God's loophole

DZ has been very remiss, and hasn't written anything for some time now. Now in (semi) retirement you'd think wouldn't you that time would press heavily and he'd be on here non stop.

None of it. I'm busier now than I ever was when I was employed and can't keep up with everything on my ever expanding "to do" list. Also the appearance in his life of a new lady has been something of a distraction. I didn't see that coming.

So what has dragged him back to the word processor? Has he become deeply concerned about some new absurdity within the NHS? No. Has the GMC once again demonstrated their unfitness for purpose? Almost certainly but not that I've noticed. Brexit? No. Trump? No. Though both would be rich sources of material.

Regular readers here will be aware that I'm not averse to railing about the weird obsessions and control freakery of religions. In particular their obsession with sex. Specifically their consternation about people having it and enjoying it. Particularly women. Religions in general are terrified of female sexuality, and see women as having to be totally controlled in this area. Female genital mutilation is perhaps the most extreme example of how this control is enforced. Lest you think this is about to turn into a tirade against Islam it must be pointed out that John Kellogg (of corn flakes fame) strongly advocated ablation of the clitoris in young girls using phenol, in the USA in the 1880s.

FGM is of course illegal now in the USA, isn't it?  But that doesn't mean that they don't have their own means of trying to suppress sexuality. One of these is the "purity pledge", or "virginity pledge"

But where there's a will there's a way. And youngsters who want sex can find a way to circumvent the spirit of the pledge while technically abiding by the letter. And as this article shows many, including a former president of the USA, take the view that when it comes down to it, only vaginal sex counts as doing the deed. Even the bible seems to support this view.

And so it seems that a proportion of young people have found a loophole that they can exploit. Rather sweetly summed up in this little song.

Keep it in a box

Yesterday's satire.

Today's normality



NHS told: give trans patients equal access to fertility service 

Appraisal, last word.

DZ wasn't going to comment further on appraisal but an article in today's Guardian made him reconsider.

Yet more evidence that standards of care are falling in the NHS has come to light, making very disturbing reading. The report doesn't once mention appraisal, nor is it suggested that the fall in standards is down to poorly performing staff.

Instead what is highlighted is inadequate resources, understaffing, delays in treatment. Hardly a surprise to front line staff. It is estimated that the NHS is short of 10,000 doctors alone.

So when the NHS is so short staffed how can we possibly justify taking what staff we have away from patient care to spend significant amounts of time on a pointless tick boxing and navel gazing exercise. An exercise reviled, ridiculed and regarded with utter contempt by the staff who have to endure it.

Appraisal is a process which achieves nothing whatsoever but to irritate, annoy and demoralise, and is a dubious luxury we can not afford. Without a doubt it has failed utterly in its aim to flag up problematic staff, as detailed here. I'll repeat what I said in my last post. It is a failed experiment.

More appraisal bollocks

One of the frequent excuses behind the imposition of appraisal is that it would "prevent another Shipman", though no evidence exists as to how the process achieves this. It has to be remembered that the medical profession has not supplied the only serial killer in the NHS, and perhaps this is why appraisal is now rolled out to blight the working lives of all healthcare workers.

Well it appears that in this one and possibly only justification it has failed. The news report does not elaborate about what sort of health care worker is involved here, but it is clear that appraisal has not provided the safety net claimed. Another Shipman/Allit has been at work and gone undetected for some time. I don't suppose for a moment that she was exposed by appraisal. Perhaps she should have mentioned it in her personal development plan.

So if, as I said in my last post, it has not demonstrated that it improves standards, and it does not pick up the psycopaths in our ranks, then what is it for?

Appraisal Appraised

Not long ago I posted on the utter waste of time that is "Mandatory Training". I pointed out that the obsession with this bollocks takes doctors away from their patients for a not insignificant period of time, to learn stuff, much of which is of no relevance to their profession whatsoever.

In similar vein I thought I'd look at that universally reviled, ridiculed and disrespected process of annual appraisal.

As Doctors we are used to the concept of examining potential therapies for our patients on the basis of how the potential benefit balances against the potential downsides. We look not only at the  expectations of therapy, but also the possible adverse effects, and, ideally, present these facts to the patient, to ensure truly informed consent. We also consider cost.

So how does appraisal stack up using this approach?

