The BritMeds 2007 (17)
A huge number of recommendations this week, the largest ever. It was another bad week for MTAS and MMC. When will it end?
But first the other news, and where better to start than with Dr Grumble. Or, to be more precise, Mrs Grumble
“So it was a very real surprise when yesterday Mrs Grumble announced to Dr Grumble that she is thinking of voting Conservative. As far as Dr Grumble knows, Mrs Grumble has never ever voted Conservative before.”
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OK, now it’s competition time. Your task is to watch this video without laughing:
Did you enjoy that?. It is not a spoof. It is for real. Honestly.
So what does Dr Crippen say to Andy bloody Burnham? He says get your arse round to the family described below, and explain to them precisely why this man cannot have treatment that is available in the USA, throughout Europe and in Scotland. Treatment that is also available to any English patient who can afford to go privately. (See a Tale of Two Cancers)
On the 27th April 2006 my husband was diagnosed with Lung cancer our world fell apart. You hear people being diagnosed with cancer everyday but when it happens to someone you love it turns your whole world upside down. He has been through months of chemotherapy and weeks of radiotherapy. A follow up CT scan revealed that the primary tumour has not grown but we do not know the impact of the radiotherapy because there is so much scarring around the site of the tumour. It showed however that he has smaller tumours which have progressed. We asked for the Drug Tarceva which is being used to treat patients with NSCLC.We were told we could not have it unless we paid for it.
Full story in Action4LIfe
And when you have done your visit, Andy, perhaps you would ask your mate, Andrew bloody Dillon, the Chief Executive of your obedient quango NICE, to pop round to the house and explain why he is so keen to paper over the cracks in lung cancer treatment by funding the silly bloody “lung cancer nurse specialists” who pat patient’s hands during their unnecessarily short “journey” through their lung cancer, but is not prepared to fund Tarceva.
They don’t have cheapo-cheapo “lung cancer nurse specialists” in France, Andrew. They have Tarceva. French patients with lung cancer have longer journeys through their illness. I wonder why that is Andrew? And Andy? (See Defrauding lung cancer patients)
Answers on a postcard to Lung-cancer : action4life, please.
I would not want anyone to think that Dr Crippen is fulminating with anger about this issue. And deeply ashamed. This is not the sort of NHS in which I wish to work.
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Bloody, whinging, whining junior doctors. It is all your fault. Add you onto the lazy GPs, the fat-cat, swan-eating, port-swilling, golf-playing consultants and those useless nurses, and you can see why the NHS has failed.
It must be true. My Lord Warner says so.
Lord Warner, has launched an extra-ordinary attack on all those who work in the NHS. He cites “productivity” issues and resistance to change within the NHS as the major causes for the failure of Labour’s investment programme and programme of reform.
Read it all in : You got us in to this mess. You get us out of it.
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Rita Pal is on the warpath:
I therefore say - Strike me off GMC. I believe if I am struck off I will be free from the sword of Damocles that hangs over my head everytime I write something. I often wonder what the GMC and its cohorts think it will achieve. I certainly will never stop writing and neither will I stop exposing matters of importance to medical regulation.
and then, later in the week, it gets worse:
Spanish Inquisition Part 2 - GMC Extracting Confessions
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GPs earn £250,000 a year, work a thirty hour week and delegate most of their patient care to nurse practitioners.
Really?
Dr Rant looks at “Myths and Truths about your GP”
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The NHS computer fiasco: why do governments keep wasting such vast amounts of money?
Why do governments keep on wasting money on this spectacular scale? Because no one is truly both a) in charge and b) accountable. When Marks and Spencer was adrift and losing market share, the chief executive and many others got the sack and their reputations were damaged. No one has publicly got the sack for this vast waste of public money.
The Welfare State We’re in explains.
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Parents who give alcohol to children aged under 15 should be prosecuted, a charity has said. The call comes in an Alcohol Concern report on the government’s Alcohol Harm Reduction Strategy.
The DK probably, on balance, does not altogether approve.
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‘Talking to Patsy’
Aphra Behn has been sending her some questions:
It is surprisingly hard to write a question which she cannot answer with “because I said so” or in some other blustering and flannelly way. I’ve tried “how can 6,000 hours of specialist medical training for a consultant be an improvement on 30,000 hours?” but she will burble on about assessments and better quality of training.
More here
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You are 7500 times more likely to be killed if you visit your doctor than if you meet a gun owner. Guns are dangerous and must be controlled by law, in my opinion. But if doctors are so dangerous, who controls them?
Read it all in “Doctors are more dangerous than gun-owners”
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Hospital Phoenix has retired from blogging – again. Did he jump or was he pushed?
