Birthdays

Birthdays are good for you.  Statistics show that the people who have the most live the longest.  


~Larry Lorenzoni


Zorro is one year old today.

Yet more fun with statistics

Yet another study has been published presenting the bleeding obvious, and making it seem as if there is a major problem demanding immediate action. 

This time it is the dire consequences of lack of exercise, and poor diet, lifestyle factors, which are said to be responsible for x numbers and y% of deaths each year. I presume they mean premature  deaths or otherwise the implication is that if you live a healthy active lifestyle you will live forever. But what exactly do they mean by premature death. I don’t think I have ever seen a definition. Measured against what? What do they consider a reasonable age to die? At what point do they consider death to be normal and acceptable? 

And what exactly are the dire consequences of dying at, say 65, rather than 85. There is an implication that somehow this represents some sort of extra cost to society, but this is rot. Relatively few people these days die quick sudden deaths having been previously healthy, so I am sure that the last six months of most peoples’ lives are an expensive time, but this will be true whether they are 40 or 80. Nobody’s life is ever saved, by any medical or lifestyle measure, simply extended. Death is never prevented, simply deferred. 

Magaret Chan of the WHO indicates just how far out of touch she is with the statement,  “Slums need corner food stores that sell fresh produce, not just packaged junk with a cheap price and a long shelf-life.” What she does not seem to get is that shopkeepers will stock what people want to buy, that is how they make a living. The reason they often don’t stock fresh fruit & veg, and other healthy produce is that the wobbling lardbuckets that come in to their store won’t buy it. 

And if we are so increasingly unhealthy why is life expectancy so high. Our demographics are now such that we have so many elderly that the younger working population can no longer fund the pensions and healthcare bills of supporting them. As a society the cost of keeping people going until they are so enfeebled they have reverted to a neonatal type of existence is now breaking us. If people really want to make the choice to pursue a hedonistic, lazy, indulgent but short life why should we be hectoring them to do otherwise. 

So these are Zorro’s suggestions for government policy that will actually reduce pensions and health costs, restore a more supportable demographic distribution, and make people a lot more contented and happy. 

The over 65s should be entitled to the following.

     Duty free fags (The UK meaning, not the US....... Or perhaps both)

     Duty free booze

     Recreational drugs available free on prescription.

     Subsidised motorcycles (over 100bhp) and helmets banned

     Subsidised meals in McDonalds, KFC and Pizza Hut.

That is a reasonable start. Any other suggestions?

Yet more defiance

Something extraordinary and laughable happened in Jordan yesterday. A trial commenced against Kurt Westergaard and other Danish nationals for drawing and publishing the mohammed cartoons. 

As far as I am aware Mr Westergaard has never set foot in Jordan, and what he is charged with is not a crime in Denmark.

The concept that a nation can reach outside it’s own borders and attempt to prosecute a foreign national in their own country for exercising rights guaranteed to them in that country would be hilarious if it were not being taken so seriously in Jordan.

The charges include blasphemy and the humiliation of islam. Unsurprisingly none of the “defendants” have felt the urge to go to Jordan and defend themselves. Who can blame them.

OK Jordan, here are those cartoons.

Come and get me.

Honeymoon over

I have said before that I am not a very political person, and I rarely pursue a political agenda. I was glad to see the last government go because of it’s corruption and incompetence and I decided to retain an open mind when it came to the new coalition. I like to think I am unbiased and that my opinions are formulated on the basis of factual performance rather than pre-cultivated dogma.

But I have come to the conclusion that David (call me Dave) Cameron is a complete and utter knob.

Coming to this conclusion has been a step by step process, as he has ratcheted up my disapproval on various issues.

Firstly there is his determination to heavily involve the private sector in the NHS reforms despite the obvious fact that previous such policies, in the form of the PFI hospitals have been a scandalous diversion of public funds into private pockets.

Secondly there is his seeming determination to ensure that a decent school and university education once again become the exclusive preserve of the sons of the wealthy.

But the final straw is what he envisages for the House of Lords. This is an institution that should not be tolerated in a country that claims to be democratic. A house, with no limit to the numbers of members, filled by political decree with government cronies as a sinecure for retired MPs. There are apparently 792 of the buggers at the moment, and nearly half are over 75. 

And perhaps the most disgraceful component of the Lords is the automatic inclusion of 26 Anglican Bishops. Who the hell ever voted for them. And Cameron wants to increase the number of “Faith Lords” by including other religions too. 

