Quote

"There are now very many registered charities that sound plausible at first, but which turn out on closer inspection. to support barmy and dangerous ideas."

Prof David Colquhoun.

You don't suppose he is talking about registered charity number 1089278 do you?

Morale

After my last two posts I guess you are expecting me to bemoan the loss of morale in members of the medical profession. But I am not.

It is true that we have genuine and justifiable grievances, but that is nothing new. We have always had something to grumble about. It is also true that a minority of our colleagues have become cynical, mercenary and selfish, and it could be suggested that this is a response to our poor treatment, but such individuals have always been present in our profession, as is well described in “The Citadel”

My perception is that our morale has been very little affected. I still see most of my colleagues engaging with their patients with as much enthusiasm and dedication as they ever did. They still seem to get as much gratification as ever from their work, despite the difficulties. The regard and respect we enjoy in the eyes of the public seems little diminished. When polls are held to discover which professions are most trusted and respected doctors still come out at, or near the top. Places in medical school are still much prized and competed for.

So if there has been an attempt to demoralise us it has failed. I, and many of my colleagues still enjoy our work and derive immense satisfaction from what we are able to achieve. In spite of expectations I see no difference in the next generations of doctors. We should congratulate ourselves. We have not let the bastards grind us down.

Guidelines

This is DZ guide to government and managers at all levels on how to try and demoralise and demotivate the medical profession.

1) Make it plain that you believe they are lazy bastards, only to be found on the golf course, or in the private hospital. Use this as an excuse to impose a new contract paying strictly for the hours you put in. When this backfires on you and the doctors get, in effect, a huge pay rise because they are now getting paid for all that work they used to put in for free, encourage the view that they are all greedy overpaid bastards milking the system.

2) Gradually introduce an increasing number of guidelines, giving the impression that these are to assist clinicians in decision making. Then, when the opportunity arises institute disciplinary proceedings against individuals for not rigidly following those guidelines. In this way clinical decisions can be taken out of the hands of professionals, and put in the hands of non medically qualified managers. When this causes disasters hold the professionals responsible.

3) By means of managerial targets ensure that prioritising of patients is done on administrative and financial grounds, rather than clinical.

4) Screw their pension arrangements.

5) Keep them disorientated by repeatedly making massive reorganisations of the system. Never give them an opportunity to allow any administrative system to bed in. Never give them enough time to iron out the wrinkles and make it work.

6) Have them regulated by a body made up initially entirely of their peers, and use this as an excuse to make them compulsorily pay for it. Then gradually introduce non medical appointees so that it is no longer self regulation. Skew all the rules so that the regulatory body is all powerful, answerable to no-one and in effect, a kangaroo court. Enable this body to prevent someone working, not just for misbehaviour or incompetence, but for being unable to tick a few boxes on an arbitrary tick box form.

7) Introduce a system whereby selected individuals receive extra financial rewards. Make the criteria for selection as opaque, unfair and arbitrary as possible. Ensure that some specialities receive a disproportionate number of awards. Discriminate against women and ethnic minorities. This will not only demoralise, but divide.

8) Make it difficult for primary and secondary care doctors to interact. Introduce reasons and systems to make them compete. Introduce barriers to ensure that correspondence between the two is intercepted by non medical personnel with a view to preventing effective co-operation in patient care.

9) Introduce a new rule compelling them, on pain of regulatory action, to speak out in the event that they perceive circumstances that adversely affect patients. Allow employers to stamp on them when they abide by this requirement. Under no circumstances allow these people any access to any effective assistance.

Do any of these sound familiar? There are probably other good tips that have escaped me for now. In my next post I will comment on how I see these actions have affected the medical profession today.

The prelude

DZ has often mentioned that he has been in the NHS a long time. He can remember what the profession was like in the 1970s and 80s. He has seen many changes. Some of these, like the introduction of controls on the working hours of trainees represent a huge improvement. 

It is possible that my recollection of those days is distorted but I remember a great sense of cohesion, from individual medical firms, to the profession as a whole. GPs and consultants were far closer then than they are now, and direct communication was far more common. Many knew each other personally. Clinical autonomy was strongly preserved and management kept out of clinical matters. Consultants consistently worked way over their contractual obligation without complaint or resentment because the work was satisfying and gratifying. Consultants felt valued. Morale and motivation were high. The profession enjoyed great popular respect.

This made them, as a body, very powerful. This in turn inevitably made the politicians distrustful. In my next post I am going to present a little guide. A guide to politicians and managers on how to demoralise and demotivate such a great profession. 

