Thursday, 30 June 2011


As you may have noticed from those children unexpectedly under your feet there is a public sector strike today, protesting about pension reform. Doctors are one of the few groups of public sector employees not involved, although the issue is highly relevant to us, and we should be watching closely to see how this issue resolves.

No group contemplating industrial action can ignore public opinion. Any strikers who do not have strong public support are doomed to fail no matter what their cause as governments know that they will gain kudos from standing up to them. So does the public sector have public sympathy? NO they fucking don’t! It would be astounding if they did. What they are striking for is to retain a huge discrepancy in pension arrangements between the public and private sectors. A discrepancy regarded with some justification as grossly unfair. (1) (2) (3)

Doctors are very well paid public sector employees. Our representatives, the BMA, should be taking on board the obvious lack of sympathy shown by the public towards this issue, and perhaps keeping their heads well down. But are they?  No, not only are the BMA also making threats over the same issue, that fool Porter is still stamping his foot over CEAs.

Let’s just see what that means in raw numbers. If the government were to acquiesce on the issues of pensions and CEAs then that would result in a possible pension for a consultant retiring at 60, with just a bronze award, of about £65,000pa. And let’s not forget the lump sum, tax free.

In the current climate these sorts of pensions can not be considered fair or sustainable. The BMA should wind it’s neck in and accept that we too have to take some share of the financial pain, rather than being considered special and protected. Because stamping their foot over these issues is just going to earn us a reputation as greedy selfish bastards. With no small justification.

Friday, 24 June 2011

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."

Thursday, 23 June 2011

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?


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.

Wednesday, 22 June 2011

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?

Law? What law?

The GMC are not the only arrogant gits who think they are above the law. 

The church of England has got itself into a hopeless muddle over the appointment of gay bishops. Reading this article it is obvious that the church, like catholicism and islam, has it’s share of bigoted homophobes. In an attempt to bridge the gulf between these throwbacks and the more liberal members of the church, it has come to a number of compromises which can only have been thought up by a committee.

You can be a gay anglican bishop if you do not actually have sex. 

Anglican bishops who are heterosexual are not required to be celibate, but homosexual ones are.

Anglican bishops who are heterosexual are allowed to keep their former sex lives private, but homosexual ones are expected to repent theirs.

In an effort to placate both sides the church has got into a hopeless demonstration of double standards. Why any gay would want to associate himself with such an openly homophobic organisation is a mystery to me.

The fact that this blatant discrimination is almost certainly unlawful has penetrated their consciousness, but they appear to think that adherence to the relevant legislation is optional, making the statement, “bishops debated the issue at a private meeting, failing to reach agreement on how far they should comply with new equality legislation.”
Really? Perhaps next time I feel like killing someone I shall justify my actions by deciding how far I should comply with the law against murder. They don’t get it do they? The law applies to all. Their adherence to an anachronistic and outdated code of conduct based on a belief in fairies does not excuse them from obeying the law. 

And these fools think they hold the moral high ground. I don’t think so.

Tuesday, 21 June 2011

High Court kicks GMC in the bollocks (again)

Back in April I wrote about the case of Dr Phillipp Bonhoeffer who had been suspended by the GMC, and was facing a fitness to practice hearing on the thinnest of evidence, evidence which was purely hearsay. 

My view that the behaviour of the GMC was outrageous and biased has been confirmed by the high court, who have described the intention of the GMC to proceed against Dr Bonhoeffer as “irrational”, and a breach of article 6 (Right to a fair hearing) of the Human Rights Act. 

The GMC in their typical arrogance are in denial. That twat Niall Dickson astoundingly has stated that the case remains open, and Dr Bonhoeffer remains suspended, despite the fact that the high court judge has forbidden the GMC from using the only evidence they had.

What makes that fool Dickson think that the GMC are above the law? What does it take to get any humility from these people? They should drop this case immediately, reverse the suspension and apologise.

What arseholes.

Monday, 20 June 2011

A question

Why is it that for running an NHS Foundation Trust a CE can expect an annual salary in the region of £160,000, and a Medical Director can expect about £150,000, when for running the entire country the Prime Minister only gets £142,500?

