Bonjour

You may have noticed that normal service has been resumed. I couldn't keep away. Back to my usual articulacy.

Full circle

So the politicians think that there aren’t enough working class youngsters going to medical school. Whose fault is that? 80 years ago you could only contemplate a university education if your parents were well off. The lower classes were kept firmly in their place by this denial of access to the professions. 

Then in the 50s to the 70s there was a window of opportunity. With Grammar schools, free university education, and student grants the playing fields were leveled and the universities started to fill with the son & daughters of the masses. My own year at medical school was a strong illustration of this. 

The first nail in the coffin was the abolition of the Grammar schools, which had provided a state school education that was the equal of the public schools. Since then, in their political quest for egalitarianism, British state schools have sunk to a state of uniform mediocrity.  Add in tuition fees and student loans and we have come back full circle.

DZ was born into a working class family. There is no way today I think I would ever have got to med school.

DZ gets it wrong

I posted recently on the BMA ballot over the pensions issue. I now have to eat humble pie and say that I was wrong in my predictions. The response rate of 50% may not seem high to some but it is far higher than I expected. And the results are not what I expected either.

Although I was wrong, I am nonetheless very pleased. Finally the sleeping tiger has woken. Doctors as a group have now united and stood up to oppose. And about fucking time too. They have put up with a great deal over the last few years, and laid down while successive governments have walked all over them over a number of issues. I expect the powers that be thought, as I did, that the profession was too apathetic to take a stand on any issue.

I do hope that, when this issue is resolved, the profession does not revert to it's previous recumbent state.

Quote

“By definition, free speech doesn’t mean anything unless some people are going to be offended some of the time.”

Michael Gove

DOH!

Orthopaedic surgeon & trainee

I know I said "Au revoir" but I could not let this go uncommented on. A paper by orthopaedic dinosaurs consultants in Nottingham purports to show that trainees training in orthopaedics has suffered since the implementation of the working time directive. Actually it doesn't show any such thing.

Firstly they point out that the total  number of operations performed by trainees dropped by 13% after the introduction of the WTD. Well that falls into the category of the bleedin’ fuckin’ obvious for a start. If they are doing less hours they are bound to do less work. It is highly likely that this statistic illustrates nothing more than possible overwork in these people before the WTD. And when you overwork people, quality suffers. Simply doing operations does not constitute training any more than driving a long way unsupervised constitutes a driving lesson, and, like driving, doing a lot of work can simply allow the entrenchment of bad habits.

Secondly the figures are claimed to show a reduction in the number of operations performed independently. Well, since the total operations in this category were unchanged that must surely mean that the number of supervised operations increased. Yes? Isn’t that what’s known as training? The equivalent of a driving lesson?

This paper is a prime example of Bad Science, to coin Ben Goldacre’s phrase. It in no way provides any evidence whatsoever of the quality of surgery, but is a crude, and inappropriately interpreted estimate of bare meaningless numbers. Quantity does not equate to quality! It is perfectly possible that the quality of surgery improved after the WTD.

The authors are not just dinosaurs, they’re fuckwits as well.

Now, back to my distraction.

Au revoir

DZ will probably not be blogging for a little while. Hope to be back sometime in the not too distant future.

DOH gets it right

DZ has in the past been ready to hand out brickbats to those high ups in the profession and the NHS who say or do things that indicate a lack of understanding or competence. Various individuals have been described here as people with their head up their arse.

So it’s nice for once to highlight the opposite. Since the working time directive was applied to medical staff the quality of life for doctors has improved enormously in both the training and career positions, but there have also been a lot of dinosaurs in the profession clamouring for a return to the bad old days, particularly for trainees, claiming that training has suffered. It’s been obvious to many that, if training has suffered, and I’m not convinced that it has, then it is because the trainees are being expected to devote too much of their 48 hrs per week to providing the service, rather than training, and that the answer is to move more to a consultant delivered service. This would also lead to an improvement in the quality of service provision.

Well a government committee has just said exactly that, and in doing so reiterated the government’s commitment to retaining the WTD for doctors. Good for them. Perhaps now the throwbacks in our profession will stop harping on about the “good” old days of 80 to 100 hour working weeks.

