doctor zorro

Every sperm is sacred

2012-02-17T15:21:00.001Z

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

2012-02-17T14:15:00.005Z

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

2012-02-15T19:50:00.002Z

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

2012-02-14T18:57:00.000Z

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?

2012-02-14T15:07:00.000Z

"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

2012-02-14T09:45:00.002Z

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

2012-02-13T19:53:00.003Z

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

Rude awakening

2012-02-13T19:37:00.001Z

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.....

2012-02-13T19:18:00.000Z

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

2012-02-12T13:48:00.000Z

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

2012-02-10T12:45:00.001Z

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

2012-02-07T21:52:00.000Z

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

2012-02-01T18:49:00.000Z

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

2012-02-01T10:26:00.000Z

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.

Do the burqa

2012-01-31T14:21:00.001Z

Johan Viemmix has recently made a short video taking the piss out of the burqa. This garment is now illegal in Holland and his video features a T shirt that can instantly be transformed into a burqa. Unsurprisingly he has had death threats and there are calls for the video to be banned and suppressed. Well we can't have that now can we.

Allergies

2012-01-31T09:39:00.003Z

Dr.... “So then Mrs Adipose, when did you discover you were allergic to latex”

Patient... “Well doctor, a while ago I put on a rubber glove to manually evacuate my rectum, and when I finished my bottom was sore”

NutraScience scam

2012-01-30T16:31:00.000Z

The scammers are back! If you spend even a short time each day surfing the web you will probably have seen ads for a slimming product promising to turn you from a lard eating pie bucket into a lithe slender sex bomb, just by taking their magic pills. If you click on the link to find out more the telltale signs of a scam are all there.

1, The site makes wild and implausible claims to appeal to the desperate and the gullible.

2, The web is saturated with sites promoting the product, often heavily supported by testimonials from satisfied customers. Some of these testimonials might even be genuine.

3, You find that the magic pills are in fact of two types and they only work in combination. So you have to buy both.

4, There is a special offer ending very soon giving you a free trial for just a few pounds.

5, You can only pay by credit card, and you are required to authorise regular deductions from your account.

6, It is difficult, if not impossible to actually contact, or get a response from the company by phone, post or email.

If you look at the list of ingredients there is nothing special. Just a few random substances, green tea, acai berries, inorganic chromate. What are these supposed to do exactly? There is not a jot of evidence that they can in any way help you lose body fat. If you really want to try them you can get them from a health shop far more cheaply, and waste much less money. And when you find they don’t work you don’t have to buy any more. There are already cases of people having signed up to this finding unexpected deductions from their credit card account.

Steer well clear. Don’t give these people your credit card details.

Pygmies

2012-01-28T10:09:00.000Z

The NHS reforms do have some supporters in the medical profession, as is seen in this article, warning of the dire consequences of the reforms not going ahead.

So who exactly are these people? The article reveals that the signers of the letter are mostly doctors who are already heavily involved in setting up the clinical commissioning groups, and who will be prominent in them once set up. In other words people with a very significant financial vested interest.

The letter has been organised by the “NHS Alliance” an organisation heavily promoting the reforms, but which has no formal or official standing whatsoever. A considerable proportion of it’s members are not doctors. And it, and some of it’s members are enthusiastic proponents of “complementary and alternative medicine”, that’s woo to you & me. One of the Alliance’s high ups is Dr Michael Dixon (OBE) who was president of the Princes Foundation for Integrated Health before it went tits up. Dr Dixon’s surgery is a centre for quack therapies.

I have no doubt Lansley will make the most of this support to claim major support within the medical profession, but in reality they are very much a splinter group, made up of self advancing doctors on the make, and a bunch of medically qualified quacks and loons.

If this is the only real support that Lansley can muster then I think he is on very shaky ground.

Mystery object answer

2012-01-27T14:54:00.002Z

"Anonymous" has suggested, correctly, that this is a special sort of strain gauge. But he does not say what specifically it is used for. I wonder why.

Mystery object

2012-01-25T20:23:00.000Z

It has been some time since I had a mystery object. Any guesses as to what this is, and what it is used for.

Spot the difference

2012-01-23T23:24:00.003Z

Despite the almost universal opposition across the medical profession now to the governments plans for the NHS, there remain a few ambitious sycophants who keep telling the government what they want to hear. Is it just me or is there a resemblance between these two.

Prof. Steve Field

Grima Wormtongue

Pioneer

2012-01-23T22:55:00.001Z

In these days when ladies comprise at least 50% of medical school intakes it is often forgotten how dominated the profession was by males until surprisingly recently.

Today is the anniversary of the graduation of Elizabeth Blackwell from medical school, who, in 1859, was the first woman ever to appear on the British medical register. Unsurprisingly she encountered great difficulty in finding employment.

There is no doubt that the medical profession has come a long way in just 150 years in it’s attitude to women, but we should not be too smug. There is still a significant degree of entrenched conservatism in our profession and women are still grossly underrepresented in some specialities, particularly the surgical ones. More unjust is the chronic and persistent disproportion of women among CEA holders.

We still have a long way to go.

Nurse training

2012-01-18T19:11:00.001Z

In one of my earliest posts I commented on the degree nursing course, and how I felt that nurses as a profession had been conned. That they had been so blinded by the status of a degree qualification that they had had the financial tables turned on them completely. In pre degree days nursing was taught in parallel with ward work, for which they received a salary, albeit small. But now they are considered students, and have to pay out for their course like any other student. The reality of this was brought home to me this week in, of all places, Tescos.

As I was at the checkout I got chatting to the young lady at the till, who told me she was a nurse in training, working at Tesco to fund her way through the course. The true reality of the situation stunned me, that she should have to do this. If she has to work to support herself why can’t she be employed on the wards, where she would get an income as well as valuable experience with hands on patient care. I came away feeling even more strongly that modern nurse training is a complete bag of shit.

And that realisation is starting, finally, to dawn on the nurses too.

Censored

2012-01-16T12:48:00.002Z

One of my readers has emailed me to tell me that the WiFi service provided in his hospital has blocked the Dr Zorro blog. The message that displays explains that this is because of “pornographic content”. I don’t know whether to be amused or offended.

Save your bacon

2012-01-14T12:38:00.001Z

You have no doubt seen the recent shock horror reporting that bacon can increase your risk of pancreatic cancer by 20%. As is usual with these reports you give a much more dramatic and scary impression by quoting relative risk.

The absolute risk is about 13 cases per 100,000 of the population per year, which is pretty long odds, and an increase of 20% increases this risk to at most 16 per 100,000, or 1 in 6250. Hardly significant enough to justify the recommendation for lifestyle change.

If you really want to significantly reduce your risk by lifestyle changes you would do far better to stop smoking, slim down, and maintain good oral hygiene. Add to that only 25% of cases occur in the under 65s. Why do we set out to frighten people, and alter their lifestyle with so little justification?

Surprisingly there is little good evidence that alcohol is a risk factor. So I will have another pint and a bacon buttie then please, and file that research paper in the large black plastic bag where it belongs.

Jesus and Mo

Communication

2012-01-14T11:20:00.002Z

To my mind automatic electronic translators rank up there in the list of mankind’s greatest inventions. It is true that as yet they are imperfect and often give a poor translation, but think of this. Even if the message is imperfect it can usually be understood, which means that ordinary people across the world can now talk to each other.

The quality of translation will inevitably improve and give us an ability to communicate across distance and language barriers that boggle my mind. And with communication, hopefully comes understanding. The power of governments to restrict the information available to their citizens is already crumbling. We are at the dawn of a golden age.

Welcome

2012-01-14T11:03:00.002Z

Fra informasjonen på min statistikk side ser jeg at bloggen min har blitt ganskepopulært i Norge. Hjertelig velkommen til mine norske lesere, og aoplogies om dette google oversettelse gir dårlige resultater.

