"Any willing provider"

What's the betting that consortia will tend to go for the cheapest?

CEAs

Articles in “Hospital Doctor” never seem to attract much in the way of comments but the article about the loss of Clinical Excellence Awards has been an exception.

Unsurprisingly the commenters are markedly polarised between those who wish strongly to see CEAs retained and those who, equally strongly believe they should be abolished.

This very polarisation is a blinding illustration of why they should go. They should be entirely abolished because they are divisive. They create a bitter schism between the haves and the have nots. If a government or an employer were to deliberately wish to foster disunity within a profession they could not come up with a better idea than that of CEAs.

For a very modest cost they can divide and rule, in effect paying off the leaders of the profession, and leaving the rest of us with no voice. 

The system creates bitter division within the profession. It is wicked, and promotes dishonesty, mendacity, greed, self interest and corruption. It encourages us to fight among ourselves and makes us weaker and easier to control. It has no redeeming features and should go, never to be resurrected in any form.

GMC gets it wrong

Just when you cut the GMC some slack and agree with one of their actions they go and spoil it all.

A locum surgeon in Hereford operated on an 8 year old girl to take out her appendix, but removed an ovary instead. I think even most medical students know their anatomy better than that and this can be nothing other than gross incompetence. She did not even realise what she had done, the error being discovered by a presumably bemused histopathologist examining the specimen.

So what do the GMC do about it. Nothing.

The GMC stated “Her actions fell seriously below the standard expected but it was an isolated case and there was no need to issue a warning” and “the doctor did not pose a risk to patients and that confidence in the profession had not been undermined as a result of her actions.”

The doctor has now done three appendicectomies under supervision and the GMC think that that is enough to allow her to be let loose on patients again. The GMC further stated “it was not necessary to issue Dr Abdullah with a warning and she remains eligible to apply for work in the UK.”

One of the unacceptable aspects of the GMC is that the panels that make these decisions are anonymous, even the accused doctor does not know who they are. Which is a shame because I would like to write to these clueless fuckwits to ask one simple question.

Would you let this doctor operate on your young daughter?

Nursing

I know from one or two responses I have had in the past, and from reactions to former blogger Dr Crippen, that any criticism of our nursing colleagues is likely to generate a hostile response. In particular, questioning the wisdom and value of the nursing degree gets one the cyber equivalent of a poke in the eye.

But what the fuck is happening to nursing? And why? The media are awash with stories at the moment about the appallingly low standards of nursing care being given to our patients, particularly the elderly.

These failings have been highlighted by the Care Quality Commission who have criticised nursing care, using the damning phrase, “a failure  to attend to the most basic requirements of care” In one Trust they found doctors prescribing water to ensure patients had enough to drink. When you read this catalogue of failings in the Independent article it is clear that these are not isolated incidents.

It is easy to suggest that perhaps the media are blowing the problem out of proportion, but the stories are confirmed by our own experiences. I recently heard from a colleague who, during a ward round, came across an elderly blind patient whose breakfast had been placed down out of her reach. He was so appalled he interrupted the round and sat down to feed her himself. The nurses seemed to him unmoved.

There is no doubt in my mind that there is a profound difference in attitude between nurses who qualified recently, and those who qualified 20 years ago or more. The caring ethos seems to be fast disappearing. I have no evidence that the introduction of the nursing degree is in any way responsible, but it certainly has not led to improvements. The public are in no doubt however. To quote one unhappy relative “Because nurses are educated to degree level, they are contemptuous of low-level care. They think it’s beneath them.”

There is no doubt that reduction in nurse staffing levels, as happened in Stafford, is in part responsible for reductions in levels of care. But there is also a marked change in the attitude and ethos of our nursing colleagues that is frequently remarked upon, particularly by older nurses themselves, who are often scathing of their younger colleagues degrees.

Perhaps it is time to think again about how our nurses are trained.

Lucky escape

I recently posted expressing my despair that the government had suggested that hospital consultants should be involved in the commissioning process. It looks as if I have nothing to worry about. The GP consortia don’t want to play with us. 

I think it is just as well. You have to wonder what would have motivated consultants to seek these positions, and self advancement would have come high on the list of possible reasons. With the demise of clinical excellence awards awards however the brownie points are no longer there to aim for. 

It is interesting to see however that the process seems to be acquiring some momentum, with boards already having appointed staff and the Royal Colleges keen to get in on the act. 

The flies are circling the dog turd.

Spot the error

The error in the picture is that the young lady is depicted as a brunette. She should of course be blonde.

Spot the error

A variation on the mystery object. The question is, What is the glaring error in this picture?

Bang to rights

Dr Richard Scott, a GP in Margate is in the shit with the GMC because he has been causing distress to a patient by proselytising his christian beliefs.