1. Benefits of annual appraisal.
This of course is going to be difficult to objectively assess. The GMC approaches this difficulty by not even trying. Their concept of "success" seems to rest heavily on compliance rates. Almost all doctors are now participating in the process and that alone is considered success. But participation is not enough. There is little reason to believe that this man should not have been able to comply and retain his license to practice. The GMC would have considered that a success

 Although it is claimed that there is evidence that the profession has a very positive attitude to the process, this appears to be based entirely on surveys. Try getting research published where the database consists entirely of surveys and see how far you get.
The claim is that appraisal and revalidation will identify underperforming doctors and thus raise the standard of practice. Really?

So how come that, as the GMC admits, complaints made to the GMC about doctors have doubled in the last 4 years? Doesn't speak of a raising of standards does it?
How about claims against the NHS for clinical negligence? In 2004/5 there were 5609 such claims, in 2015/16 there were 11000, and in 2016/17 a staggering 17338. The numbers are rising steadily and apparently inexorably. That doesn't support the idea that standards have risen since appraisal came along either does it?
Excess hospital deaths show the same trend.
Let's face it, the assertion that appraisal and revalidation improves standards is not supported by evidence.
So Benefits?   Zero!

2. The downsides.

GMC propaganda would have you believe that doctors are warming to the concept of appraisal. Odd... I have yet to meet a single doctor who has any respect or regard for the process at all. Indeed there is evidence that most find the process demoralising to the point where it is a significant cause of  doctors taking early retirement. Or deserting the UK altogether.
The BMA estimates that annual appraisal takes the typical doctor about 40 hours, a full working week, to prepare for and endure. There are approximately 250,000 fully registered medical practitioners in the UK, so that means that total doctors time spent with patients is reduced by 250,000 weeks every year to accommodate appraisal. Assuming 6 weeks annual leave a year, plus 2 weeks study leave a full time doctor will work 44 weeks per year. So appraisal causes the effective removal from the NHS of 5681 full time doctors..............and a part timer. Put another way, if appraisal was abolished tomorrow the NHS would benefit with an effective rise in clinician numbers of 5681, without cost!

Whichever way you look at it, appraisal and revalidation for doctors is a failed experiment. One that virtually no other country has sought to emulate.

An utter bag of shit tied up with string.

Crooks

DZ has long felt that corporations in the UK seem to have precious little concern for the rights of their customers, seeing them only as walking cash machines. Over the past few years he has had a number of occasions when various companies have tried to weedle out of their responsibilities.

Such as "petplan" trying to avoid paying out for a dog's vet bills by claiming, falsely, that the medical condition occurred less than 2 weeks after the commencement of the policy. A period when, despite you having paid the premium cover is not provided. It gave DZ immense satisfaction to prove them wrong and eventually present them with a bill for £8000.

Or Apple, trying to claim that a cracked screen protector (with an intact screen underneath) invalidated the warranty and therefore the defective battery could not be replaced. Could anyone explain how, even a cracked screen could damage the battery. They seem not to care about the fact that warranties "do not affect your statutory rights".

Whirlpool informing me that there is a product recall on a tumble dryer, because they burst into flames, and then offering to SELL me a new one at a discount.

These people rely on people not having the tenacity to pursue them, paying up because it's less trouble.

Probably the worst offenders here are the car parking companies, which operate many hospital car parks. Typical are UKPC who have in the past been caught out altering photographs, changing date stamps, making stuff up and blatantly lying to screw people out of exorbitant "penalty" charges. In the world of industry this is not considered bad behaviour. UKPC have on their website the statement "UKPC is very proud to be identified in the London Stock Exchange Group's "1000 Companies that Inspire Britain" 2017 report"  I think that says it all about modern Britain

Despite having been suspended in the past they have been caught out, and suspended by the DVLA yet again.

So remember. For the time being you can park in a UKPC car park at your hospital, not pay, and they are forbidden to pursue you for any parking infringement incurred during the suspension.

Alternatively you could move to Wales, where it is illegal for hospitals to charge for parking

Family

In my post "DNA" I used one of my favourite bits of film. The film of Buzz Aldrin giving Bart Sibrel a very well deserved punch in the face. But what I like most is not the actions of Buzz or Sibrel, but of the lady accompanying Buzz, who is his daughter.

In this more extended version of the incident you can see that she makes a number of attempts to separate the two men and keep them apart. It might seem that she is trying to protect her aged father from the unwanted attentions of that prick Sibrel. But I think nothing could be further from the truth. I think it was the other way round. When the words "coward and liar" come from Sibrel's mouth just see her reaction. She's getting out of the way. I think she knew exactly what his reaction was going to be. She is as much of a star as her dad.

