Welcome to the Dr Rant BritMeds. The Dr Rant team will be hosting the BritMeds on behalf of Dr Crippen during his summer recess, so please send all of your BritMed suggestions to BritMeds@DrRant.net.
Apologies to anyone who had trouble emailing in britmed nominations this week. We have now fixed the problem.
Like a leaping mountain goat
I really like the Lowly Worm blog - the photo alone is worth a trip.
None of the junior doctors in my hospital leave on time. We stay late to make sure patients receive the overnight care that they need, and then get discharged when they are ready to go home.
When we are spotted, still at work, we are accused of loitering in order to charge the hospital overtime. Within the next few weeks, we will be asked to sign a form agreeing that our jobs do not require the hours we're currently contracted to.
I quite wanted Simon not to die over the weekend, so I stayed on to make sure he had extra blood tests and that the on-call team knew all about him. I don't feel bad about that, even if it does end up causing a stink with Human Resources.
++++++++++++
Maggots
Assuming you have already eaten, EverythingHealth has pointed us in the direction of this video:
++++++++++++
The Rage
Two Weeks on a Trolley continue to make me laugh.
look at the people who are the greatest pains in the arses in hospitals. Look at how many words they get [in their title]....."advanced practitioner night nurse co-ordinator", "Diabetes nurse specialist", "consultant physiotherapy practitioner ( I still have no feckin idea what he does, and I chat to him every day in our staffroom!) ". "Surgical services co-ordinator", "primary care paediatric pathway facilitator". I could go on.
++++++++++++
Confederation of Fools
The Devil lets rip at the NHS Confederation.
The complete and utter incompetence that the government has shown in mis-'managing' the NHS continues, the latest great example of this can be seen in the bungling form of the 'NHS Confederation'. Quite what is produced in exchange for a rather large amount of tax payer's cash is really anyone's guess.
And the Ferret has noticed the madness too:
The world has indeed has gone stark raving bonkers, maybe that's a slight exaggeration of events; it is however certainly fair to say that the NHS Confederation is a complete waste of space. If you don't believe me then simply have a look at this collection of suggestions from the 2007 NHS Confederation annual conference, it really isn't hard to work out why the NHS is in trouble when the people.
++++++++++++
Confidentiality
The Phoenix on the other hand is busy buying a new car - and hearing all about other doctor's cars.
All doctors, nurses, and (hopefully) medical students will understand and respect patient confidentiality. It become second nature to us.
I'm certain the vast majority of the medical profession feel the same way as me about this - it's not difficult to maintain confidentiality and to deal with information appropriately, because to do so is the very essence of our profession. Patients come to us in confidence, and to even consider breaking that confidence would be (with the exception of certain extreme situations) an abhorrence.
++++++++++++
Lean Healthcare
This management madness is one of Dr Rant's favourite topics to attack, so it's nice to see Dr Grumble thinking along the same lines:
Here's one example. A London teaching hospital is said to be about to introduce clocking on for doctors using hand scanners - though you can't help wondering why they don't just have us all microchipped. The system is supposed to save money. It will need to be a big saving: the rumour is that the system is to cost £500,000. Just how mad is that? Interestingly, two consultants in Dr Grumble's field have recently resigned from this teaching hospital. Dr Grumble is told that they were simply fed up with the oppressive management. One has gone abroad and the other is now just doing private work. Neither is close to retirement. If you are turned into an hourly production line worker, the sensible thing is to get paid as much per hour as you can so the private sector instantly becomes more attractive. It was not like this with the old professional contract.
++++++++++++
Privatisation without stealth
Ferret Fancier continues to hit the mark here too:
The government are pretty shameless in their auctioning of the crown NHS jewels, they don't even feel the need to hide their continued privatisation of the NHS from the general public. Personally I'm not even sure anymore if the government are cynical or just plain stupid, perhaps they are a mixture of the two.
