If you have ever wondered what life looks like here at Team Rant HQ, you need only imagine a line of jaw-dropped, eye-bulging, vein-popping faces staring incredulously at the computer and TV screens as the constant extrusion of shitwank that passes for government NHS policy continues day and night.
Just when you think the final straw of beyond parody barble-wobble has been produced, they manage to top it with something new.
Now, GPs have long known that NHS policy on safe care is so secondary to cost considerations that the word secondary is misplaced. (What is the word for 84 trillionth place in a list of priorities?)
For example, back in the days when doctors did their own Out of Hours cover for free, 24 hours a day, 365 days a year, GPs in remote areas were commonly blocked from joining together into small groups to share on call because the NHS managers deemed it 'unsafe'. Fair enough, but no sooner had the cost of Out of Hours been transferred to those same managers that this 'safety' issue was dismissed and costs cut by providing Out of Hours cover from distant locations.
When GPs did on call, their response time to emergencies was expected to border on the prescient, yet once the PCOs took over Out of Hours this was dropped initially to emergencies being 'disposed of' (Shipmanesque language if I ever heard it - I beleive it meant completely dealt with) within one hour, and later this was relaxed to the 'seen by a GP within one hour'. More money saved.
In the old days, any qualified doctor could work as a GP. GPs who wanted time off could simply get the local house officer to cover for them. Then, rightly, three years of GP training was introduced and only doctors with that training could practice as GPs in any capacity. There are legion stories of GPs being unable to work because their paperwork had not come through yet even though they had passed their training weeks before.
No problem when the GPs were the ones paying the price of safety (and penpushing delays), but Lord 'Glove Puppet' Darzi's new Polytunnels are reportedly going to be staffed by junior doctors. Yes, why have safety when you can have cheap and nasty.
After all, a dead pensioner is a cheap pensioner.
What is the fucking point of going on? Anyone? Anyone?
Wednesday, March 05, 2008
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34 comments:
fuckinghell. I realise now it's going to take death - and lots of it - to stop this braindead government in it's tracks.
They still don't know what it is that GPs do, which is take risk with undifferentiated symptoms on one hand and manage chronic illness in patients we know well on the other.
Oh yes - this is going to be a shitstorm but for once it might be funny to watch in a grim way - because once the no-win-no-fee boys get in to these polyclinics they are going to bumrape the NHS so badly they'll make a rectal carcinoma look like a fuckin birthday present (to badly misquote Withnail and I).
I can't actually figure out why the govt felt that local GPs in small communities sharing the on call load was unsafe??? surely the reverse was unsafe?
Of course the tragedy is that the Gov will only really, truly realise what good values for money GP was, when it is finally irretrievably destroyed...
Well I'm very interested to see the case law of error by a dual opinion -
- who would be responsible out of Nurse Quacktitioner or Medical Quacktitioner?
Why are we training medical tudents @£250,000 each only to end up as quacktitioners ... and kill their hopes and dreams on the way too?!
well said that man..........at the Hinchingbrooke based Out Of Hours they have G.P's who are coming from Northampton after finishing a shift there to cover this stupid practice......and of course when it all goes tit's up the PCT/SHA & Government won't take the blame and it will be at arms length and the poor G.P & Nirsing staff will carry the can
Lord Dopy and the polytunnel scheme will mess up too, all the patients and staff want is a fully funded service without the political spin and meddling
Leave the NHS alone and fund it properly reduce the targets and let the professionals do their jobs
baffled, in the good old days, junior doctors worked for the deputising service my GPs used (and very good they were**), but I suppose the difference is that this time around, junior doctors may feel pushed into it, the junior doctors who do it will be the disadvantaged ones who couldn't get training posts, and they'll sometimes be acting as 'full GPs' rather than OOH substitutes. I don't though like them being called Quackticioners/'cheap and nasty', even allowing for ranting license.
oops, deleted the ** reference but not the **, sorry.
The training of GPs seems anachronistic. Yes, yes, they've had 9+ years of training, yes, but what relevance or use is simply time served? Better to make it relevant - forget the Krebs cycle, learning all cranial nerves, heroic cardiac non-resuscitations, suturing in op. theatre and all that bollocks. Nurse apprentices is the way. 3 years on the job hospital nursing until at least 21 yrs old and mature, then cream off the most academically able to spend 1 year on *relevant* academic medical study, 1 year on *relevant* hospital understudy and 1 year GP trainee. Bingo, a GP in 3yrs and a lot more medically tuned up for general practice than many current GPs. Then keep them doctoring and not wasting their training on admin/paperwork.
