By George He's Got it!

At last, the mainstream media have started to look underneath the the Government's thin veneer of spin-laden bullshit than normally gets repeated verbatim in the press.

However, it doesn't come as a suprised that the person who is at last questioning Darzi's 'Polyclinic evolution' is George Monbiot in the Guardian:

So why is this happening? In seeking to surreptitiously privatise healthcare, the government has a problem. Primary care is already in private hands - GPs run their own practices. But they are the wrong hands: the corporations demanding guaranteed streams of income from the taxpayer can't play in this field. Polyclinics are perfectly designed to let them in, while preventing doctors from competing.

Fuck me, He's Got! I really think He's got it!

George is something of a rarity in modern Britain, where intellectual exertion is regarded as 'discriminating against thick people'. He's a true independent thinker, and as such should be regarded as a national treasure. Having said that, he does occasionally come out with some really crazy shit! However, if you could stuff the whole concept inside a nutshell, Monbiot would would be the king of the fucking squirrels.

Joint Guidance on Protecting Electronic Patient Information

It looks like CfH and others are getting worried about electronic patient data security. Here’s the latest guidance on the issue from BMA and CfH.

It seems that recent articles raising significant questions about CfH and its security may have hit some hot buttons of concern amongst CfH workers.

Anyway there is now a “policy” and a “strategy” and a “code of practice” and a “monitoring group” (Information Governance Group) and a “guarantee.” Harry Cayton, Quangocrat extaordinaire, will be in charge.

So that’s all right then. No need for 93c3 after all.

There is a rumour that CfH will be abandoned just before MP’s summer recess this year. Maybe a good outcome is yet possible for a Darzi review? Or perhaps CfH could recover in the computer polyclinic?

NPfIT: an update

All I can say is: thank fuck Labour aren't in charge of the breweries as well.......

At the Ranting House we are far from convinced about the effectiveness or safety of the National Programme for IT (NPfIT) (or Connecting for health (CfH) if you prefer its new name. Windscale or Sellafield…does it make it any better?)

However new reports in the magazine Pulse, are showing the wheels coming off even further. Staff are leaving in droves, following the example of the malignant Mr Granger last year. And the government’s chief information officer Matthew Swindells is going soon too. They are advertising for another, but Lady Bracknell will haunt the appointment. To paraphrase, “To lose one CIO is poor, to lose two begins to look careless.”

Meanwhile “evaluations” are being delayed, by up to two years although their results are being “anticipated”

Oh well, it all makes work to spend £20 billion of taxpayer’s money on. We wonder who they’ll consult to get them out of this hole?

GPs currently would happily bury this government in its hole, and we have yet to see any benefit from CfH in practice.

Oh and government data security is about as effective as the Maginot Line.

This statist government is serving up another New Labour disaster- the combination of high cost with low effectivenes. Poor value whatever tax band you are in. Oh and all ladled out with grand promises, sweeping arrogance, contempt for what has gone before, and total ignorance of what is necessary.

A reply to Bernard Ribeiro

Bernie: The hardest Workest man in surgical show-business, yesterday

From our Surgical Correspondent Mr Nathaniel F Salmon FRCS


Another day, another spam email from Bernie at the Royal College of Surgeons.

"Over the last few months I have been working, through the Modernising Medical Careers Programme Board, on a proposal to secure a new scheme to enable some junior doctors, who have achieved their CCT, to acquire new skills in the treatment of rare or complex surgical conditions. There are identifiable gaps in the provision of surgical services in the NHS and I am pleased to say the DH have recognised the need and have allocated funding to support over 70 clinical fellowships for one year."

Right. So, reading between the lines, Bernie realises that MMC will churn out crap consultants. So crap, that they will need a further year of training to do the jobs that previous newly qualified consultant surgeons used to do.

