Tuesday, 29 July 2008

Medical student prefers court to revision

With logic like this I can't imagine why she hasn't passed her MCQs?

Patients also don't present as short answers questions, essays, clinical examination stations or OSCEs; however this doesn't mean that all these methods should be stuck in the waste paper basket.

"They don't let me express my knowledge,"

My heart bleeds.

Maybe I'm being a heartless bastard, but if you can't pass the exams then hard luck, you can't become a doctor, it's not as if the exams are harder than they used to be, in fact from what I've heard medical school exams have been significantly dumbed down especially at places like Peninsula.

Society has gone stark raving bonkers in my opinion, so much so that political correctness obliges that anyone should be allowed to do anything, completely irrespective of the fact that that person's attributes or lack of them may completely prevent them from doing their job properly.

For example should the job of a junior doctor be done adequately by someone who is deaf? I would argue not, as so much of the job involves communication and a lot of this is by telephone, making it impossible for large amounts of the work to be done. A blind pilot, a surgeon with a massive tremor, a maths professor who just can't do his times tables or a dentist with a phobia of teeth- you get the picture. Maybe I'm just discriminating unfairly in the eyes of the law.

One could argue that jumping words and reading much slower than other people might have some rather big implications for the health of her patients and her ability to be a doctor. Drug charts are not very forgiving for small errors, this is just one example.

How long are we away from thick people taking exam boards to court because they can't pass them?

Not far away it seems, everyone can get an extra few hours these days for some manufactured learning difficulty (if you pay a psychologist then anything is possible), and students can now get extra marks for their pets dying or getting the flu before an exam.

Bonkers I say.

Saturday, 26 July 2008

Remedy calls for accountability

The government continues to ignore criticism and consultation, while forcing through destructive reform after destructive reform; as the political beast gets nearer to the ends of its life, it seems to be thrashing around senselessly and trying to leave as great a mark on history as possible. That mark is not going to be a good one unless we can force them off their destructive path, their time bomb of reform must be exploded away from civilians.

MTAS and MMC were catastrophic disasters, the effects of which will come home to roost over the next few years, as rotas lie seriously short staffed and the service suffers thanks to this complete lack of foresight and planning from the government. Despite all the talk of a better NHS, Darzi's codpiece of a review and the chatter about accountability; we have seen no one held to account for MTAS and MMC as yet, while doctors on the ground have the nooses around their necks tightened that little bit further thanks to the likes of revalidation and IWGC.

Remedy needs you to sign up to their call for accountability over MMC and MTAS, their letter in the Lancet is a call to arms:

"Your May 17 Editorial1 states that “many of those responsible for MMC [Modernising Medical Careers] still fail to appreciate the human damage caused by their ‘inept’ decision making”, and the Health Select Committee report2 was peppered with words such as “defective”, “unsafe”, and “disastrous”. It found that “the leadership shown by the Department of Health was totally inadequate”. Despite these highly critical accounts, not one of those responsible for this avoidable catastrophe has been brought to account for the misery they propagated.

The Chief Medical Officer, Sir Liam Donaldson was the architect of the reform. During the project's development it became apparent that there were multiple risks, and there were calls for delay.2 These calls were ignored. Sir Liam chose not to take on a clear leadership role and has evaded responsibility for the 2007 crisis, and we concur with the British Medical Association that he should resign.

We also believe that the small elite group of senior doctors who led this project and who failed to heed these warnings when they were in a position to do so should now consider their future positions in the management of the National Health Service. The General Medical Council (GMC) has issued clear guidelines for doctors who take up management roles, and it has taken action in the past against doctors who have failed to maintain public confidence in the profession or to uphold standards in non-clinical roles. The intervention of the GMC might be necessary if we are to restore public confidence in the accountability of medicine."

You can genuinely make a difference by signing up to this on the Remedy website, simply follow this link and read what they have to say, then sign up if you are in agreement. It's about time those that love to control our every move were held to account for their rank incompetence, the hypocrisy of their safe position in their ivory towers is rather insulting to those working so hard for the patients on the ground. So get along to the Remedy site and let's try to force these political meddlers to account.

Tuesday, 15 July 2008

Bacon manufacturing more porkies

Dr Neil Bacon has spent a fair few hours this week peddling his propaganda to the press, for example he appears in the Oxford Mail this week telling us all how a majority of doctors are right behind his scheme (thanks for spotting that Dr C). He doesn't stop telling porkies there, excuse the pun, he goes on to talk of the site's great security, how useful it will be and on and on.

