I have it!

 

DZ has had a “Eureka” moment. It has come to him like a blinding flash what is at the top of the massive list of things that is wrong with appraisal. It’s so simple!

Imagine for a moment that in the recruitment process it was acceptable for candidates to write their own reference. I think most people can see what would be wrong with that.

So why is it considered OK that we fill in our own appraisal form? Just maybe there might be a little bias and exaggeration involved, and a little filtering possibly?

When it comes to colleague feedback might we just ask people we get on with, or have a little dirt on, and exclude that vascular surgeon you called a cunt.

And patient feedback. Might we just ask those we know like us? And exclude that guy whose young wife we comforted while he was in hospital?

And when it comes to the appraisal form itself do you suppose it’s possible that that too is bordering on a work of fiction? Is it possible that those patients you misdiagnosed, screwed up, swindled, fucked or killed don’t get a mention?

Surely not! Surely an organisation such as the GMC must have thought of that?

GMC appraisal dept.

Apprentice doctors?

DZ went to medical school in the 1970s, having been born in the 1950s. Had he been born twenty or more years earlier it is unlikely that he would have even contemplated applying to study medicine. Being the son of immigrants, and from a working class background the cost would have been prohibitive.

But the Education Act 1962 made it a legal requirement for local education authorities to provide funding for university tuition, and a maintenance grant, for any young person in their area who obtained a place at a British university.

This meant that anyone, regardless of gender, social class, parental income or ethnic background could aspire to a university education. DZ remembers well that his peers at medical school were indeed a very diverse bunch, from a wide range of backgrounds. For 36 years British youngsters lived in a window of opportunity where anyone could afford a university education.  This situation continued until 1998 when Tony Blair brought in student tuition fees, and loans. And all that ended. We now live in a time when higher education is considered a commodity. Students graduate with such huge loans that many can never hope to pay off, and many youngsters are put off going to university by the costs. The clock has been turned back, and again only the sons of the wealthy can aspire to a career in medicine. This at a time when we are thousands of doctors short, and there are plans to massively increase training places for doctors.

This has been noticed and the view has been expressed that it would be desirable to “widen access and participation in undergraduate medical education and attract students from varying backgrounds that better mirror communities, or may have struggled to pursue a traditional medical degree education”

So they have thought of a new route to a medical degree, as described here. It is assured that this will not be a second class version of an ordinary medical degree, and that those enrolled will earn a wage! It sounds a lot like a back door way of admitting the old grant system was better, and bringing it back, (but only for medicine) whilst calling it something new and avoiding all the embarrassment of admitting that you fucked it up in the first place.

It's due to start as early as next year.

0

Strike??

 

There is no doubt that over almost 20 years doctors’ pay has declined significantly, by a process of slow erosion. The same is true of other NHS staff, but I’m going to confine myself to talking about the medical profession. The BMA estimates the drop in real earnings to be 30% since 2006, a figure I can well believe. Coincidentally that also corresponds to the time period when doctors have been burdened with the extra workload of appraisal and mandatory training in most cases without any reduction in clinical workload.

The BMA are thumping their chests and demanding a pay rise of 30% in real terms over the next five years. And a national strike is threatened if they don’t get it.

Those of DZ age will know that, no matter how justified this might be, this is just not going to happen for a number of reasons.

Firstly a third of all doctors are not actually BMA members. They will not be balloted on strike action, and are unlikely to support it. The government know this

The BMA are “all mouth and no trousers”. They don’t have it in them to pursue their aims against a hostile and intransigent government. Nor will they support individual doctors who become targeted by employers and the GMC. The government know this.

Next, doctors have never felt easy with industrial action, for the simple reason that action which hurts their patients goes against the grain. Total support for strike action is unlikely, and support will fall if the action drags on. Both the BMA, and the government know this.

The GMC have in past disputes made veiled threats towards doctors who engage in such action.

Government will use the same tactics to screw us that have always worked before. Dig in their heels and wait. The BMA will not be able to sustain a prolonged campaign. Both the BMA and the government know this.

