Comments on Dr Rant: A fuckwit by any other name is still a fuckwit

YOU ARE AN ORANGE CUNT!

2008-04-17T15:14:16.079+01:00

YOU ARE AN ORANGE CUNT!

ps: Nurse Rant wants to know what an 'orange cunt'...

2008-04-15T23:39:59.937+01:00

ps: Nurse Rant wants to know what an 'orange cunt' is.

"I HAVE WORKED THE EMERGENCY DEPARTMENT FOR 15 YEA...

2008-04-15T23:35:05.857+01:00

"I HAVE WORKED THE EMERGENCY DEPARTMENT FOR 15 YEARS AND..."

....still havn't worked out how to use the CAPS LOCK key, apparently.

Oh, and:

1. PhD is NOT a medical degree.

2. The term doctor is an honorary one.

3. It is unprofessional to use the PhD title 'Dr' in a medical setting without making clear that you are not a medical doctor (ex-SoS for Health, Reid, take note).

4. If you have the equivalent medical training of a doctor, then you have become a doctor.

So you are either shouting at yourself, or you are juts a mouthy wannabe.

FUCK OFF YOU BUNCH OF ORANGE CUNTS. THE FUTURE OF ...

2008-04-15T22:38:22.328+01:00

FUCK OFF YOU BUNCH OF ORANGE CUNTS. THE FUTURE OF THE NHS IS NURSE EMPOWERMENT SO YOU BETTER JUST FUCKING DEAL WITH IT.

HOW MANY OF YOU BALLOCK DOCTORS ACTUALLY HAVE PHD'S? [AND YOU CALL YOURSELVES DOCTORS] I KNOW 7 NURSES THAT DO, SO DON'T GIVE ME THAT NURSES ARE IGNORNANT BULL FUCKING SHITE.

I HAVE WORKED THE EMERGENCY DEPARTMENT FOR 15 YEARS AND LET ME TELL YOU DOCTORS ARE GETTING BLOODY WORSE. MOST OF THEM CANT EVEN SUTER BY THE TIME THEY FINISH THEIR PLACEMENT, HOW WILL THEY EVER COPE WHEN THEY ARE IN THE COMMUNITY?? I KNOW THEY WILL SEND IT TO THE CLOSEST HOSPITAL AND LET AN EXPERIENCED NURSE CLEAN UP THEIR MESS!!

I was referring to this interpretation of the rese...

2008-04-05T02:55:19.850+01:00

I was referring to this interpretation of the research on Mental Nurse's site:

The tendency to overestimate our ability in a profession is most noticeable when the profession relies on a degree of expert knowledge. In such professions (such as medicine) a lack of knowledge implies not only the inability to perform competently but also the inability to recognize this fact. In other professions which require expert knowledge and a physical skill or ability people are far less likely to overestimate their ability.

Dr Rant you say“The research that appears to be qu...

2008-04-05T00:57:38.747+01:00

Dr Rant you say

“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 think you need to go back and read the research again. What it actually said was that professionals who rely on expert knowledge depend on their level of expertise not only to practice competently but also to recognize when they are out of their depth. The more competent the professional the better they are able to recognize their own limits and practice safely within those limits.

Diagnosing and prescribing should remain off limits to nurses because the minimum level of training needed to do this task safely is a degree in medicine. But other tasks, that in the past have been associated with the medical profession, can be taken on by a nurse provided they have received the appropriate training to enable them to carry out the task safely and recognize the limits of their expertise. Does that it make it clear enough for you?

Oh and by the way the word is crappiness not crapness you idiot use a dictionary can’t you.

I see the US is having similar discussions:http://...

2008-04-03T20:12:36.759+01:00

I see the US is having similar discussions:

http://healthwise-everythinghealth.blogspot.com/2008/04/nurses-as-doctors.html

To be fair i have a great working relationship wit...

2008-04-03T18:23:35.484+01:00

To be fair i have a great working relationship with most of the nurses i come across.

One or two very notable exceptions (though not directed at me) but in the main very good.

I don't really see the "bullying" that goes on by nurses. Some are arses, but then so were some of my consultants. Just because they are not the most friendly or were abrupt does not make them bullies...i do think lots of my colleagues may be a bit thin skinned if they think that constitutes bullying (same as when i was in the forces, people think being told what to do or given a job to do is a problem).