To put Dr Bacon's hypothesis to the test, I just wonder how many people will respond to this Mail article and agree with the might Bacon? I wonder? I may have to retire from blogging for good if a mass of doctors suddenly crawl out of the woodwork to show their solidarity for Neil's position. Somehow I suspect this will not be the case. Neil is getting rather desperate, after all a lot is on the line for him now, both he and his wife are involved in this new venture. Should IWGC fail dismally I wonder what this will mean for Dr Bacon?

Monday, 14 July 2008

Many gaps in Bacon's defences

Neil Bacon in consultation with the DoH and GMC has set up Iwantgreatcare, a new website that allows anonymous punters to say whatever they want about named doctors. There is no right of reply for the doctor, the patients can just say whatever they want and this is then meant to result in better patient care. Quite how I cannot quite see myself.

The motivations behind this site are strange as it appears that Neil Bacon may be struggling somewhat financially, hence this may be a desperate last ditch attempt to rescue his economic well being. Bizarrely comments added in support of doctors are being removed, while those slagging them off are allowed to stand; this hardy seems fair when those who are indulging the character assassinations can do so completely anonymously and unaccountably.

Giving patients a free shot at doctors is a very dangerous business indeed. Why I hear you ask? Well the kind of patient that is likely to indulge in vindictive abuse is most likely a particular type of character, for example this kind of racist and bitter individual:

''If they think that all these years we pay national Insurance , yet if you walk into XXXX Medical Centre . You will find I line of Migrants trying to get free services on our backs . Including Somalians , Eastern Europeans etc... I was told I only had 10 minutes to see a doctor . So , after paying national insurance for so many years , I only get 10 minutes . I don't think so !! Kick them the migrants out ! Its time this government realised this country is not a dictatorship . I refuse to pay for the rubbish and the scum that comes hear to steal and turn this country into the biggest toilet in the world.''

This shows just what a stupid idea this website is. There are so many hypothetical cases that would guarantee the unfair abuse of doctors that I could list them all day. What about the deluded and aggressive psychiatric patient who resents being forced into necessary treatment for their mental illness? What about the fat smoker who didn't like being told to stop smoking and lose some weight?

What about the worried well from middle England who expect several hours of a doctor's time in clinic despite the fact that the doctor has other patients that need to be dealt with? What about the woman with breast cancer who thinks homeopathy will cure her cancer and who gets angry when the surgeon tells her that that this is not the case? What about the surgical patient who suffers an expected complication from their surgical procedure? And on and on.

All these individuals may well want to abuse their doctors on Iwantgreatcare, and all their doctors will have been acting in a completely professional manner, certainly not deserving the abuse that they would be likely to recieve on Neil Bacon's poorly thought out site. Likewise any good comments will be meaningless as who knows where they came from, after all it's all completely anonymous.

The first examples of unfair criticism are already starting to appear, Neil Bacon must be so proud for the noble work that he's doing for his bank balance and high quality patient care, he's almost as devastatingly brilliant in this regard as Lord Darzi. From a personal point of view I remember one patient in particular who would have loved to slag off a consultant of mine on IWGC.

My consultant was a very eminent surgeon indeed and spent many minutes patiently explaining that there was no evidence that any alternative therapies would cure his condition, while there was good scientific evidence behind the surgical option. This patient refused to take no for an answer and almost refused to leave the consultation room after half an hour of protestation, the mild mannered consultant almost had steam rising from his ears by the end. Only in the NHS would a scenario like this occur. IWGC is yet more power to patients at the expense of doctors, whatever happened to the doctor-patient relationsip being a two way thing as I was taught at medical school? Soon why not let these patients prescribe their own drugs and book their own operations, they seem to think they know it all.

Sunday, 13 July 2008

Iwantgreatcare - farce in the making

Taken from Iwantgreatcare.org, a new insecure website created by Dr Neil Bacon for the government which enables anonymous patients to feedback on individual doctors (see the Jobbing doctor for a good lowdown on this story):

"Q: I objectively believe this is damaging to doctors, can't you just drop this whole idea?

Respectfully, no. It is clear from the evidence base that effective communication improves clinical outcomes, improves patient satisfaction, reduces the risk of medical errors and reduces the risk of litigation. The evidence also clearly reports patients can effectively judge doctors' communication skills to this effect. If you are aware of any peer-reviewed evidence that contradicts this summary, please email details to adminservices@iwantgreatcare.org.