I believe it is a strong possibility that the recent census will show that the commonest group in Britain is those of “no religion”. And yet we are going to have to put up with a Lords full of unelected faith representatives, excluding atheists of course.

The only democratically acceptable option for a second chamber is for it to be totally elected. And if the religious institutions feel they should be represented let them stand like anyone else and see how many votes they get.

But Cameron apparently is determined that the House of Lords is not turned into a secular institution. 

What a tosser.

Yeah!

Everybody wants to be a doctor

Bob Bury has written another excellent article in “Hospital Doctor”. In it he touches on something I think we have all noticed over the years, and which he describes perfectly as our nursing colleagues “unrequited desire to take up the mantle of the white coat and stethoscope.” He also makes the statement “I can’t help thinking, like the unreconstructed, arrogant, paternalistic monster of a consultant that I undoubtedly am, that it would be a lot better for the NHS, and certainly for patients, if nurses would just get on with the job of nursing.” a statement with which I identify totally.

One of the commenters to the post has said “Bob is retired. That kind of outspokenness and standing up to the nurses is never displayed by consultants in post” He don’t know me vewy well do he.

A retired friend of mine used to give his patients a first class service. If one of his patients phoned his secretary with a problem she would put a note on his desk and he would phone that patient back within 48 hours, and if the problem could not be resolved that way he would see them in his clinic within 2 weeks. Since his retirement he has been replaced. But now if a patient phones with a problem they are told they can have a phone appointment, with a nurse specialist, in six weeks time. What bloody use is that. You may as well ask the cat.

The implication here is that the nurse specialist is more knowledgeable about the subject than the GP who sent in the referral in the deluded hope that his patient would get the attention of a Consultant. If I were the GP I would be bloody insulted. 

But it’s not just nurses who want to play at being doctors. Bloody Pharmacists!  If I go into a pharmacist’s shop to buy some Paracetamol I get asked the third degree from some numptie, a mini consultation, with no privacy, from a fucking shopkeeper. And at work I am periodically told by one of these jumped up pedlars of quack remedies that I can’t prescribe drug X because it is not in the Trust fomulary, or not licensed for that indication. Let’s get this straight. As a fully registered medical practitioner I can prescribe what the hell I like, for whatever I deem fit, and this principal has been confirmed by the highest court in the land. And all I expect of the pharmacist is that he takes it off the shelf and gives it to the patient. To quote a previous president of the British Pharmaceutical Society “The interests of patients are best served when doctors prescribe, and pharmacists dispense”

And bloody physiotherapists. Every time I see one of these posing idiots poncing along the corridor with a stethoscope around his/her neck I want to strangle him with it. The meaningless jargon they come out with is one step removed from quackery and I am not alone I know in wondering what exactly they do that is of any use. Whenever I see what I think is a physio doing something useful it turns out to be an Occupational Therapist.

And as for “I’m an independent professional, don't tell me my job” midwives, I’m not even going to go there.

Commercials

Normally I loath advertising, on TV, in magazines, hoardings etc, but this is verging on a work of art.

Holidays

“I hate vacations. If you can build buildings, why sit on the beach?”

Philip Johnson That notwithstanding Zorro is off for a week, or maybe two, and will not be blogging. He has been warned.

Mystery Object

Well done to Anna, this was indeed a Davies Herniorrhaphy Clamp

Mystery Object

Any ideas on what this was from about 1850

Blood donors

It occurs to me that in my previous post on HIV and blood donation my overseas readers, and some of my British ones might not understand the reference to a “free cup of tea and a biscuit”. This is a reference to the fact the UK is one of only 39 countries worldwide that gets it’s blood from voluntary unpaid donors. Their only reward is the free cup of tea and biscuit. They have in the past also given donors iron tablets too, presumably to help them throw up the tea & biscuit again.

It is true that research shows that this approach of using unpaid donors, together with rigourous screening of donated blood maximises safety. It is important however that we should not be too self congratulatory. I distinctly remember as a student being taught that UK donors provided the safest blood in the world, because our donors were altruistic, selfless, respectable people. The sort of people who definitely definitely never get nasty diseases affecting the nether regions. 

Selfishness

I have written before about how some of my consultant colleagues can be somewhat less than altruistic, especially when it comes to private practice. Private practice is however not the only area where a minority can exhibit a breathtaking selfishness. What follows is a true story, although I have changed some details to obscure the origin.