Sorry off on a tangent there,

As i was saying the only time i have had really bad experiences was in the uni in lectures and from the nurses in hospital who came to "teach us". Maybe they resent having to do it or are on the defensive before they even got to us?

I can understand that having to teach a bunch of final year medics, esp when a bunch of us had worked in the NHS before in clinical jobs must be a bit of a ball ache.

Wish we had had nice ones like you.

p.s.
The sociologists hate us too (esp when we actually disagree with their points)...but we accept that :)

Funny PseudonymI'm not disputing that nurse lectur...

2008-04-03T15:59:41.394+01:00

Funny Pseudonym

I'm not disputing that nurse lecturers may have said the comments you describe (though, as moobies points out "nurses are not doctors handmaidens" is actually an accurate statement rather than a criticism of doctors), and yes, doctor-bashing by nurses does happen. But so does nurse-bashing by doctors. Needless to say, neither are acceptable.

I can only speak for my own nurse training, but I can certainly promise that at my university there certainly was no epidemic of doctor-bashing by lecturers, and the emphasis was on fostering good MDT working, which is what it should be.

I can certainly promise you that in every health setting I've worked in, I've always worked to ensure good working relations between the doctors and the nurses, and have by and large got on very well with the bulk of my doctor colleagues. Nearly all of the nurses and doctors I was working with did the same (though that's not the same thing as saying doctors never get bullied by nurses or vice versa).

The issue of recognising competence in self and ot...

2008-04-03T15:22:32.911+01:00

The issue of recognising competence in self and others is very important. It is difficult to know, and to admit we don't know how to do something(s). It is much more difficult to give a colleague feedback on their performance, as an experienced practitioner. It seems that many professionals will "sign off" a collague as competent rather than tell them they are not competent. consequently we have lots of people practising health care that don't know they are incompetent beacause, (a) they don't know or recognise it and (b) they have not been told they are incompetent or given assistance through feedback and education to become competent!

As a nurse lecturer and one who still gives some patient care, in palliative care, I will not indulge in colleague bashing other than when actually teaching other professions. This is always done tongue in cheek and "in the best possible taste.

At times like this when we appear to be under fire from other professions, managers and politicians it is time we looked out for each other and became more understanding and collaborative

anon - I recognise what you're saying about the an...

2008-04-03T15:17:57.793+01:00

anon - I recognise what you're saying about the anti-medical bias of some nurses and some nurse lecturers, and I try to counter that as best I can. I leave my students in no doubt that most of the flak directed at "the medical model" is bullshit, and that the notion that nurses have some sort of monopoly on caring that their medical colleagues don't share is bovine excrement of a similar nature. It was Dr R's suggestion that this hatred of doctors was somehow endemic in nurse ed that I was balking at.

moobies, I never said it was true, however it was ...

2008-04-03T14:22:30.487+01:00

moobies,
I never said it was true, however it was the tone and the fact that i don't think i have ever seen a doctor treat a nurse in that way.
Maybe the ones teaching are relying on their own out-of-date memories.

Basically even my friends who are nurses (graduated last summer) who were at uni the same time as me commented on how often they had anti-doctor sentiment directed at them in lectures/ clinical attachments.

They didn't like it mainly as they were nearly all going out with medical students/ doctors themselves!

"nurses are not doctors handmaidens" At the risk o...

2008-04-03T12:55:21.902+01:00

"nurses are not doctors handmaidens"

At the risk of being a three-post ranter, I should point out that this is true and is not a criticism of doctors.

My daughter and her colleagues, who are newly qual...

2008-04-03T12:52:14.574+01:00

My daughter and her colleagues, who are newly qualified house officers, have been threatened and intimidated by nurses.

Some of my students, as newly qualified nurses, have been threatened and intimidated by doctors/social workers/OTs/psychologists. There are wankers in all disciplines, it's not just a nurse thing.

I'm also a contributor to the Mental Nurse site, a...

2008-04-03T12:48:54.162+01:00

I'm also a contributor to the Mental Nurse site, and have posted a response there in support of Dr Crippen. This must surely be amazing to Dr Rant as I am also one of those supposedly anti-doctor nursing lecturers.

kobfusI'm not sure about the chip on the shoulder ...

2008-04-03T12:25:04.362+01:00

kobfusI'm not sure about the chip on the shoulder argument Dr Pink.

I think about it like this (if we take A&E as just one example of the current health scene) - in the short term, i.e. tomorrow there will be around 250 patients who will attend our department.

