Morons Undervalue Generalists

For those of you who missed it, in the comments section of the care home piece the following attack on generalists occurred:

For all you laymen out there, keep in mind that GP's, in a majority of cases, acquired the minimum qualification as a doctor because they are either thick or lazy, sometimes both. Consultants regard them as medical accidents waiting to happen. They hold on to patients too long and don't refer to a specialist when they should because they are "generalists" and miss things due to minimal knowledge bases. Most countries are moving away from GP's and demanding that the medical profession modernises. This blog would suggest that we won't get very far down that road here in the UK anytime soon.

When the Shrink and A&ECN came to the defense of generalists, Anon came back with:

GP's are generalists and dangerous. The argument used is one that does not hold water. If specialisation is not needed then why don't general surgeons do neurosurgery instead of puss bellies? Based on your arguments, specialised consultants are a waste of money.

If you want to repair your plumbing you don't leave it up to the electrician. Cars have become so complicated you have to use a specialist mechanic. Medicine has become too complicated and specialised to rely on generalists.

When Dr Rant pointed out to Anon that he might have problems picking the right specialist and posed some examples asking which specialist he would pick, he finally came up with this:

Internest, but of course we don't really have any of those because the medical profession has failed to modernise.

Having pointed out that:

1. Not knowing what a general physician is called makes it pretty difficult for you to go and see one directly.

2. Not knowing that we even have general physicians in the UK would make it a lot harder for you to arrange to go and see one directly.

3. Had you managed to work out (1) and (2) and the delay had not killed you, you chose to go and see a 'hospital generalist', not a true specialist.

4. You didn't know that UK GPs are specialists in primary care. GPs are not just doctors with no extra training who failed as hospital doctors - they receive at least three years of specialist training, including one year as a GP registrar. In fact, in the current NHS there is a lot of competition for places on GP training schemes.

Anon plowed on with:

Lack of expertise and onsite diagnostics make you just as dangerous as the patient self diagnosing. I would much rather cut out the amateurish middle man.

Now while all of the above morons may in fact simply be a single troll, the level of sheer stupidity is hard to ignore.

Anti-Darwinist NHS and the Fuckwit Epidemic

I had a rare moment of clarity reading the comments on this blog from Trollonymous/No-One/Anon/NHSIsKillingUs/Anit-Rant this morning: the NHS is anti-Darwanism in action.

We have been keeping stupid people alive by discouraging them from making terrible medical choices. People like Trollonymous/No-One. They are basically morons. Fuckwits. And their health care 'choices' are so incredibly stupid, that they pose a massive danger to their own health.

But, that's the price for being a fuckwit. Suddenly, I see it! The reason that we have an epidemic of fuckwits, is because of the NHS! We've been keeping them from killing themselves from stupidity. Sure, they can still get drunk and drive into a tree. They can still bankrupt themselves with stupid money choices. But, we are keeping more of them alive than ever before.

The NHS is the a Fuckwit Salvage Unit. We are stuck with Trollonymous/No-One and the increasing legion of tosspots because we saved them and their parents from Darwinian extinction.

What have we done?

NPfIT: another wheel falls off.

This week it’s Fujitsu who decide they cannot do business with this government.

Stephen O'Brien, a shadow health minister, summarises the unfolding debacle well, saying that the government's attempts to "ram through a top-down, centralised, one-size-fits-all central NHS computer system" has come "crashing down around their ears".

The Mail catches on too

A severe case of plumbum oscillans

Swinging the lead. A British disease of the highest order. No one can be unemployed any more. Unemployment is clearly an illness and so if you lose your job (or never have one) then you must be sad, which is depression, which earns you medical label and so a medical certificate and so incapacity benefit.

Even the government has realised the lunacy of this. So it has started doing medicals on the people on incapacity benefit, and seeing how many of them can be enabled to return to work. It’s got in a French company ATOS to do them.

But its rigged the rules so that nothing will be achieved. People taken off incapacity benefit complain loudly and long about the injustice of it all (sometimes rightly, sometimes wrongly.)

The rules ATOS operates under in part measure how many complaints they generate. Yet if they do the medicals with sufficient rigour, they will get complaints.

One doctor has broken ranks and this piece in Mail on Sunday shows exactly how stupid the system is, and how much taxpayers money will be wasted. The doctors at ATOS are on a hiding to nothing if they do their job at all properly.

The government will no doubt say its contract with ATOS is an example of successful private- public sector collaboration.

This current government always lies, which is why its current problems are due to world economic problems and mid term blues. Credo est, quia absurdum.

The Political Wing of the GMC

The proposed changes to the GMC are deeply worrying.

Not only is the medical profession going to be controlled by politicians who will in the future appoint GMC representatives (causing one BMJ writer to compare the changes with what happened in Germany in 1933), but they have added new advice this year which makes it unprofessional to:

express to your patients your personal beliefs, including political...beliefs, in ways...that are likely to cause them distress.

In theory, this means that when patients come in and ask me 'is the NHS in trouble, Dr Rant?', then I am unable to truthfully tell them 'Yes, thanks to the bastards in power we are all fucked' because that would be (1) a political view, and (2) distressing to the patient.

Instead, I have to say: 'I'm sorry, but I couldn't possibly comment'. No doubt it will soon be acceptable only to say: 'The NHS is having it's best year ever! Ve vill all live forever! Heil NuLabour! Heil NuLabour!....'.

I don't know about you, but I'm off to practice my mad, zealot stare and stiff armed salute.