"I would not support any measure which would lead to a two-tier consultant service. I am aware of the concerns of ASiT and BOTA who feel that this scheme will lead us down the sub-consultant route. I do not believe that this is the case, these fears are unfounded and I, and indeed Council, would not support a scheme which led to a two-tier system."

So, if these surgeons are not trainees, but are not yet consultants, then what are they? Oh, yeah, that's it. They're sub-consultants.

"Anything that promotes the uptake of surgical innovation within the health service has to be good for patient care. It is entirely consistent with our aims of ensuring the highest standards of care for patients."

Hang on. The RCS have supported MMC and MTAS at every stage, until it was obvious that it was a colossal fuck-up. And even then, our mate Bernie mumbled meekly that it was a jolly bad thing, and that something probably needed to be done.

And so, under his presidentship, hundreds of juniors doctors ended up having their careers utterly fucking ruined. Many of these doctors had passed the membership MRCS exam, and as members, were paying the RCS hundreds of pounds, and therefore Bernie's wages. At any point, the RCS could have withdrawn totally from MTAS/MMC, and scuppered the whole process. The resulting chaos would have still been better than the bullshit that was MTAS round 2 and then son-of-MTAS.

And following this miserable capitulation to Her Majesty's Government, he then goes to to tell us that MTAS doesn't even train doctor's properly.

Well, fuck the Royal College of Surgeons. And fuck the other Royal Colleges. Fuck MTAS. And fuck the 'sub-consultant' grade. How long will it be until every wannabe surgeon has to complete one of these fellowships? How long before the fellowships become two years? How long before there are post CCT 'Staff Fellows'?

Bernie, my old chum. You have presided over the RCS during the worst ever crisis to hit junior doctor training. And you are failing to notice the next great betrayal that HMG are unleashing. When the junior doctors of ASiT and BOTA tell you that the whole tits-up situation is about to go even more tits-up, well, maybe they might have a point. After all, it is their careers that are threatened.

So, Bernie, what are you going to do?

Oleaginous Scottish Git

Image from Beau Bo D'Or.

Dr Rant has never thought very highly of Des Browne, the oleaginous Labour Defence Secretary. He has never understood how Mr Browne has managed to ooze his way so highly up the greasy pole, despite having so little obvious merit. Or maybe this is just normal for New Labour? The Military can’t understand how he got there either. His approach to information is that Pravda would do it better.

Anyway I hadn’t realised he’d specifically acted against doctors. However it’s now clear, from the report at this link that he wanted to reduce GP practice income to reduce NHS cost pressures.

Bastard.

Another new Labour bastard.

More dead cheap patients

Image courtesy of 'ECG Made Piss Easy'*

This time it's an 'electrocardiogram' machine.

This clever gizmo can now be used by GPs. So long as they have a phone-a-friend nurse to show the pretty pictures it makes to because, you know, GPs are way too fucking stupid to read an 'electrocardiogram' themselves. Even if modern ones actually print out the diagnosis in ENGLISH at the top.

This is saving lots of money because:

The only way to get a proper diagnosis is with an Electrocardiograph (ECG) - a machine which monitors the patients heart rhythms, which means a time-consuming trip to hospital.

The only problem is that THIS ENTIRE STORY IS A TOTAL CROCK OF SHITE.

For a start, the 'newfangle electocardiogram was invented in 1862. GPs have been using them in their surgeries for decades, and - get this - A NORMAL ECG DOES NOT EXCLUDE A HEART ATTACK.

In fact, as any fresh-out of medical school doctor could tell you, relying on a normal ECG to rule out a heart attack is really good way to kill your patients.

But, then, this government is not interested in saving patients. It's interested in saving money.

* Not only is this not our own image, but we nicked that joke as well - Unapologetic Ed.

'Best doctors' are the ones that save money, not lives

The Perfect Doctor yesterday: Saving Planets without referring to A&E

Well, don't say I didn't tell you so.

To save money, the OOH firms are going to punish doctors who talk to patients, visit them at home, or refer them to hospital.