++++++++++++
Healthspeak
Or ManagementSpeak as Dr Rant calls it. The perversion of language is one of the hallmarks of the current political climate. Extraordinary Rendition for kidnap, enhanced interrogation is torture. It's nice to see that the people running the world have the time to put Orwell's ideas into effect.
The Nuffield Hospital has stared a 'healthspeak' campaign, which got the Ferret's attention.
++++++++++++
Out there doing some do-gooding
An interesting, if disconcerting, account of SWC&S's brother's elective in the some desperately poor part of the world.
Upon arrival, he was shown around the hospital and his accommodation and then was told that he'd be running his own general medicine clinic with his very own patient list. So it would be him and his friend, taking histories, diagnosing, investigating and then treating a whole load of patients on their own.
And my brother isn't even a doctor yet.
++++++++++++
Children with earache
We recently had a discussion on our comments section about seeing a doctor out of hours to get antibiotics for earache in children, so it is interesting to see EverythingHealth discussing the topic too:
Most parents are heartbroken when they hear their toddler cry with an earache. It is one of the most common reasons for a visit to the pediatrician and most parents expect antibiotic treatment. The American Academy of Pediatricians and the American Academy of Family Practice issued guidelines in 2004 for most cases of acute otitis media (ear infection) and those recommendations call for observation, not treatment.
A new study in Pediatrics reported that over 80% of physicians agree with the guidelines that observation is a reasonable option for acute otitis media. But only 15% of physicians really did it...85% prescribed antibiotics at the visit.
++++++++++++
One for Anonymous
I thought of our ever-present market-obsessed friend, Anonymous, when I read this report on how to make more money as a US GP:
Insurance and Medicare payments are disproportionately high for the amount of time and skill involved for most procedures. Or perhaps a better way of saying it is that physicians who spend time with patients, listening, diagnosing, interpreting tests and communicating are financially penalized. A scope or a scalpel will be far higher valued, even though the time spent (and brainpower) is far less.
Patients will pay large fees out of pocket for cosmetic procedures or anti-aging vitamins. In our capitalistic society, it is clear what is valued.
++++++++++++
Patient-doctor behaviour
geepeemama's child's playdate cancelled because they had to go to the doctor with a cough. What did her parents make of this?
Hubby had a playdate scheduled this week which is more of an unusual occurrence for him than it is for me - have I mentioned that I don't have single free day in the entire summer holiday? - but it was cancelled by T's mum that morning. Apparently she said that T had a cough so she was taking her to the doctor. Then she offered to re-schedule for the next day when she was sure T would be better.
Hubby reported this to me with incredulity. #1. Why take your child to the doctor with a cough? #2. Why, particularly if you're assuming they will be better within 24 hours, take your child to the doctor with a cough? He couldn't understand the logic...
++++++++++++
Better off with a Take Out Macky
BOM has a lovely picture of a six inch cockroach to go with his story about hospital food:
Now you know. Next time you're in an NHS hospital and feel a bit peckish, either get someone to fetch you a Big Mac, or phone Dominos Pizza. Do not on any account eat the food they bring round on those salmonella incubator trolleys...
++++++++++++
Is university education wasted on nurses?
The Dr Rant team and Dr Crippen believe that university education may have wasted nursing, not that the education is wasted on nurses. We suspect this to be the case because since UK nurses moved from diploma training to university training, the standard of nursing care in the UK has plummeted.
Mental Nurse has taken umbrage - and slightly misinterpreted our views as being that university education is a 'waste' for nurses.
You can read more here:
Regular readers will know that I profoundly disagree with the Daily Mail/Dr Crippen Stance. For one thing it’s simply not my experience that nurses are all rushing to advanced practitioner roles. A surprisingly high proportion of the nurses I’ve worked with have no ambition to rise above the level of staff nurse.
(Personally, I'm really pissed off at being placed on a list along with that mindless ex-Nazi rag the Daily Mail, but you can make up your own mind).