So hats off to Patricia Hamilton, Christine Outram & Sir Christopher Edwards for doing absolutely the right thing.

Missed it!

Yesterday was "Draw Mohammed Day" and I forgot. A little belatedly then, here is one of my favorites from "Jesus & Mo"

Quote of the day

"Britain is the whiplash capital of Europe"  

David Cameron

These tories eh?

Research

Today, 17 May, is the birthday of Edward Jenner. The man who discovered the protective effects of vaccination, and is on the shortlist for the title of individual in history responsible for saving the most lives.

It’s interesting though to look at what he did in terms of today’s values. What he did was based solely on an observation that milkmaids seemed not to get smallpox. On this sole observation he postulated that exposure to cowpox somehow conferred immunity to smallpox.

Based on this theory he first deliberately infected an eight year old boy, James Phipps, with cowpox. After an interval he deliberately, and repeatedly tried to infect young James with smallpox, but failed. Based on this series of one patient he announced to the world, correctly as it turned out, that he had discovered a protection against one of the most virulent diseases of all time.

Can you imagine trying to get a study like that past your ethical committee today. And if you did the experiment anyway can you imagine what the GMC would do to you.

Lions led by donkeys

So the BMA is balloting all it’s members on industrial action over pensions. I can’t help feeling that this is a totally futile exercise. To be fair most of the reasons why this is a futile exercise are not within the BMA’s power to change.

Firstly, of the 250,000 or so fully registered medical practitioners, only about 141,000 are members. The rest won’t even be balloted. Secondly, as previous ballots and surveys have shown the return rate is likely to be very low. Finally of those who do respond, there will be a wide spread of opinion, from those wanting a full blown and total strike, to those who will refuse to contemplate any form of action which will adversely affect patients. The BMA’s suggestion of action ensuring emergency services will be unaffected is half baked, neither one thing nor the other, and will be totally ignored by the government, even if the BMA could get the medical profession to go through with it. It will not improve our standing with the public and will be ineffective in it’s objective of getting a rethink on pensions.

Add to that the fact that doctors whose pension date is in the not too distant future will be unlikely to want to man the picket lines in support of their younger colleagues. Let’s face it traditional industrial action just ain’t gonna happen, and the BMA knows it. They’re just going through the motions.

But there is a form of action which would almost certainly gain the full support of most doctors, which would be sustainable indefinitely, and not affect patients at all. Revalidation. The BMA could recommend that all doctors refuse to involve themselves with revalidation, or even appraisal, until such time as the government revisits the pension situation. This recommendation would, I think,  be taken up enthusiastically by the great majority. It’s a win/win situation. If the government caves in then the pensions could be salvaged. If they dig their heels in then revalidation would be fatally holed below the waterline. After a while, with most of us refusing to play, the whole concept would quietly slip beneath the waves.

Going down this path would show that the BMA take their role seriously and actually do have some muscle to flex. But let’s face it, they won’t. The high ups in the BMA don’t want to jeopardise their gongs now do they.

Knockers

The PIP breast implant scandal grumbles on. The company that manufactured these implants has now gone out of business, so that door is closed for any affected lady seeking redress. The good news is that those who paid for their implants with a credit card may be able to obtain compensation from their credit card company under the consumer credit act.

The thought has occurred to me that these ladies chose to undergo unnecessary surgery for reasons not related to their health, and that a degree of personal responsibility is perhaps not inappropriate.

Why do women seek out this procedure? It would be tempting to think that it is to make themselves more alluring to us males but this does not seem to be the case. Surveys have shown that those who have breast augmentation are motivated mostly by reasons of self esteem, and what we blokes think is largely irrelevant. Nor are males particularly interested in boobs that have been enhanced and it seems to be the case that men prefer the natural, and are happy with whatever their lady happens to have.

Perhaps the idea that men are totally obsessed with ladies’ chests is a misperception, a misunderstanding.

Why we will never win

The African Wildebeest can weigh up to 250 Kg, and lives in herds tens of thousands strong. If they were capable of co-operative action as a herd the individuals within the herd would be virtually invulnerable.