Only 97% of the GPs said they did not have faith in the government.
http://news.bbc.co.uk/1/hi/health/7280995.stm
So 3% DO have faith........presumably, these must include Simon Fradd and the Concordia acolytes ?
Gareth you're a fucking prick. One, that's right, just one consultation for atypical chest pain would make the average nurse quacktitioner shit her knickers - and would take her at least 45 fucking minutes to do.
Fuck off.
Gareth
I hope you don't end up with the GP you deserve, because that means 1,999 other non-wankers will have a shit GP too.
Bob
Well, let me tell you about the GPs my family have 'deserved' to date. I was given long term ABs for asthma when I was 14 by my GP (I was too young to self-diagnose), my brother at the time was suffering bog-standard teenage angst and was labelled "schizophrenic" by our GP to my mother's terror. Bogus, there was nothing wrong with him. A while later, different family doctor, my sister was given penicillin for her glandular fever -> severe allergic reaction, she literally turned purple. Same GP prescribed 1 month of 23 hours-a-day traction for my mother's back pain (not GPs fault, but bloody idiotic medical 'wisdom'). Few years back, I had to educate my consultant dermatologist about the new immunomodulator drugs eg protopic. My father, wisely, always steered clear of doctors. Finally at 75 got nose bleeds, big loss of weight, and pain in shoulder (in my absence, I learned all this later) and the fucking GP (another one) did not even take a simple blood test until he collapsed month later and was taken off in ambulance. It was primary liver cancer, so he couldn't have been saved anyway, but WTF, I think a nurse (or work-experience) could have done better.
I've found GPs to often be fluffy, personable chaps, and blundering along as best they can. But as for medical expertise or useful knowledge? - no, little sign of that in our family's experience and certainly not worth £100k.
Ah yes, forgot the brother-in-law also. Few years back his cardiac pain was 'assessed' by his GP and he was sent away. He was later "blue light" admitted as patient for emergency bypass surgery at John Radcliffe. The GP came round to their house afterwards to apologise, but got sent away with a flea in her ear.
Please stop swearing, you fucking moron.
Methinks Gareth's Dad having primary liver cancer could provide some insight into his approach to life.
Gareth old love, we all have stories of crap services and crap people. This is an argument for more and better training of highly competent individuals not for introducing a barefoot doctor service.
Yea, gareth, You can't possibly be using crappy services as a reason to bring in an even crappier one???
Makes no sense!
Dr. Thunder
www.twoweeksonatrolley.blogspot.com
I always thought the reaction to penicillin in glandular fever was benign macular rash and not "severe allergic reaction".
Gareth your saying the consultant Derm was a bit shit too eh?
Did you "educate him" on the drug or did you "demand" that he prescribed it?
Gareth,
1. For reasons previously stated - you're a dick. Your diatribe is ludicrously unfocussed - are you seeking to replace just GPs or ALL doctors with nursey-nurses?
2. Protopic is not (and has never been) an immune-modulating agent. Perhaps you're thinking of imiquimod (Aldara)? It's not even a particularly effective (or cost-effective) treatment, so say the data.
I do hope your consultant covered your 'helpful suggestions' with emollient for easy insertion where the sun shineth not.
Chris
What about the 'GP assistants, those biology BScs who will be graduating in around a years time after only 2 years postgraduate training? They too will be competing with junior doctors for these non training gp jobs? What mess!
DrChris: "Protopic is not (and has never been) an immune-modulating agent."
You betray your ignorance, and confirm my views of many doctors on this forum's over-inflated sense of their *relevant* knowledge. Have you heard of google? Type in protopic and immunomodulator/ immunomodulatory and educate yourself, as we taxpayers have the right to expect you to be.
I hope you're not a dermatologist. to a patient (me) having to tell his consultant about these new drugs, (which ) ? I didn't want them, I was just asking what he thought of them and was shocked that he knew nothing about them, months after they'd been released in UK. But what is your reaction - dismissiveness. I just wish I could stop a penny of my taxes reaching your pocket. :-(
"I always thought the reaction to penicillin in glandular fever was benign macular rash and not "severe allergic reaction"."
