The BritMeds 2007 (41)

Welcome to the Dr Crippen BritMeds. Dr Crippen has kindly asked for the Dr Rant team to take turns with him hosting the BritMeds, so please send all of your BritMed suggestions to BritMeds@DrRant.net.

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Crippen redux

He's back!

The time has come for Dr Crippen to spring back into action. Normal service will be resumed on Monday, 15th October.

The planned two month break has stretched to nearly three months - apologies for that, and thank you for all the emails.

[John has kindly offered to let Dr Rant continue to do the BritMeds turn about with him (or something along those lines) - Ed]

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Government survey

OurNHS asks:

Why was Professor Darzi selected to review the NHS?
His track record of toeing the party line
His objectivity and intelligence
Deliberately losing to Tony Blair at tennis on sundays
He holds a special place in Gordon's heart
Gordon likes using his robots for personal pleasure
He doesn't like doing his NHS clinical work
He begged Gordon for an easy job with a predetermined course

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I check my baby every night...

Nobody wears a white coat anymore:

I went into her room when her parents were out, and stood there, just looking at a perfect little baby under a brightly lit warmer and couldn't stop from crying. Morning rounds were subdued this morning, as A presented her case. Nobody asked many questions - we all just listened.
Her grandma wanted to know, he said, if there was something she could do to help someone else.

read on here.

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Clostridium difficile : more diarrhoea

John waste's no time getting his teeth into the C diff outbreak:

The official Healthcare Commission on Maidstone and Kent NHS Hospital trust does not not provide happier reading.

Shambolic mis-management or, to be more precise, lack of management of infection in a Kent NHS Trust. A depressing catalogue of incompetence. Lack of leadership from the top – and by that I mean from Consultant Microbiologists, doctors with specialist training in infection and bacteriology - was the main problem. Add to that government pressure on non-medically qualified managers to increase hospital turnover with inadequate nursing resources and you have a receipe for disaster.

more here.

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NHS Hospital Killings


Barry Monk has this to say about the figures quoted on BOM:

This is not a problem restricted to a few hospitals.

Past Secretaries of State for Health need to stand trial for corporate manslaughter

and also:

The story about Clostridium difficile from Kent is pretty horrific, but it now emerges that there are TWENTY hospitals with a higher infection rate than Maidstone.

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Health care acquired infection - who takes responsibility?

Staying with C diff, Life in the NHS [one of the few NHS manager bloggers - also a nurse, wife, mum, and now MSc so one wonders when she has time to write stuff - Ed] is worth quoting too:

In a world where blame needs to be laid at someones door it would be easy to accuse nurses of not caring, cleaners not cleaning and managers failing at allocate money to the right areas of the health system. However, like most things just blaming one or two groups of people for individual failings would mean that people missed the point. In my very humble opinion what we have here is a whole system failure, many years of under investment (or at least in the right areas) and an obsession with counting the number of people with one infection while failing to notice that people were in fact dying from something else under their noses.

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Devil in the detail

The Devil, having had all he wanted to say said by Crippen, has saved Dr Rant the trouble of pointing out that:

as you doctors should know, the second section of the name is not capitalised.

Call me a pedant if you like, but it is Clostridium difficile not Clostridium Difficile...

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Root and Branch Reform

Front Point Systems on the same story:

So James Lee, the chairman of Maidstone and Tunbridge Wells NHS Trust falls on his sword but not before releasing a “astonishing” letter to Alan Johnson.

“We have been struggling with a state pretty close to bankruptcy,” he said. The trust’s clinical income last year increased by 1.5% in cash terms when staff pay rates were rising by over 5%. “We knew the Treasury was pumping money into the NHS, but quite frankly none of this seemed to be getting to the coalface.”

As income fell, hospital activity rose by 11%. The trust cut costs by more than £40m in an attempt to break even. It struggled to cut maximum waiting times to 18 weeks. But this was “never really achievable”.

“The NHS is run on the basis of command and control. I personally have never experienced such centralised or detailed control … This way of managing things is fundamentally incompatible with the whole concept of independent trusts … I have done my best.”

more here.

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Breaking good news

HospitalPhoenix has an interesting post on something that I now suddenly realise is not talked about enough:

After I'd endoscoped her, I was able to break the good news: she didn't have the cancer she'd been dreading, she had a mild, benign condition which could be easily alleviated. She was delighted. I fed back to the ward sister, who got quite emotional, and insisted I speak to the patient's daughter. She began dialling on her phone and I stopped her, offering to speak to the daughter in person. She began dialling again, telling me that the daughter wasn't at work today but that she'd want to speak to me on the phone. She greeted her friend, then thrust the receiver at me. I introduced myself to my patient's terrified-sounding daughter, then delivered the good news. The daughter burst into tears and began hysterically telling me how grateful she was. By the time I said goodbye, the ward Sister was dramatically wiping tears from her own eyes and getting back to work.

Perhaps it's because I've become accustomed to trying to second-guess the emotions of dumbstruck patients who've just heard bad news, that I wasn't prepared for the outpouring of emotion which came with the delivery of good news. I didn't feel uncomfortable, but there was something particularly bizarre about it.

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The spin and the reality

Dr Ray's focal spot focuses on the spot again this week with:

The Spin - Happy Shiny People from the DoH "A New Ambition for Stroke" document which sets a target for CT scan within 60 minutes for patients thought to have suffered a stroke.