In the email, Dr Reynolds said: "We have to make this reduction to balance our budget, but also to try to get the most cost-effective use of our valuable doctors. "I hope everyone can understand why we are adopting this approach. 'Dr Anxious' can produce more than twice as much work for the system as 'Dr Perfect', and 'Dr Refer-alot' can send four times the average to 999 or to hospital."

Do you see how scary that is? Dr Perfect is the one that KEEPS YOU AT HOME WITHOUT VISITING YOU! Who gives a fuck if you die of a heart attack or burst ulcer? We're SAVING MONEY FOR FUCKS SAKE!

Because, of course, dead patients are soooo much cheaper.

Long live capitalism!

Death to the sick and infirm!

Ex-BMJ editor fails to declare conflict of interest

Half human, half conflict of interest = 100% wanker.

Richard Smith, ex-communist and ex-British Medical Journal Editor, is spouting in the Guardian about:

Healthy bank balance
As an ignorant young communist I deplored the profit motive. Now I know better. It's by far the best way to deliver healthcare.

What Dickie fails to point out is that it is HIS bank balance that has become more healthy from private care. He is now a senior person at the private health care firm United Healthcare Europe which is keen to make further inroads into the NHS.

The fact that Dick 'Citizen' Smith has decided to say 'fuck you mother-fucking prole tosspots' to the poor punters in exchange for a healthy bank balance is one thing, but to NOT DECLARE IT is unforgivable.

Oh, and the research shows that 'not for profit' hospitals have lower death rates than 'for profit', so the bits about all NHS workers working for 'profit' because they get a wage is total fucking bullshit.

Nasty, horrible, little man.

DoH wants dead patients so long as the minority of selfish bastard cunt patients are happy, stupid fucks

The Department of Health is truly run by a battalion of lying, evil, malignant cunts.

Take the very sensible policy of limiting the number of medical conditions that can be safely dealt with during a 10 minute consultation.

The Sunday Times, that bastion of sensible reporting (foaming at the mouth twatathon merchants), is reporting:

FAMILY doctors have put up signs in surgeries banning patients from discussing more than one ailment per appointment.

The aim is to hurry along consultations so that GPs can meet government requirements to offer patients appointments within 48 hours.

No they fucking are not, you lying scum. Dr Rant also notes that this piece is another addition to the portfolio of shite written by Sarah-Kate Templeton who was ejected from Doctors.net's media forum last year for unethical behaviour after doing this 'cut and paste context lite' hatchet job. Lazy tart.

Over the last few years, as our society has become increasingly infiltrated by jumped-up narcissistic tossbastards, GPs have found that more and more patients turn up with a list of 15 problems which they want sorted. They will happily sit there for an hour or more, without ever giving a thought to the patients that are having to wait to be seen beyond their appointment time. Add to this the fact that these selfish flibs are the self-same people who complain about being kept waiting before unrolling their list of demands, and you can see why GP might want to put up a few signs. Dr Rant would prefer a session of waterboarding at Guantanamo for the offenders, but apparently that's illegal.

The lying harpies at the Department of (Crap)Health(Care) then ooze out their usual suppurating, putrid breath and produce this poisonous bile:

This weekend the Department of Health condemned the restriction and said it should be withdrawn. It said GPs, who earn an average of £110,000 a year in England, were paid enough to make time to listen to patients who have more than one illness.

Encourages everyone to complain about their GPs?

Assuming the £110k lie-jibe is just the press masturbating witlessly over their latest flogged fleshless hobby-whore, it still leaves the lie that THERE ARE ONLY SIXTY SECONDS TO EVERY MINUTE you stupid, souless, evil cunts.

Promise everything to everyone and blame the GPs when the laws of physics get in the way, that's how these putrid little maggots think.

Die, fuckers, die!