A monthly meeting of the surgical directorate at St Elsewheres. The agenda comes to “any other business” and one of the older consultants raises his hand to speak. “I regret to inform the committee that I have this week been informed that I have lung cancer and my condition is almost certainly terminal. My health is already deteriorating, and, although I still feel capable of some work I no longer feel able to undertake on call duties and would like to be taken off the on call rota.”

Initially there is a short period of stunned silence, before one of his colleagues speaks. “Well I am not picking up the extra work!”

More stupidity

We are, supposedly, the most intelligent species on the planet. Makes you despair doesn’t it. All around you encounter people whose acts and words are so mind numbingly stupid that you feel they should not be allowed out without a responsible adult. And this stupidity seems to be no impediment to attaining positions of authority and responsibility. Sometimes you have whole committees of such morons, such as The Advisory Committee on the Safety of Blood.

Until now gay people have been banned from giving blood because of the increased risk of HIV transmission. Undoubtedly some gay men do give blood, without admitting to being gay, but even so the risk of getting HIV from transfused blood in the UK is about 1 in two million, per unit of blood. Pretty long odds.

The committee have decided that such a ban is discriminatory and that it should be lifted, but only for gay men who declare that they have not had sex for ten years. Bloody hell, ten years. Can you see anyone, gay or straight, abstaining from sex for ten years so that they can get a free cup of tea and a biscuit?

The total elimination of risk is simply not possible. Gays may be more likely to get HIV but heterosexuals are not immune. Will the committee next insist that promiscuous heteros should also abstain for a similar period, after all there is nothing that gays do that can not also be done by a straight couple, I think.

The committee remind me of something once said by Einstein. “Only two things are infinite, the universe and human stupidity, and I am not sure about the universe.”

Witchfinder General

I have written before about how GMC procedures are skewed against doctors who are unfortunate enough to come to their attention. How unlikely these doctors are to receive fair and impartial treatment of the sort they could expect as a legal right (article 6) in a proper court. 

Within the GMC there are laid down some safeguards for doctors that should ensure some balance but the GMC is perfectly prepared to ride roughshod over these safeguards when they have the scent of blood in their nose.

Dr Phillipp Bonhoeffer, a paediatric cardiac surgeon, has recently been suspended by the GMC, over allegations of child sex abuse supposedly committed before 2004. I have no way of knowing whether or not there is any basis to the allegations, but spurious allegations of abuse are by no means rare. It is imperative therefore that guilt should be properly established before punishment is imposed. (article 7)

The police have investigated, and have brought no charges, partly because of the length of time that has elapsed since the alleged offences were committed, but also because the sole evidence for the offence is the testimony of a third party, hearsay evidence, which would not normally be accepted in a criminal court.

The GMC are not hindered by such inconveniences. Although their own policy is not to investigate allegations going back for more than 5 years they have decided to ignore that. They have also decided to accept hearsay evidence going back to events of eight years ago. The GMC of course are above the Human Rights Act, in their own eyes at least, and in this attitude they have previous form.

The unfortunate Dr Bonhoeffer therefore is at a great disadvantage. He is not going to have the opportunity to have his accuser cross examined, to question the only “evidence“ against him, which he denies strongly. The GMC, freed from any obligation to prove the offence to criminal standards, have probably made up their mind already. Fair trial my arse.

More fun with statistics

You can’t have missed the fanfare over the new study showing an increased cancer risk associated with alcohol consumption. As usual the statistics are presented in such a way as to scare the living bejesus out of even moderate drinkers. The statement “research has shown a link between alcohol consumption and cancers of the oesophagus, liver, bowel and female breast.” is not one I would dispute. However lets not forget that correlation does not equal causation, as we are all to eager to point out when dealing with quackery.

The three cancers linked to alcohol consumption in men are mouth/throat oesophagus, liver and bowel. So lets look at these in perspective.

Bowel.  This is the commonest of the three with an incidence of about 45 per 100,000, or roughly one in two thousand. According to this article “In Great Britain male bowel cancer incidence rates rose slowly by an average of 1% each year between 1979 and 1999, since when there has been a slight decrease. Over the same period the female rates have changed very little” What increase there has been has been attributed to screening and improved diagnosis. These figures hardly speak of an increasing epidemic. 

Liver. This is a much less common cancer than bowel with an incidence of about 4 per 100,000, although this has increased significantly over the last few years. However the majority of new cases present in the over 70s. Lets face it you have to go somehow.