Jesus and Mo

2012-01-13T13:15:00.000Z

Despite the fact that it has been on line since 2005 I, like many others I suspect, have only just heard of the Jesus & Mo cartoons. The reason I have now heard of it is the predictable offence that it has apparently caused, and the attempts to censor publications and other sites that wish to reproduce the cartoons. It should be restated. It is not illegal to express yourself in a manner that might cause offence. On the contrary, you have the hard legal right to do so. There is a petition for those who wish to support the exercising of this right.

The objections of those who insist on being offended has achieved another Streissand effect, and Jesus & Mo have attracted considerable publicity.

Here is a typical example.

Perfect Radiance scam

2012-01-12T12:35:00.000Z

The ads for “Perfect Radiance” beauty products are back with a vengeance and anyone who surfs much will have seen them. They seem to be everywhere. They include supposed before and after pictures showing such remarkable improvements that they are literally unbelievable. Perhaps this is the real secret.

http://vimeo.com/34813864

Messy Darwin award

2012-01-12T10:01:00.002Z

A while ago I posted commenting on some research that suggested a correlation between religious zealotry and low intelligence. I recently came across a news article that is a perfect illustration.

A would be assassin, an islamic fundamentalist, got close to his intended victim by hiding a quantity of explosives in his rectum and detonating them. The idiot got partly what he wanted, a martyrs death, but his own body took almost all the force of the explosion and the target escaped with a minor hand injury.

The intended victim is quoted as saying, “He surprised me by blowing himself up”

Go Grimsby

2012-01-11T21:19:00.001Z

My earlier post today favourably comparing Grimsby over the Maldives was a little tongue in cheek, but in fact the more I read the more I actually think I would prefer Grimsby.

If your erotic interests veer more towards the look but don’t touch variety then bear in mind that bikinis are illegal in the maldives. In Grimsby however a sex shop that sold films that were not pornographic enough was fined for breach of trading standards rules.

Also, if Maldives follows the example of other islamic states even logging on to facebook could be risky.

The only thing the two places have in common is their low elevation above sea level. Grimsby is on the coast of billiard table flat Lincolnshire, and the highest point of Maldives is just 2.4 metres above the sea. No-one seems to give much thought to Grimsby but a great deal of teeth gnashing seems to be expressed over the possible loss of Maldives to the sea resulting from global warming induced rise in sea levels. Unfortunately that is another prediction that seems to be a load of bollocks.

Paradise or hell on earth?

2012-01-11T15:18:00.001Z

It is that time of year when we all start thinking about booking our summer holidays, and start perusing the travel brochures, the greatest works of pure fiction since Gulliver’s travels. Thankfully these days with the internet we can get a more independent appraisal of our potential travel destination.

This year Mrs DZ fancies the look of the Maldives, described in the brochures as “paradise on earth”. And it does look very pretty.

But there are things the brochures don’t tell you. The Maldives is one of the most religiously intolerant, and repressive countries in the world, with serious human rights concerns. It is illegal to pursue any religion except islam, and even owning a bible is viewed dimly. This is unlikely to deter the average irreligious Brit on holiday but there are some things dearer to his heart that are also off the menu. Adultery is illegal and the punishment, for women at least is draconian. As usual in islamic states naughty boys can generally get away with sexual indiscretion.

The populace seems very much in favour of this approach and demands have been made to tighten up further by banning pork and alcohol completely.

The typical British holidaymaker has pretty strong ideas about what constitutes a good holiday. Ideas which strongly feature bacon sandwiches, cocktails by the pool, and perhaps a little illicit nookie. If that is your idea of a good holiday then be advised, you will have more fun in Grimsby.

Double standards

2012-01-07T11:21:00.001Z

My understanding of the law is that stolen goods remain the property of the original owner, no matter what subsequently becomes of those goods. If I buy a TV on ebay and it then transpires that the seller had stolen it, I would have to surrender the TV back to the legal owner, regardless of the fact that I had paid for it, in good faith. I might even find myself prosecuted for “receiving stolen goods.”

It appears that this simple principal does not apply to political parties. In 2005 the Lib-dems accepted a donation of 2.4 million pounds from a certain Michael Brown. It was subsequently revealed that this money had been stolen, and Mr Brown has been sentenced to 8 years inside for the theft. Unfortunately he has skipped the country.

You would have thought that, in the spirit of the law the Lib-dems would have to give that money back to be returned to the rightful owners. You would be wrong. The electoral commission ruled in 2009 that the Lib-dems could keep the money as it had been accepted in good faith. One rule for us, an entirely different rule for them.

A conversation

2012-01-07T00:18:00.001Z

Eldest son, watching a TV programme about the Apollo missions, "Wow dad, I'd like to be shot into space" DZ, "If I had had my wits about me son, you would have been."

Private practice

2012-01-04T16:50:00.000Z

The Earl Howe amendment to the Health & Social Care Bill was announced, with perfect timing, just before the Christmas break. This is the amendment to allow English NHS Trusts to raise half their income from private practice. At present only 2% of their funds may be derived privately.

This raises a number of questions. Firstly many doctors choose not to engage in private work, for a variety of reasons, including moral objection. Are these doctors going to be forced, not only to treat, but to prioritise private patients? As an illustration, is a breast surgeon dedicated to cancer work going to find himself expected to do cosmetic work by his employer?

And what of the financial arrangements? If you look in your contract there is a clause forbidding consultants from doing private work in NHS committed sessions. This could be used to insist that you do this work as part of your NHS contract, for your basic NHS pay, while the Trust charges the patient or insurer premium rates for your work, and makes a profit on you.

The alternative is even worse. They could allow consultants to charge these private patients in the traditional manner. This would be hugely divisive. The almost complete unity of the profession in opposition to the bill would evaporate, as a considerable proportion would suddenly see great potential financial benefit, and switch sides. And we all know how much bitterness, backstabbing and conflict is caused by consultants competing for as big a slice of private pie as they can get their grasping paws on.

It is in the government’s interests to keep the consultants divided amongst themselves, and thereby weakened. Up until now they have achieved this by use of the clinical excellence award system, but the writing is on the wall for CEAs. Perhaps this amendment is deliberately intended to replace CEAs as the main dividing force among hospital consultants. Just like Bevan they intend to stuff (some of) our mouths with gold.

New year surprise

2012-01-01T09:20:00.000Z

DZ has been amused, and bemused by some of the absurd ritual practices of established religions for many years. The virtual cannibalism of catholic mass and starving yourself for no logical reason being just two. But today, January the first, apparently is Feast of the Circumcision day for many christians, even though christianity no longer practices ritual male genital mutilation. When I first heard of this I thought it was a joke, something you might read about in News Thump but no, it is quite real. I wonder if there is a tradition as to what is on the menu. Pork scratchings anyone?

Right on cue

2011-12-30T09:52:00.000Z

God, I love it when I am right all the time. After my last post this story breaks. Lansley has stated "Patients have a right to expect that when they go in for treatment that they are looked after properly and that the treatment they are given helps them to recover,”

But Mike Farrer says that these people can be looked after in the community, or they can “self care”.

Well Mr Farrer these are the consequences of cutting back too much on bed numbers, and your idiotic suggestions, if implemented, will make things worse to the point of disaster.

What an utter knob.

Another man with his head up his arse.

2011-12-29T17:27:00.000Z

This is Mike Farrer, who is chief executive of the NHS confederation. He it is who thinks that 25% of hospital in patients don’t need to be in a hospital bed. It is true that many patients, particularly the elderly and chronic sick can prove difficult to move out due to lack of community facilities, but the proportion is nowhere near that percentage, and it is also true that, even if this were addressed there would still be plenty of patients queuing up to take those vacated beds.

The fact is that there is chronic under provision of acute beds, and the frantic drive to discharge patients as quickly as possible inevitably results in the high readmission rate we currently see.

Despite Mr Farrer’s years in the NHS he seems blind to the fact that both NHS consultants and GPs are increasingly finding it difficult to find beds to admit patients to.

Medical admission and discharge are clinical decisions, and NHS clinicians have no incentive to keep patients in hospital unnecessarily. So by and large if a doctor thinks a patient should be in hospital he is the one best qualified to make that decision.