++++++++++++
Please send your recommendations for next week’s BritMeds to: BritMeds@DrRant.net
The BritMeds will now be published from Saturday morning to Sunday evening, so please let us have your recommendations by Friday evening latest.
Dr Rant
Dr Cardigan
Dr Blue
Dr Brown
Rev Dr Green
Dr Mustard
Mr Orange
Dr Pink
Dr Purple
Mr Salmon
Dr White
Mr Beige
Ms Scarlet
Dr Informed
Posts
40 comments:
mental health nurse post link!
http://www.mentalnurse.org.uk/2007/08/18/is-university-education-wasted-on-nurses/
Hi Dr Rant
Thanks for the link. I'll just make a reply to your comments that:
Mental Nurse has taken umbrage - and slightly misinterpreted our views as being that university education is a 'waste' for nurses.
Well, that post isn't really in relation to any criticisms that Dr Rant may have of nurse education. In fact I haven't read any posts on the subject from your blog.
It was more inspired by various Daily Mail and Times columnists, and also partly by Dr Crippen's various posts on the subject, in which he seemed to believe that since switching to universities all that student nurses do is sit around guzzling sociology and cultural studies rather than learning practical clinical skills.
Something that strikes me when reading Dr Crippen's critiques of nurse education is that he simply isn't aware of recent developments in the field. I remember a discussion on his blog in which various people had to point out to him that the Project 2000 system of nurse education was actually abolished in 2002, and that no student nurses are being trained under P2000.
The new nursing syllabus (known as Making a Difference in England, and Fitness for Practice in Wales - not sure what they call it in Scotland and Northern Ireland) was introduced to address precisely the kind of criticisms that Dr Crippen makes of nurse education - that under Project 2000 it was overly theoretical and didn't properly bridge the gap between theory and practice. Students were sent out on placement earlier and more often. NHS trusts were given more input into course curricula so as to help turn out the kind of nurses the NHS actually needs. Use of reflective writing and problem-based learning was brought in to ground the academic assignments in real-world clinical scenarios. These changes have been in place for half a decade now and Dr Crippen didn't seem to know a thing about it.
Another thing I've noticed about Dr Crippen's posts on nurse education is that he has an occasional tendency to pull out some journal article filled with pretentious, obscurantist sociology-speak and tout it as being the sort of thing student nurses are learning these days. All I can say in response to that is that I have just completed the nursing degree and I simply do not recognise such articles as being typical of the sort of thing I've been studying over the past 3 years.
Overall, the feedback I repeatedly get from nurse lecturers is that the current system of nurse education is massively superior to the Project 2000 system that they trained under. As a result, newly-qualified nurses are much more prepared for practice when they hit the wards.
Many many many studies have been done regarding diploma nurses vs degree nurses. Patients have a higher survival rate under the care of degree nurses. Look it up. Both diploma and degree nurses have to be able to critically think in order to do their jobs.
An educated nurse is a thinking nurse. This is crucial to the well being of our patients. The more education a nurse has the better.
Standards in nursing care are declining because of one simple thing: appalling nurse patient ratios. Managers are intentionally short staffing the wards.
The patients on a general medical/surgical ward in today's hospitals were ITU patients ten years ago.
Patients are sicker and more complex now and managers don't want to staff the wards based on acuity. They don't want to staff the wards at all. There are no jobs, nurses are losing their jobs....and we currently have 13 high dependency patients to one RN on my ward (general medical, yeah right!). These people are on 5-6 IV drips each, blood, insulin drips, telemetry, all of them are immobile, incontinant, unable to feed themselves, confused....and their relatives demand one to one care.
Dr. Crippen is out of the loop. He has been away from hospitals way too long and he really needs to spend a day on a general medical/ surgical/ high dependency ward to get the picture.
Anyone who thinks that nurses are "too posh to wash" and that we are leaving people to lie in their own shit because we think it is funny needs a fucking reality check.
