The Good, the Bad, and the Ugly

The wisdom of medicalizing vast numbers of low risk asymptomatic people is being questioned.

                                                     Il Buono

                          Professor Alan J Taylor, Washington Hospital

                                                     Il Brutto

                             Professor Salim Yusuf, Hamilton Ontario

                                           Il Cattivo

                                                               Link

Hooray

It is so nice when you are proved right on a contentious issue. As in this research which supports a view I have held for many years in the face of strong disagreement.

So now I can show this article to Mrs DZ and go off to the pub with a clean conscience leaving her with the acronyms NORWICH, and KOALA to contemplate while I get suitably primed.

Somehow I think the most likely response I am likely to get on my return is this one.

The research is from Australian investigators. Why am I not surprised?

Ungentlemanly conduct

I recently read this case about a nurse who was struck off for having a sexual relationship with a patient. These affairs are of course an absolute no no for doctors as well as nurses, as is made clear at para 32 of the good practice guide.

But there are one or two aspects about this case that are a little odd. The patient, in his complaint to the Nursing and Midwifery Council stated “she was a big girl and I did not find her attractive”. Now if this was a single episode you might find that credible, but in fact the pair were having sex twice a week  for four months. You would have thought that if he was so upset about it he would have said something sooner.

The Mail puts it rather oddly stating that “she had sex with the man” as if he was a passive victim. Now as I am sure you all know, one thing a man can’t do, that a woman can is lie back and think of England. It takes two to tango, and the man has to rise to the occasion.

The nurse was very silly here. She broke the rules and that is that. But it is pretty obvious that the male patient took what was on offer until, as men do, he tired of her. And then instead of ending the affair in an honest manner he shopped her to the authorities. What a swine.

Compensation

One of the changes that I have seen over my years in the NHS is the increasing encroachment of management into the area of clinical decision making, not just in medicine, but in nursing as well. When I started in the NHS, management steered well clear of the clinical management of individual patients and allowed clinicians to get on with the job.

Increasingly over the years this clinical autonomy has been eroded. We now have a move towards protocol driven care, with increasing restriction on the treatments we can offer and the drugs we can prescribe. This has been justified by the concept of risk management. Since the burden of indemnity has shifted from individual practitioners to Trusts, the Trusts feel they can minimise risk and liability by dictating practice. 

Unfortunately it has not worked. The bill for NHS negligence cases has continued to spiral upwards, and has now exceeded one billion pounds for a year, according to this article. I am not suggesting that the usurping of clinical management by non clinicians has caused this increase, but it certainly has not had the desired effect.

The main point of the article is that this bill is likely to rise as a proposed cut in legal aid will drive dissatisfied patients into the arms of “no win, no fee” lawyers. The article portrays this as wholly undesirable with the implication that these lawyers are taking advantage of the situation. So it was a little ironic to see the adverts that had been placed right next to the article.

Happy holiday

A little musical interlude for the bank holiday. Enjoy

http://www.youtube.com/watch?v=EVbu8bh7SWk

Trust management gets it right

Other bloggers as well as DZ have commented on the appropriateness of providing alternative therapies on the NHS. One would have thought that the decision of the Parliamentary Science Select Committee to recommend that homeopathy not be available on the NHS would have marked the beginning of the end for the practice of witchcraft but this seems to be a beast that will not die.

So hats off to Wrexham Maelor Hospital, (Chief Executive Mary Burrows). When one of their midwives acquired a diploma in aromatherapy she was told that she was not permitted to use it on the Trust’s patients. With an arrogance typical of CAM practitioners she chose to ignore that instruction and offered aromatherapy to a parturient with a headache. She obviously did not explain the therapy terribly well as the patient drank the aromatherapy oils, causing some consternation. Fortunately she came to no harm.

The witch, sorry midwife, subsequently jumped before she was pushed and resigned her post, but did not get away without consequences. The Nursing and Midwifery Council struck her off.

So well done to Betsi Cadwalader Health Board, and well done to the Nursing and Midwifery Council.

Today revalidation, tomorrow............

