As the post nuclear option Heremy Junt/BMA contract row rumbles on behind the scenes – the top hit on google news today for junior doctor contract is a three day old blog post on Conservative Home by a psychiatrist sorely in need of Photoshop if ever there was one, and the BMA’s ‘latest update’ is weeks old, a thoughtful post by JT reminds us that the opposing comedy duo of Junt and the BMA Junta are not the only threats to junior doctors. The SPECTRE known for the time being as NICE, the National Institute for Clinician Evisceration, has produced yet more guidelines on statins. Commendably dense with the rhetoric of patient choice, the general thrust is nonetheless on upping the uptake. JT’s gripe is three fold. The first is that clinical guidelines, statistical tools, algorithms, call them what you will, become wet paper bags when they attempt to contain the complexity of real life. The second is that guidelines alongside variations of payment by result tends to get, well, results, ie more people on statins, without care for whether they want them or need them. The third, touched on more briefly, but just as important, is that, up against the hour glass of surgery time, thoughtful deliberation never stood a chance. It is the dead duck floating feet defiantly up, but head drowned in the time-hoopered barrel of clinical complexity.
At the eleventh hour, the BMA suspended the junior doctors’ strike. It hasn’t been called off entirely, it may still happen, but probably won’t. As a conspiracy theorist, Dr No suspects the whole shebang was a clever ruse by the doctors: a strike that was not a strike, a neat foil to Absolutely Stilton’s tanks lining up in the hospital car park; as a cock-up theorist, he suspects the whole bang shoot is further evidence that, even if it wanted to, the BMA couldn’t fire a rocket on Guy Fawkes Day. Apart from some bizarre even by Daily Mail standards doctors’ leader in love nest in Neasden style hackery, not to mention its doctors on dark web exposé, media coverage has been thin for what is after all serious domestic news. At the coming up of the sun, the Today programme looked the other way, and at the going down of the sun, Hoo Wedwards and his harem of squawking reporterettes hardly ever mentioned the conflict. There was some coverage of the ‘overwhelming’ 98% in favour ballot result, but few pointed out that 98% of those who voted is about just over half of all junior doctors, though even that is still an eye-watering result. For the BBC in particular, the junior doctors’ contract was, like the Health and Social Care Bill before it, to be just another ship that passed in the night.