If you are fixed in your belief that iWantGreatCare is damaging to doctors, please consider that iWantGreatCare is advised by a range of respected doctors and the emerging requirements for revalidation make patient ratings of your care fundamental to the measurement of your work. It is also clear, even with superficial knowledge of medical history, that this is not the first and will certainly not be the last new way of working that is challenging for some doctors. "

Dear Dr Bacon and GMC/government cronies,

There is also an abundant amount of evidence that useless poorly designed insecure websites can result in a lot of damage being done very unfairly to people who do not deserve it.

In fact a lot of websites have found themselves in legal trouble for allowing the baseless assassination of people's characters on their pages, what a shame if this happened to your great website.

I like it how one can only rate doctors if they have been one's colleague recently, I find it strange that there is no mechanism for rating doctors in politics or management despite the fact that their work has a massive impact on our working lives.

Why can we not rate Lord Darzi for his work proving the government with backing for their continued destructive privatisation of the NHS?

Why can we not rate Sir Liam for his pitiful work that failed to represent the profession regarding MTAS and MMC and his hermit like existence ever since?

Why can we not rate Dame Carol for taking on a lot of responsibilities and then failing to do her job properly by neglecting glaring problems that were staring her in the face?

I wonder if this is anything to do with the fact the Iwantgreatcare was created in consultation with the GMC, the Department of Health et al.

I wonder if this is because the likes of Iwantgreatcare sum up the the complete lack of accountability that is present in the political and medicopolitical establishments which is present from the very top.

Those like myself who work on the front line are already very accountable for our actions, it is remarkably easy for a patient to complain given the mechanisms in place, the argument that Iwantgreatcare will improve patient care is disingenuous.

The real motives for it are revealed by Professor Bulstrode's slip of the tongue:

'Doctors will feel threatened'

Our morally bankrupt leaders want to control and bully the only accountable people in the NHS a bit more, it is the sign of the Stalinist system that we live in today, those at the top are free to do as they see fit and would only leave office if doctors launched a military coup to depose them from power.

Respectfully you can stick your poor excuse for a website where the sun don't shine. I have no problem receiving feedback from my patients, however if this is to be done it should be done in a very regulated and secure manner so that no unnecessary harm can result from baseless vindictive slander. The good feedback is also meaningless as the website is not secure.

So overall the site is of no benefit to anyone and could potentially result in a lot of harm coming to a profession that already has amongst the highest rates of mental illness of any profession.

Respectfully if you genuinely cared about improving patient care then you would be better off investing your efforts in forcing those in positions of power in politics and in the medical establishment to act in the best interests of doctors and patients, rather than bullying doctors and acting in their own self interest, while remaining completely unaccountable for their negligent actions.

For example in medical training the DH, PMETB, Royal Colleges and government have been found to be grossly incompetent in their actions and this must be having a massive negative negative impact on patient care. However I see that no one has been called to account yet.

One rule for us and another for our masters, again, it's alright for you though Dr Bacon, you've now engineered a position for yourself that is away from the trench rot of front line accountability. Congratulations, I hope you are proud of your achievements.

ps Have a look at the mickey take site www.iwantgreatbacon.com, very amusing indeed; Dr Crippen and Rita Pal have also had their say, while apparently Iain Dale has been defending the site on the BBC. It's funny how politicians are so keen for doctors to be subject to anonymous abuse while politicians are frequently completely unaccountable for their mistakes.

Monday, 7 July 2008

Chewing Darzi's cud

Not a pleasant thought I know, however I thought I'd deliver my general thoughts on Lord Darzi's NHS review. Given Darzi's background of providing the DoH with what they want to hear, only the ultra naive would have thought that Darzi's review contain something insightful and intelligent. Alas Darzi's review has arrived echoing many government cliches that we have been accustomed to enduring such as 'world class commissioning' and 'patient choice'.

The Darzi review is verbose but lacks detail in the few areas in which it has any promise. For example as regards the formation of a new 'independent' body that will oversee medical training called NHSMEE, one has to assume that the body will be genuinely' independent' for it to have any hope of working, given PMETB's similar 'independent' status one could forgive a few groans from the medical establishment. There is no attempt to address the problems that EWTD have created in training with Darzi appearing keen to fall back on more educationalist fodder in the form of 'modular credentialing'.