That is the hand staff will have been dealt and whether we like it or not we have to either admit or discharge 98% of them within a 4hr timescale (or face the consequences such as undermining the Trusts bid for Foundation status, etc) - wouldn't it be nice if we all just said fuck off, but just as GPs are slaves to QoFs we are slaves to the target.

The grunts on the shop floor simply do not have the luxury of agonising about the various models of health, or professional aspirations that might exist on another day - and of course, it will be exactly the same on Saturday, and the same again on Sunday, etc, etc.

So, a very important issue for all of us (docs/nurses) is how to maximise the skills and knowledge within the workforce (on any given day)to provide the best possible standards.

Of course, life might be very different if we where is France, or Zimbabwe, or in the NHS in 10yrs time, but we are not - in the words of Fatboy Slim we are "Right here, right now".

If a quack can (safely) sort out a dozen minors faster than a new FY2 then that is what is likely to happen (with the consultants blessing) - our department is just doing what it can to cope with the increasing numbers who find it necessary to make their way to A&E - as I have mentioned (ad nauseum) a 33% increase in recent years - now that's a lot of tubigrip.

Oh good grief, this is novel. From my usual temp...

2008-04-03T12:13:17.191+01:00

Oh good grief, this is novel. From my usual temperate disposition I find myself agreeing with Dr Rant. I feel quite peculiar.

I commented with the same point you made of, "Someone that diagnoses medical illness is a doctor."

I feel that's key. Nurses diagnosing can work, in truth, much of the time. But not all the time. And it's a lottery as to when it's not going to work, thus it's neither good nor safe medicine.

I'm not against nurses diagnosing, I'm against people with the wrong skills and competencies trying to do a job they're not trained to do. I'm not saying only doctors can diagnose (e.g. a psychologist can diagnose mental retardation better than I can, and use Hare's Psychopthay scale etc to diagnose dissocial personality disorder as well as I can).

But as you say, most nurses aren't trained to diagnose. This isn't a weakness, any more than a nurse not being able to excise a carniopharyngioma is a weakness. It's a different skill and competency that's core to doctors' training and peripheral to nurses' training.

Beyond this opinion, objectively we've senior nurses who are exceptionally good nurses but simply don't find the diagnoses I do (depsite spending 2 hours with each new patient and doing more testing) when I see them after the nurse has.

Thus, at present, I'm deeply uncomfortable with nurses undertaking diagnosis.

"Its the expansion of the role to include "special...

2008-04-03T11:48:37.286+01:00

"Its the expansion of the role to include "specialist nurse" to mean anyone."

I think this is a key point.

It's the same as the Ambulance service insisting everyone has to be a paramedic, rather than just the to 20% of technicians.

It's the same as when they forced ENs to all 'upgrade' to RGN when not all of them wanted to be RGNs.

It's this PC bullshit that everyone has to be 'clever'. Clearly (1) everyone is not that clever, (2) it's assumes that one specific type of 'clever' is the only thing that counts, and (3) devalues everyone else's skills, qualifications, and jobs.

Presumably, we will need to import 'slaves' from the developing world to actually care for patients because we are all 'too clever'.

As for the anti-doctor propoganda in nursing school - it is now institutional from the reports I hear (multiple sources). I'll try and dig out a copy of the Biobollocks nursing textbook that we have lying around and post some examples.

I think far too many people have a chip on their shoulder in this country for all the wrong reasons. Which is really, really sad.

A&ECN,The problem is that they are not all doing w...

2008-04-03T11:33:04.408+01:00

A&ECN,
The problem is that they are not all doing well defined roles that are within their competency.

I can only point to anecdotal evidence from what i have seen.
As a medical student the specialist nurses had a lot more sway than i did and were also very well looked after.
I have been in clinics with some of the "specialists", they cannot answer my questions, do examinations that i would fail if observed doing and seem to have the "well its outside my knowledge so that means its not important".

on the other hand i have met some amazing ones who put the juniors to shame (then again they have worked in that area for over a decade which i would hope meant they were at least good in that small area).

Its the expansion of the role to include "specialist nurse" to mean anyone.

I was talking to a consultnat recently who was telling me about having to spend a long time (months not hours) to leave the role as she was terrible.
Now when the nurses are having to be quietly and gently removed it implies they are well protected in that role.