Well, pardon me for not having the benefit of your 250k's worth of medical terminology
"Gareth your saying the consultant Derm was a bit shit too eh?
Did you "educate him" on the drug or did you "demand" that he prescribed it?" - see reply above.
It seems only rants in one direction (towards the govt) are acceptable on this forum. Much/most of their policy on health is misguided and wasteful, but we are all, in our own ways, incompetent. Humility all round would be a good thing.
Long-winded doc said: "Gareth old love, we all have stories of crap services and crap people. This is an argument for more and better training of highly competent individuals not for introducing a barefoot doctor service."
Yes, but this involved 4 different family GPs (out of a total of not that many) and 2 hospital docs. Yes, I am indeed arguing for better training - *relevance* being the key point here. I've heard GPs themselves say they spend 5/6 years at med school, then chuck away 95% of what they studied, then do hosp. medicine for 3/4 or possibly many more years, then chuck away %90 of that experience, then finally learn to be a GP on placement. Doesn't anyone else here think this is a dumb way to train a primary care professional?
Hey you were the one who was telling me what they did...if you don't have a clue then don't start a rant you can't back up.
To be fair you do sound a like a bit of a dick.
So what if yo uwere given long term ABX as a kid? were you on a prophylatic dose as you got regualar chest infections?
Your mother got the "medical wisdom" not a crap GP opinion, and your sister was not hurt in any way.
I'm sorry about your dad but did he just get sent away with a box of tissues? Did he get reffered?
Maybe you should try to arrange some "shadowing" which may make you realise why a 3 year on the job scheme would not turn out even semi decent doctors.
The technical quality of GPs in this country is very poor. Perhaps 60% should be relegated to reception/filing which corresponds with other professions. There aren't any adequate checks or balances to protect the public from GP incompetence. Employing graduate nurses as GPs won't make any difference to quality but it won't make things any worse. There is a still a class system in the NHS which presumes doctor invincibility. I blame the patients for their gross ignorance.
Gareth,
Protopic is tacrolimus cream. As in the same immunosuppresant drug used in organ transplantation.
It works by inhibiting T-lymphocyte proliferation and function. It is an immunosuppresant. It's expensive, and probably less safe and/or effective than corticosteroids.
This is in contrast to imiquimod, which modulates the immune system into getting all fired up to attack whatever you want something unsavoury attacking - be it HPV or squamous cell anomalies.
Get over yourself. You're only venting your spleen at doctors because it's en vogue, and for these 15 minutes someone might actually listen to your ill-informed shit.
Chris
So, DrChris, you sound like you're ungraciously backtracking on your previous statement about protopic never being an immunomodulatory agent, I'm glad you've educated yourself. Just to make it clear, this is from the first google result (from medscape.com)
"A major breakthrough has occurred in the treatment of atopic dermatitis with the development of 2 new topical immunomodulatory therapies. Tacrolimus (Protopic) and pimecrolimus (Elidel) are both nonsteroidal anti-inflammatory agents ....."
"if you don't have a clue then don't start a rant you can't back up."
I was 15 at the time and not Dougy Houser MD. My sister had an allergic reaction, and it gave her severe discomfort. So, I joined the terms together to give "severe allergic reaction". If I was a GP and cocked up by misusing a medical term, I should rightly be fired - but I don't expect I would be.
"So what if yo uwere given long term ABX as a kid?"
I can't respond to that, as I can't take it seriously.
"were you on a prophylatic dose as you got regualar chest infections?"
No, wheezing from constricted tubes - from things like dust (house dust mite), exercise, winter cold. I did get bronchitis a couple of times, resulting from the untreated asthma.
"I'm sorry about your dad but did he just get sent away with a box of tissues? Did he get reffered?"
Thanks. Yes, he got sent away a few times. The nose bleeds got to the point that he pitched up at the OOH centre one sunday. The doc there palpated his enlarged liver, took a blood test and he got referred by that doc on the result of the blood test.
"Maybe you should try to arrange some "shadowing" which may make you realise why a 3 year on the job scheme would not turn out even semi decent doctors."
Or it may be interesting to look at how other countries train primary care doctors. Cuba and Kerala have more effective helathcare than the States, for example. I actually had treament once in Havana for an eczema flare up - very impressive. Which shows that more cash or years spent in university aren't necessarily the answer.
I don't dislike GPs, not at all. The ones I've met in their sugeries have (nearly) all been unfailingly personable and good at being the patient advocate. It's their technical/medical ability that often seems sorely not up to the job.