DZ addressed this the last time doctors engaged in industrial action and lost. He even made a suggestion that never occurred to the BMA, or perhaps it did and they decided it was too likely to shake up the government and the GMC, that the gongs that many BMA high ups aspire to might be at risk.

A form of industrial action that would be popular, sustainable indefinitely and not adversely affect a single patient.

Boycott all non clinical work.  Refuse en masse to engage in appraisal, revalidation, CME, audit, mandatory training, teaching etc. We could keep that up for years if necessary. And there’s fuck all they could do about it if we all stuck to it.

Preverts

 

The recent and ongoing battle in the USA over reproductive rights has induced disbelief and horror in most other advanced western countries. What many outside the USA do not appreciate though, is that, for the fundamentalist Christians in the USA, the overturning of Roe v Wade is just the beginning. The decision of the US supreme court made their decision on the basis of the argument that individual states should be the ones to decide on abortion policy. And yet before the ink was dry the victorious religious loons announced their aim to impose a ban throughout the USA, riding roughshod over the very idea of states’ rights that they were happy to use only days before.

And there’s more. Emboldened they have also made it clear that they have contraception, and same sex relationships in their sights too. And at least one of the supreme court judges has already expressed his sympathy with this aim. This is no surprise. With these fanatics misogyny and homophobia have always gone hand in hand.

Nothing gets them more frothing at the mouth than contemplating, obsessively and at length about what other consenting adults get up to in private. Like Grumpy in “Snow White”, they don’t actually know what “wicked whiles” are going on, but nonetheless they’re “agin em”.

This is nothing more than a frantic, and fanatical attempt at control, particularly of women, and more particularly of female sexuality. The whole concept of female sexuality terrifies them. And this is reflected in some of the frankly bizarre mythology that some of them cultivate

So I’d like to present just a few examples of the more eye popping and absurd ideas displayed by some of them.

Like this guy.

Jessie Lee Peterson

A man who manages to combine misogyny, and homophobia with a breathtaking hypocricy as detailed here. One thing in particular that seems to have him incensed is the notion that women can have orgasms. How dare they?

And how about this for some really bizarre notions?

You don't have to be a gynaecologist to understand that you can't actually insert anything into a clitoris, and any attempt to do so is definitely not going to induce an orgasm. The rest of his rant just makes DZ head spin. One gets the impression that the reverend has never actually seen a lady's bits up close at all. I've certainly never seen any that looked like that.

The same guy also wrote this!!!

So he wouldn't like this then.

If, and I don't advise it, you have a look at this deranged lunatic's facebook page, to which I'm not providing a link, you will find a whole world of mind exploding ideas that you'd probably regret reading. Fortunately much of it is in Spanish

Whenever DZ comes across people like this he comes to the view that their utter obsession with other peoples' sex lives is far more unhealthy than any of the practices that offend them. They remind him of this clip.

What?

 DZ tends to click on medical articles in the media. They're often characterised by a total lack of research on the part of the journalist, as here.

So it's difficult to say if the statement in this article originated with something the patient actually said, or was misinterpreted by a lazy journalist.

Apparently a lady having nerve blocks administered for migraines by a pain doctor had an anaphylaxis. They administered adrenaline by what looks like the intramuscular route without benefit. The day was saved by the arrival of another doctor who administered adrenaline intravenously.

There is so much about this that sounds weird.

Firstly migraines are not treated by nerve block. In this area Botox has been used, which is a licensed indication. But nerve blocks? No.

Secondly chronic pain is an anaesthetic subspeciality, and nerve blocks are done by anaesthetists, so the pain doctor would have been an anaesthetist. Who would have been well able to obtain IV access and give adrenaline.

Thirdly I would assume that the guy who saved the day was also an anaesthetist. But apparently not. To quote the newspaper article; 

"I think they gave me three shots of adrenaline but it wasn't working, so they needed to gave me intravenous adrenaline when the antitheist came. I think that saved my life."

So what qualifications do you need to be a NHS antitheist? DZ might apply for that.

Appraisal causes disaster.

 

I’ve written repeatedly here about appraisal and revalidation, and vowed to myself on a number of occasions that I’ve now exhausted the subject, and I’ll put it to rest.