Meanwhile, 'Care' Home Nurses continue to plumb new depths of depravity.

Since nursing homes were 'hived off' from the NHS and given to the private sector, the standards have gone from underfunded dodgyness, through criminal, and are currently passing mindless inhumanity.

These two 'nurses' are a fucking disgrace.

What has happened to 'care'?

Oh, of course. The private sector got it's hands on it.

We gave patients the money to choose where to go.

No-One and DK are fucking morons to believe in the 'private' sector can do anything other than find better ways to kill people for money.

Nurses deserve immediate 11% pay rise, you bastards

Not content with running down staffing levels, running up patient throughput, aiming for lethal 100% bed occupancy rates, and putting huge numbers of new nurses on the scrapheap (where they should get a good view of the NHS sinking like a fucking stone with all lives lost), the fuckers are underpaying nurses by 11%.

This is not limited to nurses, of course. All front line NHS employees work many more hours than they are paid. That's why every time those fat, sweaty useless fucks that call themselves 'politicians' negotiate a new contract to 'control' us, they find out that being paid for the work done means a big pay rise for no extra work. Stupid fucks.

I guess if you are a useless, lying, narcisist in a suit you might find the idea that almost everyone works flat out, often for free, for the good of patients a tad hard to swallow. A few days on the wards would kill most non-NHS workers from sheer fucking exhaustion.

Still, at least being at work unpaid and overworked leaves you less time to dwell on media stories about how public service workers are all inefficient, overpaid, underworked, lazy, useless fecks.

I really, really fucking hate those bastards.

ChoiceTM, Targets, and Fuckwittery: Dr Grumble breaks cover

Doc Grumble has broken cover to post on one of Dr Rant's favourite topics: the patient-damaging, top-down, Stalinistesque, totally fucked-up bullshit that is the NHS Run By Twats.

As dates were being discussed for the patient's appointment the clerk explained to the patient that the appointment she wanted would not be possible. It was too far ahead. We have targets to meet. Patients have to be seen within a certain time whether they like it or not. There is no patient choice in this whatsoever. Now isn't that just mad.

Mad?

Totally unfuckingbelievably cuntastikally barking mad.

Choice™?

I chose not to choose choice. I chose something else.

Fuck off and die, NuLabour!

Working class people 'have lower IQs'.

This is an interesting debate.

The top universities are being criticised for classism for not taking enough people from working class backgrounds.

However;

Newcastle University's Bruce Charlton said fewer working class students at elite universities was the "natural outcome" of class IQ differences.

...

Dr Charlton said: "The UK Government has spent a great deal of time and effort in asserting that universities, especially Oxford and Cambridge, are unfairly excluding people from low social-class backgrounds and privileging those from higher social classes.
"Yet in all this debate a simple and vital fact has been missed: higher social classes have a significantly higher average IQ than lower social classes."
The fact that so few students from poor families get into Oxbridge is not down to "prejudice" but "meritocracy", he said.
Higher Education Minister Bill Rammell said: "These arguments have a definite tone of 'people should know their place'.

Why do people from working class families have lower IQs on average? I would guess that factors such as poor nutrition, poor housing, stress, poverty, poor maternal nutrition in pregnancy, and a higher incidence of alcohol and drug exposure in pregnancy will have just as much effect on brain development as it does on other aspects of health.

So, the real question is why a Labour (ho ho) government that has presided over an exponential increase in the gap between rich and poor thinks the top universities and a professor who points out the obvious are to blame?

Perhaps NuLabour should take a look a litter closer to home and stop talking shit.

The Alcohol Epidemic rages on

The number of admissions for alcohol related illness continues to sky rocket.

The average age of cirrhosis patients continues in free fall.

The cost to the alcoholics, their families, society as a whole, and the NHS continues to grow.

The profits of the alcohol makers continues to grow.

The Devils' plan is to leave the individual to their own devices. Well, if you count being under-educated by a system that would rather you stayed stupid so you can do the medial tasks the Poles won't touch while being bombarded by constant images linking alcohol use to being sexy, interesting, successful, rich, and being guaranteed a life-time supply of tits and ass (or, increasingly, pecs and ass) as being left to a libertarian free-choice.

Yeah. That should work.

Meanwhile, I think I'll drink myself into oblivion. How else is one meant to cope with living in this shit country?

Too Few Nurses. Period. Fuckwit.

There is something wrong with this BBC headline:

Concern at Epilepsy Nurse Numbers

What could it be?

Oh, I know: the word 'epilepsy' is redundant. There are too few fucking nurses. Period.

Yet, despite nurse:patient ratios that would shame Albania, the NHS Fannygers seem to think that hiring less nurses and leaving more and more newly graduated nurses on the scrapheap is the way to go.

Presumably if the hospital only has one proper nurse it makes it easier to keep an eye on whether she washes her hands between patients. Which is unlikely as she is dealing with thirty patients per second because the Bastards That Run The NHS can't be fucked to hire any nurses when they need to money to hire more and more managers and give more and more money to their Corporate Overlords and if she washed her hands properly, which takes more time than seeing three patients, then 75% of her patients would have to lie in their own shit, piss, and vomit.

Oh, wait. That's already happening.

But, no, Epilepsy Pressure Group Wankers, you just blinker yourselves to your own small world.

Fuckwits.

[Actually, Frank, I think it really is a disgrace how few specialist nurses the NHS has - Ed.]

Cautionary tale: how not to use a Noctor

One of our regular readers (not you, the other one) has kindly sent in a link to this GMC case.