Too much info

I have had an email from a reader who does not want to leave a comment. He asks me what I mean about a “second use” in this recent post. Not that I have given the matter much thought but,

The top end of the tube is quite wide, about 5cm in diameter. if you were to cut off the top end just below the shoulder, and then pop the tube into the microwave for a few seconds to warm up the contents, ............ er, perhaps I should just shut up.

Off the fence

It has to be admitted that I have not commented much on the NHS reforms, unlike many of my blogging colleagues. This is not because I am disinterested, rather I have seen it as primarily a matter for primary care, and in this I have been remiss. It has now become clear to me that these reforms are simply part of a broader strategy to sell off the profitable parts of the NHS to friends and benefactors of the ruling party. This is not new in principal. I remember full well 120 million doses of swine flu vaccine being bought by the last government when realistically maybe one sixth of that would actually be administered. There were allegedly connections between Tony Blair and the owner of the company involved. 

But that possible level of corruption is dwarfed by what is now proposed. And the brazen manner in which this is being pushed in the face of such broad opposition speaks of a contempt for the electorate and the medical profession that is breathtaking. This contempt is epitomised by those invited by the government to discuss the reforms this week. Bearing in mind that these reforms are first and foremost reforms to primary care it is inexcusable that the Royal College of General Practitioners was excluded, and extraordinary that the Royal College of Dinosaurs, sorry, Surgeons was included. Lansley has shown from the start that he is not prepared to give audience to anyone who might disagree with him. He has blatantly lied about support within the medical profession and given credence to low life like Michael Dixon. Talk about scraping the barrel.

To my mind anyone who genuinely believed in what he was proposing would be prepared to argue his case passionately, not to the converted, but to those who are not convinced. A refusal to engage with these people speaks of weakness, dishonesty and deviousness.

I may not know entirely what Lansley’s motives and deep intentions are. But the fact that he is being so subversive leads me to doubt that he is up to any good.

Like most of my colleagues throughout the profession I have come, possibly belatedly, to the conclusion that these reforms will be a disaster.

Heroes & villains

Jobbing Doctor has drawn my attention to this case where Professor John Ashton has been threatened by his employer, NHS Cumbria, for daring to express his opinion on the NHS reforms. As I have been saying since I started this blog, expressing your opinion is a statutory right and his employer has no right to behave in this utterly reprehensible manner. Indeed if Prof Ashton has real concerns that the reforms will have adverse effects on patients he is required by the GMC to express his concerns.

Since he is following GMC guidelines I would expect that the GMC would take action to support Prof Ashton. I predict that they will do no such thing. Further I expect that if NHS Cumbria were to report Prof Ashton to the GMC they would then pursue him in their usual impartial style.

The guardian article, as usual refers to NHS Cumbria as an inanimate organisation as if no individual were responsible, but someone in the Trust wrote and signed this letter, which is probably unlawful. Whoever it was the one who must accept responsibility for this is the chief executive.

Here is the little shit.

Ian Gordon

Tell you what Mr Gordon. Why don't you try shutting me up, you bastard.

Political suicide

In my last post I highlighted an American Senator who has proposed a truly repressive and ridiculous law with her tongue firmly in her cheek. Surely no American politician, in the land of the free, would propose any law as repressive, intrusive and stupid in all seriousness.

Think again!

Every sperm is sacred

While we are on the subject, DZ has commented in the past about the rather bizarre attitude some people have towards masturbation, particularly in the bible belt of the USA. 

The ultimate answer to those religious nutcases who think wanking should not be allowed is to point out that there is no law against it. Yet. But in Oklahoma there is a politician who has introduced an amendment to a bill which would in fact classify masturbation as a “crime against the unborn child” and thus criminalise it.

In fact she is being sarcastic and has introduced the amendment as a protest at the bill which is designed to make abortion all but unobtainable in Oklahoma. Sadly I think her sarcasm may well be lost on many americans, and her amendment might even get some support among the loony fundamentalists. Hopefully there will not be enough of them for her actions to backfire on her.

Dual purpose

DZ is not one for reading all the promotional blurb on product packaging. Like most males, when he goes shopping he knows what he wants, picks it off the shelf, pays for it, and can be out on the street again 90 seconds after entering the shop. I am not going to contrast this with how Mrs DZ shops but most blokes with a female partner will know what I am talking about.

So as a result of DZ’s buying stuff with a minimum of inspection he has for some time had this product sitting on the bathroom shelf.

As far as he has been concerned it is for shaving with, full stop. Mrs DZ however has noticed what is written on the back of this product and seems to be under the impression that the substance has a second use. 

I plead not guilty.

