Saturday, 29 December 2012

The season to be jolly!

Well that’s Christmas over for another year. Mine was pretty reasonable, I find they get calmer and less self indulgent as I get older. Mind you it’s nice to have the freedom to celebrate, even if you don’t actually believe in the underlying basis of the event. I prefer to think of it in older pagan terms, the passing of the winter solstice & all that. 

Even though I personally have no regard for christianity I can’t help feeling that some christians are a bit hard done by. Such as these unfortunates who chose to celebrate Christmas in that jolly muslim country, Saudi Arabia. Somehow I have never regarded my plans for Christmas as “plotting”. 

Most of those at the party were christian though I expect that the ire of the police was particularly directed at the few moslems there. In that other jolly country Iran some poor bugger is facing a possible death sentence simply for becoming a christian. Just how rabid and prejudiced these people are is illustrated by the fact that his lawyer has been sentenced to 9 years inside for the heinous crime of representing him. 

Monday, 24 December 2012

Happy Christmas

Being a cynical old git DZ has scoured the web to find something really classy as a Christmas post.

Sunday, 23 December 2012

Let down!

Hot on the heels of my tirade yesterday against the Prince of Wales come two news articles which would, sadly, seem to support his allegations. 

The first is about this individual, who was erased from the medical register. I think the erasure was right and proper, his conduct inexcusable. But..... The peculiar circumstances of a RAMC regimental Medical Officer will have played a large part in the doctor’s actions and appear not to have been addressed, or even mentioned. An RMO works in an environment totally isolated from other medical colleagues, and surrounded by his other, non medical, officers 24 hours a day. If, as appears to be the case, there was institutionalised violence towards prisoners by the regiment, it would have taken enormous courage and strength of character to have stood alone and challenged this. The consequences to him within the regiment would have been unthinkable, and his position would have become impossible. It is a great shame that he lacked the necessary courage, but also that there does not appear to be any form of support from the higher echelons of the RAMC to medical officers in such situations.

The second is this report about Alexandra Hospital Redditch, which reminds one of Stafford. Many of our colleagues let down their profession and the NHS in these places and I can’t even begin to understand why. I don’t want to make excuses for the actions of the staff involved, they are inexcusable but I have no doubt that, like Stafford, the problems at Redditch will be found to emanate from the top. After all the CE is where the buck stops. I have no doubt that heads will roll at the sharp end. I wonder if anything will happen to this lot.
Penny Venables - Chief Executive - Worcestershire acute hospitals NHS Trust

Circumstances like these are unusual. They came to light after 100 hospitals had spot checks, 98 of which were not like Redditch. So I stand by my assertion that true care and compassion is the norm in the NHS, and that Charlie boy is still a twat.

Saturday, 22 December 2012

The perils of inbreeding

I think most of us who work in the NHS are well used to various people trying to tell us how to do our job. And without exception it is those with the least experience and knowledge that are the most anxious to give us the benefit of their ignorant and ill informed opinions.

Politicians, priests, hospital managers......I could compile a list that would go on & on, consisting of those who have never spent a day at the sharp end. And so it is with this absolute and irredeemable fuckwit who feels that we are all callous, uncaring and cold towards our patients. He pontificates his view that “age-old qualities of human kindness” were “palpably lacking” in hospitals and clinics. 

Can anyone tell me why this big mouthed empty headed twat is given any publicity at all to spout this bollocks as if he knew anything about it. When has this man ever been a patient in an NHS hospital, or spent even just a few hours simply watching people at work?

I worked in the NHS all my adult life. I saw all grades of staff from every medical profession at work. While it is true that a small number of those I encountered were possibly as described by Charlie, the vast majority were not. Compassion and caring did, and does abound in NHS staff on a scale beyond this man’s understanding. 

Having to endure the unevidenced spewings of this privileged and cushioned knob as if his views carried any weight makes me angry beyond words. I doubt he’ll ever read this but I would hope from somewhere he gets this message.

“You know absolutely fuck all about it so shut your mouth and fuck off and keep your insulting ignorance and unspeakable arrogance to yourself!”

Mayan calendar

Well we're all still here then. Bugger it, that means I'm going to have to pay for all that Christmas credit card spending. Hang on, I have an advent calendar that ends in two days. OH GOD WE'RE ALL DOOMED!!!!!!!!

Tuesday, 18 December 2012


I’ve been anticipating and predicting for some time the demise of the Clinical Excellence Award. It seems that the death of this system is not going to be quick and clean, and that there is going to be collateral damage to the pay of Consultants who don’t  even receive one. One thing I didn't see coming was a 20% cut in the rate of pay! The whole exercise for many will be the last straw and any doubts about retiring rather than suffer the abortion that is revalidation will now evaporate. It is my belief that in the next year or two there will be a mass exodus, and a shortage not only of numbers of Consultants, but of the most senior and experienced. The BMA will, as usual, prove utterly impotent and hospital doctors will be further massively demoralised. Only those employed through agencies can expect a bright future. No way to treat the profession.