With 170 acute hospital Trusts in Britain that means that just 340 NHS employees are costing about 105million pounds a year in pay. To put this in perspective, the 650 MPs in the House of Commons cost less than half this sum, 42.7million.

Is it not time there was a cap on how much a public sector employee can earn?

NHS reforms

Wednesday, 15 June 2011

Heroes & Villains

You will probably have seen this clip of surgeon David Nunn of Guys Hospital losing his rag, and who can blame him. 

What no-one is asking is what were Cameron and Clegg doing at the hospital in the first place. Apparently he was there to  “reveal the reforms in the NHS”. Did he really have to go to a working hospital to do it? 

The appearance of these politicians in the hospital with a full cortege of the press can have been nothing more than a propaganda exercise. Totally orchestrated theatre with the sole function of providing a photo opportunity for the PM.

I think we all wait with baited breath to see if Mr Nunn is about to feel the wrath of his CE over his quite justifiable outburst. But who is the CE of Guys? A man who thinks it is perfectly acceptable to allow his hospital and patients to be used for party political purposes.
This is the CE of Guys Hospital. His name is Ron Kerr. Ron is apparently the highest paid NHS CE in Britain, with an annual salary of 270,000.

Monday, 13 June 2011

Right again

This is getting spooky. Only yesterday I wrote "Cameron is capable of U turning when he thinks it expedient”. And today this appears in the Telegraph.

If my other prediction comes true I am definitely going into the fortune telling business.

Sunday, 12 June 2011

The end

If ever you are feeling in a really wicked mood try this. You will need mobile internet.

Get yourself onto some form of public transport, try to look furtive. Select a victim and sit next to him. Open your laptop so that your victim can see the screen.

Log on to the internet. Then click onto this site.


Jobbing Doctor, in his latest post, expresses scepticism that Dave Cameron will U turn on the NHS reforms. I am not so sure, as he has done it before.

In my last post I mentioned that the regulations on purity and safety of herbal medicines quietly became law in April. This is something of a surprise, because just a few weeks before, the government were stating that they were going to defy the EU and block this law in the UK.

Now I do not actually think that for a government to change it’s mind is a sign of weakness or poor government. If Dave were to stand up and say that, on reflection, he had changed his mind, I would regard that as a sign of open mindedness and maturity, deserving of respect. As Cromwell once said, “Think it possible you may be mistaken”

But he hasn’t. With the herbal medicine law he has said the law would not happen, and then gone quiet as it went onto the statute books by stealth. I actually think it is a very good law, but that is not the point. The point is that Dave has been devious, weak and spineless by hoping no-one would notice his little U turn.

So it seems to me that Cameron is capable of U turning when he thinks it expedient, and his only real concern is in how to carry it off without losing face. The government, as a coalition, is insecure, and having Dave the invertebrate at the helm makes it even more so. 

Zorro would not mind betting that this parliament will not run the full term, and that the next general election will come sooner than we think.

Saturday, 11 June 2011

Branching out

I have commented before on the use of herbal medicine, and how the public have this view that because the products are “natural”, they are innocuous and safe. This view is reinforced if you visit any herbalist shop or website where a very one sided view is presented, without any mention of the potential risks.

The herb itself can however be potentially toxic and two particular examples are ephedra and aristolochia. Add to this the fact that contamination with pesticides and heavy metals is not uncommon. Also some herbal products have been found to contain modern pharmaceuticals, presumably added deliberately. Drugs found have included NSAIDs, steroids and amphetamines. If that is not enough there may also be biological contamination. These problems seem to be more prevalent in Chinese Herbalism.

These significant and serious safety concerns resulted in the EU law requiring herbal products to be tested for safety and purity, which came into force in April in the UK despite initial reluctance from the British government.

This law has been misrepresented as a ban by the herbalists but it is nothing of the sort. Herbalists can see that being forced by law to provide safe pure products is going to be difficult and one enterprising chinese herbalist has decided to branch out into other areas of business. It seems to me though that this is yet another area where contamination might be a problem for customers.

