Ain’t Turning No Machine Off

neonate.jpg“I ain’t turning no machine off” said Kelly, as if she was a teenager talking about shutting down her Playstation. In fact, she was a mother talking about turning off the life support for her very premature baby.

And so it was that last night's BBC2 documentary 23 Week Babies: the Price of Life exposed one of the central dilemmas at the heart of the medical and ethical minefield that is whether to resuscitate very premature babies. Kelly was clearly up for not turning no machines off. Whether she was up for understanding, let alone navigating, the medico-moral minefield was another matter altogether. She hadn’t even in fact been asked to turn no machine off, only what her views were on aggressive resuscitation should her baby take a turn for the worst. The program’s presenter, Adam Wishart – a thoughtful cove whose brief onscreen appearances featured averted eyes, even if the eyes of his cameras probed mercilessly – asked: is it right to place such a burden of responsibility on the parents?

Apples and Oranges

apples_oranges.jpgFollowing some excellent posts by the medical blogosphere’s resident Pest Control Officer, Dr No has been learning two new words. Both get flagged as misspelt by his spelling checker, and only one has so far made it into the OED. The one that has made it into the OED is ‘commodification’, and the dictionary defines it thus:

“The action of turning something into, or treating something as, a (mere) commodity; commercialization of an activity, etc., that is not by nature commercial [emphasis added].”

At a stroke, Dr No has stumbled on the word that perfectly describes the core malevolence at the heart of Tory’s proposed healthcare reforms. And on this they have form.

U-Turn If You Want To…

lansley250.jpgIn a shock U-turn yesterday, Sports Minister Mr Andrew Lansley removed all references to bare-fist fighting in the ‘free-fights-for-all’ Boxing Bill currently before Parliament. Earlier drafts of the Bill had allowed ‘any willing contestant’ to fight ‘with or without gloves’. Critics of the Bill, including the British Medical Association, had pointed out that the wording ‘or without gloves’ provided an opportunity for contestants to fight bare-fisted if they so wished, a practice known to increase serious injury and fatalities.

My Lansley has insisted he never envisaged bare-fist fighting. Speaking in the House of Commons yesterday, he said: ‘I understand that references to ‘or without gloves’ in the Bill can be taken to mean that we want to allow bare-fist fighting. This was never the intention. I have therefore removed all references to ‘without gloves’ from the Bill.’

The announcement comes only days after Gordon Bennett, head of national fight regulator Monitor said: ‘an amount of bare-fist fighting will be appropriate’.

Jobs for the Boys

snouts.jpgIt is said British general practice is a broad church, and indeed it is. No branch of medicine collects under its wing such a panoply of talent and motivation. While most GPs sit somewhere near the centre, the tails of the bell shaped curve contain a diverse collection of crackpots, duds and no-hopers at one end; and at the other a rare collection of the exceptional – the exceptionally talented, the exceptionally compassionate – and the exceptionally greedy.

Despite the fact that general practitioners are adequately remunerated (we will leave the remuneration bun-fight for another day) for the work they do, a percentage – Dr No estimates perhaps fifteen to twenty percent – want more. Some of these individuals have an over-inflated opinion of their value to society, and consider that value should be reflected in their bank balance. And others – lets not beat about the bush here - are just plain greedy. Their primary purpose in practising medicine is to make money – lots of money.

My Last Chair as Post

knob.jpgThis is my last Chair as Postman of Council, and I write it with great joy. The last three years have been the most wonderful time; it’s been a great privilege to travel the length and breadth of the UK telling the great unwashed how to live their lives. But the real privilege has been being able to meet and suck up to politicians, journos and other movers and shakers across the country in my bid to become England’s next Chief Medical Officer. It’s been wonderful to see the great way these people lap up everything I have to say. In this, I do of course take my lead from my hero, Sir Liam Donaldson, England’s last CMO. If I can aspire to be even half as wonderful as Sir Liam, then I shall be well pleased.

Big Richard/Little Richard

richard.jpgRNLI crews, expert mariners that they are, often have to deal with casualties. The Institution has recently attempted to simplify first aid for crews by introducing ‘Big sick/Little sick’, an approach which reduces initial assessment of a casualty to simple question. It is a clever approach, and Dr No has decided to apply it to a question that has been ruffling him lately: whether Scot Junior was entirely innocent in his fate? He did, after all, build an impressive log cabin, and dumped it where it could be read. Might he in some more significant way have been the architect not just of his cabin, but of his own fate? In the battle between Needham and Scot Junior, who of the two is the bigger Richard? Who, when we get to the bottom line, is the ten bob note, and who the two bob bit?

Doing One’s Duty of Care the Machiavellian Way

no_crap.jpgDr No doesn’t really do duty of care. Instead, he just cares. When he sees a patient, he does what he does simply because he cares for his patient, just as he always has, and always will. He suspects – but isn’t over-bothered, perhaps even doesn’t care – that what he does in fact more than satisfies any duty of care baloney, which in the real world he steers clear of, finding it to be tedious, tiresome, distracting, legalistic, defensive, job-serving, and all about doing the minimum to cover one’s back, rather than aiming to go the extra mile and do the best for one’s patient. In all this, Dr No is no doubt frightfully old-fashioned, maybe even old-fashioned enough to trigger the crackle of snapped pencils in the legal offices of his professional indemnity society. But Dr No remains resolute. True care is always better than duty of care; for the former is human and comes from the heart, the latter formulaic, and from the law.

Eichmann Reloaded

adolf_eichmann.jpgPandora Needham, Postgraduate Medical Dean (North Region), has recently opened her box and set loose a fury of furies. A number of medical bloggers and other commentators, wide-mouths, forum sharks, hucksters, ne’er-do-wells and other assorted busybodies, including Dr No, have asked the obvious question: why open the box at all, and why now? Had the box remained shut, the unfortunate events of a few years ago would have remained locked in the box of history, gathering dust. By publishing the article which opened the box, Pandora on the face of it shot herself roundly in the foot.

A Woman on the Verge of a Nervous Breakdown

verge.jpgOnce upon a time, in a hospital far away, a frustrated junior doctor suddenly found himself in very hot water. Dr Scot Jnr – as he became known - had expressed himself vigorously – exceedingly vigorously - on a doctors-only forum. He had even dared to call the great and the good in his profession Richards. Even before anyone had time to cry ‘Foul!’, let alone Code Brown, red lights were flashing in Deaneries up and down the land. Deans – senior doctors responsible for junior doctors training – got on their hot-lines, and then their high horses, and before anyone could say appendicectomy – Scot Jnr was said to be a surgeon - he had been suspended.

Mary Portas: Queen of Clinic

raptor1.jpgIt is a wonder they haven’t called in Mary Portas, Raptor of Retail, to fix the NHS. Nice Gerry tried a while ago, but tea and biscuits, even Nice Gerry’s 24/7 tea and biscuits, failed to hit the fan when it came to fixing the NHS. Nice Gerry’s biscuits did what biscuits do when faced with a sea of NHS tea. They got dunked - and disintegrated.

Raptor, of the other hand, would know exactly what to do. Dressed by Dallas out of Star Wars, she would stalk the wards and clinics, skewering managers. Layabout staff would be rounded up, and their nail varnish stuffed where the sun don’t shine. A wand of retail magic would be waved, dull clinics transformed in a halogen twinkle into fun interactive experiences. Freshly botoxed greeters in Thunderbird uniforms would be drafted in, and the warmth of the Mall would embrace all. Everybody would win, and all would have prizes.