Friday, 14 December 2012


I’ve looked again at that last post and I have to say I felt a little suspicious about that figure of a billion pounds a year quoted on Sky news.. So I thought I would do a little simple arithmetic.

A typical cost to the taxpayer of providing a child with a free meal at school is about £2.20. School term times add up to about 40, 5 day weeks of the year or 200 meals per child per year.

It is estimated that about 1.1 million children in Britain are eligible to claim a free meal, but only about 800,000 actually claim. Doing the sums gives a cost to the taxpayer of 352 million pounds a year. Not a billion then, or even close. Even if all those eligible claimed the cost would still only be £484 million.

There are about 26 million taxpayers in Britain. So put your hand up if you begrudge paying £18.62 per year to prevent British children going hungry. There are lots of things I begrudge my tax being spent on but that isn’t one of them.

One billion pounds would provide a free school meal to every primary school child in England. The cold hearted cruelty it would require to try and save money on these most vulnerable members of society is bad enough. But to argue on the basis of inaccurate and untruthful figures is just despicable.

So tell me Mr Cameron. How much did your meal cost the taxpayer? You know, the one at the guildhall banquet where you stuffed yourself so full you burst your shirt open, you greedy fat bastard. I'll bet it cost a lot more than £2.20!


Standards of child nutrition vary widely from country to country. Only this morning the news featured a country where a significant number of children arrive at school unfed, and only get fed during the school day because of the generosity of their teachers. A country where vitamin D deficiency is thought to affect 25% of children and clinical Rickets is on the increase.

So which poverty stricken third world country is it that can’t adequately feed it’s children? Both these stories were describing the situation in the UK. It could be far worse were it not for the fact that over one million children in the UK are entitled to free school meals. 

It was stated by the reporter that free school meals cost the taxpayer one billion pounds a year. Now I don’t know if what he said next originated with the news channel or from some government spokesman but it was stated that this sum was excessive and unaffordable.

What sort of a country whinges about the cost of feeding it’s children? What sort of people begrudge paying taxes to ensure children are adequately nourished? To put things in perspective the money spent on the Iraq and Afghanistan wars would pay the free school meals bill for 20 years.

Tuesday, 11 December 2012

Things that make you go hmmmmm

I've just come across this picture in an ad for the TV series Downton Abbey and I'm asking myself......
Why has this lady got a tampax stuck up her nose


In my lifetime I have seen, in this country at least, a gradual loosening of the grip of religions on the populace. The latest census confirms what was fairly obvious, that this shaking off of irrational belief in an invisible man in the sky is gathering pace. One in four of us now reject the concept of religion entirely. 

It’s also true that those who still profess faith are very much the older age groups, and, with time the proportion of believers is bound to drop considerably more.

About time too. Why has it taken us this long?

Monday, 10 December 2012


I've been getting an awful lot of spam comments lately. The format is always the same. A gushing compliment on the blog or specific post, often in mangled English and not in any way relevant to the post subject, followed by a link to the commenter's own web site.

Until recently my spam filter caught most of these but they are now creeping through, and the subject matter of their links is getting increasingly undesirable. I've just deleted one possibly connecting to an under age porn site.

Comments moderation is all I can do about this. Don't be put off if you wish to make a genuine comment. Those are (almost) invariably welcome.

Sunday, 9 December 2012

Professional courtesy

Thanks to JD for the information that Dr Dan Poulter of my last post was once a gynaecologist, before he became a politician. I am reminded of a comment made by an anaesthetic colleage of mine. He was anaesthetising a lady for a gynaecology colleague of whom he was not particularly fond. The gynaecologist had just inserted a Cusco into the oblivious lady.

“Look at that” said my colleague. “ A bent piece of steel with a cunt at each end!”

Another man with his head up his arse.

Health minister Dr Dan Poulter said: 

“Today is a momentous day - as doctors in the UK become the first in the world to have regular assessments to ensure that their training and expertise are up to date and that they remain fit to carry out their important role of providing high quality care for patients.


“The UK is now the only country in the world to hobble it’s medical profession in a a supremely stupid attempt at control and emasculation which will deprofessionalise and demotivate every doctor in the land at great expense for no discernible benefit.”

DZ is prepared to stand corrected but, contrary to the implication in Dr Poulter’s statement, he is not aware that any other country in the world feels it a good idea to emulate the UK in it’s intention to fuck over it’s medical profession in this act of supreme and ignorant folly. 

Tuesday, 27 November 2012


Well it's now less than a month till the supposed end of the world and I'm going to repeat a suggestion that could just enable you to make a lot of money, though it would take a certain level of cold hard heartedness. Find yourself a deluded gullible fool who really believes that the world is ending next month. Offer him £5000 for his house, and everything he owns, the deal being that you pay today but he does not have to relinquish all his worldly goods till the day after the end. What has he got to lose?