We all wish him well, wherever he is.
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More cobblers from the Nursing Times
Heather wrote yesterday about some woo-like nonsense published in the opinion piece of the Nursing Times. Basically, the article said that obese patients were the cause of nurses back injuries. It was one of those wonderful articles that the print media so love. It had the air of self evident logic and attacked the current social demons (fat people). I am surprised it hasn’t been syndicated out to the Daily Mail (etc).
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Adults have started bullying allergic children
It seems that direct bullying is not sufficient of a burden for some school-children with allergies, they now have to cope with indirect bullying from the parents of children who don’t have allergies. It is particularly nauseating that some of these parents seek to cloak their bullying and viciousness in a defence of civil liberties.There’s an absolutely horrifying article in the current issue of Child Magazine about the food fight now raging between parents of children with life-threatening food allergies and parents of the allergy-free. The latter, apparently, have started to push back against “peanut-free” school regulations to assert their children’s natural right to eat whatever they darn well please.
Full story here
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“Employees who smoke must be given time to attend clinics to help them to quit during working hours without loss of pay. NICE claims that the proposal will cut the £5 billion annual cost of lost productivity, absenteeism and fire damage caused by smoking. It believes that a business with five smokers could spend just £66 on providing advice, including the cost of lost employees’ time, and see an overall saving of around £350 in improved productivity.”
“Either they’ve got the most extraordinary sauce, or they - a bunch of unaccountable tax-funded quangocrats - genuinely believe they are in a position to offer useful advice on boosting profits to businesses whose very essence is making money. Could anyone be that stupid?”
See : Class Dunce Gives Another Lecture
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Before I start this little rant, I want you to know that I am no Kate Moss. I’m a UK size 16 and although I used to have terrible eating habits throughout school, I try to eat a balanced diet now. There are days where I’ll eat a junk snack or chocolate bar
Twisted Barfly looks at Junk Food & Obesity
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And it was all yellow…
I was enormously angered by Prince Charles despairing of his subjects as a pill-popping nation: “I suppose the concept of being able to pop a pill that claims to solve your problem without you having to actually do anything is enormously attractive - an easy way of avoiding boring exercise or whatever,” he said in an interview with Esquire magazine.
Emily will not be asking HRH to help with her post-natal depression
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Moving on, we have noticed, here at the Ambridge Surgery, that there was a definite upsurge in “The Madnesses” over the past couple of weeks. Literally two of our long term but stable psychotic patients chose this past hot spell to drop a few of their collective marbles of their respective trays, to end up in need of hospitalizing. And there’s a whole couple of others who are simmering under.
They are all going mad in Ambridge
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Dr Rant takes a look at patients.
A simple rule for heartsinks is that if my heart sinks when I see a patient then it’s probably my problem. If I find that all my colleagues have the same reaction to the patient then the patient has a problem.
See : The patients are not the problem
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Who is the “most popular thyroid doctor in the country”?
An odd title, if ever there were. Apparently, it is Dr. Durrant-Peatfield who treats hundreds of patients, focusing on thyroid, adrenal and chronic fatigue problems, and has been the doctor of last resort for thousands of patients throughout the UK and Europe, who had given up hope of ever recovering from chronic illness.
Unfortunately, he is up in front of the GMC (again) as his treatments are unconventional.
It is all in: “Witch-Hunt in the United Kingdom — The General Medical Council vs. the UK’s Most Popular Thyroid Doctor”
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David Bradley’s friend was worried about HRT:
Either way, the recent Lancet paper, which received lots of media attention, got her all hot and bothered. She’s an earlier finisher, and is likely to be on HRT for ten years or so, is that going to mean she will get ovarian cancer. The tabloid hype surrounding the paper would seem to suggest so, but as with all statistical health studies that get pounced on by the media it’s worth taking a closer look.
Should you worry about HRT and cancer? Sciencebase has the answers
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A brilliant article on government micromanagement of the NHS, and the story of an experienced consultant coming to grief and taking early retirement.
But as we know, whereas he once had authority over the clinics, and the space to exercise that authority, his job gradually became a classic meat sandwich. He lost authority over vital areas, and instead picked up the vast new burden of central government testing. He lost authority over what happened in the hospital and instead picked up the micro-management demands of ministerial directives.And while his balls were still on the block if things went wrong, the shots were all called by those here-today-gone-tomorrow politicos (four useless Secretaries of State in four years). Responsibility without authority- the prerogative of the schmuck thoughout the ages.