Dr Rant always finds GMC cases where the doctor is struck off sad and frightening. Sad, because of the often seemingly pointless damage to the patients (and the doctor) of the doctor's errant behaviour. Frightening because working in a corrupt system which prefers scapegoats to truth, and knowing that every doctor makes a serious mistake at some point, all doctors secretly fear the knock at the door.

The GP in the above case had clearly lost the plot, however. He had not replaced his outgoing partner, and was looking after 5000 patients on his own with the help of a Nurse Practitioner and 2000 pre-signed prescriptions.

The judgment does have a wider message, however. Barking as this GP's Noctor policy was, he had only 5000 patients to fuck up. Yet, many PCOs around the country with millions of patients to look after are either providing or commissioning Noctor-heavy GP-lite services - both daytime and Out of Hours - that are just as deranged and just as dangerous.

Will we be seeing the Medical Directors of those PCOs in front of the GMC any time soon to be similarly struck off? I think not.

But don't feel too sorry for this GP - he did not turn up to the hearing, based on his year of graduation the GP is around retirement age, and he must have been raking in the money with 5000 patients on his books but only a couple of nurses on the payroll. I can only hope the poor nurse practitioner was a better GP than he was. She is unlikely to have made any money from her adventure, but is just as likely to end up with her own entry in the NMC website some time soon.

The nurse always gets shafted.

Oh, and the patients. But, strangely, never the politicians - lay or medical.

The Strange Case of the Mystery SHO

Dr Who?

Here is a strange, sad case.

Relying purely on the press report, the following seems to have happened:

-The patient had a nasogastric tube inserted so that liquid feed could be placed directly into her stomach.

-A check x ray was performed to make sure the tube was placed correctly. NG tubes have a radio-opaque tip, and a check x ray is mandatory because they are inserted 'blind' and can easily end up in one of the lungs - feed in the lungs causes an iatrogenic aspiration pneumonia (ie: an infection caused by a health professional sticking food into your lungs). This is easily fatal, hence the paranoia amongst nursing staff about being absolutely, 100% certain where the tube is before you pour a pint or two of Gold Top down it.

-A male doctor the nurse identified as the Cover SHO told her the check x-ray showed the NG tube in the stomach and to commence feeding.

-The tube was actually in one of her lungs, so when Nursy opened the tap the patient immediately aspirated a perfect bacterial growth medium, promptly developed an aspiration pneumonia, and in due course assumed rigid room temperature (which, as we all know, is Not A Good Sign).

-On checking the notes, no doctor had made an entry about the check x ray.

-On checking the rota, the Cover SHO was a female.

-On checking the X ray logs, the doctor who looked at the x ray was not in the building. This, it turned out. was because the cover SHO had borrowed his login and password - which still did not explain who the mystery male 'cover SHO' was.


Two things about this interest Dr Rant.

Firstly, having worked as a medical SHO in Derriford hospital, I would like to point out that this is a very good example of Big is Not Beautiful and the perils of Discontinuity. Most hospitals are DGH (District General Hospital) sized. The government thinks this is Too Small, and want's economies of scale by closing DGHs and creating Super Hospitals. They base this on research from the US showing that Big is Better. They failed to mention that in the US, a Big Hospital is around the size of a current large UK DGH.

DGHs were designed to function using a single medical team (traditionally called a 'firm') of Consultant, registrar, SHO, and House Officer. This way, the nursing staff on the medical wards knew the 'firm' very well.

However, this has all changed. The 'firms' are gone; replaced by disjointed groups of doctors working shifts. The idea of medical patients being admitted to medical wards is gone: there are not enough beds for that. Now patients are scattered all over, and the nursing staff have to deal with conditions which are not part of their primary area of expertise and with doctors that they do not know as well.

Also, Derriford is a BIG hospital. When I worked there, it had several medical firms on duty at once covering different specialities. I'm not sure what a 'cover' SHO is, but the fact that they have so many SHOs that they have to give them special titles is not a good sign.


Secondly, as Mrs Rant has pointed out to me, nurses are obsessive about NG tubes (or, at least, they were and should still be). NH tubes move between x-ray and feeding time. They can dislodge or get pulled out and can end up in the patient's throat. Since the patient is not allowed to have food orally for a reason, and that reason is usually that they are at risk of aspirating anything they swallow into their lungs, this can be equally fatal. So, before each feed, the nurses syringe out fluid from the tube and use pH paper to check that it is acidic, helping to confirm the tube is still in the stomach.


It is a strange, sad, story from Derriford. I can't help but think that the causes of the tragedy are a microcosm of what is going wrong in the NHS in general.

NHS IT Triumph No 176

'Health!' Gedditt? Sounds a bit 'rude' doesn't it?

Dr Rant is grateful our correspondent who alerted us to the above screen shot.

It shows the results of a websearch conducted by a doctor in training who was trying to locate information on 'regional nerve blocks' for surgical anaesthesia and the control of severe, intractable, pain.

As you can see, the National Health Service Trust's 'IT' division has decided that the term 'Health' should be 'filtered' in a teaching hospital, and that this website is probably pornographic or subversive.

Ironically, I think I am correct in stating that employees of the trust in question have unfettered access to Dr Rant.

The GP Locum's Lament

Here's another cracker from Adam and Suman a.k.a Amateur Transplants.

Pretty much sums it up I'd say, particular first time mothers who 'just know something's not right' despite plenty of evidence to the contrary and bucket fulls of reassurance*...........