Shit patient care bores MentalNurse

Crippen rightly bangs on about how shit nurse training is, and how shit nursing is today. It's a national disgrace that leaves thousands of patients lying in their own shit, piss, blood, and vomit for days on end while nurse sit and do pointless paperwork.

Apparently the fact that shit nursing means degrading, shit care for patients bores MentalNurse:

Dr Crippen reckons he’s got the answer, in the form of an email from a “soon to be ex-student”, allegedly, complaining about the nature of her course. Apparently, there’s too much “theory” (don’t know what of), not enough information on sticking tubes and needles into people and - oh the horror - far too much emphasis on communicating with patients. Something like that. I glazed over, I have to admit, as we’ve all heard this sort of stuff time and time and time again.

To recap: the secret of caring for the patient is caring for the patient.

A fact that MentalNurse seems to have forgotten.

[The rest of the MentalNurse post is well worth reading as it rightly raises issues about bullying and lack of pay - Ed.]

Lying bastard politicians. Kill 'em all!

Here's an interesting comparison for aficionados of the art of saying two exact opposite things at the same time without batting an eyelid (or 'being a lying bastard politician fuck', as we like to call it here at Team Rant):

GP surgery extended hours:
86% of patients are satisfied with the current opening hours.

Problem: 14% of patients would like more convenience.

DoH take: This is a shocking reflection of the crap level of care in General Practice. GPs are lazy, worshy, bastards who need to be brought to heel by unilaterally changes to their contract with a fucking gun to their heads.



Quality of post-2004 Out of Hours GP cover:
84% of patients were satisfied with their care.

Problem: 16% of patients are fucked up by piss-poor medical care out of hours, resulting in pain, suffering, debility, and death.

DoH take: The service is working well.



Fuckers.

Homeopathy Home Truths

Dr Rant was most amused by this weeks column by Dr Phil Peverley in 'Pulse'.

‘Why don’t you do homeopathy at this surgery?’ she asked.

I don’t normally get involved in arguments about homeopathy, because people who want to argue in its favour are, by definition, people who cannot manage a rational argument, but she was provoking me.

‘Because it’s a crock of shite,’ I told her.

He's a good lad that Peverley, and well worth keeping an eye on.

In Memoriam

Who really needs a check up?

Don't worry Prime Minister, we'll have that new health policy out of there in a jiffy.

So we all need a shiny new health check do we? Well we for one, and several others judging by the Telegraph readers’ comments, think we don’t even if Francis’ plethora is worsening, and his BP has reached 220/120! Actually for Francis writing this blog is one of the most splendid anti-hypertensives ever found.

On here we think there’s an absurdity to the government’s latest wheeze (recycled from, if I recall correctly, 2000 and 2004) to get everyone to have “health MOTs”

We need to face facts, and this Lif of Brian/Spamalot lyric might be a good place to start from:-

“For life is quite absurd
And death's the final word
You must always face the curtain with a bow.
Forget about your sin - give the audience a grin
Enjoy it - it's your last chance anyhow.

So always look on the bright side of death
Just before you draw your terminal breath

Life's a piece of shit
When you look at it
Life's a laugh and death's a joke, it's true.
You'll see it's all a show
Keep 'em laughing as you go
Just remember that the last laugh is on you.”

Look, life’s a one hundred per cent fatal sexually transmitted disease. There’s a lot of it about, and we’ll none of get out of here alive. As Dr Blue said on the Telegraph website,

“Trying to avoid death is a very unhealthy way to pass the time before it catches up with you.”

There’s something wrong with the belief that you need to see a doctor to know that you are healthy. Doctors deal in illness and the many ways in which we go wrong mentally and physically. Very few doctors have any positive vision of health. The NHS as an institution has no vision of health at all.

Trying to avoid illness is not a healthy pursuit. Being free of disease does not make you healthy. Being healthy makes you healthy.