Blimey, Gareth, you really are an ignorant fuck.
You ignorantly quote stuff copied and pasted from google that you don't understand, and claim (without any sign that you see the irony) that this shows that GPs are 'ignorant'.
You make statements like 'severe allergic reaction', admit that you don't actually know what this means (medically), and yet you suggest that doctors are ignorant.
When challenged, you say that you have an excuse for your ignorance because you are not a doctor. However, this does not stop you from attacking doctors and making suggestions for medical education based on zero knowledge.
What is this, 'bring an stupid loud opinionated fuck to work' day?
Gareth - you regale the assembled throng with a fine collection of anecdotes from what is clearly a long and fruitless life. Most of the doctors here are inevitably far too young to recall a time when traction was the mainstay of back pain treatment, but hey, you're a "civilian" so what you think after reading the latest New Labour propaganda in your Daily Mail MUST be true. After all one anecdote really does make a Virgin Healthcare summer if twats like you are to be believed.
The flaw in your argument is a simple one - indeed your diatribe is a simple one. It all happened a very long time ago, and it's amazing how clear things become with a retrospectoscope stuck to your eye as you plainly admit.
Put whatever spin you like on it, but don't fucking rant at GPs, and don't fucking generalise about them on the basis of a few whining bleats from your past, unless you've tried dealing with smug, smart-arsed cunts like you for 20 years, trying to spot the serious condition out of the thousands and thousands of trivial, vague and garbled stories people come up with. It's very sad when serious things get missed, but given the wealth of humankind GPs deal with it's a wonder anyone ever gets diagnosed. But you knew that anyway, didn't you?
Dr Rant said: "You ignorantly quote stuff copied and pasted from google that you don't understand"
You show you're own ignorance. Google is a *search engine" - I didn't copy it from google, but from medspace. Look it up, the quote is from dermatolotists at the American Academy of Dermatology. If you think protopic is not an immunomodulatory agent, then you should take it up with them, not me.
My point about my sister was that her glandular fever was inappropriately treated - why go on about me (a non-doctor) using the wrong terminology? I hesitate to descend to your moronic use of bad language (where *were* you educated?), but it's tough. I am not a doctor, so will never attempt be treat glandular fever, but I expect well-paid professionals to (mostly) know what they're doing.
BTW I haven't worked in biochemistry in ages, but have a IIi from Bristol in that. 3 grade As in science A levels from way back, when that really meant something. So, I may be too "ignorant" to know all medical terminology, but "thick" I am not.
"The flaw in your argument is a simple one - indeed your diatribe is a simple one. It all happened a very long time ago,"
Yes, most were a long time ago, but dad died 7 years ago and my brother-in-law bypass was 8 years ago, and I see plenty more current examples with friends and neighbours. Yes, GP work is very difficult, I can imagine that and so those who do it should be better prepared/trained or encouraged to leave the profession if they're not up to it.
Things like traction and ABs-for-everthing have been reduced over the years by EBM. But what started off my diatribe was Dr Rants post on ADs (and I know what humour looks like, and that was a v.poor example). It seems like this site doesn't care about EBM and was quite happy for the NHS and the public to be fucked over by big pharma and to collude with them in that. ADs are just one example, how many other drugs are involved in the clinical trials scam?
PS "anonymous" why not use a tag or something, easier to see who said what.
You ignorantly quote stuff copied and pasted from google that you don't understand
dr rant, I, too, Googled Protopic/tacrolimus, imiquimod, and immunomodulator. Tacrolimus is it appears an immunosuppressant (netcodctor calls it an immunomodulator) imiquimod an immune system stimulant (it is of course also called an immunomodulator).
Here's cancerweb's definition of immunomodulator:
http://cancerweb.ncl.ac.uk/cgi-bin/omd?immunomodulator
What a bloody fanTASTIC blog!! To all concerned, although I'm no medic, I absolutely endorse and whole-heartedly concur with Dr Rant & crew! "The dumbing down money saving life taking shit faced arse for brains fucks are" (indeed) "at it again" . . and as Rothdoc says, the tragedy of it all, is that this pathetic, shambolic group of fuck-whit wankers who call themselves "Nuuuuuu" Labour will clearly only realise the havoc they're wreaking when everything (literally) is irretrievably destroyed.
Keep up the good work chaps!!
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