Mind you, when that Fuckwit Darzi has his way and we're all working in Polyclinics, EVERY one will feel like a locum. Turn up, log onto Facebook, stick the kettle on and getting prescribing. They say that suicide is painless: So is precribing Paracetamoxyfrusebendroneomycin.


*Taking 20 minutes in a 10 minute consultation

Please don’t admit anyone- The hospitals cannot cope: Part 3

Crisis?What Crisis?

This isn't the first time, nor the second time that this situation has come to our attention.

GPs in Southampton received this e-mail:-

“Dear Colleagues,

I have been asked to inform you urgently that Southampton University Hospital Trust is currently on ‘Black Alert’ with Ambulances queuing outside A/E and the Ambulance Service [SCAST] indicating that there is a 1.5 hour wait for even urgent requests for ambulances to be dealt with.

Clearly in this difficult situation we would request wherever possible that if measures can be taken by you to avoid hospital admission or A/E attendance for patients we would be most grateful.

I am conscious that communications of this nature are often deemed unhelpful, but I hope that you will take this circumstance into consideration, in consultation with patients and carers, in informing your clinical decisions this afternoon.”

Now, firstly you need to know that the only type of alert over and above a “black” one is a full-scale Major Incident: the sort of thing that happens when there is a plane crash or a pile up on the motorway, or indeed, a railway accident- all of which could so easily happen near to Southampton.

So, the discerning reader might ask him or herself what disaster happened on this day? Did we miss something in the papers? Was there an earthquake? Was it mid-winter? No dear reader, this is mid- May. You are not hallucinating. There is NO flu epidemic, no SARS and no accidents over and above normal.

This is what happens when you leave the control of a public service to the ignorant pool of dripping cunt-slime that consists of politicians (of both parties). All these vermin can think of is closing beds. Even the noble Lord Darzi seems to be intent on the same. One is also left pondering what exactly GPs are supposed to do when confronted with messages like this.

Do people think we drive around the streets looking for old people whose shoe laces are undone so we can send them into hospital between our endless rounds of golf? No, our patients are so shit-scared of going into these mediaeval cesspools of MRSA and C Diff, that they have to be knocking on death’s fucking door before they will let us send them there. Of course, in sensible Western Countries like France and Germany, they know that an efficient hospital functions best at about 90% capacity so that there is time to sterilize the mattress between one admission and the next.

In the UK, which, under El Gordo, now spends as much on health as some of these countries, the hospitals are usually running at over 100%, with the beds still warm from the previous corpse when the next lucky “customer” gets to lie in it. “How can this be?” you no unreasonably ask yourself. Maybe it has something to do with the gargantuan monetary waste spent on the bloated corpse of paper- shufflers and meeting-attenders, who, like an obscene inverted pyramid, sit on top of the doctors and nurses who try to run the service? Some of these, in the form of the local PCT, were the same fucktards who decided not to pay GPs for doing minor injuries: their strategy of using their walk-in-centres and A&E seems to have backfired on them fairly spectacularly. Only a Nu-Labour organisation like the NHS could spend more money on management consultants than clinical consultants.

Pandemic Flu, anyone?

NPfIT (again)

Actually, computer says: 'Go on - have all the data you want!'

Well all those reassurances are going up in smoke aren’t they? £12-20 billion going up in smoke. A massive computer system that isn’t safe, and doesn’t do what it needs to do. It has been evaluated, and found wanting.

It’s ever so popular a project as shown by Bolton PCT’s experience. Even their staff did not want to use a health 'myspace' system. Or maybe they did not trust its safety? Seems many patients don’t either.

Perhaps they are right not to in light of this report .

Rant Idol

This is the 500th post from the Dr Rant Team!

To celebrate our many and enduring achievements in blogging mediocrity, we are launching a competition entitled Rant Idol ^TM

We are looking for the 'next big thing' in medical blogging, and offering aspiring bloggers the opportunity to join our team. We have a few readers, and apparently some of those are 'important' people, so your efforts will not go unheard!

The rules are complicated, opaque, and arbitrary. In fact, they are so arbitrary that we haven't decided what they are yet........but needless to say, the word of Dr Francis X Rant will be law and final.

Here's what were looking for:

Something Different, or just something really offensive that 'pushes the envelope' of acceptability. Polemic, invective, abusive, artistic, satirical, surreal, poetic, musical or just indescribable - the choice is yours.

You don't even have to use the word 'cunt' if you don't want to.

You are cordially invited to chance you arm should you consider yourself to be of sufficient durability.*

How to enter:

Send your rant, artwork, music or whatever you fancy to Dr Rant at:

dr.rant@drrant.net

Please include the text 'Rant Idol' in the subject line of your email so we can differentiate it from the usual hate mail.

Suitable submissions will be posted on the blog as Rant Idol ^TM entries, and comments invited from the readers/trolls.

The competition will be open for as long as it takes.

The winner will be invited to join our motley crew, and assist us in churning out what we do best. Frankly, most of us are so bloody busy at work we find it difficult to keep up with everything, and the rest are a bunch of lazy fuckers, so we need a bit of new blood. We may even let you chose a colour for your avatar.

* Come and have a go if you think you're hard enough!

Rachel wins Dr Rant Trollonymous Trollathon!

Sadly, No one will be attending the prize giving

After much giggling, howling, and general gawfawing, Team Rant would like to announce that Rachel's entry in the Trollonymous Trollathon was judged to be both the funniest and the most offensive.

Fabulous work, Rachel.