Our patients are extremely ill and if we don't prioritize properly people die. Doctors aren't the only one with life and death responsibility and professional liability.
Just wanted to add that yesterday I worked on my lovely general med ward with 13 fucking high acuity patients. Not only was there multiple IV meds, assesments etc but 8 of my patients needed to be fed as they were unable to do it themselves and 10 -12 of them were constantly incontinant. I was on my own and asked the managers to send me some help...anything...basically I got told "tough shit, deal with it" because they don't want to pay for staffing. I worked 15 hours with no break at all and kept all of my patients safe and well. Every single one of them complained that I wasn't giving them enough one to one time and "ignoring them".
At one point I was feeding 3 people at once while setting up a heparing drip and answering the phone. At that point in time I had 4 0r 5 callbells ringing. No health care assistant by the way. I was on my own. Once again. There was one other nurse for the 15 other patients on her own with them.
Management knows that they can short staff the wards to save money and that when the nurses are overwhelmed and can't be ten places at once.....the public will simply blame the nurses.....
13 HD patients to one RN? That's atrocious. No wonder care is failing.
Still, I bet you really appreciate having some jumped-up GP with a God Complex telling you it's because you're sitting at the nurses station daydreaming about how to deconstruct Chomsky, right?
Read the front page of The Times today
The media and the politicians are abusing and devaluing both doctors and nurses. Yet the doctors are so close minded that they believe that they are the only ones who are the victims of this smear/spin campaign by the powers that be.
Doctors jump on the "nurses leave people to lie in their on shit and starve because they don't care" bandwagon just as much as everyone else does.
I can forgive the journalists/politicians/and joe public for not having a clue and being stupid about what's going on with nursing care....but I can't find it in my heart to forgive the doctors. They should know better.
I posted the comments above about staffing levels.
Anonymous - I'm sure I do not need to inform you about research from both the States & UK, on the link between [nursing] staffing levels and hospital mortality.
One study put increased risk of [preventable] death at 26% - and guess what, nurses with the most onerous [indeed, untenable] workloads experienced the highest rates of burnout, amazing isn't it ?
http://www.rcn.org.uk/news/mediadisplay.php?ID=2202&area=Press
The above situation has been helped enormously by the estimated 25,000 nursing posts that have been shed since 2005.
http://www.kingsfund.org.uk/publications/briefings/nhs_finances.html
And now some 20% of nursing students cannot find jobs after completing training.
http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2006/07/03/nhs30.xml
Thank god we've got Dr Crippen & Co to point the finger at a few gormless quacks and academic wannabe's, as you say these commentators have really have got their finger on the pulse, haven't they ?
Hi Charge Nurse,
They are making 1000 compulsary redundancies at my trust in the next year. Many of them will be nursing staff. We already have the worst nurse patient ratios in the UK at that trust. They are telling the public that patient care will not be affected. LOL LOL LOL.
Looks like I am going from 13 high dependency patients to 26. Let the good times roll.
Of course people like Dr. Crippen, Dr. Rant, and the illiterate twunts at the daily mail are incapable of making these kinds of connections. Dr. Rant probably doesn't even read these comments.
I can't believe that these fucktards think that nurse training and nurses' attitudes have led to the mess we are in regarding nursing care.
What about the comentators who work on the front line?
Some of us have experience at both ends of the spectrum, from the nurse who i in awe of in CCU and the ITU nurse who i revise with... all the way to the (experienced) nurse who asked me what diastolic and systolic meant and the sister who abused the SHO for taking her from her drug round when we had a patient with a massive GI bleed.
I'm sure it works both ways, i have to say though that my housemates girlfriend and her friends did do an awful lot of rubbish when on their degree, and my mother who is an ex nurse said she watched standards drop...maybe just old age cynicism.
