The BritMeds 2008 (07)

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.

Apologies to regular readers: it's been a while since we had the BritMeds - Dr Crippen and Dr Rant have both been too busy to keep them up.

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Golden geese

It's great to see Dr Grumble back on form.

How things have changed. GPs used to argue passionately that they were the ones that knew their patients and that they should be the ones if one of their patients fell ill to go out at night. Cradle to grave - that was the mantra. They knew each one of their patients as a person. It was a wonderful ideal but it was exploited. The government unwittingly exploited it with the old 24/7 contract that required too much of GPs. Even a doctor's spouse had responsibilities if the doctor himself was ill. Then the patients started exploiting it whipped up on a grand scale by a government unwisely increasing rather than damping down expectations.

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The truth about GPSIs

Dr Grumble has republished his spot on piece regarding GP's with special interests schemes:

GPs have been very effective gatekeepers between primary and secondary care. It's one of the reasons why the NHS used to be the most cost-effective healthcare system in the world. But the government thinks that GPs have been wasting taxpayers' money by sending patients to hospital unnecessarily. After all, what could the hospital possibly have to offer that a GP couldn't deliver? Plainly, so government thinking seems to go, GPs have been just a little bit idle and have been offloading their work to the hospital. Just maybe, of course, GPs are not confident in every area of medicine. But that can be dealt with by a little extra training. And then you can call the specialist GP a GPSI (general practitioner with specialist interest).

The NHS Service Delivery Organisation Research and Development Programme has funded two separate studies which assess the cost effectiveness of GPSIs.

The results come as no surprise to Dr Grumble:

The introduction of GPSIs did not reduce waiting times at the hospital clinic
The cost of GPSI clinics was always higher than the hospital (up to twice as high)
GPSIs were paid more than the hospital doctors
One consultant saw twice as many patients as the GPSI (a chance finding when a consultant replaced a GPSI temporarily)

Grumble also reposted the excellent article on Giving GPs a break, which is worth it just for the gratuitously pretty photo of Lochgoilhead.

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Is there a doctor in the house

The Junior Doctor has this piece on lack of medical staff while thousands of junior doctors are unemployed or emigrating:

I wrote before about the bizarre state that we find ourselves in regarding staffing. Despite the ridiculous shambles of MMC 2007 that left the majority of junior doctors in specialist training either displaced or unemployed, we now find ourselves in a position where there aren’t enough doctors in the hospital to staff a rota.

The situation has now been picked up by Channel 4 and The Telegraph (the BBC, as always remain silent).

To put into perspective how bad things have become, in February 2007 (pre-MMC) there were 12 junior doctors (SHOs) on the anaesthetics rota at NewTown Hospital, today, there are five. Five doctors are doing the work of twelve.

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Ask a silly question

SHP made us laugh with this:

In these touchy-feely days of politically-correct medicine, where we must not allude to the fact that we are giving people drugs for illnesses by calling them 'patients', where daily nursing entries forgo the hackneyed observations of mental state and whether or not major organs appear to still be functioning in favour of 'no spiritual or cultural needs identified', we have endless boxes to tick and reams of clerking proformas to fill in, to ensure a holistic approach.

Some would say it's 'political correctness gone mad'.

I'd be inclined to agree with them.

But if you want me to fill in your patronising, euphemistic, dumbed-down check-lists, there are times it is almost enjoyable, viz:

What is the client's perspective of need?

"I want to get out of this fucking shit-hole, you cunts!"

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Jack's Eye


The Monk has this interesting post that shows what is happening to patients as the NHS disintegrates.

This is a posting from Dr Martin Rankin,a GP in Devon; he is trying to get some media coverage for the story, so do pass it on to any journalists who might be interested:

Below is an open letter that I propose to put in the public domain

Dear Mr Brown,

We need your help to save the vision of an old man.The case of Mr Herbert "Jack" Tagg * a Pit Boy turned WW2 Sergeant Pilot typifies the incompetence of your labour government in managing the NHS."Jack" has developed Wet Macular Degeneration - a condition which will mean he will almost certainly become blind within a couple of years. The good news is that there is a treatment for this. The bad news is that he has to go blind in one eye before the NHS will pay for treatment in the remaining eye. "Jack" is not a wealthy man but his wife has, without any hesitation, decided that they must sell their house to pay for the treatment. You have never met Jack or his lovely wife but I can tell you they are a wonderful couple. He risked his life for us, you are in charge of the NHS, we believe that our patients would prefer you to spend a few thousand pounds on Jack in his hour of need than bailing out an incompetent bank. The doctors who have added their names to this list will all post on a cheque for £5 payable to Mr Gordon Brown. Of course we don't expect you to get Jack his treatment on the NHS - we already know you are not up to the job of running the NHS, we simply would simply ask you to cash our cheques and then forward on the lump sum to Mr Tagg.
Yours sincerely


The Doctors of Great Britain.