Lean Slim Scam

My posts on various scams are the most visited of any of my posts by a huge margin, which I find gratifying since, of all the posts these are the ones that might be achieving something worthwhile. The latest to hit the net is a slimming programme promising weight loss of a staggering stone per week, so if you are 14 stone and want to get down to 10 this programme supposedly will get you there within a month! This is a degree of weight loss only achievable by amputation of large body parts. Once upon a time I personally lost 10lb in 7 days, but I did have campylobacter at the time. As usual you are offered a cheap introductory sample, (offer ends tomorrow) and you have to buy two products, “Beri Lean Slim Ultra” (magic berries), and ”Lean Slim Cleanse” (a laxative). This latter stuff is claimed to:

• Helps Eliminate Bad Toxins that have Built Up Over the Years

• Removes 'Sludge' from the Walls of the Colon

• Helps Get Rid of Gas and Bloating

• Helps to Regulate the Metabolism

Toxins? Sludge? Regulate the metabolism? Strewth! And as for getting rid of gas there is already a pretty efficient way of doing that for free. 

As usual the object is to get you to sign up to a regular debit authority which makes regular large deductions from your credit card, and which are then almost impossible to cancel. 

The claims for these products are so obviously ridiculous that I am tempted to suggest that anyone stupid and gullible enough to fall for them deserves to be taken. But stupidity is not a crime and the gullible have a right to be protected from fraudsters. Don’t sign up.

St Valentines

You should not need reminding that today is St Valetines day. If you have forgotten until now it is probably too late to redeem yourself. 

Christianity has a tradition of hijacking pagan festivals for it’s own purposes and Christmas and Easter are just two examples. St Valentines is no exception, being a christianised version of the Roman festival of Lupercalia. I would not recommend any young men celebrating in the Roman style. Running through the streets naked and striking young women with blood soaked thongs does not go down too well these days.

Quote?

"I have been to jail several times and I always ended up getting buggered. Father Mahoney really does take the game of Monopoly seriously doesn't he?"

More Nausea & Vomiting

I have expressed the view before that the house of lords is an affront to the concept of democracy. Filled by over 700 appointed has beens and nonentities, often on the basis of their sycophancy or financial contribution to the ruling party, with no reference to the electorate, and totally out of touch.

A typical example is this idiot, Sayeeda Warsi. 

Ms Warsi, in this article articulates the desperate reaction of the “faithful” to the gradual secularisation of Britain. She compares Britain’s majority of irreligious to “intolerant totalitarian regimes”, and accuses us of denying people their religious freedom. I suppose she means the freedom to ignore the laws on discrimination that the rest of us have to abide by. She ignores the fact that recent legal judgements against christians have been made by the courts, imposing laws made by politicians, like her. The secular, unlike the church, have no special representation in government, and are arguably very underrepresented.

But what makes her strident pronouncements all the more contemptible is the sycophantic fawning that she and others are about to show to that grand  paedophile protector, the pope. She and a delegation of other arse lickers are travelling to the vatican to have an audience with the pope, described as “a great honour.” They will apparently be discussing human rights and international development. I don’t suppose they will be bringing up these cases though. (1) (2) (3) (4) (5) (6).

Now if you or I were to be involved with just a single episode of child sex abuse we would, quite rightly, find ourselves arrested, registered, struck off by the GMC and shunned. Our careers would be over. So why do those that represent us show any respect whatsoever to an organisation that shielded the biggest and longest lasting child abuse ring in modern history. Ms Warsi, you nauseate me.

Nausea & vomiting

Perhaps I should have suggested this as an alternative means of managing vomiting.

Rude awakening

My last post reminded me of something that happened to me over 35 years ago, when I was what used to be called a houseman. It was my night on call and I had got to bed eventually. At 3am I was roused from the deepest sleep by that awful ringing of the phone. It was the senior nurse on one of the wards I covered. I remember that she was actually only a student nurse. It was not unusual in those days for a third year student to be in charge of a ward at night. I still remember what she had woken me for. "Doctor Zorro, you have prescribed patient X metaclopramide for nausea, and we don't have any. Can I give him some Maxolon instead?

At least I didn't have to get up.

When I were a lad.....

A fellow blogger has posted on her on call weekend. I don’t for a moment wish to belittle her hard work, but one phrase caught my attention. “Although I was so exhausted I pathetically crawled into bed when I got home at 10pm,”

Those of my generation will know what I am about to say. When we did a weekend on call it was 72 hours on duty, no going home, and often no going to bed at all. I do not advocate a return to that appalling state of affairs. I have made my stance on doctor’s hours clear in previous posts. (1) (2) (3)

But there are plenty of throwbacks in the profession who are advocating that the working time directive not apply to doctors in training, and that we should return to the working practices of the past. This would be a disaster for young doctors. Possibly greater than the screwing of our pensions. Do NOT let them do it!