Hi Funny Pseudonym
I can't speak for your housemate's girlfriend's university, but I can promise that I certainly haven't spent my degree wading through stuff thinking, "I'm not going to need this on the wards." Quite the opposite in fact.
I should also point out that the nursing degree, due to its greatly shortened holiday time, crams 4 years degree work into 3 years. Even if a quarter of it were worthless cultural studies drivel (which it isn't, at least not at my university) then we would still graduate with the equivalent of a regular degree's worth of useful knowledge.
As for the experienced nurse who asked you what the difference between diastolic and systolic was, I guess nurse training must have improved since her day, because I learned the answer to that question in the first term of my first year.
The older nurses who left nursing years ago are completely unaware of what the patients of today are like. They are 1000x more complex than the patient population of years ago. Today's general medical surgical patients would have been in ITU with a ratio of one nurse to one patient years ago. Now they are on a general ward where there nurse must stay with them to ensure their surviva...on top of having 10 other patients.
I do not need to inform you about research from both the States & UK, on the link between [nursing] staffing levels and hospital mortality.
Well now look at the lawsuit in the USA where hospital corporations conspired to freeze nursing salaries in a beach of Robinson-Patman Act
Then see how KKR bought out Hospital Corporation of America and wonder if KKR bought Boots to use it as a new Health Provider in the Privatised NHS
Anonymous nurse
Thanks for your comments. Please be assured that we do read these comments.
We try to present the view from GP land accurately on here.(although we have 2 hospital doctors on here as well Mr Orange and Dr Brown) Apologies if we inadvertently malign nurses- it's probably cock up rather than conspiracy.
You've picked up the Ranting style very well. Would you like to do a piece "Nurse Rant from MAU"?
We're basically very keen on good nurses, and if things are stopping you providing proper care then let's get them debated in public domain. (Paraphrasing Larkin, "They fuck you up, your trust management")
Abuse of NHS staff only continues as long as it is a secret.
Doc Blue
ALL abuse can only occur in secret.
Hi Doc Blue,
I love the Doc Rant style. I have had a foul mouth for a very long time...spent about 10 years in the New York area before I came back to the UK. I am actually working on a pissed of medical nurse blog.
I really think that the crap that goes on really needs to come out into the open....otherwise patients will continue to get crappy nursing care and the nurses will continue to leave. Without decent nursing care and safe nurse patient ratios hospitals will continue to fail in everyway.
We'll enjoy reading it. Give us the link.
Actually I think the Dr Rant team have given nurses a pretty easy time of it, considering the shit we have aimed at doctors, managers, and politicians. This might have something to do with at least two of the team members being married to nurses.
I'm loving the debate here, because divide and conquer is the order of the day as far as The Enemy is concerned, and the more we read each other's honest thoughts the less they can do that.
My motto has long been "say what you think - if you don't like that then change what you think, not what you say".
I've known nurses who qualified over fifty years ago who would by pretty horrified that anyone suggested they were unused to dealing the very sick patient in inadequate environments - there are nurses alive today who were looking after seriously ill patients before ITU had been invented (Copenhagen in 1953 after a polio epidemic left shifts of medical students ventilating large numbers of patients by hand.
It is the nature of things that those who get older long for a better day gone by, but equally it is the way of things that the young imagine their battles are new and unique.
1j4N3W Very good blog! Thanks!
bP5zib Please write anything else!
actually, that's brilliant. Thank you. I'm going to pass that on to a couple of people.
Magnific!
actually, that's brilliant. Thank you. I'm going to pass that on to a couple of people.
Magnific!
Magnific!
Wonderful blog.
Please write anything else!
Magnific!
Thanks to author.
rAKR13 write more, thanks.
Please write anything else!
Please write anything else!
Magnific!
Wonderful blog.
actually, that's brilliant. Thank you. I'm going to pass that on to a couple of people.
Good job!
Nice Article.
Magnific!
Thanks to author.
Post a Comment