Sloth, gluttony, debauchery, anger etc do make you ill. The seven deadly sins are deadly…but did you need a doctor to tell you this? For most of the time doctors acknowledge their patient’s poor lifestyles, and treat them as well as they can around this. As Mencken puts it,

“The true aim of medicine is not to make men virtuous; it is to safeguard and rescue them from the consequences of their vices.”

There’s something odd about this mania for health checks, and that’s before you get into the practicalities (time, money, blood bottles, result handling, follow up etc)

In hospital medicine we used to spend a long time working out fluid balance, and potassium levels on seriously ill patients. They still died…but their potassium level was normal. We’re reaching a stage with these health checks where everyone will die, but their blood pressure and cholesterol will at least be normal! What progress.

At The Dr Rant Foundation^TM we’re puzzled by this latest wheeze on the NHS. It couldn’t be a distraction to satisfy the worried well away from service failings in dentistry, obstetrics, oncology, obstetrics, hygiene could it?

Anyway as a proactive measure and in good spirits (with normal blood pressure) we are next going to do a health check on this government.

Pharmacists could, you know, do doctory thingies...

Now nurses staying dangerously into diagnostic areas is bad enough, but the government now thinks that pharmacists are an 'underused resource' that could be doing the job of GPs.

Fucking helski (as the Devil would say), why not just get the porters to do surgery while you are at it?

The research shows that pharmacists get the diagnosis wrong FIFTY PERCENT OF THE TIME.

FIFTY FUCKING PERCENT

That's monkey random chance levels of success.

I mean, get the bulk order in for body bags now. The only questions to ask your pharmacist are 'can I drink while I'm on these antibiotics?', 'are you sure you can read my doctor's handwriting?', and 'which way to the nearest doctor, my completely and wholly non-medically trained friend?'

What a bunch of wanked out, tossed over, cuntronic, shit4brains, flying fuck at a moving dougnut arseholes.

NuLabour? FUCK OFF YOU STUPID CUNTS!

Misogynistic bastard BBC bad for Britain

Fuck me, the BBC are at it again.

I don't know which prick they have subediting their headlines, but they just keep producing these tabloid topics which bear no resemblance to reality, or even the article they herald.

The rising number of female doctors is "bad for medicine", and universities should recruit more men, a GP warns.

screams the BBC this time.

Er, no.

The doctor actually comes closer to saying that Britain's misogynistic and outdated working patterns mean that women are unable to fulfill their potential; wasting their talent and our money:

"The main thing we need is a revolution in the attitude of society towards childcare and who has the responsibility for childcare.

And that there should be equal numbers of men and women in medical school (not 'more men'):

"But I think medical school numbers should reflect society generally and we need a more even split between men and women."

So, "working mother unfriendly society 'bad for medicine' says top doc" would be my suggestion. But the modern day public service broadcasters don't believe in accuracy anymore: they're more interested in maximising the traffic to their various multi-media portals of consumer throughput. Fuckers.

I like you so much. I really do. It's just a shame you're useless.

Lets return to the subject of the research that Mental Nurse brought up:

But research shows that patients are at least as satisfied, and in many cases more so, with the care they received from a nurse practitioner than from their GP. Nurses score better on communication and make better and more complete records in many cases than their medical colleagues. In a paper published in the BMJ, researchers from the department of Primary care at the University of Bristol, led by Dr Chris Salisbury, wrote:

“Nurse practitioners seemed to provide a quality of care that is at least as good, and in some ways better, than doctors.”

Don't get me wrong. I think it's great that people like nurses. It's nice to be liked. But as a measure of effectiveness and safety, patient satisfaction ratings are worse than useless.

Was the person that treated you a safe, effective provider?

Well, they were really nice. They listened to me, and they had really neat writing.

Being nice does not make you a good doctor. It makes you a good friend. Or neighbour. Or pet. But it does not, by itself, make you a good doctor. It makes you a popular doctor (or noctor).