Wednesday, 7 November 2012


“Four years ago it was a feeling of joy. This time the main feeling was relief that we don't have to wake up tomorrow in Romney's America.”

Salman Rushdie

A sentiment that I wholeheartedly agree with!

Sunday, 28 October 2012

Happy Birthday

Today would have been the 100th birthday of Sir Richard Doll.
The man who first established the link between cigarette smoking and lung cancer. Since his original study smoking rates throughout the world have declined steadily, although in the UK the rate has plateaued at a stubborn 20% or so who persist with the habit regardless, and who are all candidates for a Darwin award.
Another man on the shortlist for having saved the most people from premature death in human history.

Wednesday, 24 October 2012


“Freedom isn't a demand, it's a life I'm living. Freedom isn't bodily freedom, but freedom of the mind, belief, expression and thought. You are calling for freedom for me but I struggle for your real freedom. “

Monday, 22 October 2012

Spot the difference again

The best political weapon is the weapon of terror. Cruelty commands respect. Men may hate us. But, we don't ask for their love; only for their fear. 

Over time this system will not only provide greater assurance to patients about the competence of their doctors, it has the potential to enhance patient safety and improve the quality of medical care in the UK

Spot the difference

“If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.”

Revalidation will be a world leading system and we are confident it will make a major contribution to the quality of care that patients receive through supporting doctors’ ongoing professional development.

Car crash

The government and the GMC have both recently been putting out a fair bit of propaganda about revalidation, with Hunt and Dickson both stepping up to pontificate about how this will vastly improve the quality of medical care. I’m not really sure who this propaganda is aimed at. The impression I get from my lay friends and former patients is that they don’t really know or care about revalidation, and if you google “patient satisfaction” you find such a consistently high level of happy punters that you wonder what the powers that be think they are going to achieve.

So perhaps the propaganda is aimed at the medical profession. If it is then they’re wasting their time. Peruse the medical blogs and speak to your colleagues and you find a strong consensus that the whole process is a bag of shit. A pointless, oppressive, time wasting, expensive exercise that is nothing more than a further attempt to intimidate and control doctors.

Even if the process were to be administered by a competent and well regulated body it would still be a bag of shit. The fact is though, that it is to be administered by the GMC. Widely perceived, with good reason, as incompetent, inconsistent, overbearing, arrogant and out of touch. The point has been made also that they are answerable to no-one. Their own performance in revalidating will be unmonitored, unassessed, and unregulated. They will be able to act pretty much as they please. For any unfortunate doctor who is unhappy with their verdict there does not appear to be any appeal mechanism. 

Putting together the inherently flawed process and the all powerful GMC is a recipe for disaster. Just about the only people who can’t see that are Jeremy Hunt, a politician who believes in homeopathy, and Niall Dickson of the GMC.
"The Emperor is wearing no clothes"

I’ve pointed out before that we have only ourselves to blame for this imposition. If the profession had stood up and simply announced that every one of us would boycott the process, then revalidation would have sunk without trace. But I’ve also pointed out that we, as a profession, don’t seem to be able to organise ourselves.

So all we can now do is sit back and wait for the inevitable.

Sunday, 14 October 2012

Life of leisure

Those of you with sharp eyes may have noticed a single word change on my home page that indicates a major change in my life. Yep, I hit 60 and retired at some time in the last 12 months. I had thought I would continue blogging, particularly on NHS subjects, but very rapidly found that I no longer give a shit what happens in the NHS, and I don't suppose I will regain any interest until the time comes when I start to need it. heres hoping that that won't be for some time.
My blogging input has already declined in the last few months, and I think this lower frequency of posts is going to be the norm. But I'm not shutting up shop. Anybody out there who has an NHS story they would like aired can send it to be and I will consider posting it.
I expect as I settle into retirement and develop new interests I will start blogging in a different direction.
Thanks for all your comments over the last couple of years.

Tuesday, 25 September 2012

Hospital Medicine

“Specialisation means that everyone becomes better and better at less and less and eventually someone will be superb at fuck-all.” - Kenneth Williams 

Saturday, 22 September 2012

Double standards

Regular readers to my blog will know I am a passionate defender of freedom of speech, especially the concept that this necessarily extends to expressions of opinion that may offend.

Someone who has exercised this right recently is Dr Una Coles, a previous unsuccessful candidate for the position of President of the Royal College of General practitioners.
(My understanding is that if copyright exists on this picture, 
it is the property of the Daily Mail newspaper)

In a recent booklet she strongly implies that her own college, in it’s examination procedures, is guilty of racism, sexism, fatism and homophobia. Now I’m all for expression of opinion, but this goes further than that and is an implied accusation of illegal practices, and I would have thought that the laws on libel may well apply here. 