Hmm.
You know how if you go for a long run on a hot day, you sweat in all sorts of interesting places?
Well imagine you didn't wash for a month or so, while working naked in a fish gutting factory, then went for a long run.
Preferably just after having a really offensive runny shit without realising you had no bogroll, so it's left to drip down your leg.
Now imagine you got back from your run, wiped some of the sweaty sticky stinking effluent from your peritoneum onto a bit of raw chicken in a bowl, covered it with clingfilm, and left it out to sit in the sun for a week or two.
That stuff it's grown on top?
That's No One's mum that is.

If you email us with the address that you would like the prize to go to (and your choice of book if you already have NHS Plc) we will make sure that it wings it way to you in time for Christmas!

Thank you to everyone who took part (even the irresponsible contestant who tried to get us all sued by suggesting that Rita Pal was No-One!) - I'm sure you will all agree that Rachel is an inspiration to us all.

Frank 'n Team

Nurses Day

"Which of you fuckers works for the Department of Health?" - Flo Nighty, a London Teaching Hospital, circa 2008

May 12th is Nurses Day (thank's to life in the NHS for pointing this out - it really must be being kept low key, as I had forgotten).

The RCN has some information on their website.

Personally, I think the Nurses should be shouting about it from the roof-tops. Britain invented modern nursing, Florence Nightingale showed how a good nurse should not take any shit from jumped up medical twaterrati, and there is no point trying to provide good medical care without having good nursing care.

The Dr Rant team would like to wish all of our overworked, underpaid brethren in the Nursing Profession a very Happy Nurse's Day!

May you never stop striving to care for your patients better in the spirit of your founding woman, who if she were around today would surely lose no time at all in telling those NuLabour toady shits to go fuck themselves!

Trust. The only way to save the NHS?

The I Pay Your Salary brigade, such as our very own resident IPYS acolyte, No-One, are well known to public servants throughout the country. Presumably every country has them, but the British ones seem to be the most rude and extreme ones in my experience. Perhaps that's because rudeness and mistrust are so endemic in Britain. France has the highest levels of mistrust of public figures in a recent study.

Mistrust and public rudeness are very negative things for an economy, business climate, and social structure. Modern economies are founded on systems of trust and when either that trust breaks down or is perceived to break down the economy suffers badly.

Tony 'Scars on my Back' Blair did not trust public servants. Neither did Thatcher. In fact, mistrust and systems-of-control (financial in the case of Thatcherism, structural in the case of Blairism) are central to the Blatcherite ideology.

We see this, in the NHS and elsewhere, expressed as a constant Reform culture. The NHS keeps getting worse, and the current ideology says that this must be due to public servants that are selfish, lazy, and/or stupid. The intuitive solution is: more management.

And yet, as more management is applied, things continue to get worse. So, of course, more management must be the solution. The promised land is just over the next rise! More management! Like the cultists who stuck with their leader even after he falsely predicted the end of the world over a thousand times, the failure of reform to work is seen as a sign that we did not reform enough. The ideology allows no other solution.

And yet, it seems obvious to me that the more reform is applied, the worse things get. Sure, there are some positives - for example, the four hour target has put more resources into a chronically underfunded A&E system. But, on the whole, these positives are accidents. You could have had a far better effect on A&E waiting times, without the dangerous corruption of the service, by simply providing more funding to professionals who were working flat out to keep times down all along.

Meanwhile, the percentage of the NHS budget spent on management continues to climb. And the percentage of time spent by highly trained professionals - GPs, consultants, and senior nurses - on management continues to climb. And climb. And climb. Bear in mind that the NHS budget has shot up so the amount spent on management, as the percentage of that budget climbs, is huge.

At it's inception, the NHS spent 2% of it's budget on management. The Tories never trusted the professionals, and started an enquiry aimed at showing that better management was required and that the professional-led service was inefficient. That enquiry showed the opposite. The NHS was efficient. Nonetheless, the politicians have never been able to believe this. When Thatcher introduced her reforms in the 80s it climbed to 12% of the budget.

But simply trusting professionals to get on and do the best job possible for patients. It is counter-intuitive for people like No-One. They will never accept it. They will continue to blame the 'professionals' for all of the problems. Will the No-Ones of this world every grasp the truth? Will they ever be forced - screaming and kicking - to look into the mirror of their own guilt and folly? History would suggest they will go to their deaths convinced they were right.

I once had fun driving a reverse-stearing Land Rover on an off-road course. The No-Ones, Tony Blairs, and Thatchers are driving a reverse-steering NHS: no matter how often turning the steering wheel left results in the car going right, they refuse to accept that they might be getting it wrong.

In the meantime, I'm going to dream of an NHS utopia with no managers. No targets. No intrusive distrust. A utopia where doctors and nurses get on and do the best for their happy patients.

I'll leave you with one interesting thought: the most efficient health care system in the world is arguably the Japanese one. It's hospitals are almost bankrupt, and it's doctors don't earn much, but it is efficient and popular. Japanese patients beam with delight at being able to simply turn up at a GP clinic during office hours and wait to be seen. They may wait a couple of hours, but they think this is a great system. The GP only sees them for an average of three minutes, but the Japanese love it. I knew a single-handed GP that ran a similar system. His patients loved it, but they were a self-selected group (there was another practice next door that ran a more traditional 10 minute appointment system). I wonder how No-Oneites would feel about such a system? Would they be as gushing about it as the Japanese patients I saw were?

Oh how the government despises Nurses!