The Reality - "Many of the buildings, especially at the Kent and Sussex Hospital, were old and in a poor state of repair. Many of the wards did not have sufficient storage, space in utility rooms, or hand basins, making the control of infection difficult. The beds on several wards were much too close together, making it difficult to clean between them and seriously compromising the privacy of patients. Although there had been improvements generally in cleanliness and hygiene since the outbreak was declared, there were still some serious concerns. When we visited, we observed levels of contamination that were unacceptable, such as bedpans that had been washed but were still visibly contaminated with faeces."

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Bloody Beetroot

Inspector Gadget finds a suicide and the comments upset Wife of a Schizophrenic:

A man in his fifties has blown his own head off, and is spread out dead on the lawn. The shotgun is beside him. I take a sharp step back and place my boot in the vegetable patch next to the border. I sink up to my ankle in mud. Bloody Beetroot!

The victim’s wife isn’t too good. Sergeant Dan is with her. He comes out when he hears that I’ve arrived. “It’s OK Boss, it’s not sus” he says cheerfully.

“What do we think has happened here?” I ask, trying to sound inclusive. He tells me and I nod. “So there isn’t anyone outstanding then?” I ask. No. We both act like there isn’t a headless body at our feet.

But there is.

This is a suicide, and despite the Sergeant Dan’s assessment, all suicides are suspicious until declared otherwise by a Detective Inspector. At this time of the night we can wait an age for one of those.

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Dear Doctor

Militant Medical Nurse is really pissed off:

Dear Dr. Napoleonic Complex Hospital Consultant:


I am writing this letter to you because I think that you need to be made aware of a few issues. You are about to get your ass handed to you on a plate and I want you to know why. I hope that this letter will open your eyes. You do not spend any amount of time on hospital wards and are very unaware of what exactly is occurring.

Your lack of knowledge, your ignorance, your attitude problem in conjunction with an ego that is writing checks your body can't cash and a propensity to lash out with opinions that have no grounding in reality often makes you look like a wanker. I am writing this in the hopes that in the future it prevents you from the misfortune you had today of looking like a complete asshole in front of your patients.

Currently our hospital is short staffing the wards to the point that we have so few registered nurses that we are completely ineffective. You know this is true unless you are completely stupid.

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Abusing the NHS

We have missed Crippen here at Team Rant:

It is easy to forget that most patients with genuine illness are either old or very young, and none of them work. They prefer to come during normal working hours. It is only the pretentious, middle-class, focus-group attending, Rolex wearing, alfresco dining, BMW driving, foreign-holiday booking (“Do you know how much the safari is costing? Why should I have to pay for those Malarone tablets?”), BUPA subscribing, well-off “worried well” who demand the “right” to see a doctor in the evenings and at weekends. Sebastian is 27 and wants to “pop in” on Saturday afternoon to discuss the merits of regular PSA monitoring. His partner, Harriet, is with him and wants to know if intestinal yeast is a possible cause of her Irritable Bowel Syndrome.

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London Medicgirl gets on her soapbox

about GP-bashing:

I have a feeling the rest of the world (and I guess we do live in a instant gratification society) don’t really understand the concept of General Practice and illness.

If you are ill- needing medication and the like- go to your doctor… the fact that you are having to take time off work to do so shouldn’t be that much of an issue remember- because you’re ILL.
If it is out of hours, you have a choice- are you SO ILL you cannot wait until the morning? In which case, you need to go to A+E because otherwise you might die.
If it is some routine thing that you need to get done? I don’t know, like injections for your fun little holiday coming up? Well, you’re going on holiday so one can only presume you can afford to take a morning off. And if its a routine appointment for a long term illness? Well, again- this is presumably what sick days are for.
The one place that I can see that would actually benefit from decent out of hours GP service is in the countryside, where the GP is going to get to the patient faster than an ambulance in many cases; my mother would not be here to day were it not for our local GP schlepping out to give a very necessary injection of adrenaline one summer evening.

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Criminal Defence Services Direct

Life With Leukaemia has spotted this terrifying news story which we missed:

I am not kidding!

Although I am now developing a concern about the independence of the media regarding our government’s policies towards our socialised and wonderful health service, I notice this worrying report by a (perhaps courageous) BBC journalist on, or relegated to, the bottom of the BBC’s UK news webpage.

Apparently, from February next year in the UK, those arrested for “minor” offences, will no longer have the legal right to the physical presence of a lawyer or solicitor, but will instead be allowed to phone a “call-centre” run by a private company staffed by non-legally trained ex-police officers!

You’re worried by NHS Direct?

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The Ferret on MTAS

Tons this week from the Fancier on MTAS here, here, here, and here:

Just after the Tooke review has been released, hopes were high that the powers that be would be forced to change their incompetent ways; a reality check is often only just around the corner and it has come rather quicker than many expected.
The new Foundation Programme application form is available for all to see online and it contains the same white space questions that caused such uproar in MTAS 2007. These white space questions have been used to select for Foundation Programmes for several years and I have yet to find a trainee who thinks that they are not an utterly useless load of rubbish. Here they are:

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And finally:

Courtesy of Militant Medical Nurse:

Top ten reasons to become a nurse:

Pays better then fast food, though the hours aren't as good.
Fashionable shoes and sexy white uniforms.
Needles: "Tis better to give then receive"
Reassure your patients that all bleeding stops...eventually.
Expose yourself to rare, exciting and new diseases.
Interesting aromas.
Courteous and infallible doctors who always leave clear orders in perfectly legible handwriting.
Do enough charting to navigate around the world.
Celebrate all the holidays with your friends- at work.
Take comfort that most of your patients survive no matter what you do to them.

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Please send your recommendations for next week’s BritMeds to: BritMeds@DrRant.net

The BritMeds are usually published from Saturday morning to Sunday evening, so please let us have your recommendations by Friday evening latest.