In fact, the article is about a headmaster, but if you go through it and substitute “consultant” for “headmaster” and “hospital” for “school” it is frighteningly familiar. Clearly a generic problem after ten years of New Labour.
Read “Life after the job from hell”
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Here we go:
She’d heard on the news yesterday that women who take HRT have a 30% chance of getting ovarian cancer, and since she had this pain and she’s on HRT….Do you understand the difference between overall risk and percentage increase in risk, or have you thrown away your HRT? The Daily Mail certainly does not.
Some sense from Funky Mango’s musings
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Today the National Institute for Health and Clinical Excellence (NICE) released guidance that calls on firms to help smokers quit, particularly in the run up to the public ban on smoking that comes into force in England on 1 July.
Civitas – “classical liberal comment on the news and current affairs” approaches this in the right spirit:
I smoke… really, I started today!!
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We have not heard from the wonderful Professor Joseph Chikelue Obi for a while. He is on sparkling form:
Speaking via Satellite Phone while on the final leg of an exceedingly extensive Mediterranean Tour (which mysteriously took him through the dazzling Maltese Fortresses of Valletta , Gozo and M’dina - together with the Evergreen Sicilian Strongholds of Taormina , Catania and Pozzallo ) , Britain’s Most Controversial Regulatory Critic, Professor Joseph Chikelue Obi , categorically stated :
“By means of substituted (public) online service, I hereby ethically give the outgoing GMC President , Graeme Robertson Dawson Catto , up until 12 Noon on the very first day of May 2007 to either formally vacate his post with the astoundingly diminished smithereens of dignity which he actually has left - or seriously face the highly unsavoury prospect of publicly being put on trial for Far-Reaching Fraud and Corruption.
See Abolish the GMC
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Oh! Boy, they are loving this in the United States
The reader is encouraged to outgrow the false Hegelian Left/Right paradigm, think independently about these issues, get empowered and help create a better world.
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A medical student starts to worry…
Today I developed a non-blanching rash on my legs. It’s a petechial rash (= minute red/purple spot on the surface of the skin as the result of tiny hemorrhages of blood vessels in the skin) one cause of which is Meningoccoal Meningitis and Septicaemia.
So I got a little worried..
(note NHS direct says that with any non-blanching rash you should phone 999).
Strewth, does it really? Eczema does not blanche. That will please Tom Reynolds.
See how she coped in Non-Blanching Rash -call 999?
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Is this real general practice, or is it a hobby-doc pretending to be a GP.
It began in a rather different environment, Barcelona and Belfast dont quite rhyme. Tuesday is my day in general practice and, in the interests of trying to maintain some continuity for patients, I try to protect the day. This means a late evening to ensure all the day’s work is complete before leaving in the early morning. The patients, of course, are not interested in my travel plans. Good medicine is taken for granted, and quality means being there. But general practice is never routine; my colleague spent the evening with the police and an ambulance trying to arrange the compulsory admission of a patient while I saw an urgent extra, checked the mail and results online and completed some insurance reports. A lovely spring evening alive with birdsong when I eventually locked the chain on the metal gates at 7pm. For some, a gin and tonic clears the fog of the work but, for me it is exercise. Tonight the jog was a bit of a shuffle.
One extra, hey? That sounds stressful.
BMJ “blogger” doc tells it as it isn’t for most of us.
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It seems the not-in-my-backyard mentality is alive and well in the UK. While most people are sympathetic about the struggle facing would be buyers and workers such as nurses, they are opposed to particular new developments in their area.
I don’t want nurses living in my area, thank you, say UK Nimbies
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Cambridge Angry Medic tells of the new young doctor given a chocolate egg injected with frusemide.
But revenge was sweet.
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Outrage directed against the organisations that so misrepresent autism.
If I might be permitted to make a few assumptions I believe its accurate to say that we’ve had enough. Who are we? We’re parents like you. However, unlike you, the self-styled ‘autism community’, we are also autistic people. We are also scientists. We are also professionals working in the field of autism. We represent groups of people that you never can and never will. We are fundamentally different in attitude from you and we have had enough.
Quacks take cover whilst Kevin at LeftBrain/Right Brain has his say.
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Do we discriminate against women in medicine?
“In 1986, many trainees had to work 120 hours a week and move to different locations every few months. Women were asked the most outrageous questions at interviews, the old boy network and behind the scenes telephone calls were dominant factors in the selection process, and women who wanted to reduce their hours to spend time with their children were not regarded as proper doctors.”