In my last post I suggested that, if we could all unite in refusing to play the revalidation game, the whole idea would have to be abandoned. Alas to make this work we would have to have a union with bollocks, organisational ability, determination and purpose. What we have is the BMA, a verbose and pompous bunch of ineffectuals who could not organise a poke in a brothel. An organisation that brings to mind the saying “all mouth and no trousers”

It is a shame because with determination and unity we could achieve far more than just the shelving of revalidation.

The GMC is now an organisation so flawed and out of control that it has been severely criticised by the previous CMO Sir Liam Donaldson, and even by a previous President, Sir Donald Irvine, who has called for it’s abolition.

A sure way for any individual doctor to get his name erased from the register is to refuse to pay the annual retention fee. But what if we all refused en masse. We don’t actually get anything for this payment, we would not lose anything by not paying. If all of us together withheld payment, what could they do. They would fold overnight.

I am dreaming again aren’t I?

If only

In Dr No’s latest post he points out one of the possible consequences of revalidation, the loss of a considerable proportion of doctors from the system. Most colleagues that I have spoken to are antipathetic to revalidation, seeing it as no more than a stick to beat us with, with no real practical benefit to anyone. A massive, hideous and expensive bureaucracy administered by an organisation with all the empathy, fairness and arrogance of the Spanish Inquisition.

We are being pushed around a lot at the moment especially financially. We have put up with a pay freeze, our pension contributions are about to rocket. Some are about to lose child benefit, and others can no longer aspire to a CEA. In addition the steady erosion of our clinical autonomy has also contributed to the decline in morale, and for many for whom retirement is an option revalidation will prove the last straw.

And yet if the profession could get it’s act together we could stop revalidation in it’s tracks. If one of us simply stood up and said he was going to boycott the whole process he would of course be singled out as the first casualty of the system. The GMC would take him out like a pride of lions homing in on a lame zebra. But what if all of us told them to shove it up their arse? Or at least a big enough proportion to make the whole system unworkable. As this picture shows the zebra can fight back effectively.

What could they do, strike us all off?

Job vacancy

Have you ever wondered how someone gets to be Chief Executive of an NHS trust. Well just like you got your job, by applying for it. And just like the job advert you responded to the employers are clearly looking for a superman. 

If you look at this advert you will see what I mean. In their next CEO they are looking for “an outstanding CEO...........with a demonstrable track record of achievement” although previous hospital experience is only “preferable”. It goes on, and on demanding a visionary person showing strong leadership and the ability to inspire staff.

With a likely salary in the order of £150k there will probably be no shortage of applicants. If you are interested in this post, but don’t think you measure up to these expectations, don’t let that put you off. No CEA I have ever met has measured up to them either.

Rapture?

The revised date for the end of the world as predicted by Harold Camping, October 21, is, unsurprisingly, getting far less attention than the last time. One youngster I spoke to before the last date did not understand what Camping meant by “rapture” and was seriously worried that humanity was going to be afflicted by a return of vicious dinosaurs. Poor kid thought he said “Raptors”

Iatrogenesis

It is now four years since Dr Malcolm Kendrick published his book questioning the wholesale prescribing of statins to asymptomatic and low risk patients. He has been mainly ignored by the mainstream medical establishment and statins are now taken by nearly 7 million people in the UK. I personally have seen patients who have been started on statins in their 70s and 80s, having never had a cardiovascular event. What are their doctors thinking? 

There seems to be little acknowledgement that these drugs can have serious and unpleasant side effects and in people who have no history, no symptoms and little risk, starting these drugs on the basis of numbers on a lab report is very poor medicine. Inducing side effects in these people is unforgivable, and persuading these patients that the drugs are giving significant benefit is dishonest and insupportable.

Yet more evidence is now emerging that supports Dr Kendrick’s view. How long is it going to be before the medical profession takes notice?

And as for the polypill, not yet adopted by doctors, this concept should be strangled at birth.

Quote

“I am clear that I no longer wish to continue to live and hope that people can respect this wish and now allow me to die. I want it over with without delay.”


Martin

Which hospital?

The World Wide Web has finally let me down. Despite an extensive search I have been unable to track down the London hospital where this happened, so I am unable to name and shame the managers responsible.

Does anybody out there know for sure where it was?

