Ow!

The media have over the last few years been full of stories about the perceived deterioration in standards of nursing care in the UK, particularly in care homes for the elderly. I don't however recall reading anything as horrific as this.

It is rather reminiscent of the British officer in a Japanese POW camp who is told by a guard that his comrade, Nobby, has been taken away for interrogation. He tells the guard "Ha! Nobby won't talk, he'll fight you tooth and nail"

The guard replies, "No no, Nobby no longer got teeth or nails."

Knowledge and Certainty

One area I have never touched on here is climate change.  I don’t intend to get embroiled in the subject itself, but there is one statement used again and again that irritates me. “The science is settled”. What an unspeakably arrogant phrase. I think anyone who believes that any scientific matter can ever be “settled” should reflect on this quote by Bertrand Russel.

“The triumphs of science are due to the substitution of observation and inference for authority. Every attempt to revive authority in intellectual matters is a retrograde step. And it is part of the scientific attitude that the pronouncements of science do not claim to be certain, but only to be the most probable on present evidence. One of the greatest benefits that science confers upon those who understand its spirit is that it enables them to live without the delusive support of subjective certainty.”

Honesty and deception

The main criticism of the NHS reforms is undoubtedly the strong potential for the NHS to be handed over to the private sector bit by bit, or at least the potentially lucrative bits of it. There is I think an open mindedness to the concept of abolishing PCTs, which many see as far too controlling, and giving more power to practices through commissioning, but the thought that segments of the service will so blatantly be sold off to Cameron’s mates so that they can skim off the top drives most of us to teeth grinding apoplexy.

You have probably noticed that Trusts are already starting to act as if they were private companies. For example, I will bet that your Trust has a mission statement. A completely meaningless and empty phrase that appears on Trust literature to give the impression that the Trust is a dynamic, forward thinking, hypersuperlative organisation, when in fact at best the care is no better than it has ever been, and at worst, well Stafford springs to mind. Perhaps they should focus less on telling us how wonderful they are, and more on showing us.

Something else that Trusts are indulging in is the active soliciting of feedback from the “clients”, as patients are now referred to. It is not enough that the staff are overwhelmed by useless tick box forms, now the patients are asked to fill them in as well, by prying into the “patient experience”. How was it for you?

The results of these will always be positive, because despite the attempts of management to fuck things up the medical and nursing staff usually manage to deliver the goods in spite of the increasingly difficult circumstances. For which the management will then take the credit.

But the results of these surveys will always be useless. The bottom line is that the British don’t like to complain. When was the last time you had a poor meal in a restaurant, with indifferent service, and not only failed to complain but left a tip for the surly ape who threw the food at you.

This unwillingness to complain was brought home to me once by a patient. I had been seeing him for some time, and none of my endeavours gave him any benefit. I wondered if a change of approach might help and referred him to one of these multidisciplinary teams that everyone thinks are the way forward. Some weeks later I received a letter from the team leader telling me how well the patient had responded to their approach, and that he had informed them that he was so improved that they had been able to discharge him.

I was somewhat surprised therefore when he subsequently reappeared in my clinic with the same problem, claiming to be no better. I showed him the letter. His exact words were; “Well, they were nice people, and they worked hard, so you tell them what they want to hear don’t you? But actually it was a complete waste of time. Utter crap.”

Eine kugel kam geflogen

Like me you have probably been following events in Libya. Something that has been seen commonly on the news reports has been that of jubilant rebels firing large numbers of bullets up into the sky. Although one can understand this expression of excitement, have you ever wondered what happens to these bullets. Well what goes up must come down.

Because of the American domination of all things to do with firearms all measurements to do with ballistics are in old units. No SI here. Velocities are in feet per second, calibres are in inches and weights, of bullets and powder, are measured believe it or not in grains, rather like drugs in the UK until the advent of metric units. 1 Grain is 64.8mg.

A high velocity bullet, such as that fired from an AK47 leaves the muzzle at 2300fps. For comparison a low velocity round such as a .38  pistol has a muzzle velocity of 900fps, still highly lethal.

A falling bullet attains a terminal velocity of 300fps, while 150fps is sufficient to penetrate the skull, so a falling bullet is not something you would want to hit you on the head. Apparently gunshot wounds have a surprisingly low mortality of only 5%, but falling bullets are far more likely to hit you on the head and have a staggering mortality of 32%.

In 1991 the end of the first gulf war was celebrated in much the same way as we are now seeing in Libya, and falling bullets killed 20 people.

What a pathetically stupid way to die.

Freedom of speech

I posted the quote by Lembit Opic in my last post partly because of my ongoing preoccupation with freedom of speech. He actually made the statement referring to a specific story recently in the news. The story is another illustration of the common, but erroneous, view that some people have that they have a right not to be offended.

The offence was caused when Roger Lewis, a Welsh author wrote a piece in which he quoted Kingsley Amis, who had made derogatory remarks about the Welsh language. The remarks were read by Jonathan Edwards, a Welsh MP, who reacted in a manner that can only be described as hysterically excessive, reporting Mr Lewis to the Home Secretary, the Press Complaints Commission, and the Police.

Fortunately most Welsh have seen Mr Edwards for the pompous arrogant oversensitive little twat that he is and seem to be unimpressed with his outburst. 

So what was said that drove Mr Edwards to such self indulgent spluttering. The offending phrase was that Welsh was, "an appalling and moribund monkey language, which hasn't had a new noun since the Middle Ages" The first half of the statement is pure opinion, but the point about nouns is testable and I have done a little brief research. From what I have found it looks as if Kingsley Amis had a point. I simply looked up the Welsh equivalents for a few modern words, and I am going to illustrate with just three examples, though I found more.

English                  Welsh

Garage                 Garag

Ambulance           Ambiwlans

Computer             Compiwter

Hmmmmmm...... That’s not a language. That’s Dyslexia that is.

Quote

"With a free press, not everything that is written is going to be pleasant.... people have the right to hold objectionable views."

Lembit Opic

Another Knight

Fellow blogger Dr Grumble has not posted now for a couple of months, but in  his last post he highlighted something that we have all noticed. “.....employer wants more healthcare assistants to do nurses jobs, more nurses to do doctors jobs and more GPs doing consultant jobs.“ It might have been thought that this was something of a cynical viewpoint but as this article in the Telegraph reveals, that is exactly and precisely what they do want. 

Lord Crisp of course has never had any medical or nursing training, he has been an NHS manager of one type or another all his life. He seems to have learned nothing in all that time. What he advocates is on a par with the provision of medical services in China by the barefoot doctors. It is nothing more than saving money by providing a sub standard service. 

You can bet your life that if Lord Crisp or his family need medical attention they will have the most reputable consultant available, while he expects the rest of us to put up with a nurse practitioner.

Lord Crisp inevitably has a knighthood, despite being in no small part responsible for the state of the NHS today. Another suit full of bugger all.