Needless to say her comments have attracted widespread condemnation. My only comment would be that if she were to make such allegations I would expect to see some evidence to support them and as far as I am aware all Dr Coles has is one or two anecdotes relating to unidentified individuals. Hardly what I would call evidence.

But it gets stranger. In the article as it appeared in yesterday’s Daily Mail it was stated that another GP had made strong but perfectly valid criticism of the publication on the twitter account of Ms Coles. I think that if someone makes provocative and unsupported statements it is inevitable that they would draw criticism, and that again falls under the laws of freedom of speech. However again according to yesterdays Mail she had responded to this in a completely excessive manner, allegedly reporting the GP to the Metropolitan Police for being a Troll.

Now I’m not sure that trolling even constitutes a criminal offence, but if this were to be true then it would demonstrate a degree of hypocrisy and arrogance that is quite startling. If you want to make controversial statements then you have to expect critical response. Hysterical responses as if your own views are above criticism just makes you look an arrogant twat.

Strangely, in the Mail article as it appears on line today the reference to Ms Coles involving the police has disappeared. And so has Ms Cole’s twitter account.

I too have had overreactions from Ms Coles in the past. I gained the impression that she favours her own freedom of speech, but isn’t too keen on others using it to criticise her, and would like to silence critics. I don’t know if she will be in touch with me, or if she will express a desire to deprive me of my pen. But if she does................

Wednesday, 19 September 2012


The concept of tolerance appears to have two meanings. In the scientific field it refers to the margin of error inherent in any investigative study. And in the field of human interaction it refers to the ability to accept that others feel strongly about a view you oppose. 

But the meanings are the same, they both amount to a willingness to accept that your most firmly held beliefs might be wrong, and to accept that, if you are shown good enough evidence, a good enough argument, then the only reasonable response is to adapt your stance.

I have always been strongly opposed to the concept of judicial execution, the idea that some crimes can justify the calculated official killing of the perpetrator. One of the pillars of that belief has been that this sentence can not bring back the victim, and can not serve any useful purpose. 

Norman Tebbit has today written something that has rocked that pillar.

“I have kept track year by year since the death penalty was suspended then abolished of the number of people who have been killed by persons previously convicted of homicide. It has averaged three people a year. About 150 people killed because their killers have been freed to kill again.”

I never thought of it like that.


I’ve recently had a small string of abusive comments to some of my posts from a troll well known to previous readers of retired (and missed) blogger Dr Aust. Now I know some people regard deletion of comments on a blog as a form of censorship but I don’t see it that way. I’m not trying to stop anyone expressing their point of view, but nor am I obliged to allow my blog to be used as a platform for people I regard as objectionable. They can say whatever they please, but not here. And so I’ve quietly and without fuss simply deleted his comments and not been drawn into a slanging match. It's my blog, I can do it, and I will.

He’s obviously noticed this and started commenting under a different user name, but the style is the same and I’m not fooled for a moment. His first comment was the single word “to**er” (sic) Why he can’t just write “tosser” I don’t know. And then he accuses me of bringing the entire medical profession into disrepute by making rude comments about past and present health ministers.

I think that’s rather good, being accused of bringing the profession into disrepute by a man who has previously been dismissed from his post because of gross misconduct.

Wednesday, 12 September 2012


I think I may be a little behind the times here, and most people might already know this but our new health minister, the one in charge of the entire NHS, believes in homeopathy and other CAM modalities. This is the vacant looking twat here!

One has to question the state of intelligence of a prime minister who thinks that such a fucking ignorant and opinionated moron is a suitable incumbent for the post. Jeasus wept! What a government! 

Thursday, 6 September 2012

Spot the difference?

Let's face it, there isn't any.

Plus ca change, plus ca la meme chose.

Tuesday, 4 September 2012

Godwin's law

“Godwin’s law” refers to an internet phenomenon whereby, in any ongoing discussion, on any topic, it is only a matter of time before one of the comments will make a reference to Hitler or fascism. 
My most popular post by far has been the one on the “nutrascience scam” which has now had almost 20,000 visits. Also it has attracted 233 comments, and so far Godwin’s law has not applied. Scientifically speaking I think that that may constitute enough evidence to support the view that the probability of Godwin’s law applying is not 1, but <1.
Having said that I fully expect now that someone will go and put a mention of Hitler on the thread just for the hell of it.

Friday, 31 August 2012

Oh shit!

We are now faced with the distinct possibility that this religious nutter could be the next president of the most powerful nation on earth. He's already promised to "show backbone" to Russia and Iran. Perhaps predictions that all will end in December this year are not so implausible after all.

Friday, 17 August 2012

Nursing process

Grumpy, in one of his comments has dredged up something I have not heard of for a long time. The “Nursing Process”. This was an approach to nursing that was very popular about 20 years ago but has now, thankfully, died the death. 