Get the 2007 update from The Witch Doctor
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Sometimes you cannot get a chaperone…
A young woman came to see me with pain in her chest, just above one of her breasts, after an accident with a chair. After listening to the story I asked her to show me where the problem was, and she took off her cardigan leaving a tee-shirt on her chest. It was apparent she wasn’t wearing a bra. I was slightly perplexed. If she didn’t mind me seeing her breasts then she would have taken the tee-shirt off. If she didn’t want me to see them I would have expected her to put on a bra this morning.
Tales from A Fortunate Man
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A man jumped into the river tonight. I was asked to stand-by on the Embankment while the River Police, LFB and a helicopter searched for him but, after almost two hours of scanning the fast flowing water, he wasn’t found. He is unlikely to have survived.
A Paramedic’s Diary: In the River
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Dr Rant’s health care manifesto has caused a stir, but was not well received in all quarters. The DK was luke-warm to say the least:
…with a state-run NHS we have increasing costs, and then we have, in companies subject to market mechanisms, we have falling costs. And Dr Rant thinks that market mechanisms have failed. Er…There you go, Dr Rant; we provide a decent health service (modelled, essentially, on the consistantly best-rated system in the world) using those very market mechanisms that you despise. We can see that it works in France, there is no reason for it not to work here.
And Tim Worstall was, well, tersely dismissive. Come on, Tim, the Rant manifesto deserves more thought than that!
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Some 130 distinguished doctors in Britain Saturday called for a boycott of the Israeli Medical Association (IMA) and its expulsion from the World Medical Association (WMA).
“Persistent violations of medical ethics have accompanied Israel’s occupation. The Israeli Defence Force has systematically flouted the fourth Geneva convention guaranteeing a civilian population unfettered access to medical services,” they said.
But the IMA has declined to condemn this action.
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Diary of a Goldfish looks at media hype, killing and the UK/USA in Iraq
I felt as most other people felt when I read about the shootings in Virginia. However, by Tuesday the media coverage here was becoming irritating to me; the analysis of nothing, the endless speculation about this or that, the voyeuristic dissection of events and characters. And I thought, my country is involved in an unofficial civil war one and a half thousand miles closer to home. Tomorrow they’ll be more bombings in Iraq; innocent people, just like these college students, people just as bright and bubbly and earnest and loving, will be have their lives snatched away whilst going about their daily business. But that will make for just a tiny wee headline.The next day, over two hundred people were murdered on the streets of Baghdad.
No monsters. No profiles. No corpses reclining on the couches they couldn’t be coaxed onto in life. No names and photographs even. But ordinary people, faced with circumstances they considered intolerable, consumed with emotions they found overwhelming, choosing to commit evil.
One for Tony and George to answer
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Plans to clamp down on the way cigarettes are sold are being considered by the government to protect children’s health. The sale of packs of 10 cigarettes - attractive to teenagers because they are cheaper - would be banned and cigarettes kept out of sight in shops.”
Full story here
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In India we may criticise the medical facilities available here and hail those in the UK, but amazingly, a London-based retired radiologist consultant experienced the opposite. He described the medical facilities in Glasgow as “filthy” and hailed those in India. He said that his wife, who suffered from a head injury after falling off a bicycle, received a “far better treatment” in Ajmer and then in Delhi, as compared to NHS in the UK.
Full story here
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‘Within every patient there resides a doctor and we physicians are at our best when we put our patients in touch with the doctor inside themselves’
Albert Schwetzer (1875 - 1965)
Philip Booth of the Green party talks about Self-Management Courses for People Living with Long-Term Illness
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Free at the point of entry?So what are we to do? Here in the real world these treatments, despite being standard practice in Europe and the USA, are not economically affordable by the NHS, though they are all funded by ‘proper’ insurance companies.
Mens sana takes a look in “But I want to pay…”
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After Blair it could soon be Cameron, punctuatetd by a brief Brown moment. But is there any difference between Blair and Cameron? Dizzy thinks there is.
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A nurse turned manager says:
Lets stop running each other down, lets stop trying to get one up on each other, after all we don’t actually do this in the course of our daily work (well I try not to). Lets start to work out the answers not just winge about the problem or am I just being a naive nurse turned manager who has got above herself?
Life in the NHS
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The Americans note that ‘Big Pharma’ corruption is approaching the UK
The Independent, one of the big UK dailies, ran a story, which is the first time the scandal has made the mainstream press on the other side of The Pond….
“The pharmaceutical giant AstraZeneca is at the centre of a storm in the US after firing one of its sales directors for comments he made likening doctors’ offices to “a big bucket of money”.
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Why are there not enough ambulances available for real emergencies? Tom Reynolds explains : it is the maternataxis
But, thinking about it, if you do go into labour unexpectedly at home, what do you do? Midwifemuse does not think you should do this.