DNA2

No sooner was the ink dry on my last post than I came across this article in the Guardian. The article itself is bunk and illustrates exactly what I was saying about the dumbing down of the British public, who are increasingly falling for this sort of thing.

But...............................................

My faith is restored because the article also illustrates that there is hope for us in the form of two different groups of people.

1. The practitioners of this therapy.

 These people are almost certainly aware that their IV high dose vitamin therapy is total drivel. But they at least are making money out of the gullible and the uneducated. Cynical possibly, certainly unethical, but not without a degree of calculating intelligence. A fool and his money are soon parted. You may not admire these people, but I don't think you could call them stupid.

2. My real respect though goes to the vast majority of those who have made very appropriate responses to the article in the comments section.

 It appears that a lot of people out there have had a decent education after all.

DNA

DZ has a friend who used to live in the USA. The family moved from there to the UK some years ago for the sole reason that they felt the standard of education in the states was very poor and they wanted their children to get something better. I remember at the time being very surprised and doubtful that things could be so bad over there that they would undergo such disruption.

After all, the USA is the most technologically advanced country in the world isn't it? Surely that speaks of a very high level of scientific education. After all, they sent men to the moon.

But of course many Americans will now assert that that was all untrue, which starts to make you wonder about their intellectual prowess. And telling this guy that he's a liar and a coward is particularly stupid.

But perhaps a good illustration of the startlingly poor level of scientific education of Americans is this study, which indicates that 80% of Americans have no idea what DNA is, and want foods containing it to carry a warning label! And it seems this level of ignorance goes all the way to the top

To be fair there is no similar study for the UK population so I don't know if we would be any better. And a lot of bizarre pseudo scientific beliefs do seem to be creeping in here too. Our own government has precious little in the way of scientifically literate people. Out of 650 MPs, only 25 have a science degree. The last PM with a science degree was Margaret Thatcher. In addition the Health and Science committee of the House of Commons for many years has had this guy on it.

Perhaps we are getting close to this a lot sooner than we thought.

.

Days, weeks and months.

Most people will be aware that a lot of dates in the calendar are dedicated to some historical event, or worthy cause. Many of the dedications are well worth honouring, such as "Human Rights Day", December 10, "International Beer Day" (YAY!) 1 August, or "International Holocaust Remembrance Day" January 27.

Others, though this is purely DZ subjective opinion are  a little more............dubious? "International day of Francophonie", March 20 ("Nous nous rendon" seems to cover most eventualities.) Also "World Puppetry Day" March 21, and "Star Wars Day" May 4! (Yes really!)

And finally others are positively shite. In particular is April 10, the birthday (in 1755) of Christian Friedrich Samuel Hahnemann, the founder of the utter bilge known as homeopathy. The date has now been appropriated by quacks as "International Homeopathy Awareness Day" Indeed, so keen are they to perpetuate and encourage this tripe that the day seems to have metamorphosed into a whole week, which, thankfully ends today. It was preceded by "Chiropracty week", celebrating another load of pseudoscientific drivel, pushed by a load of quacks.

Why they should be entitled to a whole week when the cause of abolishing slavery only gets one day is beyond me.

But my faith is restored by the fact that some causes actually get a whole month. And one such is just around the corner. May is "International Masturbation Month"

In the words of the song "It does me good, like it bloody well should". Which is more than you can say for homeopathy or chiropracty.

Price of a hard on.

DZ has noticed, purely professionally, that Sildenafil is now available over the counter. When you look at the pharmacology of the drug there's no reason why it shouldn't be. But you do wonder why the drug companies are so supportive of this move. Could it just be that the basic cost of the generic version of this drug is about 40p a tablet. So an NHS prescription costing £8.80 could provide 22 tablets and the taxpayer would break even. Similarly a private prescription could provide 50 tablets for £20.

Buying Viagra over the counter will get you just 4 tablets for £20, or £5 each.

You don't suppose it's all just a con to protect someone's profit margins do you?

Medical dishonesty

Another case for the "some doctors will do anything for money" file. Regular readers here will be aware that DZ has a somewhat cynical view of his own profession, and the motivations of at least some of his colleagues.

So reading about this case came as no surprise to him. Insurance fraud is now becoming quite a big thing these days and, DZ is pleased to see the insurance companies starting to fight back.

