Novelty lightswitch

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Doctors & Nurses again

If there is sometimes some discord between professionals about the relative roles of doctors and nurses, the general public can often see things differently.

This is apparently a true story but may be apocryphal. It concerns a gynaecologist about to perform a vaginal examination on a patient, who called in his clinic nurse to act as a chaperone. Once the nurse was present he turned to the patient lying on the couch and asked her to remove her knickers. The patient ignored him so he asked again. “Sorry” said the patient, “I thought you were talking to the nurse."

acting up again

And another thing relevant to my post on acting up. Why are trusts so keen to pay premium rates to nurses to do the doctors job, but so reluctant to spend money on ensuring adequate nurse staffing levels on the wards?

Backlash

When I wrote about Mr David Nunn recently I predicted that his chief executive would likely take action over Mr Nunn's spoiling Cameron's PR stunt. We did not have to wait long.

Acting up

In his latest post, Dr Grumble criticises the current tendency of Trusts to employ HCAs as nurses, nurses as doctors, etc. I have to say I have come to agree with Grumble. This is no more than providing a sub standard service on the cheap

When the concept of the Specialist Nurse was first put forward I could agree with some of the logic. Once a patient with a chronic condition had been sorted out by the consultant his ongoing care is often no more than routine monitoring, and I could accept that this work could be undertaken by a specialist nurse.

However once installed it is the case that some Trusts are extending this role to what I consider an unacceptable degree. This was brought to my attention by an old friend in general practice. He had referred a patient for a specialist opinion. After some months the patient received a letter telling him that he had a first appointment in the relevant hospital department with a specialist nurse, who would then decide whether or not the patient would go onto the waiting list to see the consultant.

This is wrong. Firstly the implication is that the nurse, with her few weeks extra training is better qualified to make this decision than an experienced GP. It is a form of rationing, and referral management combined. It is an insult to the GP, and the PCT are definitely not getting the service they are paying for.

But as ever the patient is the one that stands to suffer the most. He can be denied the specialist care that his GP thinks necessary, by someone simply not qualified to make that decision. And it is going to get worse. When you throw nurse prescribing into the mix the potential is there for patients to be seen and treated without ever having seen the specialist. They may as well never have been referred in the first place. They would be far better off had the GP managed them himself.

When management try to get the work of doctors done by nurses the potential for disaster is obvious.

This may seem like a humorous exaggeration, but the potential consequences of nurses doing the doctors job is not funny, as the case of Rebecca Cain illustrates.

Breathing tax

Wherever you stand on the issue of anthropogenic global warming, it has to be admitted that the argument has generated some laughably stupid suggestions. 

Perhaps one of the stupidest comes from an Australian academic, Prof Barry Walters, who wants to impose a carbon tax on babies. This has to be the ultimate in taxation, a tax on breathing, a tax on simply existing.

And what exactly does Prof Walters think you could do about people who refuse to pay, as I think most would. You can’t exactly put a baby back where it came from now can you?

An Australian lady with, I suspect, a far less academic background has described Prof Walters as “a self important professor with silly ideas”. Spot on, although somewhat more restrained and polite than I would expect from an Ausie.

Readers in high places?

You don't suppose Dave reads my blog posts?