Past Posts...


Tick Box Medicine

Dr No’s mother, a fit 80-something year old, recently attended an ophthalmology clinic, on the advice of her optician, and was told – out of the blue, by a nurse – she hadn’t even seen a doctor - that a bed had been arranged for her to come in two days later to have her cataract removed. The nurse was most put out when Dr No’s mother – who knows her mind very well – said she had no intention of coming in for an operation she neither knew about, nor did she need. Yes, she does wear reading glasses – but otherwise her eyesight is fine.

Revalido, ergo non sum

The one-time partly elected General Medical Council, now reincarnated as a State appointed Stasi, has started to rev up its revalidation machine.

Appraisal will change from an annual tea and biscuits affair into a game of Russian roulette. Multi-source 360 degree feedback will provide a Catherine Wheel display of our gaffs. Serious Untoward Incident reviews will expose out deepest faults. No amount of lists of dutifully conducted CPD will erase the stain of our failures. The Herr Obersturmführer Appraiser will click his heels and pronounce our conduct inadequate; and the Herr Oberscharführer Responsible Officer too will click his heels, and regret to inform us that he is unable to make zee rekommendation that we be revalidated. Our career will end, not with a bang, but with a click.

Ross Kemp on Gangs: The GMC

Medium shot of Kemp standing outside GMC Towers.

KEMP (to camera): I’m on my way to meet a gang that has been regularly mixed up in spurious allegations, career assassination, perjury and perverting the course of justice. A truly notorious gang who have been terrorising innocent doctors for more than 150 years, while at the same time always looking after their own. A gang so fearsome in its reputation that its victims refer to it only by its initials. It is the gang simply known as (dramatic pause) The GMC.

Alma Mater

Today is Mothering Sunday, the day when we thank and honour the mother who has nurtured us. Dr No has been doing his filial duty - when it comes to Mothering Sunday even Dr No says 'Yes' - but thinking of nurturing set him thinking of the other nurturances and influences that have shaped the way he is. There are a number, but without doubt many cluster round his years as a medical student, when a young, volatile, opinionated, yet still malleable teenager was transformed at the anvil of apprenticeship into a brash and brittle junior Dr No, who walked the wards burning bright from the heat of the forge.

Most Drugs Don’t Work

One of the most bizarre facts about modern medicine is that most of the time, for most people, most drugs don’t work. Naturally, this is something that Big Pharma is keen to keep hidden. Even most doctors are only dimly aware that most of the drugs they peddle might not always be what they are cracked up to be. At a time when drug companies and doctors are pushing ever more pills onto ever more patients, we should perhaps be a little more savvy about the pharmaceutical pact we enter into when we agree to pop pills.

For hundreds of years, doctors had few effective drugs at their disposal. Those that they did have were either herbal toxins used in small doses - opium, digitalis, quinine and the like, which most certainly did and do work - or so-called “tonics” – dubious placebos that nonetheless pleased the doctor and his patient.

Database State

We have seen in recent times how secure our national databases are. HM Revenue & Customs, the Ministry of Defence, the Department of Health, the Foreign and Commonwealth Office have all been reprimanded for serious ‘lapses’ that have put at risk the personal data of millions of UK subjects. On a wider scale, The Information Commissioner reported in January that there had been over 400 data breaches by government and the NHS in the past two years. Last month, the national children’s database, which records details of England’s 11 million under 18 year olds, was described as ‘not stable’ – official-speak for yet another security breach. Our national databases, it seems, are about as secure as a paper bag full of water.

Trust Me, I’m a Trust

The Orwellian coup of calling the corporate bodies that run the NHS ‘trusts’ – with the comforting overtones of propriety and trustworthiness - hides the fact that underneath the surface they are like any other corporation: selfish, secretive and psychopathic.

Dr No was brought to this cheerful observation by a dull but worthy documentary aired by BBC2 last week. Fronted by a man with a puffy dial whose every alternate sentence started ‘I wanted to find out…’, Why Did You Kill my Dad? was an over-scripted attempt to, err, find out ‘the true scale and [human] cost of killings by the mentally ill in Britain today’.

Virgin Shags Assura

Big business is all about big branding, and nobody does branding better than Branson. His red logo is just about everywhere – travel, banks, media, mobiles, you name it – except healthcare. Until now, that is. Earlier this week, the Virgin Group bagged a three quarter share in Assura Medical, the company that runs the Khazi Klinics.

Virgin have been sniffing the panties of healthcare for some time, but, like most novices, were for some time unsure about how to proceed. “For us, this is the culmination of what has probably been five years of knowing we wanted to be in this space but really not finding the right entry point,” said Gordon McCallum, chief executive of Virgin Management. Now they have found the ‘entry point’, the shagging can begin in earnest.

Why Revalidation is Wicked

In its proper form, the doctor-patient relationship is not unlike a marriage. It is founded, above all else, on trust.

The essence of trust is an implicit assumption of the benevolence of the other. Good marriages do not rely on annual appraisal folders, multi-source feedback or revalidation to stay on course; instead the partners simply trust each other. Indeed, the very concept of needing to re-establish trust periodically would be laughable. Why then do the medical revalidatchiks – the Obersturmführer Marshalls of this world – insist that we must replace implicit trust with explicit checking; and that revalidation is now a professional imperative, a ‘core professional activity and responsibility’ that we doctors ignore at out peril?

The Varring and Betting Scheme

We are seeing the first blowback from the introduction last autumn of the Government’s absurdly over-egged Vetting and Barring scheme. Children scheduled for surgery are having their operations cancelled by zealous apparatchiks blocking surgeons who – despite CRB clearance in one trust – are being refused entry to others, where they would otherwise be able to operate. The var, one might say, between stooge and surgeon is on, and all operation bets are off.

On a benign view, this is an example of goal displacement – a triumph of process over outcome. One could leave it at that, were it not for the fact that this triumphant process has trumped real kids needing real operations by real surgeons. And so we have a scheme designed to protect children perversely achieving the opposite result – harm to children.