Mr Farrer thinks that we should be be moving more towards care in the community, rather as was done with psychiatry, and patient self care, otherwise known as “you’re on your own mate”.

So what qualifications and experience does Mr Farrer have that makes him feel he can pontificate on clinical matters to clinical professionals? Well his first NHS job was as a gardener. Before that he worked for Grand Metropolitan, and was a semi professional footballer. Not a doctor then. His numerous roles in NHS management do not qualify him to venture any opinion on a single hospital patient’s requirement for admission, or readiness for discharge. Perhaps instead of hectoring doctors in both primary and secondary care, and telling them how to do their jobs, he should shut his ignorant mouth and listen.

Prophets?

2011-12-28T22:45:00.000Z

And so 2011 draws to an end. We are all still here despite the apocalyptic predictions of Harold Camping and his moronic followers. They are not the first failed prophets of doom and their humiliation does not deter those making similar predictions for future dates.

But fundamentalist religious loonies do not have a monopoly on outrageous and ridiculous predictions. A widely reported scientific theory released in 2007 suggested that by now the world human population would be down to less than 2 billion, with cataclysmic disasters wiping out 4.5 billion people. And just like Harold Camping, the response to failure of the prediction is is to claim mathematical error and give a revised date.

I like to think I keep an open mind on the science of climate change. The science has been delivered by some very clever scientists using state of the art technology. But I can’t help noticing that a lot of their early predictions that should have now come to pass have not been confirmed by reality. And their response to these discrepancies has been to successively revise the date of the apocalypse, rather like the Jehovah's witnesses who have made no fewer than eight successive stabs at the date.

Perhaps the problem is that some scientists share yet another characteristic with the fundamentally religious, that of assumed infallibility, the arrogant belief that their most prized “knowledge” is unquestionable. The finality of the word of god or the science that is “settled” are both manifestations of the same mentality. We should remember what Einstein once said; “We still do not know one thousandth of one percent of what nature has revealed to us.”

Merry Christmas

2011-12-21T22:24:00.000Z

Zorro does not expect to be doing much, if any, blogging over the next week or two.

So whatever you want to call it, and however you choose to celebrate it I do wish you a very happy festive season.

Dream job

2011-12-20T20:43:00.001Z

Objective 2.5 of the recently released NHS outcomes framework has, as it’s objective, getting people with mental illness into employment. There is no reason why some of these people should not find suitable employment in the NHS itself. Take this unfortunate individual with obsessive compulsive disorder. Had he not died all he would have needed, in addition to his obsession, would be to have fed himself up to a BMI of 42. Then he would have had to cultivate the demeanour of a bad tempered, pre menstrual midwife on anabolic steroids and dexamphetamine. He would then have made the perfect infection control nurse.

Driving

2011-12-20T14:43:00.000Z

I mentioned recently that I had made one of my exceedingly rare visits to my GP. Subsequently returning to my car in the car park I saw something that left me speechless and scared. There was a very elderly lady also returning to her car. What astounded me was that she appeared to be finding her way back by feel until she found her own vehicle. She then got in and drove off while peering over the wheel. I got the strong impression that she was blind as a bat.

I expect her GP would be aware of her poor eyesight and wondered why he had not stopped her driving. Well I did a little research, and apparently it is not his responsibility.

Those who drive for a living, HGV and PSV drivers, once they attain a certain age, are required by law to undergo a yearly medical to ensure their continuing fitness to drive. Private motorists however are under no such obligation. Nor are their GPs under any obligation to enforce driving restrictions arising out of the ill health of their patients. The ultimate responsibility to report health related unfitness to drive actually lies with the driver. I think we can see the flaw in this system.

GPs are required to advise patients if they have a condition which requires notification, but how many do. Losing your driving license is a huge loss and I suspect many GPs would feel uncomfortable with effectively removing this privilege.

Government, and the DVLA have not addressed this problem, nor do they have any plans to do so. So step forward those unlikely heroes at the GMC, who have now stated that doctors should be more pro-active here. It is true I don’t often find much good to say about the GMC, but I agree absolutely with them on this. Because frankly I don’t care to share the roads with drivers who are unfit to drive through age and ill health any more than those who are drunk.

Organ donation

2011-12-19T22:35:00.001Z

The ethics of acquiring organs for transplantation is something I have questioned before, with some illustrations of the less savoury means that have been used. Well I have found some more instances, from China, (again) Pakistan and even Holland.

As a youngster I used to read a lot of science fiction, and I recall one story where, to satisfy the demand for organs, the state gradually lowered the threshold of seriousness for which the death penalty was imposed, until you could be executed for speeding, and your organs harvested. Fiction can sometimes become uncomfortably predictive.

Dr Eva Michalak

2011-12-17T11:07:00.000Z

It is a sad fact that bullying and harassment are rife in the NHS, and consultants are not immune. I have seen colleagues bullied until they resigned, unable to obtain justice because of the sheer weight of legal expertise pitted against them. Often justice in the UK still goes to him with the deepest pocket.

I have commented before on individual cases and how those who bear ultimate responsibility are the chief executive of the trust, but also the medical director. The medical director is someone to whom the victims should be able to turn but are often deeply implicated in the bullying themselves.

One of the vilest examples of this is what has happened in Mid Yorkshire NHS Trust. Reading this story it is hard to imagine a person less suited to the post of medical director than the incumbent. I can’t say if he is the most malicious, vindictive or mendacious medical director in Britain, after all there is some pretty stiff competition out there, but he is definitely on the shortlist.

Dr David Dawson, described by the industrial tribunal as a “self acknowledged liar”. A man who suspended a colleague, presumably on the urgings of his mates, without even knowing what offence she was alleged to have committed. He is no longer listed on the trust’s web site as medical director. One can only hope that the GMC look into his conduct and make a suitable example of him.

The Chief executive however is still in post and this is she.

Julia Squire is another example of how, in the NHS, failure is consistently rewarded. It remains to be seen whether or not the Trust Board, or the Senior Staff Committee have the integrity to remove her.

Get a gun

2011-12-15T12:22:00.000Z

For over 30 years of my career I have done my job with, I think, a pretty average degree of competence. My training has been long and detailed, but appropriate and relevant.

So why, all of a sudden, am I expected in addition to relevant CME, to attend presentations on stuff that I have got by without for those 30 years. Manual handling, substances hazardous to health, Riddor and Caldicot. What is the logic behind taking me away from where I am doing my job to lecture me on stuff which is of no use or relevance to that job. I regard finding various reasons and excuses not to attend as something of a sport, but running rings around the intellectually challenged and pointless individuals who run these lectures is something of a hollow victory. rather like kicking a toothless old dog.

So I thought that, just to cheer them up, I would attend just one, and I actually found one that I thought might be interesting. “Handling violence and aggression” seemed to me that it could be worthwhile, as apparently this is on the increase in the NHS, even though I have never seen a single instance.

Well I was disappointed. Firstly, what could have been an interesting topic was presented in as dull and dry a manner as you could imagine. No juicy anecdotes, no personal experiences, no examples. Just a drone on how to recognise and avoid potentially dangerous situations, most of which came under the category of “the bleedin’ obvious.”

And that was where it stopped short. What, I was waiting to hear, happens next? When all the various actions to recognise, avoid and defuse a potentially nasty situation have failed, what then? When 18 stone of drunken ape is definitely going to hit you, what do you do then? Well that was not addressed. The talk stopped once all the sociological and psychological claptrap had been exhausted. The one bit of potentially useful advice they could have given was never imparted.

What a fucking waste of time.

All together now

2011-12-14T21:56:00.000Z

Time again for another Streissand effect

Yet another quack, peddling pseudoscientific drivel, has threatened legal action against a blogger making perfectly valid criticisms of his absurd practices, combining classical chiropractic subluxation with faith healing.

Well Dr Dan Golaszewski of Hanover, Pennsylvania is a quack. He is either a deluded nutter who genuinely believes this rubbish, or a cynical fraud who knows full well the worthlessness of his made up fantasy, and is simply using it to fleece the gullible and stupid.

Git!

