Private practice

Very early in DZ’ career he watched a debate on regional TV about the place of private practice in UK healthcare. On the one side was an eminent and respected local surgeon who I shall call “T” practicing in a speciality noted for very considerable potential for lucrative private work. He vehemently and passionately argued that private practice was an abomination, promoting inequality and conflict of interest and wanted to have it outlawed. On the other side was a surgeon “A” with considerable private practice arguing the opposite. He was known to be wealthy and it was clear a lot of his wealth had been spent on pies. To the young, idealistic doctor I was at the time I quickly formed the view that T’s arguments were well supported, cogent and came from a man of enormous principal and integrity. A’s arguments came across as spurious, contrived and flawed and A himself, a greedy fat bastard. It left a suspicion and discomfort with private practice that has stayed with me all my working life, even though at times I have practiced in this area.

After over 40 years I have become, if anything, even more cynical about the area. I have seen doctors make dubious clinical decisions clearly where there was a conflict of interest, promoting treatments to private patients that they would not recommend in the NHS, purely for financial gain. I have seen entire departments bitterly divided by the issue of private practice, which worked it’s way into almost every other issue. I’ve seen backstabbing, abuse, harassment, denigration all arising out of the area of private work. I’ve seen doctors deliberately cultivate long waiting lists in order to encourage patients to take the private route, and when Trusts have opted to increase capacity I’ve seen syndicates of doctors press hard to ensure that this work is accommodated at the local private hospital, where they can insist on full private rates to treat NHS patients. Waiting lists became regarded as gold mines.

At worst the system has spawned doctors like Ian Paterson, but for every doctor like him who gets caught and disgraced there are hundreds who practice a lesser degree of the same principles.

I’ve seen good conscientious dedicated doctors have their careers destroyed by vicious but baseless attacks by others whose ulterior motivation arose from a perception that their private income was threatened.

I’ve seen doctors whose competence was highly questionable carry on working because they had the support of colleagues based on financial interdependence.

The happiest, least dysfunctional,  most dedicated, professional hospitals I have worked in were those where private practice was non existant.

So, after over 40 years of experience and reflection, I agree with T. Private practice is an abomination and should be outlawed.

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DZ recently came across this in a hospital changing room. It raises a question to which he would rather not know the answer.

Pandemics

DZ has not written anything here for some time, in no small part because he is now back working full time in the NHS. The worst of what may only be the first wave of the Covid 19 pandemic is, in the UK at least, on the decline. Elsewhere in the world the picture is variable, the most badly afflicted places being those with poor infrastructure or appalling government administrations.

DZ has been doing a lot of reading and has learned a great deal about virology, immunology, public health and epidemiology, and going down the rabbit hole has found some fascinating and informative sites. I'm old enough to still be awed by what the internet can provide

DZ distinctly remembers when he was a child, being vaccinated against smallpox, a disease with a 30% mortality. . In 1962 there was a small epidemic of the disease in Bradford and it caused utter panic in the UK. I remember standing with my Mother in a queue maybe a quarter of a mile long going into the clinic where they were engaged in mass vaccination. The fear was palpable even to me at that age. Not an antivaxer in sight.

In my reading I came across this fascinating account of the response to the outbreak written by one who took part. What struck me in reading it was the sheer speed and efficiency with which the public health authorities responded. The outbreak was nipped in the bud very quickly. When it was over there had been only 12 cases, of whom 6 died. A truly stunning result from consummate and astute professionals. I will not compare this to the response to the current pandemic, other than to say it appears to me that we have been guilty of enormous complacency.

Smallpox was still a blight on humanity when I went to medical school. I remember when I did my paediatrics being taught by a paediatrician in a district general hospital, who spent some time on talking about the disease. He emphasised that, early in the disease it could be difficult to distinguish Smallpox from Chicken pox. I still remember his simple teaching on how to distinguish by a single sign. "Look in the armpit" he said. He told us, in chicken pox there is always at least one spot in the armpit. If there was no spot there it may well be smallpox.

Of course, in 1980 Smallpox was eradicated. An unimaginable success by the WHO, the pinnacle of many years of sustained work and dedication.

Or was it?

It has long been known that the USA and Russia have kept smallpox virus in highly secure laboratories. But any secure system is only as safe as the weakest link. In 2019 there was a fire at the Russian facility where the virus is kept. The virus did not escape, or so we are informed. The reason given by both nations for retaining the viable virus is "research" Definitely not for possible weaponisation by the leaders of the two countries then. Let's face it Putin, currently trying to engineer the system so he stays in power for life., is ex KGB. He's ruthless, ambitious and deranged. And as for Trump. He has now withdrawn from 3 nuclear treaties, destabilising the world. Recently Noel Casler, someone who has worked with Trump on "the apprentice" has defied a non disclosure agreement to release some very unsavoury information about the president. Click on the link to access the site and pick Noel Casler- Captain Valtrex, on the menu.
Once you get past the bit about Trump being so drug damaged that he wears a diaper to cope with his double incontinence, (yes really!), Casler points out that Trump simply likes to break things. The thought that he has access to nuclear weapons is small beer compared to the fact that he has access to Smallpox Virus.

If that wasn't enough as early as 2002 there was evidence that Smallpox virus is secretly retained by France, Iraq, and North Korea. Who knows who has it today?

In 1980 we had an opportunity to rid the planet of Smallpox totally. It should all have been destroyed. It wasn't, and the opportunity was lost.

DZ believes that it is only a matter of time before, by accident or design, this disease will be unleashed again on humanity. If the current situation is anything to go by we will not be prepared, and the ensuing carnage will make the covid 19 pandemic look like a sniffle.

Grifter

I see that, in the midst of the pandemic, with public gatherings now banned for some time, this mendacious wanking charlatan is still taking money for evening shows which are highly unlikely to go ahead. I don't claim to be a medium, but I'm prepared to make a prediction. I predict, if you give money to this fraud, my first prediction is that the show will not go ahead. My second prediction is that you won't get your money back.

Covid consequences

Long queues and empty shelves at the supermarkets are a bizarre phenomenon. The selfishness and greed displayed are disappointing to say the least. But at least there's no threat inherent in swiping all the bog roll. Things in the states are somewhat more disturbing.

Return

In my post of 10 days ago DZ expressed uncertainty over whether he would return to work to help with the Covid 19 crisis. He's had a little time to think about it, and was finally swayed when he remembered this.

I will go back, because I would be too ashamed not to.

Says it all