Scams

It may have been noticed that there are no ads on my site at all. I suppose I could make a little money by “monetising “ the site but I would rather have total control over what goes on it. 

I have a dislike of advertising at the best of times but what really annoys me are the various ads that are in fact scams, which are extremely common on monetised blogs. Once he has given permission for ads to appear the blogger has no control over the ads placed on his site.

The modus operandi of these scams is always the same. A product is offered at an introductory price of just a few pounds, or even free, though you have to pay for postage. Once you give your credit card details the trap shuts. Regular substantial sums are then deducted from your account despite your trying to cancel the agreement, and often without you even receiving the product. The companies are impossible to contact and ignore all communications.

The style of advertising is always the same and the web is saturated with different sites heavily promoting the product. Even if you google “product scam” the list of sites is headed by promotional sites that front for the company.

Products so far used to carry out this scam include tooth whitening products, slimming berries, stomach flattening and the latest is an anti wrinkle cream, called Perfect Radiance. the products themselves are of very little worth or value. 

People have lost considerable sums of money with these scams. I am glad they have never been led into them from my site.

Obesity postscript

In my recent little series of posts on obesity I mentioned the hazards to health of the obese person, but it did not occur to me that there might be potential hazards to the immediate family. 

I don’t suppose it occurred to this unfortunate diminutive husband either, until it was too late.

Live fast, die young

Although far more of us these days are living to a ripe old age, I think it is fair to say that for many that achievement often turns out to be something of a disappointment. It is bad enough finally retiring just as your body has begun to fail you, but far worse is what can await those who pass 80 and 90 years of age.

It might be tolerable if we could anticipate being well looked after once we lose our independence, but sadly this is not the case. 

One of the statistics that came out of the collapse of Southern Cross was that they employed 44,000 staff to look after 31,000 care home residents. You don’t have to be a genius to see that a ratio of 1.3 staff to every patient is simply not sustainable, especially with our changing demographics. So it is impossible to maintain standards of care. (1) (2) (3) (4) (5) This problem is not exclusive to Britain.

As a profession we have simply got too good at our job, managing to keep people alive long after what might be natural, and producing individuals who are little more than pharmacologically sustained heart lung preparations.

Very few of us want this. Without exception everyone I have asked has stated that they would rather die somewhat sooner than go on to a life of dementia and total dependance. Mostly we would rather die wearing our boots than a nappy. Sadly by the time we are at the state where we would rather be dead, we no longer possess the wherewithal to do anything about it. 

So what is the solution? Euthanasia is unlikely ever to be considered acceptable, the idea of murdering the helpless and the elderly being too repugnant, even if it is what the victims would have wanted.

The only solution is the “live fast, die young” philosophy, though this is usually meant to imply dying before 30 and from my perspective dying young means at about 70. I think it is no surprise that more & more late middle aged people are taking up more risky lifestyles. They may fear death, but they fear senility far more.

Tea in a cracked pot

Whatever you might think about our mainstream politicians, of any party, there is one thing they have going for them. They are not American.

One of the front runners in the early stages of the next presidential race is Republican Michelle Bachmann, a woman who has been described as “The only politician dumber than Sarah Palin”. 

The possibility that this woman could become the next President of the USA is something that should deeply worry not just Americans, but the whole world. This ultra right winger has startling views on a whole range of issues that are really scary. Rampantly anti gay, anti abortion, a religious fundamentalist with a desire to introduce creationism into US education, and a terrifying attitude of American superiority gives a little taste of what goes on in her mind. She is also bitterly opposed to the concept of universal healthcare, seeing it as the thin end of a communist wedge.

You only have to read some of her quotes to see the lack of cerebral activity, a frightening example of uninformed ignorance coupled with arrogant aggression.

Her lack of thought and self awareness is well illustrated by this picture.

Can you imagine Harriet Harman being caught out in this pose. Would you even want to. Caroline Flint though..............dream on.

Double jeopardy, double standards

As far as I am aware no registered medical practitioner has been arrested in connection with the recent riots and opportunistic looting. If they had they would not only be facing the courts, but the GMC as well. At para 58 of the good practice guide it states “You must inform the GMC without delay if, anywhere in the world, you have accepted a caution, been charged with or found guilty of a criminal offence.”