2011-12-14T15:40:00.000Z

I find as I get older more things irritate me. Like a patient I saw recently. Born and raised in the UK he has lived and worked in Dubai for several years “so I don’t have to pay tax and national insurance Doc.” So when he needs medical care for an elective condition obviously he gets on a plane and comes back to the UK where it is free.

Well it’s not free you fucking selfish parasite. It is paid for through the taxes of those who live and work here and if I had my way you would have your UK citizenship stripped away, or at least made to pay for the care you get from the NHS you don’t want to contribute towards.

Quote

2011-12-13T19:22:00.001Z

Don't tell people how to do things, tell them what to do and let them surprise you with their results.

George S. Patton

Enough already

2011-12-13T19:14:00.001Z

I am not going to go through module 5 of the NHS outcomes framework item by item. It is just more of the same. Empty posturing, badly thought through by people who seem to know nothing of the realities of modern medical practice. A load of public relations bollocks insisting that we must now “do something” along the lines of, did they but know it, what we have already quietly been doing for many years.

So how does shit like this get written? Quite simple. Various governments have, over the years imposed more and more NHS QUANGOs, committees, regulatory bodies, working parties etc to regulate a shrinking front line with more and more restriction, regulation and supervision, stifling clinical autonomy, innovation and advancement, and destroying morale and motivation.

And once all these parasites are installed you have to find something to occupy them. And in return they have to produce something to justify their well paid existence. So an entire superstructure is built up of various bodies exchanging meaningless crap back and forth, oblivious to the fact that they are contributing nothing. And they report their worthless documents back to governments of PR men who don’t know shit from shinola, and publish it with a flourish, not realising the contempt it generates in those actually providing care.

Unhappy punters

2011-12-12T23:23:00.000Z

Talking of patient satisfaction, why exactly are the writers of this report so obsessed with it. It is at such a high level that we are likely to make very little improvement. There will always be a hardcore of career malcontents, determined to find fault no matter what we do and we are not going to make any difference to them either. I have certainly known one patient who was such a prolific writer of unjustified complaints that the trust eventually just refused to acknowledge them any more. And even when patients are justifiably aggrieved they still tend to be very British about it. Although I am told violence against medical staff is on the increase I personally have never seen an instance in my entire career, and even verbal abuse or threats I have seen very rarely. The worst most of us have to deal with is the odd written complaint. When it comes to the actions of dissatisfied patients or relatives our American colleagues have far more serious possibilities to worry about.

Module 4

2011-12-12T15:39:00.001Z

Module 4 is about improving patients’ experiences. This is going to be as much about patient expectation as service delivery. For example are we supposed to accommodate people who want homeopathy and reiki? Expressed dissatisfaction will be rife but will it be vetted for justification or will it just be used as a stick to beat us, and put on our appraisal.

.....4.1 Improving patient experience of out patient care.

I don’t know what it is they imagine is a problem here. Is it the clinical care itself or other aspects, such as waiting. Here is a suggestion. Patients attending for outpatient appointments are going to be less grumpy if Trusts stop ripping them off for parking charges before they have even entered the building.

.....4.2 Improving responsiveness to in patients’ personal needs.

Ooh yes yes yes, I agree with this one. It sounds to me like a concise rehash of the “Nursing Process” which came and went a few years ago. This was a questionnaire completed for each patient by the admitting nurse. No matter what you came in for you had every aspect of your life documented in order to better satisfy your holistic personal needs. Most nurses wisely skipped the box marked sexuality, but I recall one article in a nursing journal suggesting that this was an important area that should be addressed. There was even a suggestion that young male patients in hospital for any length of time should have their sexual frustrations alleviated by a specially trained physiotherapist who would give them a helping hand, so to speak. So next time I am an inpatient I would like to be seen by the physio, the special one with the hairy armpit and a tube of KY jelly please.

.....4.3 Improving patient experience of A & E

Perhaps you could start by employing a heavy to keep out the drunks, the work shy, the unruly and all those who are there because they can’t be arsed to make an appointment with their GP for that six month old niggle.

.....4.4 Improving access to primary GP and dental care.

Are there really people out there who can’t get to see a GP? As for dentistry who exactly was it who imposed a new dental contract that so alienated dentists that most of them simply abandoned the NHS altogether?

.....4.5 Improving women and their families’ experience of maternity services

This is a particular area where patient expectation is going to affect the experience. It is an area where medical advice is often regarded with suspicion. But when the patient has, at her own insistence, a “natural” childbirth in a pool of water, at home, with acupuncture and herbs for pain relief and has an adverse outcome it will of course be the NHS’ fault.

.....4.6 Improving the experience of care for people at the end of their lives

They have at least realised that asking the dying, or dead “how was it for you?” is not a good idea. So instead they are going to assess the care by asking the carers. I think a little bias might creep in here.

.....4.7 Improving experience of healthcare for people with mental illness

I would imagine that this is likely to be difficult to assess.

.....4.8 Improving children and young people’s experience of healthcare

Another area where an indicator is yet to be developed.

The repeated use of the phrase “improving experience” implies that there is a problem with patient satisfaction. Even measuring as nebulous a factor as satisfaction is hardly precise, but what studies have been done suggest a degree of satisfaction that is already very high. To my mind this entire module presents invented problems, and the individual factors are being used to present an illusion of concern and progress.

Interlude

2011-12-09T17:13:00.001Z

This is not a quiz as such because I don't know the answer. Does anyone out there have any idea what these three gentlemen are doing.

Module 3

2011-12-09T10:26:00.001Z

Module 3 is about helping people recover from illness and injury. Most of the specific objectives fall into the category of “Yes, we are doing it already”

.....3.1 Improving outcomes from joint replacement, hernial repair, and varicose veins.

These have been the subject of considerable investigation, improvement and advancement over many years. All done without higher directive. Don’t teach granny to suck eggs Lansley.

.....3.2 Preventing respiratory infections in children from becoming serious.

Again this has already been the preoccupation of paediatricians for many years. UK mortality has decreased steadily for 30 years and a guideline has been published and is regularly updated. What more is this objective likely to achieve?

.....3.3 Improving recovery from injury and trauma.

This is another one where “an indicator needs to be developed.” Bearing in mind the sheer diversity of trauma patients I think developing a single indicator is going to be impossible. And what precisely do they think trauma surgeons and their supporting teams are doing every day?

.....3.4 Improving recovery from stroke.

Again, no indicator, and again being done already.

.....3.5 Improving recovery from fragility fracture.

I think whoever wrote this has never seen the average patient with fracture of the neck of femur. A substantial proportion of these operations are done solely for reasons of palliation and pain relief, and the medical status of many of them is such that simply surviving the procedure itself represents as full a recovery as you can expect.

.....3.6 Helping older people recover independence after illness or injury.

This is about preventing readmission to hospital. The problem only arises because patients are often discharged earlier than the clinicians might deem appropriate, simply because of pressure to vacate beds. It is a problem that is insoluble as long as the powers that be continue in their obsession with keeping patients out of hospital at almost any cost, and as long as bed numbers continue to fall.

So my response to this section is, “Don’t tell us what to do, we know what needs doing, and given adequate resources we are already doing it”

Objective 2.3

2011-12-08T19:27:00.001Z

Objective 2.6

2011-12-08T19:00:00.001Z

Tickboxes, module 2

2011-12-08T18:47:00.001Z

Module 2 is about enhancing quality of life for people with long term illness. This module contains to my mind the vaguest, most imprecise and ill defined objectives of the entire document. A catalogue of sound bites with no substance whatsoever.

.....2.1 Ensuring people feel supported to manage their condition.

“Feel supported?” How is that for a nice, crisp, scientific end point. Bearing in mind the wide differences in inherent self sufficiency, and the huge variability in peoples’ willingness to complain this is going to be impossible to measure with any reliability. I have no doubt that those involved will be able to throw up some figures but these will be utterly meaningless.

.....2.2 Improving functional ability in people with long term conditions.