*I have Jack's consent to use his name. Please sign your name below and send your cheque for £5 to Mr Gordon Brown (his address is 10 Downing Street, LONDON).
Let's see Brown spin this.

edit:
Please send the cheque payable to Mr Gordon Brown to me at Plym River Practice, Plympton, Devon PL7 1AD. I will get a photo and supply it with a photo of myself and Jack and the bundle of cheques next to a post box.

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The fall out of MMC

The Ferret, meanwhile, points out that the Awkward Squad were, as usual, right all along:

Rabid doctors like myself have been predicting the massive service shortfalls that would result from the rushed Modernising Medical Careers reform of medical training. The media have started to take notice.

(Note to Ferret: could you provide your entire posts via RSS rather than just a teaser - it would make my job a lot easier!)

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Old enough to be your doctor?

I'm A Medical Student Get Me Out of Here is worried about looking wet behind the ears as a 'house officer' [I think that's 'F1' now, but the young whippersnappers keep changing their job titles and I can't keep up. - Ed, feeling very old]

So come August (pending finals) I’ll probably be one of the youngest out there, there is a high probability that I’ll be the youngest in the SW deanery what with 6yr courses, intercalation etc etc. Personally I think that’s quite cool, I’m not sure the patients will though. I think I look about my age so I’m certain I’ll get plenty of comments about being too young to be a doctor, behind my back mostly I expect. It doesn't bother me, they're probably right. Who would you want to be treated by? The 35 year old doctor who spent 10 years as an accountant before deciding on a career in medicine or fresh faced me who'll still be 22.

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Blogtitioner Alert #1

Mental Nurse, as mentioned on Crippen this week, has a piss take piece about freedom of speech being wasted on amateurs...

There has been a disturbing rise of ill informed comment masquerading as serious Journalism on what has become known as the “blogosphere” in recent months. These Blogtitioner lead “walk in centres” for news and current affairs are springing up all over the place and are a symptom of this Governments obsession with dumbing down and saving money. First it was our schools, then it was our health service and now it is our newspapers.

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All about control

Life in the NHS sums it up here:

It is becoming clear that the UK government would like to control every element of our lives. There is no doubt that there are some great ideas going on there in the various government departments. Ideas about better parenting, opportunities for children, the variety of education, the food that we all eat, our lifestyles and the amount of exercise we take, the way we live our lives as adults, the food and alcohol we consume, our moral lifestyles and the way we spend our money. The trouble is they are not happy with just offering up ideas and schemes, they are not happy with giving guidelines, making policies. No they want to tell us all how to live every aspect of our lives.

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Stupid Bitch Matrons

Militant Medical Nurse has a photo of Luc Besson's Nikita and is not afraid to use it!

Bring Back Matron you say? Oh they are back all right.

At my hospital we always had a saying..."Matrons are like ghosts...we know they exist but we never see them."

Who are the modern matrons? They are highly trained and highly educated nurses who take on clinical specialist/ management roles. Highly trained and highly educated nurses are great at the bedside. Research has shown that patients have a higher survival rate when they are receiving total care by a degree educated RN. Even better if she has a manageable number of patients.

Many of our modern Matrons, however, are as useless as tits on a bull. They have no soul. They have no interest in patients. I would rather eat c-diff positive shit than bestow the honourable title of "Nurse" onto one of these people.

More on matrons and nurse patient ratios here.

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US view of problems with the NHS

The American site Hot Medical News has their take on the problems with the NHS:

Imagine that you are seriously, even critically ill. You are in a dirty, rundown, understaffed hospital. The nurses, doctors, and other employees are rude, inattentive, and incompetent, and you can't get out. What could be more terrifying?

Although government mismanagement is without question part of the problem, the UK spends much less on health care than the US. Still, the British government nationalized the health care system in 1948 and has had over fifty years to work the kinks out of the system.

The British people deserve better.

They also have an excellent image of Seattle police with masks on during the 1918 Influenza Epidemic as their archive picture of the month:


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And finally...

Funny Things


The Girl with the Blue Stethescope (still Dr Rant's favourite blog-title) asks...

What funny things have you noticed that have changed about yourself since becoming a medical student?

I now understand more of House. It makes even less sense than before. ;)

Medstudentitis. Feeling tired? Leukaemia! That spot on my brother's back? Could be melanoma! Feeling down? SAD! Unwell after drinking spirits? Must be early diabetes!

At least I am enjoying it.

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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.