One of it’s features was that it set out to be thorough and holistic, so all patient’s had to fill out a questionnaire enquiring into every aspect of their lives, no matter what they came in for, and all aspects were supposed to be addressed while they were in hospital. While this is perhaps no bad thing when it comes to, say, dietary requirements, there was a section that pried into the patient’s sexuality. So you could come in for an ingrown toenail and asked how you got your jollies. Unsurprisingly most nurses skated over that bit without being too intrusive, but some of the more fanatical felt that this was wrong.

One (male) academic published a paper in which he asserted that, not only should this area be fully explored, but any problems uncovered should be dealt with. He even gave an example. These were the days before the popularity of internal fixation of fractures and many orthopaedic wards had several patients on long term traction, some of whom were young males. 

The author suggested that being in this situation for weeks at a time was likely to cause a build up of sexual tension, and that this should be addressed. His idea was that the hospital should employ a specially trained physiotherapist who would periodically visit these young men and give them “a helping hand”

I remember thinking at the time that this was likely to result in perfectly fit young men breaking their limbs on purpose.


There is little doubt in my mind that the great majority of Doctors regard the practice of appraisal with utter contempt. A purposeless, unfit abortion of a concept, with revalidation as it’s bastard offspring.

That this seething undercurrent of animosity exists was brought home to me by a friend who recently attended an interview for a Consultant position. He was asked what he thought of the revalidation process by one of the committee. He knew the “correct” answer but felt strongly enough to be truthful, and let rip with what he really thought.

He got appointed.

Saturday, 11 August 2012

Driving again

Back in December I commented on the dilemma faced by GPs who might feel that one of their patients is no longer fit to drive because of their age, and the fact that the GMC have issued guidelines to address this problem. It looks as if one GP hasn't read these guidelines.

Monday, 6 August 2012


I've commented before on the dilemma a doctor might find himself in if he perceives substandard care within his Trust, and that there is no body that can assist and protect any whistleblower. There is now a petition to address a number of problems related to whistleblowing, including, hopefully, the safety of the whistleblower. Please sign it.

Friday, 27 July 2012

Wanking again

Bloody hell, you'd think he'd switch hands once in a while wouldn't you.

Wednesday, 18 July 2012


each pupil in attendance at a community, foundation or voluntary school shall on each school day take part in an act of collective worship."
Education act 1998, section70

Avilean scam

One of my readers has alerted me to yet another scam, another slimming product called Avilean. Yet again it features acai berries, together with mango and tea. I don’t normally provide a link to these sites but have done on this occasion because this time the ad is so badly done that I don’t think it likely to persuade anyone to part with their cash. 

It seems to have been written by someone for whom English is not a first language. It’s a combination of mangled English with meaningless gibberish so poor that it can’t even be described as pseudoscientific. Here are a few quotes taken directly from the page

“in the event that particular factor needs to make a move with sensuous and unattractive looks, then you definitely really have careful analysis build your fancy become a reality.”
“This component adjusts the look of adiponectin by enhancing blood insulin meter. Weight loss, the doppelganger of the element, lower downs the amount of C-reactive proteins.”
“enhances the metabolism by maintaining a reliable heartbeat.”
“The product not just inspections weight but additionally includes a check up on its prices. Hurry, and grab Avilean today, should you desire the having a properly contoured physiology.”
All scams eventually become so well known that they become unusable, but that doesn’t stop crooks from trying, far too late, to jump on the bandwagon. I am still occasionally getting emails from Nigerian gentlemen offering me huge sums of money, provided I send them some first. 

Hopefully the Nutrascience type scam is now getting to that stage and fewer people are being taken in. I expect they will think of something new.

Tuesday, 10 July 2012

Special offer!

One of the buzzwords we keep hearing in the NHS these days is “choice”. The concept of patient choice is frequently cited, particularly by non clinicians, without there being any apparent thought about what that actually means.

If you take your car to a mechanic, and he diagnoses a problem, I don’t think many of us would consider it appropriate to tell the mechanic how to fix the problem. So why is this considered a good idea in medicine. The older generation of patients tend to have no truck with this idea and many of them seem not even to want too much information about their condition. This is the age group who are most likely to be taking medication prescribed by their doctor, without actually knowing, or even caring what it’s for. They simply trust their doctor to act in their (the patient’s), best interests.
Patient choice

The younger generations however are more likely to want information and choice, but can any amount of information given to a lay person really give them the basis to make a truly logical decision. I’m not advocating that patients be treated without informed consent, just that a little professional advice is often appropriate.

This is especially important when your patient gets all his medical information from the Daily Mail, or some similarly informative rag. And when you throw in the whims of fashion the extremes of “patient choice” can lead to a demand for some very dubious treatments.

