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Breaking Bad

Like a pair of blind impotent bulls, Humph and Jimbo crashed about the Today studio this morning, breaking bad, but not much in the way of news. The programme reverberated to the dull thud of blunt horns getting stuck in wooden stories. Humph deployed his standard technique of exclaiming ‘Ha!’ every time an interviewee started to answer a question, to put the interviewee off balance, while Jimbo has extended his extended question technique by inserting…long…pauses. More crotchety than ever, Jimbo has even started to avoid questions altogether, preferring instead to crochet together a long series of statements…and pauses…and…assertions, more waffle, more saccharisms, more Jimboisms…before delivering a final semi-triumphant statement, leaving the by now stunned hapless interviewee little to do except to agree.

Deaths In Custody

News last week that there were 17 deaths in or following police custody in 2014/15 in England and Wales has rekindled outrage at the scandal and led to the usual political wails. Theresa May, announcing an inquiry into the deaths, said they ‘represented failure’. Well, that’s one way of putting it. Others rallied round ‘one death is a death too many’. Had Stilton been asked for comments, he would have said the deaths ‘absolutely represented failure,’ and that ‘one death absolutely is a death too many’. Sotto voce, he may have added, ‘we absolutely have been here before,’ because of course the GMC has had a hand in the death of similar annual numbers of doctors under FTP investigation, but from a far smaller population at risk. We should also note Stilton does not count year-and-a-day deaths, ie those occurring after FTP investigation. As a killing machine, or if you prefer a negligent machine that allows deaths, the GMC is far more lethal than the police. For once Stilton would be in error to say the GMC absolutely is more lethal, were he ever to admit such a thing, because in absolute published numbers the police are equal to, or slightly ahead of the GMC, but in relative, pro rata, terms, the GMC’s FTP processes are more lethal than police custody processes. If the police’s grim reaper is a scythe on open land, the GMC’s grim reaper drives a combine harvester down narrow streets.

Zombie Patients

Writing in the well-known Blue Top, the BMJ, Margaret McCartney, a fellow scourge of Bad Medicine, recently described the 16% higher chance of death if you are admitted to hospital over the weekend as a zombie statistic. The essence of a zombie statistic is not necessarily that it is wrong, but that it won’t go away, even when it is shown to be at least spurious, possibly wrong, and almost certainly misleading. Zombie politicians, who tend likewise to be at least spurious, probably wrong and almost certainly misleading, but still wont go away, love zombie statistics, as does the zombie press, which attracts zombie stats as a dunghill attracts flies. Shortly before the election, David Cameron, increasingly the zombie party leader as BJ hots up the mustard, pumped up the 16% higher mortality statistic, and true to form it just won’t go away. Today the zombie minister Jeremy Hunt will use the 16% zombie statistic to prop up his case for seven day zombie working in the NHS.

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.