What a good idea. I am surprised none of the physiotherapists, occupational therapists, remedial gymnasts, speech therapists etc etc already employed doing exactly that have not already thought of it. A slightly different sort of sound bite this, exhorting us to do something we are already doing. This one emphasises getting these patients in employment. So it’s primary purpose is to get people off benefits.

.....2.3 reducing time spent in hospital by people with long term conditions.

Well of course we can’t have hospitals full of nasty sick people who need looking after. It will make the hospitals less attractive to private sector investors.

.....2.4 Enhancing quality of life for carers

I am fully aware that long term carers have a raw deal in Britain. But this is a problem for government, not the NHS. Your problem boys, not mine. Financial and social support for these people are not something I can do anything about. And if you want to give carers a little time off you are going to have to put the patient in hospital, contrary to 2.3.

.....2.5 Enhancing quality of life for people with mental illness.

I touched on this in module 1. And again the primary aim here seems to get these people in work, and off benefits.

.....2.6 Enhancing quality of life for people with dementia.

This is the first of a number of points which carry the rider, “An indicator needs to be developed” What this means is that the bright spark who thought up this noble objective has not the faintest idea even how to assess quality of life in these patients, let alone how to identify areas and means of improvement. We all know care for these patients is often poor, but that is not the fault of the over stretched and underpaid carers. It is a matter of resources. This objective will be used to berate staff who are doing the work of two for not doing the work of four. The demoralised staff will hand in their notice, and the problem will get worse.

Dying for a fag

2011-12-07T23:33:00.001Z

While we are on the subject of lifestyle and health, there can be few people today who don’t know how harmful smoking is. Yet, despite the indisputable hazards of smoking the proportion of smokers in the UK has remained stubbornly at 20% for some years now.

Most people know about the cardiovascular and respiratory consequences of smoking, but there are other risks which may be lower in incidence, but are more dramatic and horrific, and maybe the hard core of smokers might take more notice of these.

For example, I remember when smoking was allowed on public transport, but, on a double decker bus those who wanted to smoke had to go upstairs. So when, as occasionally happens, the driver lost his way and ended up going under a low bridge, those decapitated were mostly smokers.

Then there is the risk of setting fire to yourself like this idiot.

Or how about when the desperate smoker does something inadvisable to try and get his fix, and comes to grief.

There are even bacteriological risks that have probably never occurred to many smokers.

I think we need a more catchy approach to this, like this clever picture on the ceiling of a smoking room.

Sixty tickboxes

2011-12-07T18:08:00.001Z

It has been pretty obvious that Andrew Lansley, once he gets an idea into his head about the NHS is pretty tenacious. His persistent head down and keep going approach despite numerous criticisms is well illustrated by the proposed NHS reforms. Even though there is evidence of failing support even among those who initially bought the idea, he still blunders on.

His announcement today of his “sixty steps to health” is yet another example of an ill thought out and pointless tick boxing exercise to distract doctors and trusts from their job. This is set out in a long and tedious document in which we find that the definition of quality has been laid down by none other than that well known fucker up of the NHS Lord Darzi. Why do people keep listening to this pratt, bearing in mind his record.

I have read the sixty steps. Fortunately they are divided into 5 “domains” so I thought I would give my views on these steps one domain at a time.

.....Domain 1, preventing people from dying prematurely.

They have at least defined what this means. Apparently it means dying before 75. Sounds like a “one size fits all” statement to me. Is this an oblique way of telling us that after this age we are to be considered expendable? If, in dying. we are not, at that age going to breach any guidelines, then does not that give trusts an implicit instruction to not waste any resources on us.

So to the specifics.

.....1.1 - 1.4 Reducing premature mortality from cardiovascular, respiratory, and liver disease, and cancer.

As is now well known a huge number of premature deaths in these areas are due to patient lifestyle. All the NHS can do in this area is advise. More and more of our patients spend their lives stuffing their fat faces with lard pausing only to drag on a fag and slosh down a quart of vodka. Exercise means hunting for the TV remote and sport is something you watch on TV. What the fuck am I supposed to do about that Lansley? He seems to share the attitude that the punters have, that after a lifetime of bodily abuse, it is my job to rectify the damage, as if it is somehow my fault.

.....1.5 Reducing premature deaths in those with serious mental illness.

Yes these are a particularly vulnerable group. So who exactly was it who decided that these people should no longer be looked after in the safe, warm, well fed and closely supervised environment of a hospital specifically aimed at their needs, and decided instead to throw them all out onto the streets to look after themselves? Care in the community it was called. All too often they were lost to care and ended up living, and dying in the gutter. Still at least closing all those hospitals saved a packet.

.....1.6 Reducing deaths in babies and young children.

Well who could argue with that. But Britain ranks at 25 out of 197 nations when it comes to infant mortality, and the bulk of these deaths are associated with complications of gestation, which again come down largely to lifestyle or sheer misfortune. Making political statements of intent is one thing. Saying how is another.

.....1.7 Reducing deaths in those with learning disabilities.

Again this statement does not address the why and how. The figures in these people will be skewed by the fact that a considerable proportion will have their learning difficulty as one aspect of a multifaceted syndrome, often congenital. You could achieve a considerable apparent improvement by providing more intensive ante natal screening, and aborting affected foetuses. Anyone for eugenics?

I will deal with other domains in future posts, if I can retain the will to live, but it looks to me like yet more central diktats, without thought for cause or consequence, to give the illusion that our politicians are achieving something worthwhile. Just more shit basically.

Torygraph

2011-12-04T06:47:00.001Z

The Daily Telegraph is regarded as a right wing newspaper, strongly supportive of the Conservative party, to the point where it has acquired the nickname “Torygraph”. But even it is highly critical of government policy on health as seen in a plethora of articles today criticising David Cameron for his doublespeak, treachery and total disregard for patients, in his apparent absolute determination to privatise the NHS.

The pretense is now over, the veneer stripped away. The agenda is now clear and being pushed through with all the subtlety of a battering ram. And by the time we can vote again it will be done and dusted.

Alternative career

2011-12-03T14:08:00.001Z

There can’t be many doctors who have not at some time wondered what might have been if they had chosen another career. Indeed more and more of my colleagues are so disillusioned with the way medicine and the NHS are going that they are expressing a wish to have done just that. Sadly by the time this impulse kicks in it is usually to late to act on it. In my case for example I think I would have been happier as a member of a successful rock band, surrounded by nubile young lovelies. However I don’t think there are many openings of that sort for a middle aged porker such as DZ......... Or are there?

Interesting anniversary

2011-12-03T11:25:00.001Z

Today, December 3 is the anniversary of the first ever heart transplant. As with many pioneering procedures initial mortality rates were extremely high but medical science has gradually overcome many associated problems and transplants of heart and kidneys are now so common that demand far exceeds the supply of donated organs.

Inevitably some have seen market forces as a way of satisfying demand and this is a prime example of what market forces, without any consideration of ethical behaviour, can do within medicine. (1) (2) (3) It is arguable that transplant surgery causes more human suffering than it alleviates. Also, if you have ever bought a recycled car part you will know that, with second hand parts, it is a case of "buyer beware". Not all advances represent progress

Ulp!

2011-11-30T23:12:00.001Z

Don't you just hate getting letters with the words "General Medical Council" written prominently on the outside. Even when they are just circulars.

TOLD YOU SO!

2011-11-30T16:40:00.001Z

You will all have seen reports in the media about the report showing the increased mortality in patients admitted to hospital at the weekends. One of the factors is said to be a lack of Consultant presence in the hospital at weekends. Well who would have thought? Many of the commenters to the news articles place the blame for this at the feet of the Consultants themselves. It is of course that we are all spending time at the golf course or the private hospital when we should be in the NHS hospital. The thought that we may simply be off duty doesn’t occur to these twats.

From the inside it is obvious that the reason the consultants are not in the hospital at the weekend is because of the increasing trend for trusts to have medical care provided not by doctors but by the chiropodist’s assistant’s mate’s aunt, because it is cheaper.

I have ranted about this before. (1) (2) (3). If trusts want care provided by pretend doctors rather than those who have the skill, training and experience to know what they are doing, then the outcome is going to be pretty fucking obvious, isn’t it?

