A Crack at The Afghan, Sir!

hsc_2.jpgA medical school somewhere in England. A panel has assembled to interview prospective candidates. In the centre is Professor Sir Turpentine Stephenson, newly appointed Chair of the GMC. On the left sits Stilton, Chief Executive Pongo for the time being of the GMC; on the right sits His Honour David Fake-Pearl, Chair of the Medical Students Tribunal Service. Fake-Pearl appears to be reading a catalogue of some sort, possibly of spring bulbs. Stilton repeatedly inspects his finger nails. Stephenson gets out a fountain pen labelled ‘MI6 100% nitric acid, emergency use only’ and twirls it in his fingers. Bored observers sit behind the panel.

A bell rings, the panelled door opens to reveal a young lad standing on the threshold. The lad has wing-nut ears.

Developing Magna Carta Medicorum

magna_carta_medicorum.jpgThere are those who want to torpedo the GMC using the Human Rights Act, or even the European Courts, but it must be remembered that such processes are always time-consuming, often futile, and inconveniently prone to blowback, like trying to clear a blocked drain with a toothpick. Instead, we have Magna Carta. As Lord Bagg continues to develop his history of the 1215 Charter, Dr No has been working on Magna Carta Medicorum, a present day Charter to ensure fair treatment of all doctors facing and under professional disciplinary regulation.

Magna Carta Medicorum

magna_carta.jpg2015, as the wonderful Lord Bagg reminded us this morning, is the 800th anniversary of Magna Carta. The speech of the once melodious Melvyn is maturing into the voice of the English Establshmnt, in which later vowls are largely discardd, and each utternce is gaspd, as f’twere speakers last, though never is. Over those 800 years since the first Magna Carta, the Gods of ye mystries have placed the Charter firmly in the mythical sphere, and lodged it anywhere between the Ye Olde Scroll of Ye Commone Law, to a scrap of parchment that was binned shortly after it was penned. Somewhere in the middle ground it is seen, primarily, as the first declaration in English history that the King be subject to the same laws as his people, and that furthermore the laws must be both just, ordered and decided by one’s peers. It was a momentous change.

Burning Bad News

gmc_review_2.jpgOnly yesterday, Dr No was working on a post noting that the GMC had still not published its internal review of doctors who died while under Fitness to Practice investigation. He noted that publication was originally slated for July 2014, then November 2014, and, as of earlier this week, possibly sometime in 2015. He even noted that at the very time the GMC is consulting on doctors’ duty of candour, it was showing a striking lack of candour in its own conduct. The last sentence of the first paragraph of the post said ‘In the absence of certainty, it is not clear whether the review is still incomplete, or is complete, but currently too hot to handle, with Stilton’s PR goons waiting – sorry – for a good day to bury bad news’. It now seems they were: the review has been published today, the last Friday before Christmas.

Better Read than Dead

john_donne.jpgIt emerged last year that doctors facing General Medical Council Fitness to Practice hearings have a remarkably high death rate. Over the last decade, these doctors have been dying at between fifteen and thirty times the expected rate, depending on the comparator group used to do the calculations. Some of these deaths are known to be suicides, with others suspected but not so recorded. A groundswell of grassroots objection grew to a chorus of high profile outrage, culminating last September in the discreet – it was all but buried in Council papers - announcement by Stilton, the GMC’s Chief Pongo, of an enquiry into some of the deaths. In a faux pas on a par with appointing an Anti-Terror chief to enquire into the Muslim school plot, Stilton appointed a National Patient Safety Agency chief, one Ms Horsfall, to enquire into the suicides.

No Profession for Old Men

no_country_for_old_men.jpgDr No made no secret of the fact that Dropping Like Flies was a quick and dirty assessment of whether the apparently very high number of deaths among doctors subject to GMC Fitness to Practice investigations was something to be concerned about. He concluded it certainly was, because on that crude assessment – crude because there was no attempt to adjust the figure for factors that might influence the death rate – it appeared that these doctors were at least fifteen times more likely to die than ordinary members of the working age population. The ratio of fifteen to one was, he believed, an approximate answer to the right question rather than a precise answer to the wrong question. It was, he argued, so gross in scale as to make it very unlikely, though not impossible, that the finding had arisen either by chance, or by a sufficient number of unadjusted for factors, such that being caught on Stilton’s prongs was not one of them.

Indicative of Tendencies Dangerous

dangerous_tendencies.jpgPloughing through General Turkey Council Fitness to Practice data with a tractor ever more bogged down in numerical mud, Dr No got distracted by another question: what do ‘erased’ – the chilling term used by the GTC in place of the plebeian ‘struck off’, chilling because where the plebeian leaves a name albeit with a line through it, erasure effects obliteration, total obliteration, for not even a name remains – doctors get erased for? In the past, one was encouraged to suppose it was the three As, alcohol, advertising and adultery, a supposition borne out by the General Medical Council’s, as it was then, 1965 ‘Blue Book’ guidance, which does indeed list the three As (alcohol comes under splendidly archaic ‘Offences Indicative of Tendencies Dangerous to Patients’ heading), along with other examples of ‘infamous conduct’ likely to bring a doctor to the Council’s attention. But over time, as two of the capital As have become, so to speak, of lower case severity, we might suppose that ‘gross neglect in diagnosis or treatment’, the 1965 heading for clinical failings, might have risen in prominence, such that today most doctors are struck off for substandard treatment. But what are the facts?

Council to Survey Turkeys about Christmas

turkeys.jpgFor Immediate Release:

Council to Survey Turkeys about Christmas

GTC Press Office, London, UK

Thousands of turkeys are to be invited to take part in a survey of their views about Christmas, the General Turkey Council has announced.

The survey is part of a new piece of research examining whether turkeys think the GTC is operating in a fair and objective way and whether turkeys from different backgrounds have different views of the Council’s processes.

Dropping Like Flies

flies.jpgThe Inquisition known for the time being as the General Medical Council is under fire. Its fitness to practice procedures, which for doctors caught on the sharp end of one of Stilton’s prongs feel much like being popped into a beaker of dilute sulphuric acid with a rack of Bunsen burners arrayed underneath, have come under scrutiny because of an apparently high mortality attached to being left to simmer in warm sulphuric acid. Figures available online suggest that there were at least 92 deaths between 2004 and 2012 in doctors under investigation. The denominator – which Dr No suggests should be the number of GMC cases referred to panel investigations – stands somewhere in the region of 2300 (see footnote), giving an approximate average annual mortality rate of 4%. Working age (25-64) mortality in the same period was around 200 per 100,000, or 0.2%. Something is clearly going on. If we apply some crude ‘observed over expected’ numerology to these figures, we get a (very) crude mortality ratio, on the normal 100 base, of around 2000: that is, where we would expect 100 deaths, we find 2000.

Pax Pemberton

white_flag.jpgDr Max Pemberton – Apology

GMC Statement – For Immediate Release
22 Apr 2013

Earlier this morning, Count Rubin (not his real name) appeared on the Today programme opposite Dr Max Pemberton (not his real name), defending the General Medical Council’s decision to implement new guidance requiring doctors who use social media to reveal their identities.

By appearing alongside Dr Pemberton, and not challenging Dr Pemberton’s identity, Count Rubin gave the impression that the Council knew who the real Dr Pemberton was, had got his number, and furthermore the Council knew where he lived.