You are hereBlogs

Blogs


Prolapsed Participles

Good medical practice, perhaps, but bad English. Absolutely Stilton’s announcement of his latest hair shirt guidance for doctors, absolutely jointly produced with the Nursing and Midwifery Council so that it applies to nurses and midwives as well, is focused, if that is not too strong a word, on the duty of candour, more generally understood as the duty to be honest. It tells clinicians, with a ringing third degree participle prolapse, that ‘When something goes wrong with a patient’s care, doctors, nurses and midwives should: speak to the patient, or those close to them, as soon as possible after they realise what has happened.’ Wily clinicians, and those liable to be bent by their learned friends, are thereby provided with a useful loophole. So long as the patient hasn’t realised something went wrong, there is no need for the clinician to embarrass themselves. Piling Pelion on Ossa, the next point reverses the prolapse. Clinicians, the announcement says, should ‘apologise to the patient – explain what happened, what can be done if they have suffered harm and what will be done to prevent someone else being harmed in the future’. From where Dr No is sitting, it seems they absolutely don’t know who they are, and if they don’t know who they are, the what hope can there be for the rest of us knowing who we are, let alone what we should do?

Shoots You, Sir

If patriotism is the last refuge of a scoundrel, then news about news is the last refuge of a desperate editor. In an editorial in the BMJ this week, Ben Goldacre and Carl Heneghan report on ‘extensive news coverage’ of a ‘leaked letter’ from the Chief Medical Officer to the Academy of Medical Sciences asking for an enquiry into how society should judge the safety and efficacy of drugs. This is hardly the stuff of which crackling headlines are made. Dr No missed it, and so too did most of the media. According to google news, only the BBC and The Guardian covered the story in the national media, with remaining coverage confined to such erstwhile journals as the PharmaTimes of Freakistan. The leak, it turns out, was about as newsworthy as a damp patch on an incontinent’s mattress.

Ill Winds

The other day we had David Cameron getting pumped up about a seven day NHS. Pumped up is the New Tory, but a lot of old hats were still put on pegs, some hats more moth-eaten than others. JC (of the Department of Health Sunshine Band) was wheeled onto the Today programme, sounding about as pumped up as a flat tyre. Despite the ill wind blowing today through NHS General Practice, with more vacancies than currants in a bun, the government’s prescription is five thousand more GPs. Quite which wind these GPs will arrive by has yet to be explained. Historically, the NHS has outsourced, or at least gained, extra doctors from abroad. Pigs, after all, can always fly, if they are pumped up enough.

Docs Told To Stick Drugs Where Sun Don’t Shine

Despite the colour scheme, Bad Medicine is not a red-top, but sometimes a red-top headline doesn’t do any harm, unlike over-diagnosis and over-treatment. The campaign against the problem of meddlesome doctors, a problem that has been around for as long as there have been doctors, had a re-launch last week, guided by a collaboration – now there’s a modern word – between the Academy of Medical Royal Colleges and the BMJ. What was ‘Too Much Medicine’ is now re-branded ‘Choosing Wisely’, a title so generic it could apply to anything: at least with ‘Too Much Medicine’ you knew what they were on about. The language has become stifling, like the still heat of a tropical day. We are assured that ‘Choosing Wisely conversations will rebalance discussions’ between doctors and patients, who will jointly ‘be supported to acknowledge…that, sometimes, doing nothing might be the favourable option.’ Hullo? To you and me, that’s stick the drugs where the sun don’t shine.

The Fly-Away Election

There’s no doubt that, in no particular order, the BBC, the SNP and the Tories won the election, just as, in no particular order, Labour, the Lib Dems and the Kippers lost the election. If any one moment defined election night, it was Mouldy Auld Sporran asking a craggy slit-eyed Pantsdown shortly after ten pm about the BBC’s newly announced exit poll which predicted a Tory win. Pants piled on more crags, tightened the slits and went Hatsdown: if the poll was right, Pants cragged, he’d eat his hat. At least one viewer was left wondering for a moment whether Pants’ appearance was the consequence of a life spent digesting hats. Mouldy declined to offer to eat his sporran if the exit poll was wrong. Pants appeared to nod off, his eyes the natal clefts of two hippos reclining back to back. In the bowels of the building, a prop hand searched for a digestible hat.