Pensions

2011-11-30T13:28:00.001Z

I have every sympathy for my younger colleagues whose pension schemes are about to be used as a form of extra taxation by stealth. My sympathy also extends to other public sector workers who are being similarly screwed.

However I also think, bearing in mind what has been happening to pensions in the private sector over the last few years, that slogans like this are a little insensitive, and indicate a degree of tunnel vision.

I think this poster unlikely to generate sympathy and support in private sector employees

Haircut sir?

2011-11-30T08:58:00.001Z

One of the many, to me, strange and pointless hang-ups displayed by the ultra religious is an obsession with hair. Whether the faithful should grow it, or cut it, whether it should be covered, whether or not you should shave. One of the religious groups who have this hang-up is the Amish. Which is why, when a breakaway group of dissident Amish wanted to hit back at the community, they had left they kidnapped some of their former friends and cut their hair. This was an act designed to deeply humiliate their victims.

I can think of far worse things that could happen and you may wonder why I am finding this noteworthy. What amused me was the name of the dissidents’ ringleader, one Samuel Mullet.

Burzynski clinic update

2011-11-29T08:37:00.001Z

The Streissand effect has taken off spectacularly with regards to Stanislaw Burzynki's quack clinic, with blog articles springing up all over the web. I have not had any threatening communication from Marc Stephens and the sheer volume of sites now involved makes it increasingly unlikely that I will. That is a shame really as I was quite looking forward to using Jack of Kent's advice and referring Mr Stephens to the case of Arkell v Pressdram.

Friendly neighborhood police

2011-11-28T12:39:00.001Z

Those unfortunates who suffer from type 1 diabetes mellitus have a lot to put up with. Lifelong dietary restriction, daily injections, hypoglycaemic attacks and all the complications that go with the disease. It’s also unfair in that even the best control of blood sugar levels is no guarantee against these complications.

So you would have thought that diabetics have enough on their plate. But no, throw human ignorance and prejudice into the mix and things can be even worse.

Gotcha!

2011-11-27T20:26:00.001Z

I have posted on paragraph 58 of the good practice guide before. “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.”

The underlining is mine and illustrates the fact that you could be brought before the GMC for allegations of actions which are not even criminal offences in this country. This has got me thinking about what you might get done by the GMC for, if it suited them, under para 58, such as

Firstly, simply being homosexual, which is illegal in 70 countries.

Extramarital sex, illegal in the Maldives.

Chewing gum (Singapore)

Drinking Alcohol.

Licking a toad (Los Angeles)

Having sex with a porcupine (Florida)

Throwing a moose from an aeroplane (Alaska)

Not wearing underwear. (Thailand)

Perhaps I should not go on. We don’t want to give the bastards ideas now do we.

Burzynski clinic

2011-11-27T11:09:00.001Z

There are no depths to which some doctors will not sink in the pursuit of riches. Readers of other blogs will be familiar with Stanislaw Burzynski, and his quack clinic. These articles by Andy Lewis and Prof Colquhoun explain the details fully.

Children with serious conditions will always pull on the heart strings, and loosen the purse strings of the most stone hearted miser, but those who are contributing to this child’s fund in good faith are surely being scammed. And that pales into insignificance compared with how the child and his desperate family are being used and conned.

In his post Prof Colquhoun calls for maximum exposure of this story to create a Streissand effect to counter the legal threats emanating from Burzynski’s clinic and other bloggers have already responded. I don’t suppose I have a fraction of the following enjoyed by Lewis, Colquhoun and others. I expect my followers are already fully aware of the story, and I think it unlikely that my little blog will be noticed by Burzynski. That is not the point. I have copied both articles, and in the unlikely event that they disappear I will repost them here.

Tick box medicine

2011-11-25T11:28:00.001Z

On a recent post on JD’s blog an anonymous commenter has made the comment, “my GP is crap, what can I do about it”. Well I suppose the simple answer would be simply to change his GP. But if we don’t know why he perceives his GP as crap it is possible that he may be equally dissatisfied with his new one.

If you take your car in for a new tyre these days you find, when you go back for it, that while they were replacing the tyre they found other things that needed replacing, brake pads, shock absorbers etc. You have to take their word for it in the interests of safety, but do you ever have a sneaking suspicion that you are being had? And aren’t you just a little irritated that they did not just replace the tyre as requested and not snoop into the other bits?

I very rarely visit my GP, but recently had to see him for a very minor simple problem. I sat down with the GP, who, to me, looked about 14. He dealt with the problem quickly and efficiently, so about 90 seconds after I sat down I rose to leave. Not as simple as that is it? I was sat down again and subject to a whole lot of stuff I had not gone in for. Yes, I do know what my cholesterol is, and no I don’t think it would be a good idea to go on a statin. No I don’t want my BP taking, I do it at work and it is fine. And when asked my alcohol consumption I managed a polite response even though I was thinking ”mind your own fucking business”

Now I know full well that this was done because it is part of the tick box approach that has been forced onto my GP in the name of preventative medicine. But it still irritates me that my GP is having to act like a Kwik-fit fitter. And if that is how I feel just think how the lay punters feel.

Careful

2011-11-25T09:49:00.001Z

I can't quite articulate what I am feeling here but I feel that this picture has a certain relevance.

Explanation

2011-11-23T21:52:00.001Z

Two posts recently have generated a considerable degree of interest and debate. There are still unanswered questions and gaps in the information relating to these events. There are also a number of facts which I feel are now indisputable, but see no good reason to further aggravate the situation.

I have been informed that the photograph on this post is subject to copyright, and a request has been made to remove it. Initially it had been my intention to therefore remove the photograph, but leave the post intact.

However, although I do not currently have comments moderation in place I have kept a very close and regular eye on the comments and there have been today a number of comments placed anonymously which I think have been excessively abusive and misogynist. Had they been directed at me I would have let them stand. I have a thick skin. These posts were deleted promptly. The fact that they are being written leads me to the view that the posts are no longer generating just heated debate and their continued presence is becoming counterproductive.

I have therefore decided to introduce comments moderation, and remove the posts. Apologies to those whose comments have made cogent points.

Who turned the lights out?

2011-11-22T11:30:00.001Z

I once light heartedly rebuked a married male friend for making an appreciative comment about an attractive young lady. He responded “Just because a man is on a diet does not mean he may not admire the beautiful food” This, I think epitomises the cultural attitude in the secular west, that women can dress as they please, and be admired for their beauty, secure in the knowledge that their person should be respected. The attitude, usually encountered in the religious, that women who dress attractively are fair game and bring unwanted attention on themselves is contemptible. A particularly vile example is featured here.

Equally contemptible is the religious attitude that, for a man to see a woman’s body is so inflammatory, that the man can not be expected to control himself, and that the woman must therefore conceal herself entirely in a sack, with just a slot for her eyes, so that she looks like an animated black post box.

Well apparently even this is too much for some religious zealots. When all that is visible of a woman is her eyes, even these become erotic, and therefore have to be covered. So how are they supposed to see where they are fucking going? Would it not be equally effective to cover up the blokes' eyes?

Welcome

2011-11-22T09:27:00.001Z

It is clear that I have recently had a lot of visitors over the last couple of days who have not been here before. They are most welcome but, if they are expecting things to be this interesting on an ongoing basis they are going to be disappointed, as a browse of my old posts will testify.

Normal service will be resumed shortly.

Another blogger gone

2011-11-21T17:01:00.001Z

Fuddled medic has now announced he too is leaving the circuit. Nothing sinister or untoward, he has simply tired of it. He is at the start of his career and I wish him farewell and all the best for the future.

Fairness

2011-11-21T14:34:00.001Z

I have been castigated after my last post for changing the subject. Apparently we “need to talk about the GMC just now” I make no apology. I have broader interests and would not like to be thought of as having only a single string to my bow.

Regular readers will know full well that I have no time for that collection of scum and villainy that calls itself the GMC. I would argue that we need to talk about the GMC, not just now, but constantly until something is done to bring them under some form of supervision and control.