As regards Primary Care the review is just more privatisation dressed up in the same old lies. The Darzi 'GP-led' health centres have been railroaded through by the DH in very PCT independent of the local needs that Darzi pretends to care so much about. I suspect the disingenuous 'GP-led' nature of the them will mean that it will be rather hard to see a doctor in Darzi's New NHS. There is more emphasis in 'reinvigorating' commissioning and 'patient choice', again this is the government's way of handing out sweeties to its friends in big business while pretending to give a monkeys for the sick and elderly. Dr Crippen has aleady commented on this being rather lucrative for Branson and chums.

There are many other little chestnuts hidden in the many pages of DH propaganda and spin. NICE is presented as being the envy of every other country in the world, while the word 'clinician' is dishonestly re branded in Orwellian manner as meaning anyone who has every seen a patient in their lives. PBC is seen as an overwhelming success, while PCTs are set to be handed even more power to waste millions of our money on 'healthy living' schemes. There is also a lot of talk about more and more measurement of care quality, surely another surefire way to waste money on more bureaucracy and QUANGOs.

The question as to the nature of Darzi's motivation is posed by Dr Grumble, this report offers me little choice but to go for the 'tethered goat' option. The worst thing about Darzi's review is the pretence that it has been constructed in partnership with front line NHS clinicians, nothing could be further from the truth. Darzi's review represents yet another pretence at consultation by this dishonest regime, a pretence at listening and a pretence at responding to local needs. The only needs being represented by Darzi's review are those of the ruling political classes who see further developing a market in heath care as the best way for them to continue their privatisation campaign.

Darzi's review has been a sham from the start, the consultation process was beyond a joke while the reform started even before the interim report had been produced. The reforms will result in good GP practices closing while the sick have to travel further to see less trained staff for lower quality care. The continuation of these destructive reforms will see health inequalities worsen, more money wasted on bureaucracy and more money gifted to the cherry pickers from the private sector. There is no easy answer, we can either have a locally driven service with a postcode lottery or have a Soviet style top down disaster. The artificial state managed market in health care will only be good for the cherry picking private sector, it's about time it was scrapped, the chances of seeing this bulldozer being stopped are pretty slim though. I'd like to finish by summing up Darzi's review as being:

"Centrally driven by a politician for politicians against the interests of both doctors and patients"

Saturday, 5 July 2008

BBC acts as government arsehole

The BBC doesn't seem to understand rather basic concepts of good journalism, either that or they are deliberately spinning things in the government's favour. The following letter has been taken with the author's permission as it demonstrates nicely just how low in standard their journalism is. The BBC often presents both sides of the story, even when one side is clearly lying, making things appear 50:50 when in reality they are nothing like this. However when the government is lying then they do not present the other side of the story, making the government's line appear to be fact. I would be embarrassed if I were them:

"I am not a GP but I would like to formally complain about the reporting of the Today programme's top story http://news.bbc.co.uk/today/hi/today/newsid_7486000/7486975.stm. Essentially the BBC reported the comments of Health Minister, Ben Bradshaw, that GP's are in effect running a cartel with a "gentleman's agreement" to avoid taking on patients. Yet the BBC did not challenge Mr Bradshaw to produce any evidence to support these claims. Further on the BBC's website http://news.bbc.co.uk/1/hi/health/7475985.stm, Mr Bradshaw claims that there is one GP practice with only 2 patients, again no journalist has challenged him to produce any evidence to back this claim. There was no second source to this story in effect.

Yet just over a year ago I was interviewed by the BBC's Michele Paduano in March 2007 when I accused 2 ministers of Health (Patricia Hewitt & Lord Hunt) of either lying or misleading Parliament over the data in the relation to the junior doctors training scandal , MMC . The BBC even had a second source for the story, an e-mail from XXX which entirely backed my claims. Yet that interview was never broadcast, as the XXX mysteriously couldn't remember where they got the figures from. I was told by the BBC that since the Andrew Gilligan/David Kelly affair that they will only run a story if they have 2 sources.
Yet the Today programme is quite prepared to run a scurrilous rumour from one junior minister without presenting any evidence to back the story up....or indeed a second source.

I think this is dreadful and frankly when a programme like Today fails to take a government minister to task over such a rumour, they are failing in their jobs as journalists. I would also point out that Mr Bradshaw is a former BBC journalist and his partner works for the BBC, could this explain why the BBC are being so soft on him?

I await your reply.

Yours sincerely"