Mouth/throat/oesophagus. this is the least common with an incidence of 2 per 100,000. Although there has been an increase in the incidence lately this has been attributed to human papilloma virus, transmitted during oral sex. This is a cancer where the correlation/causation factor is most dubious. Is it oral sex, booze, or both? Is there a correlation between drinking and oral sex? Are you more likely to indulge in muff diving while pissed? I don’t suppose that the researchers have asked themselves these questions.

As usual I think this research has been blown up out of all proportion. I don’t believe anyone will take the slightest notice of it. I certainly won’t. As a last word I think this is a far more sensible view. And so is this.

The Professionals

Something of a first for me today. I was asked to sign a proxy vote application form, confirming that one of my patients could not physically attend a polling booth. I expect this is something my GP colleagues are well familiar with, but as a hospital consultant I had never seen one before, so I had a good read of the instructions.

At section 11 it states that the applicant who has difficulty in voting in person, by reason of long term illness or disability, requires the support of a medical professional. It then goes on to give a list of acceptable professions.

Naturally it lists doctors, nurses, dentists and opticians, but then turns surreal by including chiropractors. Yes, the form can be countersigned by someone who believes that all illnesses are due to (radiologically invisible) vertebral subluxations. Why chiropractors are singled out as the only quacks who can do this is not clear.

But it gets worse. The final “profession” on the list is christian science practitioner. How come they are the only looney cult singled out? There are hundreds of others, not to mention other far more popular and conventional religions.

I would love to have been at the meeting where this list was compiled.

Changing times

In a comment to my post on retirement GrumpyRN asks"who the h*ll wants a 66 year old nurse looking after them?"


I agree. I prefer them like this too. 

Sadly even young nurses don't look like this any more

Retreat or feint?

The media are widely reporting that the NHS changes are being drastically watered down, and even talk of a complete U turn on the part of the government. This is being viewed as a major victory for those who have campaigned against the reforms.

But I am not so sure. It all seems to have been a little too easy. Those GPs I have spoken to may have had differing views on the reforms, but all were more or less resigned to commissioning going ahead, and were busily engaging with the transition. All government had to do was press on and it would all have happened. 

It is possible that they have not had the courage of their convictions, or the confidence that it would all work and have caved in to what was in all truth a bluff from the BMA and others. This would require a degree of unintelligence and spinelessness that I don’t buy.

But maybe there is another alternative. Perhaps they knew that any proposals whatsoever coming from a Conservative government would be bitterly opposed by various quarters. Logically they may have released proposals going far beyond what they actually wanted to achieve, and then, in the face of the inevitable opposition, retreat back to a position which gives the impression of compromise, but is actually what they were aiming for all along. 

I welcome the concessions, if that is what they are. In particular the intention to closely regulate any private sector involvement is to be welcomed. We don’t want a repetition of the PFI scandal do we?

Government are being portrayed as weak, dithery and indecisive over this. Maybe. But the revisions to the proposed reforms are likely to lessen what resistance there was, and perhaps those who opposed the reforms have been cleverly manipulated.

Retirement? No thanks.

In any gathering of senior consultants it is not long before talk turns to retirement. The general consensus is always that retirement is that wonderful goal to which we all aspire, the ultimate target, crossing the finish line and enjoying a life of leisure. 

What is interesting is when you ask what people are going to do in their retirement. Amazingly many have not looked any further than the day after retirement, and have no plans for what they are going to do with all that time on their hands.

This may seem like heresy, but there are a lot of downsides to attaining retirement. Firstly there is the instant transformation from a person of status, responsibility and importance to being some aimless bloke, getting under his wife’s feet all the time. Many of our colleagues, with egos the size of Dorset, must find this a huge culture shock.

Then there is the fact that the bodily deterioration starting at that age precludes many of the activities we might have thought of taking up. Unless you have an activity that you have pursued while working, you are going to find it very hard starting something new.

This excellent article by Bob Bury illustrates that retirement is not all it is cracked up to be. 

Ian Duncan Smith has suggested that many would prefer to work on after 65. Most of my colleagues scoff at this suggestion, intending to go at 60, but I think he has a point. I personally would be inclined to work on as long as I can retain my edge, but then, I have always loved my work. It would require of course that my immediate colleagues let me know, as gently as possible, when I am starting to lose it. Some I am sure would tell me that point has already come and gone.

Sadly retirement and ageing go hand in hand, and ageing is not something I look forward to. The only thing you can say about growing old is, as Maurice Chevalier said, “it’s better than the alternative.”

The importance of leisure