But they aren’t. When predators attack, all the individuals within the herd panic until the predators single out their victim. And then they all go back to calmly grazing even while their comrade is being torn to pieces and devoured within their sight. Once they realise “it’s not me today” they lose all interest.

The reason I describe this phenomenon is because that is exactly how NHS consultants behave when confronted by a belligerent management. I have commented before on a small number of the more publicised cases where individual consultants have been targeted for special attention by management, and received virtually no support from their colleagues. But these few I have featured are the tip of the iceberg.

Another analogy is to be found in the book “Watership Down” The wild rabbits of the story encounter a group of rabbits who appear to live a utopian existence. They live a life of luxury, fed and watered, constantly warm & dry, and protected from predators. But every now & then one of them is taken away, and is never seen again. These individuals are never mentioned. It is if they never existed.

Management at all levels from the local to the national know full well that this is how the consultant body behaves and that is how they keep us under control. They know they can isolate and destroy any one of us, and our colleagues will stand by and let it happen, conscious that it might be them next time. 

And that is why we will never win. For whatever reason we are unable or unwilling to co-ordinate our considerable strength for the common good. Why should it be like that? We are not wildebeest.

Happy day

Today, apparently, is “International Nurses Day”. Can’t say I had ever heard of it. Anybody out there doing anything special to celebrate? This particular date was chosen as it is also Florence Nightingale’s birthday. So happy nurses day to all our nursing colleagues.

Fat birds!

DZ has the uneasy feeling that what he is about to write may make him look sexist, and fattist.

Occasionally you come across a research project, the results of which come into the category of “the bleedin’ obvious” This paper, reported in the Telegraph is one such. So obese girls are less successful at getting pregnant than their slimmer sisters. Surprise surprise! The study actually refers to the success of IVF treatment, but the principle is well known to most blokes. If your typical male were trapped on a desert island with these two ladies which is more likely to end up pregnant?

Some of you may feel that I am being a little unkind and unfeeling, and NICE would agree, telling us all that we should not be using the word obese to our obese patients because it’s derogatory.

But the UK is fast becoming a nation of fatties and perhaps it’s time we told the plain truth . “No Mrs Lardbucket, you’re not big boned, you’re not retaining fluid, and it’s not your glands. You’re too sodding fat, because you have no self discipline, and you eat too much.” How's that for sensitivity?

DZ

Regulation

Regular readers here will know I have scant regard for the General Medical Council. I consider them arrogant, overbearing amateurs, inadequately supervised or regulated. An organisation  that seems to think itself above the law, with human rights breaches proven against it in the high court, and maintaining a system heavily skewed against any doctor that comes it’s way.

You would have thought that having the GMC as a regulator would be enough wouldn’t you?

I have mentioned before that there are several other bodies that also have regulatory powers over doctors, but until today I had never heard of the “Health, Education & Social Care Tribunal,” which has recently banned a doctor from working in the NHS. The media seem unsure as to the function of this body as well, the headline claiming that the doctor has been “struck off”, while admitting further down in the article that the GMC has done no such thing.

The medical profession is fast becoming the most over-regulated profession in Britain. The plethora of bodies involved constitute a chaotic mess that inhibits the proper professional conduct of doctors rather than enhancing it. We are all perpetually looking over our shoulders wondering who might be scrutinising us.

We no longer have double jeopardy, it’s now multiple. The possibility exists that we might have to defend ourselves several times for the same perceived offence. For the many bullies high up in the NHS it’s a gift. As soon as one body rejects a charge against your victim, simply send the complaint to another. I have seen this happen. A NHS Trust sent a file of complaints against a Consultant to NCAS. NCAS rejected the entire document in a single afternoon on the grounds that it’s contents were spurious. So the Trust sent the same folder to the GMC, who took somewhat longer to do the same.

This is tyranny and should be addressed. Over to you BMA.

Kids TV

Apparently the old children's programme "playschool" was not as innocent behind the scenes as might be imagined.

"Rainbow" was not much better.