At first sight it looks as though the GMC are up to their usual bullying tactics of harassing anyone who crosses their line of sight. What the previous CMO, in one of his rare episodes of perceptiveness, meant when he said,  “the council causes distress to doctors over trivial complaints”.  After all subjecting your patients to preaching, although distasteful, is hardly up there with shagging your patients, or killing them, or taking advantage of them financially.

But then if you look a little closer it is possible that there is more to this than is at first apparent. Firstly it is stated that all members of the Bethesda Medical Practice are christians. I have known a GP practice like this and the members unashamedly confirmed that when a vacancy arose only committed christians would be shortlisted. I am not sure if this is legal, but it shouldn’t be. My own view is that applicants for NHS posts should not even be asked their religion, any more than they should be asked their politics. And the vast majority of patients don’t expect or want religion introduced during a medical consultation. It simply isn’t appropriate.

Secondly Dr Scott admits to having had “a handful” of complaints before, which were resolved locally, so he is obviously in the habit of foisting his unwanted religious fervour on his captive patients. One wonders how many other patients have been offended by his approach but have not actually complained.

GMC good practice guidelines are quite clear on this. Paragraph 33 states “You must not express to your patients your personal beliefs, including political, religious or moral beliefs, in ways that exploit their vulnerability or that are likely to cause them distress.” I think that that is pretty clear and Dr Scott is indisputably in breach of this one.

So much as it pains me I have to side with the GMC on this one. These rules apply to us all and christians do not have an exemption. It’s a fair cop.

A fair trial

There is an episode of Blackadder 4 where Blackadder is on trial for killing a pigeon. At one stage in the trial the court decides to prosecute the defence lawyer, George, for turning up and wasting the court’s time. Sounds ludicrous doesn’t it. The scene is a stroke of comic genius, that a court can be so biased against the defendant that it is offended by the idea that anyone should defend him.

I don’t think that Javid Houtan Kian is finding much humour in the scenario. 

More prescience

Another prediction come true. I have been predicting the death of the Clinical Excellence Award for a while now and it has now happened. And not before time. 

Surely once new awards are gone it can not be right or fair that existing holders still get, and can still apply for renewal of, their awards, or that those awards are pensionable.

Come on Lansley, the CEA is down, now get the boot in.

Told you so, again

On Friday I predicted that the world would not end on Saturday. Pretty prescient I think. I also predicted that a likely excuse by Mr Camping would be 

"1. He got his calculations wrong and the revised date is.............”

Well right on cue here is the revised date for the end of the world. Religious nutters are so predictable

Is it not time that this man was taken somewhere where he can be cared for?

Mystery Object

A couple of guesses along the right lines but no-one guessed the purpose of this object.

In fact it is a genital clamp. Some people get their jollies that way. I hear a rumour that the General Medical Council are evaluating this device as a possible means of acquiring information.

Aftermath

It is now the aftermath of Harold Camping’s failed prediction of the second coming of christ and there are two aspects worth commenting on. 

First is the glee with which so many are mocking Mr Camping. True he has been a complete idiot, but let’s not forget he is 89 years old and it is quite likely he has literally taken leave of his senses. Perhaps we should remember the words of Frankie Howerd, “Oh no, don’t mock the afflicted”

Secondly there are the thousands of gullible followers who sold everything they own and left their jobs because they were stupid enough to believe this ridiculous prediction. There is talk of setting up help and counselling services for these people to help them cope with the disappointment, dejection and despair of the prediction not coming true. But what are they really pissed off about? The earth is not about to be destroyed, and billions of people are not about to endure a protracted and horrible death. And they are disappointed about that?

Fuck 'em!

Mystery Object

This one may look like a surgical instrument, but it's not. Any guesses

Wrong!

RAPTURE???   I thought he said rupture.

This page is still on the web, at the moment, and so is this one.
I wonder when they will get round to an update.

Draw Mohammed Day again

Apparently last year there was a competition for the best drawing. This was the winner.

Priorities

Among all the quangos associated with health provision I think that the National Institute For Clinical Excellence is one of the better ones, Also, it’s Chairman, Prof Michael Rawlins seems to have some common sense.

We might not all agree with all of the NICE decisions, but at least we know that NICE themselves, being independent, can make their decisions on value for money in a detached manner. In fact Trusts are obliged to provide treatments which are NICE approved and their decisions can be used by clinicians to force the hand of Trusts who are slow to fulfil this obligation.

Professor Rawlins is not blind to this reluctance to provide new drugs and has highlighted the attitude of some Trusts in this article. This increasing control of consultants prescribing is something we are all familiar with, particularly in the form of local formularies. Getting new drugs onto a local formulary is usually a difficult and drawn out process, where decisions on whether a drug should be prescribable are made by a committee, which may include no-one from the relevant speciality. These committees of management arse lickers seem oblivious to the fact that, in light of the Herceptin judgement by the law Lords, enforcement of local formularies is almost certainly unlawful.