I would also argue that at the moment we do not know if the GMC has done anything, on this occasion, that should concern us. Dr No has now confirmed that two doctors have been reported to the police and under paragraph 58 of the good practice guide that means the GMC must now be involved. What matters is not their involvement but their response. What I would expect of any fair regulator is that if the police feel there is no case to answer then there should automatically be no further action from the GMC. I have previously published this communication from the GMC.

"In January 1999 the Standards Committee of the GMC met to consider issues involving the behaviour of doctors who comment in the media. It was their view that the GMC should not attempt to curtail doctors' rights to express their personal opinions. Doctors, like anyone else commenting in the media, are subject to the same constraints imposed by media regulatory bodies, and the libel laws. Furthermore, the committee considered that the professionals reputation depends principally on the standards of care and conduct provided by doctors to their patients, and not on personal opinions as put forward in published letters or articles. Whilst you may disagree with the comments Dr Y has made, we cannot take action against a doctor who is expressing a personal opinion".

If the GMC choose to respond contrary to their own policy then that would be cause for concern. As yet there is no evidence that they have, or will.

Troll? not really.

2011-11-21T10:44:00.001Z

Like many blogs mine has attracted a troll, and mine has been with me intermittently from very early on. She usually comments anonymously, but has also commented as Sam or ZI. For simplicity I have christened her George. We disagree fundamentally on free speech, particularly when it comes to religion, and George has become mildly abusive and has on one occasion made a threat. However compared to some of the trolls afflicting other blogs mine is relatively benign and our disagreements I think stem from her strong views rather than a desire to offend. Despite our disagreements I bear George no animosity, and in what might be considered a variant of the Stockholm effect even have a slight affection for her.

From what I understand George is currently located in a place where there is considerable unrest and danger. I sincerely hope that George is taking care and comes to no harm. Look after yourself George.

Advice

2011-11-20T21:47:00.001Z

Kameraden

2011-11-19T20:25:00.001Z

There is a lot of speculation going on about the disappearance of some of our fellow bloggers, but no actual information. It may be nothing. The most obvious potential villain, given their obvious desire to regulate our private lives, is the GMC but there is no evidence that I have seen that they are involved. I certainly intend to carry on if for no other reason than to exercise my right to freedom of speech. The rest of us should stick together, and exchange any information that comes our way, either openly on our blogs, or, if appropriate, by the back channel of email. To repost something I wrote very early in my blogging days;
We few, we happy few, we Band of Bloggers. For he who shares his blog with me this day shall be my brother. William Shakespeare ("King Henry V")

More disaster

2011-11-19T09:03:00.001Z

Fuck me, Grumble has gone too. Two gone in two days, without warning or farewell. Those of us left are starting to look over our shoulders.

Disaster

2011-11-17T22:58:00.001Z

What has happened to Dr Rant? Both his blog site and his facebook page have imploded. Gone completely.

Make love, not war

2011-11-17T20:02:00.001Z

I recently posted about the French magazine “Charlie Hebdo” suggesting that the animosity they have attracted from militant islamists might be neutralised by the “make love, not war “ philosophy. Well someone else has had this idea. As part of an ad campaign Benetton had produced a number of photoshopped pictures depicting pairs of mortal enemies snogging each other. Of the four pictures 3 featured political adversaries and the last one had a religious theme, featuring the pope and sheik Ahmed el-Tayeb, who are apparently not the best of friends.

None of the politicians involved seem to care greatly, a thick skin comes with the job, but the pope is said to be very upset at being depicted in a man-love embrace and Benetton have pulled the ad. The vatican has protested strongly about the picture and would obviously like this picture to disappear completely, saying that it wants the image removed from all media, including websites. Well we can’t have that can we, so here it is.

A vatican spokesman has said that the picture shows a serious lack of respect for the pope. Yup. Sure does.

Career change

2011-11-17T13:53:00.001Z

Now and again you hear colleagues grumbling about the job, planning to retire at the earliest opportunity, as if they were caught in a job that might feature on Tony Robinson’s “worst jobs in history” You even occasionally hear them contemplating doing some other job and quitting medicine altogether. They never do though. Most of us acknowledge that, although the job, like any other, has it’s ups and downs, we are in fact privileged. We have jobs that are secure, interesting, challenging, gratifying, and rewarded, not just by excellent pay, but also status and respect.

There are far far worse jobs than being a doctor. For example you could be a street cleaner in the village of Elsa in Bavaria. I suppose that there are jobs that in one respect or another might appear more appealing than medicine but I suspect if you spoke to someone in that employment you would find the grass not as green as you thought. As an example working in Cadbury’s sounds all right, but would you soon sicken of chocolate? I am sure even that being a detective in Spotsylvania, Virginia must have it’s down side, though after reading this report that is an alternative job I might actually consider.

The perils of blogging

2011-11-15T00:02:00.001Z

I am fully aware that my blogging is likely to upset some people, that is inevitable for any blogger. I don't suppose that the GMC is too happy about some of the things I have written about them either. However it never occurred to me that blogging could get you killed. Another good reason to stay anonymous I think.

Dumbing down

2011-11-14T09:23:00.001Z

The Independent newspaper seems to be turning into the Daily Mail, if this article is anything to go by. If this study were to be believed one in six people is allergic to something in their own homes. What a load of cock. The figures were derived from a poll of people canvassed by the charity “Allergy UK” so is really nothing more than a collection of anecdotes.

As anyone involved in healthcare knows the general public have very poor understanding of what an allergy is. If you closely question people who claim to have an allergy a considerable proportion clearly have no such thing. Firstly there are those who claim to be allergic to substances which are actually found normally in the body, and which are often essential. I have had a patient tell me he was allergic to water, which is obviously absurd. Monosodium glutamate is another which might sound feasible but for the fact that glutamate is an amino acid.

Then there are the ones who claim allergy to drugs when what they have had is a simple side effect, Allergic to Morphine doc, (It makes them feel sick). Antibiotics, (They give me thrush) and so on.

And then there are the ones who will blame any malady of any description on “chemicals” and call it an allergy. And even those who claim allergy to substances which are universally toxic.

I don’t know if my experience is shared but I find that older patients are far less likely to report allergies than younger ones, and if they do it is far more likely to be the real thing.

This survey was a pointless waste of time. The results it vomits up are absurd and of no value whatsoever. What were the Independent thinking when they published this drivel.

11.11.11

2011-11-11T00:04:00.001Z

Remember the dead, but don't forget the living.

Scavengers

2011-11-10T08:34:00.001Z

I expect most of the medical bloggers will be commenting soon about the latest move by the government to privatise the NHS. I think that the “Cockroach Catcher” has done an excellent job of summarising the situation so I will simply link to him.

And even before it has actually happened it is apparent that there are sleazy and distasteful aspects. Mark Simmonds MP apparently gets paid £400/hr to advise Circle, the company taking over the management of Hinchingbrook Hospital. Until now of course that money has come from the funds of Circle. Once the contract is implemented it will be coming out of your pocket, and mine.

Simmonds and Circle are like hyaenas. They will kill the NHS and feast off it’s carcass. And when the carcass is picked clean they will move on with their bellies full.

Sorry!

2011-11-09T22:04:00.000Z

I have had my attention drawn to the fact that the French satirical magazine "Charlie Hebdo"has already resumed publishing, despite having it's offices burned down after publishing a cartoon of mohammed. There is an article in the latest magazine commenting on the attack. Now I don't speak much French. Like most Brits I take the view that to get Johnny Foreigner to understand me I simply speak to him in English, as if he is deaf and stupid. I could be wrong but the impression I get in this article is that what they are suggesting is that they can reconcile their differences with the moslem extremists by employing the "make love not war" philosophy, as illustrated by this cartoon.

Somehow I get the feeling that a cartoon of mohammed wetly snogging a bloke is not going to bring the two sides any closer.

Stats

2011-11-09T13:20:00.001Z

A question that must go through every bloggers mind is “why am I doing this?” I suppose there are as many different answers to that as there are bloggers. Occasionally though you get a little unanticipated reward that makes the effort worthwhile.

