Comments on Dr Rant: I like you so much. I really do. It's just a sha...

Oh, for fuckety's sake! Save me from concrete fuc...

2008-04-15T22:23:00.000+01:00

Oh, for fuckety's sake! Save me from concrete fucking non-thinkers!

Ok, in SIMPLE language:

1. Patient satisfaction surveys are fuck all use in determining what is SAFE PRACTICE.

2. Extended opening hours are about CONVENIENCE and political point scoring.

3. Extended opening hours have fuck all to do with safe care.

4. Patient satisfaction surveys are VERY USEFUL for non-clinical issues surrounding convenience.

Add to this that any fuckwit can work out that extending hours (convenience for the worried well) by reducing the budget for actual care for actually sick people will make care worse, and you really do make me want to kill myself by gouging my eyes out with a pair of knitting needles.....

Didn't 84% of patients say they were satisfied wit...

2008-04-12T16:20:00.000+01:00

Didn't 84% of patients say they were satisfied with GP opening hours?

Of course, now we understand how the Rant team thinks patient satisfaction surveys are utter shite and that they have no fucking clue... you will shut the fuck up about having to open evenings and weekends now because they obviously have no fucking clue about how satisfaction with opening hours actually relates to good fucking patient care.

How's the shotgun wound in your metatarsal healing?

Call me old-fashioned but I'd rather be treated by...

2008-04-08T09:29:00.000+01:00

Call me old-fashioned but I'd rather be treated by a cold psychopath who actually knew what they were doing though high intelligence, years of experience and hard work rather than by any touchy, feely, empathic, MSc-lited noctor. Trouble is, in these 'all must have prizes', falsely egalitarian times, many professionals in the NHS are being actively encouraged by HMG to practice beyond their abilities and they simply cannot recognise this. Basically, on average doctors are far more intelligent than nurses or other non-doctor groups therefore they are in a better position to recognise the safe limits of their abilities and know where to refer a patient thereafter. God knows what the cost to the taxpayer will be in a future where diagnoses are regularly missed, inappropriate treatments are commonplace and patients are generally ill-served.

Yes, anonymous (April 06) - quack referral rates a...

2008-04-07T10:16:00.000+01:00

Yes, anonymous (April 06) - quack referral rates are higher, this is because the nurses are less able, and less knowledgable than doctors.

None of the nurse quacks (unless they are incredibly foolish) would suggest that they can, or should replace docs.

But, we can be useful and safe in certain conditions, hell even Dr Crippen admits that his practice used to employ a quack who ran a few of the clinics (and was pretty good at it apparently) - I must admit that little snippet suprised me.

The same "research" that keeps getting posted on h...

2008-04-06T22:56:00.000+01:00

The same "research" that keeps getting posted on here and other forums supporting nurse practitioners shows some other things too.

In many of them there is the fact (not often brought up) that refferal rates for the nurse are higher than for the doctor "i don't have a clue so will send you to a specialist" , investigations were higher and the time spent with patients longer.

I bet if the GP had longer consultation slots and sent people off to specialists more often they would have higher "satisfaction scores" too.

I just think, the wage savings are going to be ofset and them some by the cost of tests and refferals.

Do the patients know how good the care was? Well,...

2008-04-06T00:57:00.000+01:00

Do the patients know how good the care was? Well, sometimes yes, and sometimes no. An example from some years ago (somewhat anonymised for obvious reasons). A parent brought their child to A&E. They had been treating them at home for about a week, having looked up what they thought was wrong with them on the internet. The parent had diagnosed the child with something that would probably get better on its own, and they felt defensive as they had declined immunisation against it. They came to A&E because they felt that, as a secondary event to the previous illness, their child had a n ear infection and they wanted antibiotics. The A&E doctor thought there might be more to it, so asked for my opinion. The mother was unhappy about this. She just wanted the antibiotics, and had she received them would have been happy with the care. I assessed the child carefully. The mother was unhappy about this, as she wanted them to go home with antibiotics. I explained that I was worried that this looked like a different medical condition, for which there is no specific test, but for which there was a treatment. The mother was unhappy about this. Because she was certain that what the child needed was antibiotics. In the end, my consultant and I convinced her that there was a problem, and why we needed to treat her child. She wasn't happy about that. Until, of course, she went home and looked things up on the internet again. And realised that we had been both right and honest with her. We hadn't given her child the care she wanted, and demanded. We hadn't made her happy. We hadn't done what she wanted. But we had reduced the liklihood of her child developing a very serious complication from about 20% to 2%, and the liklihood of dying from the illness from about 2% to virtually nonexistant. Of course, there was an 80% chance that if we'd sent them away with antibiotics the child would have been fine, and mum would have counted the care as excellent. But it wouldn't have been.

