There 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.
2015, 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.
Doing his best to out-kip UKIP, a British surgeon has come under fire for blowing the wrong sort of raspberries in that esteemed organ of Middle England thought – if that’s not too rich a word – known to its readers as The Daily Mail, and by various other non-printable names by its non-readers. The gist of ex-Prof – his professorship ‘expired’, however that happens, though the Mail continues to provide its man with a fictitious chair – Joseph Meirion Thomas’s jam is that the time has come to round up health tourists, nice lady doctors and GPs and shoo them back from whence they came, preparatory-like to re-staffing the health service with proper male hospital doctors.
Faced with the GMC’s latest antics, Dr No was tempted to do an RDJ (rapid demolition job) on some of its sillier notions, such as ‘emotional resilience training’ for doctors to prepare them for fitness to practice investigations (‘General Turkey Council: toughness training for turkeys facing Christmas process’), but instead he offers another variation on a favourite line of his, borrowing from great orators of the past. Three quarters of a century ago, Britain stood against the Nazi menace; today the medical profession stands against the regulatory menace. What would Mr Churchill have said had he been the leader we so clearly lack today as our profession prepares to face the greatest menace in its long illustrious history?
Only 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.
Imagine for a moment Dr No is now a peer, Lord No (of Nowhere), and it has come to his fancy that there are a lot of worthwhile advertising folk out there who are being cruelly frustrated in their attempts innovate by a constant fear of litigation. Radical campaigns to sell coals to Newcastle, defy gravity and achieve eternal life, these two possibly at the same time, though the Church has had a protected monopoly on promoting that particular proposition for the last two millennia, have remained but twinkles in the eyes of advertising executives. Those pesky anti-free market types have got too big for their boots; and every day, another regulator leans forward to breathe down the necks of advertising executives. A chill hangs over the corridors of innovative advertising; brilliance lies stunned into submission. All in all, it’s enough to make a right-thinking peer weep.
There’s not much to say, even if Dr No is going to say a bit, about Atul Gawande’s third 2014 Reith Lecture, except that he blew it in the title – overweening confidence, Gawande’s definition of hubris, is not the problem, striving officiously in hopeless desperation is – and then spent thirty or so minutes stating the bleeding obvious. Called The Problem of Hubris, the lecture dealt with doctors’ failure to deal with the inevitable, the appointment we all must keep when our bell tolls, the appointment not with a doctor, but with death.
Time for a Gawande anecdote, this time about a friend called Peg. Emotional strings were taughtened by casting Peg as piano teacher to Gawande’s 13 year old daughter. Given Gawande’s subject, one knew Peg’s cards were marked: at some point, Peg would peg out. Best be grateful for small mercies: at least Peg wasn’t called Sue.
When the Chief Medical Officer feels uncomfortable, should the nation tremble? Probably not. Certainly, Dr Atul Gawande didn’t, fielding Dame Sally Davies’s troubled comments after giving his second 2014 Reith Lecture, broadcast this morning on Radio Four. Speaking in his now familiar, you know, George W Bush style “Our people done a really good job…of, you know…hauling in a lot of the key operators”, Gawande extolled the virtues of getting systems right. Goaded by air industry experts baffled at the casual approach of surgeons to their work, Gawande developed The CheckList. Depending on viewpoint, the CheckList is either strictly for the dumb-assed, or a sort of systems alchemy that transforms the inept into the ept, and experts into super-experts. Doubters are stumped and declared out for a duck by asking them a simple question: “If you’re having an operation, would you want the team to use the checklist?” Unsurprisingly, ninety four percent did, though that leaves the intriguing question what did the other six percent want? Dr Frankenstein? A one armed blind surgeon with a prosthetic hand and Parkinson’s disease? We’ll probably never know, because by now they will have maimed or killed themselves some other way.
Browsing the web about the latest round of Health and Social Care Bill backed pile-em-high, sell-em-higher NHS services currently out to private sector tender, Dr No chanced upon a success statement (SS) so hilarious his eyes would have popped (EWP) were it not for the fact that it came from the Orkneys, where Dr No had the privilege of spending a few weeks as a medical student with a real GP doing real medicine. The statement reads:
SHARED SERVICES IN THE ORKNEY ISLANDS
The annual metronome to British public service broadcasting, the Reith Lectures, have begun this year’s tick, with Dr Atul Gawande doing the tocking. A smooth tocker with hints of George W Bush style pulsing rising enunciation, today’s first lecture – the first of four, we should note – asked ‘Why do Doctors Fail?’. Master of the personal anecdote, Gawande told the tale of a certain Baby Walker – not the contraption, but his son – who survived despite being born with an aortic abnormality, while the baby in the next cot with the same condition did not. The answer, by and large, was systems failure: Baby Walker ended up in the right place at the right time, while Baby Maine next door did not: the right place, perhaps, but too late. Walker walked, Maine died.