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.
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.
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.
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.
The wonderfully uplifting and generally obstetrically sound BBC series Call the Midwife has got Dr No worried. Playing catch up on the current series, he worries about the way the plots are getting more extreme, as if the writers, lacking the discipline of Jennifer Worth’s now expended memoirs, have decided to go commando. We’ve already had outbreaks of diphtheria, syphilis and rats: will bubonic plague be next? Or will it be World War Three? Dr Turner is burning out and booze has crept up on Trixie: when will the sponge-o-cidal Sister Monica Joan’s magic mushroom habit be exposed? Is unflappable Sister Julienne unflappable because she smokes cheroots behind the bicycle shed? Having put her back in a nurse’s uniform, will Dr Turner’s wife Shelagh now be transformed, Dennis Potter style, into a Singing Receptionist, complete with leather crop and corset? Will Dr Turner’s stress trigger a bout of crippling psoriasis? Such are the possible alarming developments on which Dr No frets.
Just as forecasters talk of a ‘fog situation’ or a ‘snow event’, so do medical educators now talk of the ‘shape of training’. Why the accessory words are needed is beyond Dr No, but then again he is not all that surprised because the recent Shape of Training Review – hashtag ShoT or in this parish bashtag ROT – was led by a certain eminence situation, one Prof Sir David Greenaway, a distinguished looking egg-head and leading light from the science that makes astrology look good. The #ShoT review’s publication situation was treated by and large as a no news situation – maybe being #ShoT didn’t help – though for some reason the BBC did cover it, and of course our dear friend the Ferret Fancier has been poking holes in the review for some time. One of the Ferret Fancier’s notable achievements has been, on appeal, to get an order for the release of certain GMC minutes of #ShoT/DoH meetings, which the GMC had previously determined should most definitely remain as an ongoing non-situation.
In a curious move, because to many it will suggest the GMC perceives itself to be on the back foot, Stilton yesterday had published in Pulse an article in which he attempts to portray the GMC as a listening organisation which ‘accepts there is a lot more to do’. Or, to put it another way, on the matter of its regulatory functions, the Council accepts this is ‘an area where more can be done’. Pulse’s standfirst boldly promises an explanation of ‘how the body is ‘improving fitness-to-practise regulations’ – this being, after all, and as the Council accepts, ‘an area where more can be done’ – but in the body the article fails to keep its promise. Instead, Stilton delivers a peevish nit-picking lawyerly rebuff to two recent articles, and a bizarre waffle on why GMC punishments are not punishments. These, however, are diversions. The real message, the payload, part-hidden as it is, is much darker. It is that age old defence against charges of involvement in state sponsored evil that has become known, since the Nuremberg trials, as the Eichmann Defence: ‘only following orders’.
Once upon a time there was a turkey farm that grew so large that no one had ever seen one so vast. There were so many turkeys that, over time, the turkeys began to specialise in what they did. There were turkey-surgeons with white plumage, who operated on other turkeys. There were turkey-physicians, with fancy black and white plumage not unlike a human frock coat, who were called in when no one knew what to do. The turkey-physicians didn’t know what to do either, but were very good at making it look as if they did, which made everyone feel better. There were turkey-apothecaries, always busy in their brown aprons, handing out this pill and that potion. Over time, the turkey-apothecaries renamed themselves turkey-GPs, which made them feel more important, but no one else was fooled, and the turkey-GPs carried on doing what the turkey-apothecaries had always done, the over-worked under-appreciated back bone of Turkey Farm. There were even mad turkeys, as they were affectionately known, whose plumage tended to look as if they had been dragged through a hedge backwards, whose job it was to lock up deranged turkeys. No one liked locking up fellow turkeys, but sometimes it had to be done, and it was the mad turkeys who did it.
Any lingering hope that Parliament’s Health Committee could hold the GMC to account at its annual accountability hearing earlier this week over doctor suicides while under GMC FtP investigation has now disappeared as sand in the desert. Though delayed for a few days, the transcript of the hearing is now available online. It makes grim and depressing reading. On the matter of FtP doctor suicides, the Chair of the committee – a doctor – came to the proceedings with a regrettably light grasp, if that is not too strong a term, on the facts. Stilton, the GMC pongo who answered the questions on these deaths, turned out to have an even lighter grasp. Indeed, so poor were these grasps that Dr No has no hesitation in saying that they were, and are, an insult to democratic process.
A 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.