Hard Working Politicians

The election manifestos have been delivered, like tickets from a parking machine, along with their announcement speeches. Perhaps Dr No has a forgotten cotton wool bud stuck in each ear, but it seems to him that the tones and voices of the three main party leaders are doing a sort of verbal regression to the mean, and are becoming increasingly difficult to tell apart. Sometimes the content provides distinction, sometimes it doesn’t. The smaller parties, as they are politely known, on the other hand, tend to have distinctive voices. We all know who has taken the Hay Rood, and who is behind all that farfing and barfing. Mostly lacking any realistic prospect, the smaller parties can indulge their creative sides, and entertain us with curious pledges, like the one to nationalise bluebell woods, or reverse the smoking ban in schools, the better to turn nippers into Kippers.

Windmills of the Mind

In the second part of Not Guilty by Reason of Insanity, Louis Theroux went a whiter shade of pale. In Part One, the patients had been linear: given time, though the content was often horrific, sometimes bizarre, they talked straight. Louis wandered, but remained grounded. In Part Two, everything, including Louis, was up in the air. Windmills of the mind rolled aimlessly, milling nothing. A toxic runt of a shrink made it his job to finger the malingerers. He did this by raising an eyebrow and curling his lip. When patients-experts in madness faked symptoms of madness, he just knew the shirkers were doing it to dodge their day in court, but they were tough nuts to crack. Weary Dr Lip Curl sure had a hard hoe to row. Here was the proverbial patients running the asylum in action: the nuts had cracked the shrinks. Every day, one flew over the cuckoo’s nest. Dr Curl was damned if he knew what to do about it. It was enough to make anyone’s lip curl. He ratcheted up the curl another notch, to no avail. At some point, Dr Curl will need surgery, to put his lip back where it should be. He may even need anti-psychotics, to calm the delusion that all the inmates have got one over him. All the while, Louis gazed on, his mind as focused as a windmill in the sky. Everything was going nowhere, and nothing was going everywhere. Windmills of the mind, turning slowly in the sky.

Thanks For Coming In Today

Wearing togs of mailbag grey, but missing the convict’s vertical arrows, Louis Theroux’s cubist aspect stalked the corridors of an American asylum for the criminally insane, searching for nutcases. The nutcases failed to stand out. Scanning a corridor, it was not possible to discern whether that man with a trolley was a janitor on rounds or an axe-murderer who just might rip the steel bars off his trolley and wrap them tightly round your neck. To make matters even more confusing, some of the staffers looked pretty nutty. Only the psychiatrist was easier to spot, dressed in a cream suit from last year’s fashion rail at the local charity shop. She’d come a long way, from Lithuania to be precise, and had three settings: stern, giggly and frightened rabbit, as well she might, given the human powder kegs she sat on. This being a psychiatric instatooshn, ward rounds and meetings were called reviews, many opening and/or closing with that old psychiatric smoothie, ‘Thanks for coming in today’. Despite the smoothness, it tends to sound a bit hollow when addressed to an inmate who has not a hope in hell of not coming in today to the review.

Stasi Report – All Good

Two days ago Dr No got another fun email from the GMC. Unlike the recent email from O Chair – ‘I’m Terry, and I’m your buddy!’ – the latest email is GMC News, March 2015, e-bulletin edition. Dr No passed on the email’s ‘Forward to a friend’ link – if friends are forwarding GMC emails to you, you need to check out who your friends are, and if you are forwarding GMC emails to your friends, you need to check out whether you’ve actually got any friends. He also declined to click the link offering Dr No the opportunity to check his registration online, on the grounds that he already knew his registration status. He learnt, from the GMC News e-bulletin headline, that there was ‘Strong support for proposals to improve patient protection and public confidence in doctors’, which turned out to be another eight out of ten cat owners who replied story. He also learnt that the theme for this year’s GMC conference, hashtag #GMCconf for those who can’t – perhaps because they are busy forwarding GMC emails to friends - make the regulator’s annual gangbang in person, is ‘creating a culture of openness, safety and compassion’. Coming from an organisation which, at least in the conduct of its fitness to practice procedures, is known for its opacity, recklessness and indifference, this struck Dr No as a bit rich.

Meaning To Do Something About It

It’s a matter of conjecture whether Stilton wants more complaints to the GMC. Last year, he was all for it. The GMC’s State of the Profession report for 2014, published on 8th October 2014, noted ‘regulators…are seeing a rise in complaints…much easier to raise a complaint. This is all to be welcomed…’. The ellipses cover many words but the meaning is unaltered. By 11th February 2015, only four months later, writing in BMJ Careers, he said ‘We do not “welcome” the huge increase in complaints’. It is not clear why “welcome” is in quotes but that aside the two positions seem rather at odds with each other. Perhaps they have the heating at GMC Towers set rather high, and Stilton is starting to overheat. Or maybe it’s complaint blowback, be careful what you ask for. Welcoming complaints, the GMC got more than it bargained for.