Thursday, 5 July 2012


The catholic church doesn't like it's "miracles" debunked. So much so that in this case they have even set the law on someone who done just that.
Please sign this petition

Wednesday, 4 July 2012

Acai berries

For those out there who would, in spite of all my rantings against the scammers, really like to try Acai Berries to help you lose weight here are one or two tips.
1. Don't be disappointed when you find they don't work. There is no reason why they should.
2. You can buy the bloody things in your high street health food shop at a tenth the cost they charge you on the scam sites.

Slimvida scam

As fast as I can highlight new scams out there the products highlighted seem to simply rebrand under a new name. This is particularly true of acai berry products, which I have commented on before under various trade names. They are now again being heavily promoted this time under the name “Slimvida”

Other than the name change the ads show little variation from the standard formula. The product is sold together with another product called “Colon Flow”. Totally unrealistic claims are made for the product, bolstered by pseudo scientific bollocks. There is of course the ubiquitous free trial, where you only pay postage, and no other way of paying than allowing a regular debit authority on your debit card.

They rely of course on people not reading the terms & conditions, particularly where it says “your credit card be automatically charged 1 easy payment for the 1 trial bottle at just £69.95”
Are there really still people out there who are still ignorant of how this scam works? Surely people are beginning to wise up.

Sunday, 1 July 2012


It is some years now since Female Genital Mutilation was made illegal in the UK. The passage of this legislation was a no brainer. The degree of mutilation involved, and the relatively small proportion of the UK population engaged in this activity meant that precious few people would have opposed the measure, and it was an easy, and very necessary law to pass.

Male circumcision for ritual or religious reasons is philosophically in my view no different, but politically it is a much more contentious issue. Unsurprisingly British politicians don’t want to visit this issue as the potential for large numbers of lost votes is very significant. So they turn a blind eye.

Finally one civilised western country has started to take a stand. Not the politicians, by making new laws, but the legal establishment itself for pointing out that the practice is probably already illegal by the application of existing legislation. The fact that this practice has been pursued by a large number of people for thousands of years is no excuse or justification.

For a first rate argument against male circumcision read this. In my view there is no justification for any doctor to involve himself in male circumcision unless performed for valid medical reasons. And any doctor who does should have to explain himself to the GMC.

Wednesday, 27 June 2012

Mystery object again

No guesses on this one. The instrument is called a probang. It was used for disimpacting the oesophagus when blocked with an over ambitious bolus of food, usually in cattle. You simply used the instrument to push the impacted food through into the stomach.

It reminds me of a patient I was involved with many years ago, when I was in training. Young male out on the town with his mates drinking heavily, and playing silly games. He bet his mates he could swallow a whole, intact chicken wing. He couldn’t, and it got stuck at the lower end of the oesophagus, and he needed surgery to move it.

For reasons I won’t go into, the rigid oesophagoscope was not available, and the fibre optic simply wasn’t up to the job. The surgeon, George, improvised. So what instrument did he use to retrieve the chicken wing? An old fashioned, steel & chrome, non disposable, used thousands of times rigid sigmoidoscope, like the one below. Good one George.

Tuesday, 26 June 2012

Mystery object-answer

Anonymous gets it right

"Looks like a burdizzo to me. we use them to castrate male calves"

It is in fact a veterinary instrument known as a “bloodless castrator” Nice.

Staying on the same theme this is another instrument used in veterinary practice, but also, historically, in humans. What is it? & what's it for?
To get an idea of scale, it would be one to two feet long

Mystery object

It's been some time since I posted a mystery object. This one, unlike my previous offerings is not an antique, and I think is quite easy. Any ideas what this is.

Sunday, 24 June 2012


On this day, June 24, in 1916, the first British gun opened fire to start a week long artillery barrage, preceding the battle of the Somme. The first day of the assault, a,week later, generated 60 thousand British casualties. The RAMC of the day was totally overwhelmed.

RAMC stretcher bearers, 1916

Saturday, 23 June 2012


Have had contact recently with the physiotherapy department in my hospital. Physios have a jargon all their own, treatments largely unevidenced, and to my mind mostly illogical and ineffective. They spout stuff that I don't recognise as science, and ponce around with a stethoscope around their neck.

I have had a nagging doubt for some time about the profession, which has now crystalized. I think they're the closest thing in the NHS to quacks. A total waste of money.

Friday, 22 June 2012

Losing battle

There is precious little in the media this morning about yesterday’s industrial action, and what there is is heavily biased against the doctors. It seems there was little support in the profession for the BMA action, and certainly my perception of my own location is that it was all very much business as usual. Can’t say I am surprised. 

Tuesday, 19 June 2012

No-one's all bad

I have been pretty scathing on this blog about the General Medical Council, and it’s chief executive, Niall Dickson, and I’ve highlighted cases where the GMC has behaved with vindictiveness, pettiness, inconsistency, and a total disregard for justice, or legal safeguards such as the Human Rights Act.

But it has to be acknowledged that sometimes individual doctors do cross the line and, as a group, we have the full range of villains just as people in other areas. I don’t assert we don’t need a regulatory body, we obviously do, but we need one as impartial, consistent, competent, and fair as possible, and it is here that the GMC often falls short.

