Monday, 22 September 2008

Ambling into the abyss

Apologies for my recent lack of blogging, have had my finger in many a pie recently, shame not many have been particularly fragrant, that's the NHS I guess. Quite a lot has been going on as regards the infamous Dr Scott, he's now back at work but at what cost, only time will tell I feel. I certainly feel that the abuse of power that appears to have gone on in this case is merely the top of the iceberg on this intimidatory front.

The medical hierarchy seems rotten to the core. Many a doctor has been subjected to this kind of disproportionate venom in recent years, frequently the suppliers of the venom are remarkably powerful people bullying people with much less power, and those with the power do not seem to be particularly accountable for their actions.

A recurring theme throughout the failed reforms of MMC and MTAS has been just how unaccountable those in positions of power have been, no one will take responsibility and no one takes the blame when things go tits up. Hence the same people remain in their ivory towers running the dismal show. Darzi's review is simply a game of rearranging the deckchairs, it's not the formation that matters, it's the fact that our deckchairs are bloody useless.

There is a hell of a lot more to this Dr Scott story than one might imagine, I will leave the rest to your imaginations. There's a nice summary of events here, it doesn't fill one with much hope for the future. This is bigger than the odd individual for me, this is about a system that does not work, a few institutions have become far too powerful over time and they react to criticism in the only way they know how, with the iron fist. The problem stems from Whitehall and the tentacles extend locally to the Deaneries and centrally to the GMC.

The worst thing is that the behaviour of those in power goes against everything that we are taught to do as good doctors and it stifles progress so absolutely. Those who dictate the 'duties of a doctor' seem to think that they themselves are exempt from the same rules because they wrote them, they are hypocrites on high.

The clinician on the front line is so very accountable for his or her actions, as well as being an easy target should they fail to comply with the centrally enforced directives pushed onto them by small minded managers. Meanwhile the medico politicos and the managers are completely unaccountable for their own errors, this is no healthy state of affairs. However it does explain why those in power are so keen to crush dissent with so little regard for the law, they are desperate to keep hold of their positions of power, and they can see that if they are exposed for what they really are, then their time will most certainly be up. They are most definitely afraid and that is our best weapon.

Thursday, 4 September 2008

Obesity - it's all the NHS' fault!

There's always someone to blame for the obesity epidemic, except that if it's the fatties talking then they will never blame themselves and if it's central government then they will also never blame themselves. For example this overweight fatty thinks the NHS should take more of the blame:

"Yes, we are letting ourselves down by being overweight and it’s my choice what I eat, but if someone makes that big decision to access services, even if they are just a couple of stones overweight, the resources should be there."

Indeed it is your choice, I also agree that the resources should be there, however largely (what a pun) I do not mean NHS resources. This is because much of the money that is being thrown at anti-obesity treatments and resources is a complete waste, as there is no decent evidence that they will do anything to make our fatties less fat. The drugs are rubbish, and as for PCTs handing out slimming vouchers, don't get me started on that.

Most of the problems come from a complete lack of holistic management and policy making from central government. Where are our cheap and excellent communal sports facilities? Where is our excellent school sport and healthy school food? Where are our green open spaces? Where is our excellent public transport that would encourage us to walk a bit more rather than using the car for everything? Where is that cheap subsides and tax free fruit and veg? Where are the fast food grease pits that have been taxed more heavily to make profiting from heart attacks that bit more tricky?

You get the picture. Doctors can at best do very very little to help their fat patients, they can refer the fattest for bariatric surgey which is only a very last resort with significant morbidity and mortality attached, they can prescribe drugs that cost a lot and do sod all, or they can refer patients to services that also do sod all.

Unless people start taking more responsibility for their weight and stop blaming their genes, then we will just carry on getting fatter, by the way if it was all in the genes then we would have all been this fat fifty years ago. Also the government could also do a hell of a lot more to counter this growing problem in all areas of policy making, blaming the NHS and staff is utterly stupid as well as futile. This is a big systematic problem rooted in our rather short termist culture, and untiul we start to address the real underlying causes, this tide of lard will only gather momentum.