A great example of this is our old friend Harold. You see, Shipman - the most successful serial killer in UK history - was an incredibly popular doctor. On patient satisfaction scores he was off the scale. He did the patient's shopping for them. Ran errands. Visited them at home and sat and chatted for ages. Oh, they loved old Harold. (Even when it was clear to the rest of us that he was guilty, there were patients organising petitions of support for their much loved GP).

You see patients are stupid. I should know, I've been one often enough. I've also seen enough incompetent doctors get away with terrible care because their patients liked them, and I've seen plenty of apparently excellent doctors who were in trouble because they were grumpy bastards. Research shows that the chance of a doctor being sued is unrelated to the doctor's clinical outcomes: it is directly related to how popular they are.

Of course we would all love to be treated by Dr Kildare - competent, safe, and gorgeous. But given the choice of being treated by a nice incompetent or a grumpy genius, I know which I'd choose.

A fuckwit by any other name is still a fuckwit

Mental Nurse has an interesting post on the ongoing debate regarding nurses doing doctor's jobs.

Mental Nurse is upset by Crippen's view that nurses who provide diagnosis are 'off piste' and are acting outside their area of competence: they don't know they don't know.

The research that appears to be quoted to defend the performance of nurses is based on the idea that professions that operate on expert knowledge are unable to spot their own crapness. I'm not sure whether Mental Nurse thinks this brings to the debate, but it seems like a pretty fucking stupid line of reasoning to me.

Let me make things simple:

Diagnosis requires expert knowledge.

Someone that diagnoses medical illness is a doctor.

When a nurse takes on the role of a primary diagnostician, s/he becomes a doctor. (If you have wheels, run on a track, and pull carriages you are a train. If you adapt a car to run on tracks it becomes a train: maybe not a very good train, but a train nonetheless.)

A nurse who takes on primary diagnostic tasks is either (1) going to require the expert knowledge of a doctor, or (2) going to be a very shit diagnostician.


Finally, only a total spaktard would think that 'patient satisfaction' scores are a reasonable assessment of clinical competence. Patients have fuck all idea what is good medicine and what is dangerous medicine. (Presumably if they received lethal medicine they would not be around to answer the questionnaire, which is a bias right there).

The fact that the punters thought the nurse was nice is of absolutely no fucking use whatsoever. I'd rather be DIAGNOSED by an obnoxious bastard who knew what they were doing than by the nicest nurse in the world that did not.

But then isn't that just like a nurse: thinking being nice IS the job.

You don't need an expert to know that the best bet by far is to be diagnosed by a doctor that has actually been to medical school rather one who has not (whatever they call themselves).

Anyone who has been to any nursing lectures will know that nurses are taught to distrust doctors, who are systematically belittled and denigrated in nursing teaching.

I think the abused have become the abusers.

Birthday Coup

Comrades, Frank Rant is 60 today!

Born April 1st, 1948 and only a few years till retirement, but still going strong.

Some of you may have been worried to wake up to find tanks on the lawn, but Dr Rant would like to assure all the UK's citizens that this morning's coup d'etat was a bloodless one.

The Dr Rant team are now in charge of the country, NuLabour have been rounded up and sent to an upmarket detention center (sort of a cross between Gitmo and a 1968 Butlins).

Dr Rant would like to assure the population that No-one will be tortured and executed, which I think we can all agree is exactly what the sanctimonious little fucker deserves.

Rant HQ is now in Tavistock Square. The first Awkward Squads to arrive at BMA House found it deserted. We are now looking for anyone who was anyone in the BMA. If you see them, do not approach them. They are highly dangerous to the state of your Health Service. Call us, and we'll send someone with clippers round to shave their heads in public. Quisling bastards.

If anyone (note - not No-one) has any suggestions for how the country can be improved now that we are in charge, please feel free to post your ideas below. Please note, we can only reply by email or crayon drawing, as the guards won't let us have anything sharp while we're still in the padded cell.

Long live the NHS!