But the GMC does get it right once in a while, as it did when it erased  Andrew Wakefield.

Mr Dickson too can’t be wrong all the time, and this story is one such, concerning a GP who introduced religion into a medical consultation. No-one wants to stop doctors talking enthusiastically about their religious beliefs if they have them, but at the best of times they have little place in this setting. And to use phrases like “the devil haunts those who do not turn to jesus” is simply inexcusable. Just plain wrong. 

The GMC have issued the GP in question a warning, and quite right too. So for once, when Mr Dickson said “This is not about religion. It is about respecting patients and making sure doctors do not use the incredibly privileged position they hold to push their own beliefs.” I have to say I agree with him.

Monday, 18 June 2012

Shag break

It has been pointed out to me that the goings on highlighted in that last post did not involve doctors, and that this might be because doctors have reserved car parking spaces in the hospital, making such activities impossible. I don't think that is the reason though. The giveaway is that the staff involved are engaging in these activities in their break. What the fuck is "a break"?
Still, the next time a nurse excuses her lack of knowledge of what is going on on her ward with the phrase "I've been on my break" I will look at her in a new light.

Sunday, 17 June 2012

Job change

DZ sometimes feels like a change of scene, but where to go? The grass always looks greener but the reality rarely lives up to expectations. Still some places have perks that aren't available elsewhere. I wonder if there are any vacancies at Darent Valley Hospital.

Friday, 15 June 2012

Research & ethics

Today, June 15, is the anniversary of the first attempt to transfuse blood into a human being. Those who might think that blood transfusion is a relatively new idea might be surprised to learn that this was in 1667.

I have commented before on the total lack of regulation of medical research in history which meant that doctors could, and did, try literally anything on their patients, with impunity. No ethical committees then.

Unlike my previous example however these early attempts at transfusing animal blood into patients contributed nothing to benefit humanity. 

Anyone who thinks that ethical committees have today have eliminated this attitude to research should remember what Andrew Wakefield got away with, for a time at least.

Ethical committees, unsung heroes.

Sunday, 10 June 2012

Thin end?

One recent story that doesn’t seem to have generated much interest is the recent recommendation by the Joint Committee on Vaccination & Immunisation that all children should be regularly vaccinated against flu. The rationale is that this would help prevent flu moving through the population as a whole.

Unsurprisingly this has caused a lot of the anti vaccine campaigners a fit of apoplexy. If you look up their various blogs & websites, which I’m not going to link to, you can find a level of rabid irrationality which is quite entertaining. I’m not going to spend time here dissembling their incoherent and ill informed rantings. Other bloggers out there do this far better than I could.

What is worrying is that, if you read the comments to the article, it is apparent that there are more than just a few people out there who have very odd and ignorant ideas about vaccination. As just one example one commenter seems to believe that tuberculosis is a disease of the past. If you want to spend a little time having your faith in human intelligence steadily eroded just have a good read of the comments.

But I do have one tiny reservation about these recommendations. Vaccinations against diseases other than flu are primarily promoted as being beneficial to the individual patient vaccinated. There is obviously a public health benefit too, but this is secondary. This is the very first time that I have heard of, of a vaccination programme being recommended primarily as a public health measure. Which means that the benefit to the individual patient has been placed as a secondary consideration. And that’s what bothers me just a little bit. 

Tuesday, 5 June 2012

A bedtime story

From "The Medical Registrar" (facebook)

Once upon a time, there was an elderly care team of doctors who became very concerned that none of their demented patients were being fed at lunchtime.

So at the expense of their own lunchtime, the three junior doctors went round feeding and watering the patients as best they could.

This did not go down well with the "patient experience matron" especially when the local MP and the Chief Exec witnessed this and asked why the doctors were feeding the patients.

In response, the trust banned all medical staff between 12:30 and 2PM from the ward so such embarrassing scenes will not recur.

And that was how protected mealtime (at least at one hospital) was born. True story.

Friday, 1 June 2012

21st century humanity

I read this article with horror & disbelief. Let’s summarise;

A man and a woman are arrested in Sudan and charged with adultery. The male denies that adultery has taken place, his word is accepted and he is released. The woman has a confession beaten out of her, which is also accepted, and she is sentenced to death by stoning.

How is it possible to commit adultery by yourself? This is like something out of Monty Python, except that it’s not funny.

O24 Scam

It is getting difficult now to keep up with all the scam products appearing on the net at the moment. My post on the Nutrascience scam has now attracted over 10,000 visits and is still getting comments on a daily basis, but this is just one of the slimming products out there using the same modus operandi to swindle people out of their money. I say products, in fact it is usually the same product just renamed and put back out there, promising unfeasibly spectacular weight loss.