Not only can patients be stupid, but they are incr...

2008-04-05T11:15:00.000+01:00

Not only can patients be stupid, but they are increasdingly coming in armed with information from the internet. Here you go, plonk, now I know as much as you do or indeed better.

Of course, never having met the old aristocrat Peer Revue nor being able to spell words like reputable, and being scientifically illiterate still makes them instant professors of medicine after a few minutes surfing chelation therapy and crystal healing.

the patient died

2008-04-05T09:06:00.000+01:00

the patient died

"Do patients have any fucking idea how good the ca...

2008-04-05T09:05:00.000+01:00

"Do patients have any fucking idea how good the care was?"

Well yes actually I think they probably do have SOME idea, especially in my field which is psychiatry. In fact the patients view of things is pretty much all we have to go on in some cases.

You remind me of the Surgeon who quipped that the operation was a complete success but unfortunately

The fact that the research was published in the BM...

2008-04-05T02:52:00.000+01:00

The fact that the research was published in the BMJ does not mean it is any good.

The research is shit. It looks at 'patient satisfaction'. Exactly what relevence does 'patient satisfaction' with their care have?

Do patients have any fucking idea how good the care was?

How do patients judge the quality of care?

I would suggest that they base their 'satisfaction' on how much time was spent on them and how nice the person spending the time with them was.

Save me from stupid fucking morons who think that this kind of total fucking shit research somehow shows nurses are safe at diagnosing illness.

(Which reminds me of the research on how degree nurses are safer than the old-style diploma nurses - I looked it up and it is just as shit.)

Dogma, PC, bullshit, dangerous, fucking pile of wank.

The research did not make any mention of patients ...

2008-04-05T00:21:00.000+01:00

The research did not make any mention of patients "liking" nurses” more than GP’s, it said that patients were at least as “SATISFIED” and in many cases more so with the CARE they received form a nurse compared with the CARE they received from a GP. It also said that Nurses often communicated better and made more complete records than the GP’s in the survey. None of this has any relevance to liking someone although that may be a consequence.

Further the research was published in the BMJ and concluded that the QUALITY of CARE was at least as good and in some ways better than that provided by GP’s.

The word LIKE was nor mentioned anywhere in my post, why do you insist on so obviously misrepresenting the research and throwing in the complete red herring of patients LIKING Nurses more than Doctors even assuming that to be true.

Talk about a straw man fallacy, you had to build that particular straw man all yourself' didn't you.

This issue of "nurses are more holistic" is entren...

2008-04-04T21:23:00.000+01:00

This issue of "nurses are more holistic" is entrenched, and given that even student nurses with next to no experience seem to think so supports the endemic anti-doctor attitude prevalent in nurse training

I'm sorry, boys and girls, but a nursing qualification doesn't give you the monopoly on holistic care. To argue that it does is pretty insulting to others, such as myself, who'd like to think that they're pretty holistic too.

Wiping poo, administering drugs, doing dressing changes and the 1001 other tasks that falls to the nurse (and I know, 'cos my wife is one) makes you neither less or more of a person than me. But neither does it give you super powers that allow you and only you to appreciate the multifaceted presentation of the patient in front of you.

Even as an archetypal orthopod (apparently we're all thick dinosaurs or something), if presented with the same clinical problem in half a dozen different patients I can, and would, suggest half a dozen different management plans based on all the facts. I think the ability to take a decent history that doesn't need a tick box sheet and a widespread understanding of human anatomy, physiology, pathology and pharmacology helps with that.

Maybe I should argue that when the NP has that level of understanding as well as being the modest, sociable and chatty type that I am, rather than having a huge chip on their shoulder, just maybe they'll be as holistic as me. When nurse education stops sneering at intelligent, learned professionals as elitist dinosaurs maybe we'll make some progress, who knows.