Yet another example of how much our 'government' cares about the people that work in the NHS. Or perhaps it is just an example of how the government cares about people in general. (BBC Story)

Basically, the NHS poached a third-world nurse because so many UK trained nurses leave the profession because the UK taxpayer is too fucking mean to pay a reasonable amount of tax to pay nurses properly or provide staff:patient ratios that are not inhuman.

Having ripped off the Phillipines, who can ill afford to pay to train nurses and then lose them to the NHS, the NHS then goes and kills the poor fucking nurse during childbirth.

Not content with this, the Home Office then deports her husband and children.

Normally I would rail about patients lying in their own shit, vomit, and blood at this point. However, today I think patients deserve it. We are a corrupt, selfish, nasty, little country. And we voted for it.

The Dr Rant Trollonymous Competition

Will No-One attend the prize giving ceremony?

Regular readers will have noticed that No-One/Anon is off his meds again.

The Dr Rant team is, as always, grateful to the yawnonymous guru for boosting traffic to the site, but as always we are bemused as to just what kind of person would spend all of their time trolling medical forums in this way.

So, please post below your preferred diagnosis, description, motivation, guttural attack, or imagined life circumstances that they feel best fits everyone's favourite medical Troll.

The poster of the wittiest (or, failing that, most offensive - we are not picky) description will receive a free copy of Allyson Pollock's NHS Plc (or another of the 'Dr Rant reads' selection of their choice from the sidebar).

Happy Troll Hunting!

Frank 'n Team

Junior Doctor Training a Fiasco Shock!

Dr Rant is astonished to discover that MPs have branded last year's Modernising Medical Careers as a disaster.

The cross-party group of MPs said there had been inappropriate governance, management and communication by the Department of Health, while chief medical officer Sir Liam Donaldson had failed to take responsibility despite being the architect of the reforms.
And they said the new application system, which has now been scrapped, was little more than a "creative-writing" exercise that failed to recognise the best applicants.

The BMA comes in for criticism too. The bastard NuLabour-loving BBC helpfully does not distinguish between the Quisling BMA leadership arse-licking the DoH and the Heros of the Revolution Remedy UK who the BMA stabbed in the back with doctors own money, the evil fucks.

The Devil has a more accurate take on the BMA:

is it not the case [Dr Meldrum] that you are now head of the BMA only because your predecessor had to resign?

And is it not true that the main reason for said resignation was because of the BMA's unquestioning support for the government's position?

And is it not also true that, so egregious was your support for government policy on MTAS and MMC, doctors set up a new organisation—Rememdy UK—to represent their interests?

Further, is it not true that the BMA supported the government to such an extent that it even testified on behalf of the government against Remedy UK?

And, finally, do you think that—just maybe—all of this might fairly be described as "a damning indictment" of the BMA's "failure to listen" and, as such, that you should shut your fucking face, you fucking hypocrite?

Well, knock me down with a feather! Who'd have guessed it?

MMC - Medicine Mismanaged by Cunts (blast from the past!)

The fuckers. noun

Fucking fucks. adjective

Fucking fucked. adverb

The fucking fucks have fucking fucked the fucker. entire sentence

FUCK ! FUCK! FUCK! exclamation

FUCKETY FUCK FUCK poetry


The thoughts going through doctor's minds as the slow motion train wreck that is Modernising Medical Careers hits the buffers this week.

Modernising. Yes, I suppose you could say that turning a highly regarded education system which is one of the best in the world into a kind of cheap, bargain basement, like-it-or-lump-it, farce that it has now become is a very modern thing to do. Not a good idea, but a modern one. Presumably we'll be able to spot modern patients because they'll be the ones dying horribly in a pool of their own vomit and blood while their 'modern' doctors scrabble around to find a physician who trained before 2007 who actually can do the job (after all, their 'modern' nurses don't nurse any more, so why should 'modern' doctors be able to doctor?).

Medical. We'll, yes, it is medicine. But not as we know it, Jim. No, this is not an ancient profession. This is not a highly trained elite who have an age old code of ethics. No, medicine is now a technician level job done by people who are willing to bow down at the alter of Fundamentalist Capitalism and worship. These will not be the doctors of old who say 'First do no harm!', these will be test-monkeys who will do their masters bidding. In the future doctors will not dare to question the policy of throwing the poor and the infirm out on the streets still sick and dying. They will not question the inequalities that their predecessors fought so hard to eliminate - overcrowding, poor housing, child poverty, poor education. The Victorian era of the rich riding roughshod over the poor and the infirm is once again with us, and New Labour (what an irony that the party of the working people should be taken over by Blacherites who worship extreme capitalism) cannot afford to have professionals stand in the way of their capitalist utopian dream. Fuck the poor. Fuck the infirm. Fuck the poverty stricken. Fuck the hopless. Fuck the ill. They are all a drain on our society. They cost MONEY! The great God Of Capitalim must not be angered. No money? Then Fuck off! Swore an oath to protect the poor and the infirm, did you doctor? Fuck off! Bring in the Medical Technicians!

Careers. Yes. Careers. The careers of a generation of high achievers. The best we have. The Altruists who chose not to chose the money and power of Law and Accountancy and The City. Good people who say at their interviews 'I just want to help people'. Heros who study hard, work long hours that they are often not paid for, and do the hardest jobs. They tell people they are going to die. They tell them their children have died. They put their hands inside bodies to try and fix broken people. They experience things that other people only see in times of war. But, what the fuck. Let's just flush them down the toilet. Who needs idealists in a time when the POUND/DOLLAR/YEN are all that matter? Who are these fools who could have had real jobs working with money and made far more income than they do in medicine? What a bunch of idiots. Wanting to help people. Spaktards every one.