Not sure what the vested interest is but lots of the specialists seem to be in every consultation meeting where doctors seem to have been excluded.

Now I hate to get all Freudian but isn't the belit...

2008-04-03T11:07:25.836+01:00

Now I hate to get all Freudian but isn't the belittling/denigration claim a classic case of projection ?

Just look at the tedious jibes that arise whenever the quack issue surfaces - perhaps some docs might be taken more seriously if they dropped references to monkeys, bedpans, or big-tits (if we take some of Dr Crippens recent output).

These condescending put downs are inevitably bolstered with a Pavlovian chocolates & shit combi, usually followed by the air hostess/pilot analogy (an analogy that is so wrong in so many ways).

Here's a little conudrum for the docs;
If the quacks are so dangerous why has this NEVER been demonstrated in the literature ?
Ferret recently came out with some guff about there being no research demonstrating that senior consultants are better than junior consultants.

But I would have thought comparing quacks with docs is akin to comparing a Rolls Royce with a Skoda, or Man Utd with Accrington Stanley (reserves) ?

The gap between them is so huge that surely we should need several fork lift trucks and a posse of Rolling Stones roadies (led by Tommy Saxondale) to transport the mountain of evidence backing up the scaremongering - I mean let's not forget that the quacks have been at it for some time now, so it's not as if there hasn't been plenty of time for such (self-evident) data to emerge ?

I will leave the semantics to others (because I am not clever enough) but if an abscess needs draining, or a wound needs closing or a fracture needs reducing, etc then this will be done by somebody like me because it can be done effectively and efficiently most of the time (according to the research evidence) - and as appalling as it may sound we (in A&E, for example) do develop a certain level of expertise, not least because GPs seem to prefer to pass a lot of stuff over to us (at least in London).

My daughter and her colleagues, who are newly qual...

2008-04-03T09:50:50.451+01:00

My daughter and her colleagues, who are newly qualified house officers, have been threatened and intimidated by nurses.
My daughter is a conscientious and caring doctor, who knows that she has much to learn, but bullying is NOT the best way to encourage young doctors.
I trained and worked as a medical social worker in hospitals in the 70s & 80s and the nurses described to me by my daughter bear no resemblance to the professional men and women I worked with. Maybe the training has something to do with it?

Oh i should point out i can't remember the exact w...

2008-04-03T09:27:17.670+01:00

Oh i should point out i can't remember the exact words but it was not quite as mild as the examples i have used above

Zarathustra,Not being mean but as a medical studen...

2008-04-03T09:26:10.254+01:00

Zarathustra,
Not being mean but as a medical student (i.e. in the last 12 months) we had to attend lectures with nurses as part of our "integrated learning".
I was pretty shocked, as we sign up at the medical school I don't think the lecturers knew we were there. However we heard then say how "doctors are not as clever as they make out" and "nurses are not doctors handmaidens" "you often know more than the doctor".
It was pretty bad.
We had to attend 3 of these lectures, and in each one something similar came up. Now on the wards we are getting the same thing.
I think it may be a shift in the teaching.
But anyway the doctor bashing really is there, i was pretty shocked by it as in many of our lectures (some of them were specifically for this purpose) we got told how great the nurses were, how much they would help us and how we should defer to them more often.

Oh and or the "inter-disciplinary learning" we were the only ones who HAD to attend so there were a couple of hundred of us and about 7 nurses and a couple of physios...funny watching a whole tables of medical students ask each other how they could improve the working balance between their professions!

Mental Nurse is upset by Crippen's view that nurse...

2008-04-03T08:03:16.990+01:00

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.

Actually I don't that was the gist at all of the post (by E, one of the several contributors to Mental Nurse). It was more of a psychological musing on the issue of "not knowing what you don't know".

Personally (since I'm also one of the Mental Nurse authors) I thought I made my own opinion perfectly clear in the comments threat of that post. Just to restate that opinion: I'm in favour of extended nursing roles in principle, but I do not think those roles should be extended to diagnosis. I believe diagnosis to be a doctor role, not a nurse role.

This comment of yours bemuses me:

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.

Really? I must have missed that "How To Hate Doctors" module during my nursing degree. It was most certainly *not* my experience of nurse training that doctors were "systematically belittled and denigrated" over the course of it. Overall, they emphasised repeatedly the importance of good multi-disciplinary teamworking - doctors, nurses, PAMs, social workers etc all working together for the benefit of the patient.