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Channel 4 broke the story on Wednesday of the first breach of security on the MTAS site. The following day, NHS BLOG DOCTOR was tipped off that there was a further and bigger breach. I checked it out, found it was true, informed RemedyUK and then telephoned Victoria Macdonald at Channel 4. She was very interested. I asked that, if she ran it, that an appropriate credit was given to NHS BLOG DOCTOR.
I then telephoned the Department of Health and spoke directly to Mike Clement the MTAS project manager, and told him exactly what was happening.
The MTAS site was closed down within the hour.
I received this email from Mike Clement.
Dr CrippenThank you for alerting me to this issue.
Regards
Mike Clement
MTAS project manager.Workforce Directorate
Working differently
The story was the lead item on Channel 4 news. I had expected to be credited as the source of the story. The final email exchange with Victoria Macdonald was:
Your site gets a starring role tonight—–Original Message—–
From: Dr John Crippen [mailto:drcrippen@nhsblogdoc.wanadoo.co.uk]
Sent: 26 April 2007 16:33
To: Macdonald, Victoria
Subject: RE - it is true, and you can read them without even logging in to the site.When trying the URL below, make sure you get it ALL - it goes onto a second line. It got truncated in the email. It is the last four digits of the second line that are important.
I have reported all this to the DoH.
I spoke to a civil servant called Mike Clement, who deals with MTAS and MMC
John
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It did not happen. There was a brief screen shot of the NHS BLOG DOCTOR article, but that was it. Channel 4 ran the story as their own.
Off to the BBC next time, I feel.
Mind you, I was not overwhelmed by the response from RemedyUK to whom I sent the story as well. No reply at all until long after the Channel 4 news, then:
> Thanks for the tip.
Matthew Shaw
Lots of emails from doctors, and the story was widely covered in the medical blogosphere and properly accredited. We may not be the MSM, but there is honour and etiquette amongst bloggers. See Rhetorically Speaking.
Mind you, not that exploring the holes in government data collection services is difficult.
Driving through MTAS security
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But let’s move on to a more cheerful note. Mangling Medical Careers goes from strength to strength. If you have not already, then meet “the team” here
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As always, a good round-up of all the MTAS developments at The Ferret Fancier
Who do you think said this? Where was it said?
“‘I am sick and tired of listening to junior doctors complaining about their job prospects. It’s a tough and competitive world out there and the public might be a little more supportive to these gods in white coats if there were fewer cases like those of Gertrude Danforth.’He then described the sad case of an 85 year old woman who died after a low blood sodium level was missed. The coroner returned a verdict of natural causes contributed to by neglect.
See what the Ferret makes of it. He is angry.
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I thought we’d hit rock bottom yesterday. Once you’ve openly and illegally posted intimate details about applicants on the internet, I didn’t think there was anywhere else to go. I was wrong.
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The U.K. Department of Health has been forced to apologize after the personal details of hundreds of doctors — including home addresses, phone numbers, sexual orientation and previous convictions — were made available online.
Computer World takes a look at MTAS technology
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A highly trained economist does some simple arithmetic about MTAS – and shows that the government is either dishonest or innumerate. Or maybe both.
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Vicky Ford is supporting the hospital doctors:
If the process goes ahead as planned 22,000 doctors will change jobs on 1st August this year. That is every junior doctor in training in every hospital in the country. Many doctors will not even know where the reception is in their new hospital let alone the x ray department. Do not be sick in August. I am taking my children to Ireland for a couple of weeks.As of right now the junior doctors don’t have jobs. They don’t know where they might be moving to and tens of thousands of interviews are still to be held. It is a fiasco. The doctors are mounting a legal challenge and there are rumours of massive compensation claims.
Full story of the lobby in : I could have made toast on the fumes rising from the doctors’ heads
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Dr Michelle Tempest looks at the Medical Heroes of MTAS & MMC
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Dr Rupert Beale does not agree with Dr Crippen’s views on abortion; or, more particularly, on Dr Crippen’s views on Libby Purves’ views on abortion. So be it. Shame he was rude (see his comment here) but that does not detract in anyway from his excellent guest piece on MTAS and MMC
“I’m not going to recite the litany of blunders and half-baked lunacy that has led to the sorry mess we find ourselves in now. What I’d like to do is highlight the various forces at work behind what is happening at the moment.”
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Please send your recommendations for next week’s BritMeds to: thebritmedsATnhsblogdoc.wanadoo.co.uk
The BritMeds will now be published on Saturday morning, so please let me have your recommendations by Friday evening latest.