No, this is not 'Modernising Medical Careers'.

This is 'Medicine Dumbed Down and Patients Murdered in Their Tens of Thousands by Evil Self-aggrandizing Shits'.

But M.2D.P.M.3T.E.S.S. just doesn't have that 'modern' Management Consultant ring to it (and, therefore, no doubt costs several million pounds less than the snappier 'MMC').

Oh, and the Quisling doctors (ie: the Great and The Good of the Royal Colleges and the BMA) who helped this happen, or failed to stop it, had better pray that they die before they have to suffer at the hands of this 'Modernised' NHS. I figure things will really start to go wrong when most of the consultants that trained properly under the old system have retired. About 10 year from now.


This article was first published on 03.03.07 and is republished to co-incide with the MP report into MMC.

Private is better!

After the roaring, internationally renowned, success that was the opening of T5, Dr Rant thought it would be sensible to look at the privatisation of that other useless pinko-lefty commie organisation full-a-wasters, the Royal Mail.

About time too! Dr Rant has for far too long had to suffer from a single national carrier that delivers 95% of it's first class letters next day, and a world-leading parcel service. What I really want is to drive the Royal Mail out of business so I can pay much more for an inferior service. Oh, and by strangling The Royal Mail to death slowly, I really would love to suffer from strike-induced problems too as the unionised workforce suffer death throws.

It brings us all much joy to watch the same process make every new year another 'Best Year Ever'.

We celebrate 30 years of uninterrupted Blatcherism next year. Joy.

Agents of The State

A New Labour Propoganda Poster promoting changes to the General Medical Council, circa 2008

We are now in the last days of of the age of doctors and nurses as Patient Advocates.

The State, and I mean here the Thousand Year NuLabour Third Reich [Surely, Third Way? - Ed], does not like professionals. Professionals are self-regulated groups that operate to a code of honour. Professionals do their best for their patients, not because they are paid well, or because they are 'appraised', or 'monitored', but because they are professionals. Should they fall short of their professional code, they they will lose their honour.

The clash is essentially an ethical and philosophical one. Professional codes are, in essence, Kantian. Something that is wrong is always wrong - such as killing patients. Politicians, however, are basically Utilitarians: things are wrong or right based on circumstances. If killing patients will lead to another term in office, then it is The Right Thing To Do.

The State has had plans in motion for some time now to neutralise these problematic professionals. Firstly, it has reduced the Burden of Proof in professional fitness to practice cases. The General Medical Council and the Nursing and Midwifery Council are already prosecutor, judge, jury, and executioner. The new rules on a 'sliding scale' of proof, now also allows them to decide how much proof is required on a case by case basis. Basically, they can just make it up as they go along.

The second part of the plan is to remove professional self-regulation. Previously, the members of the professional court were elected by the professions. In future the NMC and GMC are almost certain to be run by State-appointed members.

Now, some people will point out that if the GMC had done it's job in the first place none of this would be happening. And you are probably right. Dr Rant has seen two GMC 'investigations' into dangerous doctors up close, and the only thing I can say is that the GMC are utterly useless. Both 'investigations' consisted of writing a couple of letters to managers - the first doctor continued to practice for another two years until someone unrelated to the GMC actually visited the doctor's practice (ie: what I'd call an 'investigation). The second doctor is, to my knowledge, still practicing. You could say that the GMC is lowering the burden of proof because it is too lazy or useless to raise the standard of its 'investigations'.

However, whatever the faults of the GMC and NMC - and they are huge faults - they are less frightening than what we will soon have: The State in control of the professional bodies. The State will control who is prosecuted, for what, and what standard of evidence is required. The State will act as sole Judge, will appoint the jury, and will decide on the punishment.

Leaving aside the fact that lowered burden of proof means that any psycho now gets a 50:50 chance of success from a free shot at any doctor of their choice (and paediatricians involved in child protection are already subject to a co-ordinated barrage of malicious complaints from a small number of individuals), basically if you are a Good Nazi then you will be allowed to practice and if you are not, then For You The War Iz Over.

Agents of The State do not put patients first. Agents of the State put their Political Masters first.

Long Live New Labour!

I don't think I can do this anymore

The Ferret has posted this excellent item on why doctors should leave the NHS.

"Another family member arrives, walks over to his relatives. They point at me, the relative walks over touches my arm and smiling thanks me for all I am doing.

What am I doing? Am I colluding with a system that is letting this man and so many others like him down. I am trying to tread water in a what sometimes seems a third world system. A system crippled by short sighted targets and budgets. A system where a waiting list is more important than an intensive care bed. A system where the four hour target means that patients are rushed through the hospital, not getting the correct diagnosis, waiting in corridors, in pain and critically ill.

I don't know if I can do this for another 20 years."

Anonymous will no doubt suggest that the doctor who wrote this should have done the complex cardiac surgery himself on the kitchen table while being paid minimum wage.

I fucking hate Anonymous.

Give GPs a break!