Friday, 10 June 2011

The best and the worst

Fuddled Medic, in his latest post, demonstrates how astute he (she?) is by his realisation that he is about to “join a profession that includes a whole lot of bastards”, something that Zorro did not fully realise for many years after he had qualified. It is a sad fact that the profession seems to have it’s share of misogynists, racists and egocentric bullies.

But, with nearly a quarter of a million registered medical practitioners in Britain it would be absurd to assume all of our colleagues are saints. Temperament, like any other human variable will always follow a distribution curve, and there will always be those at either end beyond two standard deviations.

We all know colleagues who we regard highly and trust absolutely, just as we all know those we would not turn our back on. Doctors are no different from any other group of people and will include the full spectrum.

As an illustration, this has set me thinking about who I would nominate as the best and the worst of our profession. This is bound to be a personal and arbitrary choice, based on how I would define merit, but, sod it, it’s my blog and so here goes.

The very best.

Since January 1856 the Victoria Cross has been awarded to 1353 recipients. Only three recipients have ever been awarded a VC twice, and two of these were doctors. The selflessness, devotion, and courage displayed by these two men  can not be exaggerated, and I would nominate them as the very best of our profession.
                                               Noel Godfrey Chavasse

                                  Arthur Martin-Leake

So what about the very worst. I have no doubt we all would have our own nominations, but I have decided to stick with my theme of double achievement here. I have decided not to name them, though it is easy enough to find them on a google search. Astoundingly I have found two doctors who have been struck off by the GMC, twice. They were both struck off, later reinstated, and subsequently struck off again. Quite an achievement.

So yes FM we do have some real bastards in the profession, but don’t let it make you too cynical because we have some stars as well.

Tuesday, 7 June 2011

Another miracle

Extract from a consultation letter.

"Thank you for referring this little girl who attended today with her mother. The mother is concerned about spina bifida, which occurred in her sister’s child, and is worried about the child’s back. On examination the child was perfectly well. She does however have a sacred dimple."

Monday, 6 June 2011

From the mouths of children

I was talking to a youngster today, and he explained to me that your choice of religion should be based on how various deities have delivered on their promises, rather like politicians.

Now Jesus promised to bring peace to the world. He has now had 2000 years to deliver on his promise and manifestly failed.

Thor however promised (and I suspect this information comes more from an X box game than from genuine mythology) to rid the world of Ice Trolls.

Now, when did you last see one of those?

Thursday, 2 June 2011

Witches and witchcraft

Anyone well familiar with this blog will be aware that I do not have much time for complementary and alternative medicine. I have also in the past been quite scathing about midwives, so an article featuring both betes noir is bound to get my attention.

The Journal of Advanced Nursing has accepted a paper from an organisation called NORPHCAM suggesting that quackery should be offered by midwives to their patients, and included in the nurse and midwifery training. The apparent reasoning is that these techniques are “popular”.

Where do you start. 

Firstly nowhere in the paper does it actually state what these techniques are supposed to achieve, and no evidence is presented that any clinical objective is attained. In fact there is no evidence that any of the CAM practices are of any benefit in pregnancy and some may even be harmful. For example herbal medicine. What are they doing encouraging pregnant women to take herbal substances without any evidence that they are safe to mother and foetus. This article indicates also that these substances may be contaminated. One can imagine the exchange between a suitably “educated” midwife and her patient. “Good morning Mrs Gullible-Loon, and how would you like your agricultural pesticides this morning, with or without heavy metals?”

That a journal should accept a paper of such appalling quality from a CAM promotion organisation, which is what NORPHCAM is, indicates perhaps that it is not a very discerning journal. 

And why is a nursing journal pontificating on Midwifery. As the midwives tell us forcefully, they are NOT nurses. In fact a very good way to get a spectacularly aggressive reaction from a midwife is to call her a nurse.

To get a good idea of what happens when you persuade midwives that CAM is a legitimate therapy for pregnant women have a look at this.