The latest scam product to catch my eye is a topically applied concoction of various random oils called O24, making unsubstantiated claims to relieve pain that I have no doubt breach Advertising Standards Authority rules, just as Finitro Forte did. Perusing the terms & conditions you find the phrase “authorising us to charge payments against your debit or credit card that you provided.”  That’s the phrase that gives the whole game away.

This variety of scam should be well known by now, but there are, I am sure, lots out there who will be lured in by the “special introductory offer” which will subsequently be very expensive for them. Don’t be one of them.

Wednesday, 30 May 2012


You may have noticed that normal service has been resumed. I couldn't keep away. Back to my usual articulacy.

Full circle

So the politicians think that there aren’t enough working class youngsters going to medical school. Whose fault is that? 80 years ago you could only contemplate a university education if your parents were well off. The lower classes were kept firmly in their place by this denial of access to the professions. 

Then in the 50s to the 70s there was a window of opportunity. With Grammar schools, free university education, and student grants the playing fields were leveled and the universities started to fill with the son & daughters of the masses. My own year at medical school was a strong illustration of this. 

The first nail in the coffin was the abolition of the Grammar schools, which had provided a state school education that was the equal of the public schools. Since then, in their political quest for egalitarianism, British state schools have sunk to a state of uniform mediocrity.  Add in tuition fees and student loans and we have come back full circle.

DZ was born into a working class family. There is no way today I think I would ever have got to med school.

DZ gets it wrong

I posted recently on the BMA ballot over the pensions issue. I now have to eat humble pie and say that I was wrong in my predictions. The response rate of 50% may not seem high to some but it is far higher than I expected. And the results are not what I expected either.

Although I was wrong, I am nonetheless very pleased. Finally the sleeping tiger has woken. Doctors as a group have now united and stood up to oppose. And about fucking time too. They have put up with a great deal over the last few years, and laid down while successive governments have walked all over them over a number of issues. I expect the powers that be thought, as I did, that the profession was too apathetic to take a stand on any issue.

I do hope that, when this issue is resolved, the profession does not revert to it's previous recumbent state.

Tuesday, 29 May 2012


“By definition, free speech doesn’t mean anything unless some people are going to be offended some of the time.”

Michael Gove

Saturday, 26 May 2012


Orthopaedic surgeon & trainee

I know I said "Au revoir" but I could not let this go uncommented on. A paper by orthopaedic dinosaurs consultants in Nottingham purports to show that trainees training in orthopaedics has suffered since the implementation of the working time directive. Actually it doesn't show any such thing.

Firstly they point out that the total  number of operations performed by trainees dropped by 13% after the introduction of the WTD. Well that falls into the category of the bleedin’ fuckin’ obvious for a start. If they are doing less hours they are bound to do less work. It is highly likely that this statistic illustrates nothing more than possible overwork in these people before the WTD. And when you overwork people, quality suffers. Simply doing operations does not constitute training any more than driving a long way unsupervised constitutes a driving lesson, and, like driving, doing a lot of work can simply allow the entrenchment of bad habits.

Secondly the figures are claimed to show a reduction in the number of operations performed independently. Well, since the total operations in this category were unchanged that must surely mean that the number of supervised operations increased. Yes? Isn’t that what’s known as training? The equivalent of a driving lesson?

This paper is a prime example of Bad Science, to coin Ben Goldacre’s phrase. It in no way provides any evidence whatsoever of the quality of surgery, but is a crude, and inappropriately interpreted estimate of bare meaningless numbers. Quantity does not equate to quality! It is perfectly possible that the quality of surgery improved after the WTD.

The authors are not just dinosaurs, they’re fuckwits as well.

Now, back to my distraction.

Friday, 25 May 2012

Au revoir

DZ will probably not be blogging for a little while. Hope to be back sometime in the not too distant future.

Wednesday, 23 May 2012

DOH gets it right

DZ has in the past been ready to hand out brickbats to those high ups in the profession and the NHS who say or do things that indicate a lack of understanding or competence. Various individuals have been described here as people with their head up their arse.

So it’s nice for once to highlight the opposite. Since the working time directive was applied to medical staff the quality of life for doctors has improved enormously in both the training and career positions, but there have also been a lot of dinosaurs in the profession clamouring for a return to the bad old days, particularly for trainees, claiming that training has suffered. It’s been obvious to many that, if training has suffered, and I’m not convinced that it has, then it is because the trainees are being expected to devote too much of their 48 hrs per week to providing the service, rather than training, and that the answer is to move more to a consultant delivered service. This would also lead to an improvement in the quality of service provision.

Well a government committee has just said exactly that, and in doing so reiterated the government’s commitment to retaining the WTD for doctors. Good for them. Perhaps now the throwbacks in our profession will stop harping on about the “good” old days of 80 to 100 hour working weeks.

So hats off to Patricia Hamilton, Christine Outram & Sir Christopher Edwards for doing absolutely the right thing.