Until then, each time I hear a nurse trotting out the whole "doctors aren't as holistic as nurses" thing I'll smile happy in the knowledge that it makes them sound an ignorant twat. If they follow it up with the fervent belief that nurses have the monopoly of "being the patient's advocate" I'll know I'm dead right too.

"May I take advantage of your house style to say w...

2008-04-04T20:37:00.000+01:00

"May I take advantage of your house style to say what I really think about this comment?"

Thank you, John.

We are saving a place for your evil twin brother on the Dr Rant team.

The reason most of my friends elect to rely on Nur...

2008-04-04T19:22:00.000+01:00

Dear Pn, SnNurses do not have a holistic approach ...

2008-04-04T15:35:00.000+01:00

Dear Pn, Sn

Nurses do not have a holistic approach compared to British GPs. Given that their training does not cover in as much depth various pathological processes, nor does it cover in as much depth the nuances of the consultation and various psycho-social aspects, there is no way one could call their approach holistic since it isn't "whole".

British GPs spend 10yrs being trained, have to have hours of consultations videoed, pass numerous assessments both by peers and patients and only then are deemed fit to practice. Now that is "whole". Anything less is superficial

"The reason most of my friends elect to rely on Nu...

2008-04-04T02:26:00.000+01:00

"The reason most of my friends elect to rely on Nurse Practitioners rather than MDs for their general health care basically boils down to holism."

The reason British GPs are so pissed off with the erosion of continuity etc. is that British GPs are highly holistic.

The US system is very fragmented, and general practice is very basic compared with UK general practice. Canada lies somewhere between the two.

Seems like HM Goverment is out to erode doctors' p...

2008-04-03T23:54:00.000+01:00

Seems like HM Goverment is out to erode doctors' professional position still further, and in the process decrease the ability/need to pay (some of them) so much cash.
An unfortunately by-product, i'm sure.

I'm more than glad i didn't heed my wife's advice about medicine as a career being great, even though i knew i didn't have many of the qualities that doctors need. At least in private enterprise its a real market and your individual effort can elevate you, not mark you out as a target to be taken down.

The reason most of my friends elect to rely on Nur...

2008-04-03T21:49:00.000+01:00

The reason most of my friends elect to rely on Nurse Practitioners rather than MDs for their general health care basically boils down to holism. Even diploma nurses are trained in all of the same physical assessment skills that MDs learn, fortunately we live in an area where NPs still have prescriptive abilitiy. Nurses are subject to all the same fluctuations in mood and personal style that MDs are, I've met some cold, heartless NPs and some warm, caring MDs. Still, there's an advantage to being treated by someone trained to treat people holistically rather than just their disease process. Honestly, the diagnosis and treatment of disease is something that can potentially be automated, with enough advances in technology.

The fact of the matter is, though, an extensive and expensive education in medicine can (and often does) result in a diagnostician poor enough to require a student nurse (or a paramedic) to point out (for example) that their patient is not, in fact, having an MI.

I think some of people's concerns about NPs are being addressed by the fact that by 2015 (in the US), NPs will be required to upgrade their academic credentials to the new DNP (doctor of nursing practice) degree. This didn't exist before, so people were basically doing doctoral level work with a master's degree, just because no higher terminal degree existed at the time.

When I went to the orthopedist for a torn medial miniscus in one of my knees, I didn't see an MD once. I saw a PA.

I think the various traditions of the guild-style occupations involved are in-play moreso than the actual qualifications of these people to do their jobs.

Yes, anonymous, not all patients die from systemic...

2008-04-03T21:15:00.000+01:00

Yes, anonymous, not all patients die from systemic sepsis after developing a perianal abscess - but some do.
http://news.bbc.co.uk/1/hi/england/london/5408218.stm

4 week old

2008-04-03T20:57:00.001+01:00

4 week old

Saw a 4 old baby today (Surgical doc at a children...

2008-04-03T20:57:00.000+01:00

Saw a 4 old baby today (Surgical doc at a childrens hospital) with a peri-anal abscess. Mum was almost in hysterics as a nurse consultant or equivalent at her GP's had told her that if her baby didn't have antibiotics it would get blood poisoning and die!
Took me a whole hour to calm her down. F'ing noctor twats