It is widely accepted that Trusts have to balance the books and savings have to be made. I think that is why most consultants have accepted our current pay freeze without complaint. A freeze which, in light of increasing inflation, actually constitutes a pay cut. 

It is nice to know that restricting new treatments to patients, and cutting consultants pay is allowing funds to be diverted to where they are really needed.

Quote of the week

"There is no possibility that this is not going to happen. There is no plan B"

Harold Camping.

I wonder what he will be saying on Sunday. Assuming he has not by then gone into hiding to count his fortune, I predict he will be saying one of two things.
1. He got his calculations wrong and the revised date is.............
2. By their piety & prayer Mr Camping and his followers have persuaded God to change his mind. By their intercession we have all been saved.

The only scenario for which there is "no possibility" is that he will admit he was totally and completely deluded and wrong.

Quote

"Life in Lubbock, Texas, taught me two things: One is that God loves you and you're going to burn in hell. The other is that sex is the most awful, filthy thing on earth and you should save it for someone you love."

~ Butch Hancock

Stupid

If there were an award for the thickest journalist of the year then I would have to nominate Andy Bloxham for this article in the Telegraph. The uncritical and ignorant credulousness which he displays in this article is outstanding in the field of stupidity.

The commenters to this article are clearly far more perceptive than he is. And the buffoon gets paid good money to write this crap

Lost for words

This story is from a dentist friend of mine, and illustrates that they, as well as we in the medical profession, should be careful about finding ourselves alone with female patients.

He was working one day on a young, and very elegant lady. He had placed the local anaesthetic, and as is his practice had sprayed a little topical anaesthetic to the mucosa prior to injection. He was waiting a minute or so for the injection to take effect and his assistant had had to leave for a few minutes, leaving the two alone.

The lady asked if she could rinse her mouth as the topical spray had left an unpleasant taste in her mouth. The dentist handed her the mouthwash and pointed to the receptacle for her to spit the mouthwash out.

She fixed his eye with hers and smiled. “Oh that’s all right” she said, “I don’t spit, I swallow.”

Oh no!

The one thing about the commissioning process that I have been quite pleased about has been that it did not involve us hospital consultants. We were merely going to stand on the sidelines and watch as the whole thing went (probably) tits up and our unfortunate GP colleagues were made to carry the can. This may seem a little selfish but it was a nice feeling that we would be pure spectators with no involvement and no responsibility. No blame could fall upon us, all we had to do was carry on doing our normal work under whatever system came our way.

But that bugger Cameron has seen through that, and has now said that he wants us involved as well. I bet he does. The more of us he gets involved the more he can duck the blame in the event of failure. It will be all our fault. Some of our colleagues such as John Black of the Royal College of Surgeons have actually welcomed this idea and are actually enthusiastic about getting sucked into this.

Getting involved with these reforms is going to be like playing pass the parcel with a bomb. I for one don't fancy having the thing go off in my face. I am coming to the conclusion that the only way to win is not to play the game.

There's gratitude.

More doctor bashing in this morning’s Telegraph in an article which would even look over the top to Mail readers. And if the article itself is misrepresentative and ill informed just take a read of some of the comments.

GP’s are berated for failing to pick up a third of cancers at the first presentation. But if you turn that round what that means is that two thirds are picked up at the patient’s first attendance which I would have said is pretty damned good. 

But for those not picked up, the blame is laid squarely at the feet of the GPs. No mention of the referring restrictions placed on GPs by the PCTs, no mention of referral management systems,  limits on consultation times etc etc. All the factors imposed upon GP practice that make it a miracle that in your allotted 10 minutes with a GP you have a 66% chance of him picking up your new cancer.

We are all worried that the NHS is becoming a shit service, but when you read this crap you can’t help feeling that the punters get what they deserve. Look out for the next installment when I predict the Telegraph will turn it's guns on the Consultants.

Someone worse off

We all bemoan what has in the past happened, and what is going to happen to the NHS. But to be fair I think things are not as bad as they are often portrayed. It is my view that patients today get better, safer, more effective and consistent treatment than ever before, though I think that this has been in spite of government action rather than because of it.

To see what a complete balls up governments can make, one has to look, not at our health system, but at education.

Firstly, in a cynical attempt to give the appearance of rising standards the examination system has been completely devalued, something that has been obvious for years but which is only now being acknowledged.

Secondly, for years higher education has been held up as the route to a decent well paid career, and the current cost of university promoted as a good investment. What bollocks. The obsession of the last government with getting as many people as possible into higher education was in part no more than an attempt to manipulate the jobless figures, and has led to a glut of graduates, and now, after all the expense of those years at university, graduates face a strong possibility of life on the dole, or behind the counter at McDonalds. 

