going to eat next, who am I going to screw next, and can I run fast enough to get away. They are very much like the French." 

-Ted Nugent

Job Interviews

In my time I have been on both sides of the table at job interviews and I am sometimes asked what to expect by trainees at the end of their training. I have always found the question difficult to answer, but this picture I think gives a good idea of the experience from the point of view of the applicant.

Freedom of speech

Regular readers will be aware that I have a particular obsession with freedom of speech, and I am incensed by efforts to suppress this, either by individuals or institutions. The right to freely express our opinions has just been strengthened, and quite right too.

Midwives

I have risked criticism in the past for my views on midwives, (1) (2) (3) but you don’t have to make up stories about them being stupid, some of them will quite happily confirm that with their own words and deeds.

I have personally known one who thought reflexology potentially useful in labour, and, more seriously, another who thought that prayer was a suitable alternative to resuscitation in a flat, blue newborn.

This article is another illustration. The opening phrase “Having a medical background as a qualified nurse and midwife is an extremely useful tool for being a homeopath” Says it all I think.

Quote

Thus that which is the most awful of evils, death, is nothing to us, since when we exist there is no death, and when there is death we do not exist.

- Epicurus

Death

I commented recently on the media reporting of death rates being at an all time low. Well someone agrees with me.