The application of the WTD to doctors has been the greatest advance in our quality of life in my time as a doctor. When we bore you with tales of what it was like for us take heed, and believe me. You don’t want to go there.

Job interviews

Being interviewed for a job can be very stressful and unpleasant even when the panel are at their most sympathetic. All too often one or more members of the panel abuse their position and make things deliberately unpleasant for the candidate, presumably just to flex their ego. I have heard one story of a candidate for a consultant position being interviewed. His CV showed him to have several vigorous and very physical sporting interests. One of the panel commented on this and then added, "have you ever thought of taking up something more cerebral?" He was apparently a little fat porker. What an arrogant little shit.

Still even at it's worst I don't suppose that anyone going for an NHS post has ever had to endure anything like this.

Skewed poll

A Judge has recently ruled that it is unlawful to commence council meetings with prayer. Quite right too, that is not what they were elected for, and inevitably it is christian religion that is marked out for special treatment. As usual the christians are trying to play the victim card, and even just simply lying. The Bishop of Exeter stated "Every time there is a survey of religious beliefs in this country, around 70 per cent of the population profess a faith and to saying private prayers.” and he portrays the secular as “a tiny minority” He obviously has not seen the ICM poll referred to here.

The Telegraph has set up a poll for people to express their views but it is one of the most disgracefully skewed polls I have ever seen. There is one option for those who approve of religion being included into council meetings, but then there are three different options for those who disagree, effectively giving the same option three times, and dividing the secular vote. You don’t suppose the Telegraph are biased do you?

Daily Mail

When it comes to reporting on health matters the Daily Mail, which I am not going to link to, really is one of the most reprehensible publications on the market. Not a day goes by without them waxing lyrical about the wonderful benefits of quackery, old and new, while their approach to mainstream medical practice is nothing short of outrageous opportunism. In the pursuit of a bit of sensationalism there are no depths of distortion, exaggeration, misrepresentation and plain mendacity to which they will not sink.

This article is a good illustration, in which the actual results of some research are distorted to suggest something entirely unsupportable. The research shows that there seems to be a small fall in motility of sperm in vitro when placed in proximity to a laptop, and that is where the researchers end. They make no further conclusion. The Mail however tries to give the impression that sitting for long periods of time with a laptop near your crutch is going to reduce your chance of fathering children.

It would be tempting to think that anyone who pays good money for this crap and chooses to read it must be verging on brain dead, but if you read the comments it is clear that some readers at least are fully aware of just how reliable as a source of health information the Mail actually is. One in particular makes the point that, far from laptops damaging sperm, it is usually the other way round.

Fat chance

Over on Pharyngula, American blogger P Z Myers is getting justifiably annoyed that some US states seem determined to promote religious education in public schools. In the US this is prohibited by law but proponents are getting round it by having it included, bizarrely, in the science curriculum. The intention is clear and dishonest, to expose american kids to religious doctrine, masquerading as science.

I don’t think that american secularists have too much to worry about. US citizens already have a high proportion of faithful, and fundamentalist christians, and these would be unaffected by the change. Similarly atheist youngsters are unlikely to be swayed. That leaves those sitting on the fence. But young people are not stupid and are perfectly capable of recognising the ridiculous implausibilities and absurdities of religious dogma, and coming to rational conclusions. 

As an illustration just look at the UK. In stark contrast to the US, British state schools are legally obliged to make all pupils engage in a daily act of collective christian worship. And yet this has resulted in Britain becoming the most irreligious country in the world. The young particularly have turned their backs upon religion so much that the anglican church has admitted that when the current generation of over 60s passes away the church will probably die with them.

So I think if legislators in these states succeed in their aims they are likely to achieve the opposite of what they imagine. Stupid buggers.

Hoarding

Most of us, especially if we have lived in the same house for a number of years will have acquired a certain amount of junk. Stuff that we no longer have a use for, but we don’t throw away in case, one day, it comes in handy. Just take a look in your own loft or garage to see how much stuff, realistically, you will never use again. And look in the back of your kitchen cupboard and you will probably find something you know you will only ever eat if you are snowed in for so long that the family dog is next on the menu.

For some people however this natural unwillingness to discard things becomes all consuming in a form of obsessive compulsive disorder characterised by hoarding. Most of us find this behaviour incomprehensible, but once in a while it can pay off.

This unremarkable and ordinary pill pot, that once contained phenylephrine tablets would normally have been discarded. Instead someone retained it, and it sold at auction for £2,600, purely by virtue of the label.