What a con. What a waste. What a kick in the teeth.

Not a good time

Ouch

From a recent exchange with a patient.

"Yes doc, a few months ago I saw my doctor for a bad attack of vomiting, and he treated it with a Dom Perignon suppository."

                                "Sorry doctor, you're going to put this where?

Perspective

If you read the medical media you could be forgiven for thinking that doctors in the UK are getting a pretty raw deal. Our pay has been frozen, pensions attacked, and so many GPs claim stress that many are contemplating early retirement.

Read this article, and reflect on how badly off we really are.

Blowing with the wind

Up until last week Nick Clegg  & the lib dems were fully supportive of the government’s NHS reforms and it seemed inevitable that these would go ahead. What a difference a week makes. 

Cleggy is now saying that he is going to oppose the reforms. There is no doubt that his change of stance is due to the panning he got last week in the elections. His lost voters were telling him that when they voted lib dem in the past they were not voting for conservative puppets.

He could be criticised for being vacillating, opportunist and lacking in integrity I suppose, but on the other hand he is responding to the electorate, so you could say this is democracy in action.

Whatever his reasons the consequences of his change of stance are significant. Without lib dem support the reforms can not go through, and, more than that, the conservatives face defeat in the commons. We could be in for yet another general election sooner than we think.

There are two big ifs. Firstly, is his new found opposition to the reforms a genuine point of principal, or is he cynically using the issue as a convenient expression of independence? If he delivers the goods that does not really matter. But that is the other big if. Will he maintain his opposition or will he simply switch back again if and when it is expedient?

Quacks again

In my post yesterday about quacks I mentioned that they can now be reported to the Advertising Standards Authority for making misleading or untrue claims, and the role of the Nightingale Collaboration in using this legislation.

For those who believe as I do that the CAM brigade really do need to be brought into line over the claims they make there is now an easy way to get involved.

Go get em.

Quacks

There are lots of thing about quacks that piss me off. Possibly what gets my goat the most is the sheer irresponsibility they practice. If they were to limit themselves to foisting their nonsensical delusions on the worried well with more money than sense then I might find them tolerable, barely.

But they are yet another group of people who want to play at being doctors, and, in the pursuit of this end they will venture into areas where they can do nothing but harm.

One of my readers has drawn my attention to this article, which is a prime example. Our old friend the homeopaths up to their usual two pronged trick of promoting their worthless crap while disparaging proper treatment by us nasty allopaths. I am not going to go on at length about this particular article, Andy Lewis has already done that. I just highlight it as an example. 

It is bad enough that homeopaths should act with such irresponsibility towards those already suffering from a devastating disease, but possibly even worse is when they influence the well in such a way as to put them at serious risk. 

Many homeopaths still assert that you can avoid malaria by taking their sugar pills, and so do not need to take anti malarials when travelling to malaria endemic areas. This article highlights a recent increase in the incidence of malaria worldwide. I don’t know if any of these patients were eschewing conventional anti malarials in favour of homeopathy, but if there was just one then it was one too many.

The ability of homeopaths to make insupportable claims has recently been severely curtailed by the fact that health therapies have been brought within the remit of the Advertising Standards Agency, and organisations such as the Nightingale Collaboration have set about ensuring compliance.

The more switched on homeopaths have realised that the jig is up and are already backtracking, as this page illustrates. I recently approached a number of homeopathy sites asking about anti malaria prophylaxis, and found them extremely cagey. However some of their commenters were not so restrained, claiming proven efficacy for homeopathy, not only in malaria, but also diphtheria, polio and smallpox. They seem not to have noticed that modern medicine eradicated smallpox 22 years ago.

I am at a loss to understand what motivates people to go to homeopaths in the first place, and afford them such credibility. In an attempt to try and understand the mentality of these suckers I had a little browse of some of the questions put by those who frequent homeopathy sites, and here is a little selection. 

I’d like to know if Homeopathy offers any treatment for Phimosis 

I am taking Homoeopathic medicines for my corns in my feet for the past 3 years now. I have faith in Homoeopathy but it is really testing my patience. 

how can we increase size of our pennis

I notice that occasionally (typically once or twice a day) my urine is yellowish in color. Is there any significance to this ? I am not taking any other allopathic medicines. 

which medicine should your suggest to take to enlarge my breast

Hello Doctor B. I am curious to know what the possibility is for sperm to travel through underwear, blue jeans, light pants, and panties and still be able to penetrate a woman causing her to become pregnant? Thanks.

So I think I can now answer the question as to what sort of person turns to homeopathy.

oops

This is doing the rounds and I can't resist reposting