And then along comes another horror story.

This one concerns a doctor who started working in an NHS post in 1991 as a haematologist, who carried on working into his mid 80’s by simply informing his employers that he had made a mistake with his date of birth, and “updating”. He did this more than once until it was noticed that his latest update would have made him just 8 years old when he qualified from medical school.

He duly appeared in front of the GMC, was found guilty of dishonesty and his registration was suspended for twelve months, after which he was restored to the register.

Prior to his suspension he had accumulated a number of adverse incidents relating to his work, no doubt related in part to his advanced age. You would have thought that the Trust involved would have taken steps to ensure his retirement but no. Unbelievably they gave him his job back and he returned to work.

So let’s just summarise

He had a string of adverse incidents

He had a GMC conviction for dishonesty

He was 85 years old

And his Trust gave him his fucking job back!!! With the full acceptance of the GMC!!!

So what happened next should not surprise anyone.

A patient of this doctor required bone marrow sampling and he chose to obtain it by sternal puncture using the device featured in my recent mystery object post. This is a simple procedure and very safe if properly done. DZ himself performed it a number of times as a houseman in the 1970s. It requires some physical force to penetrate the front of the sternum and it is absolutely crucial that the adjustable collar on the needle is securely set at the correct distance from the tip to prevent the operator from “following through” and coming out of the back of the sternum. The correct distance is usually just a few millimetres.

Reading between the lines either, the collar was removed, the collar was not set at the correct distance, or it was not properly tightened. The result was that the doctor went through the sternum and penetrated the heart causing rapid death from haemopericardium and cardiac tamponade. The patient was in her 40s, and was accompanied by her husband, who witnessed the entire debacle.

Naturally the police were involved and the doctor found guilty of criminal negligence. He has been sentenced to three years in jail.

The GMC, and the Trust involved undoubtedly failed in their duty of care to the patient. But they also have a duty of care to the doctor. In restoring his registration, and reemploying him they clearly failed in that duty too. He should have been quietly and gently informed by both that he was being retired, not just for the benefit of his patients, but also his own. As a result of their abject failure a woman died, and the doctor will spend what is almost certainly the rest of his life in prison.

So where does appraisal and revalidation come in here. Well obviously he has successfully navigated these since 1991. Had he not he could not have been revalidated and reemployed. So this is not just yet another case of the process not working in weeding out an unfit doctor. It is far worse. This is a case in which the appraisal and revalidation process actually facilitated the return to work of someone unfit.

Nice one boys.

Mystery object, answer

 An anonymous reader has correctly identified this as being for the aspiration of bone marrow. It's used specifically for obtaining this by sternal puncture. The important part is the adjustable collar on the needle which limits the depth to which the needle can penetrate. The idea is to get into the marrow cavity, but not perforate the posterior wall of the sternum, and the large pulsating organ behind it!

 This instrument, and the collar on it, will be featuring in my next post.

Mystery object

 DZ has found a better pic of that last mystery object. maybe we can get some suggestions as to what it is.

Mystery object

It's a very long time since DZ published a mystery object. Not a very good quality image I'm afraid, but if you know it you'll recognise it. DZ is old enough to have used one of these in the dim & distant past. So, any guesses?

 

Hypoxia!

 DZ has always been careful to ensure he does not identify himself on this blog, but on this occasion has decided to post a pic of himself. Here I am.

Yes, DZ has acquired a dinosaur suit as a present, and very pleased he is with it too. It's a wearable plastic inflatable. It's kept inflated by an electric fan which also supplies the wearer with an air supply, very important when wearing a large plastic bag. Like most men DZ finds the idea of reading instructions a bit demeaning. After all I can figure out something as basic as this without having to resort to patronising instructions. And so it was that I installed the fan the wrong way round. I put it on, zipped up and turned on the fan. Which promptly sucked all the air out of the costume, causing some consternation as the resultant suffocation started. Unlike some strange souls I am not someone who finds this a pleasant experience. Fortunately I was able to find the zip fairly quickly and open up. 

Lucky I didn't end up like this.