The claim was described in court as "blatantly false". But it could not have proceeded without the encouragement of a claims management company. We've all had calls from these parasites, wanting to generate spurious claims from nothing. DZ enjoys immensely responding appropriately to these leeches. They also had their own tame solicitor. One wonders if the Solicitor's Regulation Authority has a procedure for those who act dishonestly.

We of course have the GMC.

It is clear that the claim was fully supported by a doctor, who must have been fully aware that the claim was false, but went ahead anyway for the money. This one case is just the tip of the iceberg. Pretty much every false personal injury claim made, be it a holiday claim, accident at work, traffic incident or whatever, has to have the collusion of a crooked doctor. The GMC good practice guide is quite clear on what it expects.

"71. You must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents.²² You must make sure that any documents you write or sign are not false or misleading.

a. You must take reasonable steps to check the information is correct.

b. You must not deliberately leave out relevant information."

Time to start acting on this I think boys!

Mandatory waste of time

DZ has just lost several hours of his life engaged in "Mandatory Training", the annual foray into areas of knowledge utterly irrelevant and pointless to his actual job. Conducted on line, he is supposed to read a number of documents and then answer questions on the contents rather like the comprehension exercises he did at school when he was six.

The questions fall into a number of categories;
1. The stupidly obvious. for example, choose one of the two following answers about the cause of dementia. 1.Some brain cells become damaged, or 2. as a result of limb amputation. Even the demented would get that right just by counting their limbs.
2. Clinical questions so simple that a foetus with medical ambitions would get right. e.g. Platelets are involved in blood clotting, true or false. Strewth!
3. Questions where the options don't include the correct answer. Such as the one asking what appraisal is. The options strangely don't include "An utter bag of shit tied up with string".
4. But perhaps the commonest questions are those which all have the same answer, like these;
   How many stages are there between taking a blood sample, and transfusion?
   What year was The Patient's association set up?
   How many "C"s are there in "Compassion in practice"
   What does the Royal College of Nursing think about (anything)?
   Anything at all about food handling.
   What year was .................................?
   How many reasons are there for "challenging behaviour"

So what is the common answer to so many questions in such diverse areas?

          "WHO GIVES A FUCK? WHY DO I NEED TO KNOW THAT?

So two sessions of clinical work were given up for this crap. Extend that to every medical practitioner in the UK, all 250,000 of them and you get a total of half a million clinical sessions. That's the equivalent of 1623 full time doctors, and a part timer. Toss the whole process in the bin and you overnight effectively gain that many extra doctors at no cost.

Lest it be thought that my ire is because I failed the tests I'd like to point out that I did very well, like every other doctor in the place. But not because we were all diligent and attentive. It's because we all had (unofficial) access to a crib sheet.

Yes, DZ cheated!

Quack.

Those who have followed my blog for any length of time will be aware of my feelings on freedom of speech. The concept is constantly under attack and has to be constantly defended. Governments don't like it, though most democracies would not dare diminish it. But companies, individuals and organisations, including the GMC, repeatedly try to stamp on it, and rely on financial or authoritarian muscle to bully their way over the right to freedom of speech.

Practitioners of complementary and alternative medicine seem particularly aggrieved by freedom of speech. This is hardly surprising. When you profit by dishonesty, mendacity and fraud you hardly want anyone drawing attention to it now do you. The attempted silencing of Simon Singh by the British Chiropractic association is a good example.

Another recent example has recently come to light. I'm not going to go through the details, the link takes you to a fully comprehensive account.

It's notable that, an American quack is attempting to sue a German resident, who is being supported by an Australian sceptics association. It is also worth mentioning that Colleen Huber, or to give her her correct medical title, Colleen Huber, would almost certainly fall foul of the Cancer Act 1939 if she were to make her ludicrous claims in the UK.

Ms Huber also seems not to have taken into account the Streisand effect. Her actions have drawn her a great deal of adverse attention worldwide, and the fund set up to defend Ms Hermes has collected 54,000 dollars (Aus) in 4 days. A great many people have written a great deal about Ms Huber and her dodgy dealings.

DZ has never been one to hold back against these people. Colleen Huber's treatments are unsupported bilge. Her "research" and practice an utter disgrace. Her claims are distorted, exagerated, invented, fabricated and without foundation in fact or reality. In promoting her bogus treatments, and discouraging conventional treatments she is undoubtedly causing the premature deaths of many of her victims.

Colleen Huber

Ms Huber has produced a promotional video entitled "Cancer can be killed with Colleen Huber". Well, the only thing likely to be killed by Ms Huber is her unfortunate patients.

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