Dear Dr Rant,
Please find below a peice I've written for Centreright.com going up tomorrow [Two weeks ago now! Sorry, Julia, this one got missed at the time - Ed]. It's a family channel so the language is tame - but wondered if you'd hightlight it on your sites as 2020health is running a petition in support of GPs! Also attached as you loose the italics.
yours
Julia Manning

Give GPs a break!
I remember his words like they were yesterday “I’m quitting the NHS”. Last year, this GP who had given 30 years of his life to caring for patients looked at me with tears in his eyes but a wan smile on his lips. Pain from the resignation and disappointment; relief from the burden and battle. “I’m an effective doctor because I know my patients, their history, their families, their jobs and their neighbourhoods,” he went on. “Up until now I’ve adapted and changed to the Government’s whim, but no more. They behave like we cannot be trusted – I can’t work for a boss that doesn’t trust me”.
You may have noticed, barely a day goes by when GPs are not being criticised and maligned, or pushed and shoved. No matter how much the Government messed up the GP contract resulting in a few doctors being paid a six figure salary, is this the way our health ambassadors should be treated? Our confidant in sickness? The professional who we trust with our most intimate care?

More here.

Thanks Julia.

IPPR - thick cunts

Get your 'Think Tank' off our lawn!

The news has been flooded this morning by stories based on some 'fresh new' research from the Institute for Public Policy Research that is calling for more top down meddling and monitoring for teachers to contend with. Surprisingly none of the media, for example the BBC, have even mentioned who the IPPR are, who they are funded by and what their conflicts of interest are, strange that. You can look through their raft of cracking new ideas here, amongst them are the following gems:

"Introducing a higher tier of managers, selected from head teachers due to retire in the next five to ten years, to improve the advice and support given to head teachers, and keep expertise in the system.

Rant: yep, more tiers of management, what a great idea, taking yet more experienced teachers away from actual teaching.

Using psychometric testing alongside exams to assess each candidate’s personality and suitability for teaching.

Rant: psycho babbling rubbish that has no evidence behind it, another brilliant part of their rafting turd

Improving performance management, with all teachers required to observe four lessons by colleagues per term and take part in six-monthly appraisals.

Rant: Yes, patronise teachers more, treat them like children and subject them to useless appraisals which simply serve to increase the rate at which rain forests are chopped down

Strengthening links between pay and skills and development.

Rant: vague political waffle, another idea that in practice would simply waste more money trying to make improvements that simply would not materialise as the IPPR do not have the brains to think through their nonsensical plans"

Has anyone at the IPPR bother to engage their slimy brains? I think not. The reason that a lot of the brightest and most able do not go into teaching, or quit teaching having given it a go, is because the government's top down control freakery has ruined teaching as a profession.

The government treat teachers as they treat doctors, with no respect and no trust, they have also enforced a 'raft' of controlling measures in the form of inspections, appraisals and box ticking that have done nothing to improve teaching standards, they have actually served to lower standards by wasting teachers' time and encouraging people out of the profession.

Less Stalinist monitoring of teachers, less bureaucracy, a bit of continuity and less tinkering with curricula, less changes to exams and the associated bureaucracy that goes with it, less wanky new subjects like citizenship, more power for teachers to discipline pupils who misbehave; these changes might go some way into improving teaching and attracting more excellent teachers into the profession.

Interestingly when one has a peek at who is funding the IPPR, then one sees quite a few friends of the government there including Lord Sainsbury, Accenture, PwC, London Development Agency and none other than the General Medical Council. It's funny how the wankers at the IPPR are so confident in their ability in telling teachers how to do their job better, when I doubt that any of their esteemed researchers has been anywhere near a real classroom since they were at school themselves. Cunts. I can tell you that the vast majority of teachers do a damn good job under very difficult circumstances, cirumstances that have been inflicted upon them by greasy fuckwits in Whitehall who rely on the illogical drivel that is spewed forth from think tanks like the IPPR, because none of them have a clue what is really going on the ground.

Horrible Fat-Headed New Labour Pig Gets His Disgusting Porcine Proboscis Well And Truely Wedged In The Gravy-Laden, Corrupt, Private-Sector Trough

Cunt

Suprise suprise - Former Secretary of State for Health, and all round total wanker, Alan 'Fingers' Milburn has landed him self another 'mega-bucks for fuck-all work' consultancy job for a private sector company looking to buy itself a slice of the NHS.

Since resigning 'to spend more time with his family' (or getting caught having an affair by his wife) he's managed to collect a nice little portfolio of part time 'jobs' that earn him £90,000 per year for 'giving advice'.

The latest is with a shady US 'healthcare company' based in Berbuda called Covidien:

Covidien, which is based in the tax haven of Bermuda, spent more than £400,000 last year lobbying the American government. Milburn declines to say how much he will be paid.

He already 'works' for PepsiCo, despite having previously branded junk food the worst threat to world health.

Sleazy, corrupt, lazy, philandering, stupid New Labour bastard!

A hundred grand for the few remaining principles that this odious little former union agitator has left is a pretty handsome deal.

Right, its the 1st of May, and I'm off down the polling station.........

Saving money NHS style

Rantingshire Hospitals NHS Foundation Trust expects to save 3% on it's heating bill this year.

The patient, a 73 year old lady with hypertension has her cholesterol level well and stably controlled on atorvastatin.

But says the PCT (or whatever their Welsh equivalents are called) that drugs is too expensive (£18 per month) when generic simvastatin is so much cheaper (£2 per month).

So the lady’s medicine is altered to simvastatin.

Her cholesterol is now not so well controlled so Ezetimibe is added. The cost of this to NHS is £26 per month.

So total cost of treating the 73 year old lady’s cholesterol is now £28 per month. That’s a grand saving of minus £10 per month.

Well done the local prescribing advisors! Joined up twattery at it's finest.


[n.b. This figure doesn't include the cost of totally uneccesary GP appointments at £30 a go, and additonal blood tests - Ed]