If you are tried and found guilty in a court of law the GMC will accept that verdict without question and proceed accordingly. You will have no opportunity to argue your case, you are guilty and that is that.

You might think that if the court of law finds you not guilty, and acquits you that that would also be taken by the GMC as final and no further action would be taken. However that would require the GMC to behave in a fair, unprejudiced and balanced way. In fact if you are acquitted you may still have to face the GMC at a fitness to practice hearing where, notwithstanding the decision of the court, you can still be found guilty and punished. The GMC view seems to be that there is no smoke without fire, we all know you dunnit, and if you managed to escape justice undoubtedly on some legal technicality, we will be there, untroubled by legal niceties to give you what you deserve.

The theoretical possibility exists that you can be tried in a country you have never visited, for something that is not a crime in the UK, and the GMC can then hold you to account in their own unique way.

In the UK we are all supposed to be equal under the law. However doctors seem to be less equal than others.

NHS management

My eye was caught this morning by this article describing how two catholic nurses had to take their employer to court to win the right not to participate in terminations of pregnancy.

This is not going to be a rant about catholicism as you might expect. I am actually in this case on the side of the nurses, although I personally fully support the right of any woman to terminate her pregnancy. But it should never have been necessary for this legal case to have been brought.

I have worked in the NHS for a long time and at a lot of places and wherever I have been it was considered quite legitimate for staff to be accommodated if they did not wish to be involved with abortion. It is a right we already had. Section 4 of the abortion act, 1967, states “Subject to subsection (2) of this section, no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection:”

Even if it were not a right, most employers recognise the strength of feeling engendered by the issue, and allow objectors to opt out of these duties. The hospital management have now backed down but what depths of insensitivity and tyranny drove them to try and force the issue. This is yet another example of piss poor man management by people who are in the wrong job.

The article does not identify the hospital, or the managers responsible for treating their staff so unlawfully, and with such contempt. I will have to see what I can dig up.

Death penalty

I recently posted on how I disapproved of the death penalty. This was before another blogger's recent campaign to reinstate the death penalty in English law.

It is funny how things you say can rebound on you. I recently had something that belongs to me vandalised and willfully damaged. It is something that cost a lot of hard earned cash. Something I highly value. I don't know who was responsible but I WANT HIM DEAD!

The things they sell

I understand this shop is very popular with Gary Glitter and catholic priests.

GMC thickos

As some of you are probably aware the GMC are not my favourite organisation. In my view they have the degree of arrogance only found in those who have power, without accountability. Most public bodies are accountable to someone, usually an Ombudsman. Even the police are accountable, through the Police Complaints Commission, which, in theory at least is independent. So why then if you want to complain about the GMC is your sole and only route to the GMC itself? So what happened to the legal principal of “Nemo Debet Esse Judex In Propria Causa”?

I used to think that their attitude to the quarter of a million UK doctors who keep the GMC alive through the retention fee, was one of indifference at best and malicious contempt and disdain at worst, and their attitude to whistleblowing seems to support this view. 

But I have now started to think that they are in fact simply incompetent and stupid. I have come to this view by reading something recently sent my way by a reader.

The GMC recently held a hearing against a doctor who I shall not name. Since the hearing concerned itself greatly with a matter of the doctor’s health the press and public were excluded from the hearing to protect the doctor’s right to medical confidentiality.

“The Panel passed a resolution, under Rule 41 (3) (b) of the General Medical Council (Fitness to Practise) Rules 2004, that from time to time, the press and public be excluded from those parts of the hearing where the Panel considered information relating to the physical or mental health of the practitioner.”

So why then, having excluded the press and public from the hearing, did they subsequently publish the entire proceeds of the hearing on the internet, revealing these medical details? I am not going to provide a link to this page, but I have seen it and you will have to take my word for it that the unfortunate doctor’s full medical details are laid bare for the public to see.

What are the GMC thinking? I have no way of contacting the doctor in question, and have no idea if he is aware of what they have done, but if it was me I would pursue this as far as it would go. 

Bloody arseholing hypocrites.

The penny drops

It looks as if the government are finally waking up to the fact that the NHS IT project is a complete waste of time & money. Maybe they will also realise that the same is true of revalidation.