One of the free services I get with this blog is a stats package, so I can see how many view my posts, and where they come from. This is a two edged sword as it can reveal periods of disinterest. Also you sometimes get a surprise with very high numbers, that turn out to be referrer spam, and thus illusory.

My second most viewed post of all time is this one where I wrote about scams, with the post specifically about the Finitro Forte scam not far behind. This is quite gratifying. If just one person of all those who have viewed these posts has been deterred from giving his credit card details over then that would make all the effort worthwhile. I do hope that there are one or two out there who have not been swindled as a result of what I wrote. The thought there might be gives me a nice feeling of satisfaction.

This post is still a long way behind my most popular post of all time. I don’t suppose I can finish without saying which one that is. Perhaps it says a lot about those who view my blog, but my most popular post to date has been that picture of a little boy giving jesus a blow job.

Compassion

2011-11-09T09:33:00.001Z

A while ago I posted about a study that showed an inverse correlation between religiosity and intelligence. To see a few examples of the mind numbing stupidity shown by some ultra religious just take a look at some of these clips, and listen to the callers to this Texan atheist TV channel.

But it is not just stupidity that seems to correlate with religion. Paradoxically (?) religious types are more likely to approve of torture of their fellow man. Historically this should come as no surprise. The Salem witch trials, and the Spanish inquisition are just two examples.

This mindset persists today as is shown by this survey. In true 1984 style however the old fashioned term “torture” now seems to be unfashionable, probably due to it’s negative connotations. The practice has now been sanitised by calling it “enhanced interrogation.” There, doesn’t that sound better?

More Pareidolia

2011-11-04T12:45:00.001Z

What a load of bollocks, or rather bollock, (singular)

Fun with pareidolia

2011-11-04T11:48:00.003Z

Having learned a (to me) new word I just had to use it. Anyway here are lots of examples.

Scams update

2011-11-04T11:23:00.001Z

I have previously highlighted the prevalence on blogs of adverts for products that are scams, and specified one or two examples, the most recent being for Finitro Forte. Well the ads for Finitro have all disappeared although the company web site is still there, and still making the same claims that the Advertising Standards Authority have forbidden them from using. The site shows another identifying characteristic of these scam sites, which is that nowhere on the site can you find a contact phone number, despite a picture of a smiling young lady wearing a telephone headset.

But even better, nowhere now can I find any ads for any of these scam products at all, though again their web sites are still out there. I assume that Google, and the other companies that have processed these ads have had many complaints, and have finally taken appropriate action. And not before time.

Live & learn

2011-11-04T09:57:00.002Z

Several of my posts in the past have focused on people seeing religious figures or texts in random objects. My recent post on the virgin Mary in a bit of bird shit is an example. Something I did not know is that there is a word for this. Pareidolia. You learn something new every day don’t you. Many thanks to Orac for the education.

Choke on it

2011-11-03T11:28:00.000Z

The media are reporting the deliberate burning down of the offices of the French satirical magazine that put a cartoon of mohammed on it’s front page. I don’t think you have to speculate too hard to conclude that this was done by fanatics following the religion of peace.

Once again however these idiots have not thought things through very well. Had they ignored the magazine it would probably never have been noticed outside France, and even in France it would have faded out of memory fairly quickly. Their actions have now ensured that this image will be accessed and reproduced by millions around the world. The arsonists have ensured that this picture has acquired a certain notoriety and fame, not somehow what I think they set out to achieve.

The caption, translated, reads “one hundred lashes if you don’t die laughing”

Another miracle

2011-10-29T21:35:00.001+01:00

I have posted before on the tendency of the religious to see miraculous appearances of their particular religious personalities in the mundane. Jesus in the Marmite, koranic verses in a courgette, that sort of thing. Well I have come across another, this time, I kid you not, the virgin Mary in a piece of bird shit.

Perhaps the picture is not a very good reproduction but I can’t see anything in this that looks remotely like a human figure. And even if there was something here resembling a woman, why does it have to be the virgin Mary. Why can’t it be a coincidental resemblance to Mrs Jones of Acacia Terrace Flitwick. After all who could possibly know what Mary actually looked like, or even if she ever existed.

Eeeeuuuw

2011-10-29T16:54:00.000+01:00

This story is courtesy of a friend.

Friend works in a DGH and has occasion to go onto the labour ward. In the labour ward office there is a basket containing notes of those ladies who have already delivered and been discharged. The notes here are awaiting the dictation of a discharge summary by the medical staff and the basket has a label identifying it as such. The label reads “Post natal discharges”

Your health

2011-10-26T16:26:00.001+01:00

The Royal College of Physicians has recently recommended a change to the, already arbitrary, guidelines on safe alcohol consumption, and have stated that we should all have three alcohol free days a week. Presumably they want us all to drink water of all things.

In the past everyone, including children, drank nothing but beer, as the water was too contaminated and unhealthy to drink, but if you think that this is the distant past then think again.

A “Which” report in the 1980s revealed that all the bottled waters then on the market in the UK, except one, had levels of bacteria far in excess of the statutory limit for tap water. Still today there is no limit for bacteria in bottled water. And if you think tap water is clean and wholesome read this article.

As it says on the NHS website linked to above, "Your health, your choices" Thanks very much, I will have another beer.

Jesus is coming

2011-10-25T19:22:00.000+01:00

One thing religious apologists will point out is that a nation’s religious history to a great extent defines and determines the modern character of that nation. They will highlight the religious involvement in the art, history, architecture and culture of a nation.

While that as a fact can not be denied the implication is that this would not have happened without religion and that a secular nation would not have developed art and culture and it’s modern identity. This is plainly nonsense as we would simply have developed differently, and probably for the better.

That religion is still all pervasive there is no doubt and there is no area of modern life that is free of it. The extent of this was brought fully home to me by this web site offering an unusual type of religious artefact.

I have to say that the “baby jesus butt plug” brought a tear to my eye.

An ill wind?

2011-10-24T12:14:00.000+01:00

Possibly the main concern about the forthcoming NHS reforms among doctors (or at least those that give a shit) is that it will lead to a deterioration in patient care. That introducing the private sector will give financial considerations too much emphasis, and that the drive to provide health as cheaply as possible, driven by the need to compete and maximise profits, will put quality of care a very poor second.

There is an analogy here with the roadside assistance organisations, the AA and the RAC. I remember when these organisations were rather like clubs. When you needed them their first priority was service, not profit. Then they were bought up and became insurance companies, and my perception is that the service has plummeted. I have twice called out the RAC in the last 3 years. On one occasion I was told to expect a 5 hour wait, and on the other I was told that the problem was “not covered”

The new bill will not really affect the delivery of primary care. It’s main effect will be on how GPs acquire secondary care for their patients and this is where the potential lies for a financially driven deterioration in service.

There could be rationing of care as contracts become filled. There could be lengthening waiting. There could be money saved by getting work done cheaply by less qualified people, increased reliance on inflexible protocol lead care, reduction in staffing levels, and less involvement of consultants, despite this being the gold standard of care.

Oh wait, we have got all that already, in the current system of the NHS. Could the new system really make things worse?

I have a little experience of working in an Independent Sector Treatment Centre. Recent evidence suggests that they actually have better results than the standard NHS, though obviously there are numerous factors at play. The main factor is that the patients are cherry picked, reasonably fit, and having very routine care. But another factor could be that they only employ Consultants to do the work. No trainees, no acting up nurses, just patient/consultant contact, from start to finish.

There is no doubt that, like it or not, the reforms are coming. The medical profession over the years has suffered numerous NHS reorganisations, and has always managed to produce a silk purse from a pigs ear. The front line staff have always managed to make the system work for the benefit of the patients despite their misgivings. As Patton once said, “when you leave people to get on with the job you will be surprised by their ingenuity”

Ultimately whether the NHS survives or goes tits up depends, not on the politicians, but the front line staff. And that is why I am less worried than some. It is a question of where, and in whom, you put your faith.