Past Posts...

Crossed Lines

Now that Call 111 has gone live, Dr No has sent a team of his crack undercover reporters into 111 call centres to discover how the new service is working.

The following is a transcript of a secret recording made at a call centre located somewhere in the South of England.

A 111 call centre, with two operatives with headsets on at desks with computer screens. Op-A is taking a call from a patient; Op-B is taking a break; his screen has flashing betting odds on it. We overhear the conversations…

Op-B: I didn’t quite catch that. Did you say the 1:11 at Aintree?

Op-A: That’s right caller, 111 Braintree here, what’s troubling you today?

Op-B: Number 2, Hot To Trot, followed by Rimfire.

Toothless Wonder

Dr No gazed in open-mouthed if not toothless wonder as the first episode of Frankie (BBC1) unfolded last night. Not content to be the life and soul of the party, Frankie, a SuperNurse for the time being on the district beat, is the life and soul of the known universe. In a script that pasted it on like a bricklayer mortaring a wall, Frankie was given lines to assist even the dimmest viewer to a full comprehension of Frankie’s awesome powers. When cutbacks have ordinary doctors and nurses quivering, what does Frankie do? Why, she laughs at the cuts! When a cut of a literal sort threatens to come her way in the hands of a demented war veteran, she turns the other cheek. Nothing is beyond the toothless wonder’s extraordinary powers. When a child arrests in her car, Frankie becomes paramedic and then emergency ambulance driver; later, she turns her hand to a spot of midwifery. Dr No suspects Frankie has a fold-up operating theatre in the boot of her car, and in later episodes will turn her hand to a spot of surgery. Nothing is beyond Frankie for, as she told at least one gagging viewer, ‘the world is her patient’. When not fixing the world, Frankie likes to turn up the stereo, and dance, turning the show into a musical: Frankie Goes To Bollywood. Truly, nothing is beyond Frankie, but then, Dr No supposes, that is what happens when you have done Torchwood. Even Captain Jack has been turned into a shadow of his former self, a hapless plod who’s always got the wood, but never gets his way, because every time he gets his pecker out, Frankie’s away.

The Baby and the Bath Water

The night before last, the Section 75 Regulations slipped through The Lords like a U-boat, silent and deep. A limpet mine attached to the hull by one Lord Hunt failed to go off, and the boat got through unscathed. The crew even found time to loose off a few tin fish at 38 Degrees, but, on the whole, anyone watching the surface of events would have seen nothing remarkable. Certainly the BBC saw nothing remarkable, and reported nothing. The recent Reynolds analogy, that if the Health and Social Care Act was an aeroplane, then the regulations were the engines that would enable it to fly, failed to take off, leaving no scope for engines on fire, or jumbo-jets falling out of the sky. The health service revolution said to be so large it can be seen from space is all but invisible on earth. There has been no bang, not even a whimper, just the night time passage, silent and deep, of some regulations through the Lords. Nothing has changed - except that the U-boat is now on the inside, torpedoes armed and periscope at the ready. The lumbering ships of the health service convoy still steam across the healthcare seas, unaware of the peril that now lurks in the deeps.

Pax Pemberton

Dr Max Pemberton – Apology

GMC Statement – For Immediate Release
22 Apr 2013

Earlier this morning, Count Rubin (not his real name) appeared on the Today programme opposite Dr Max Pemberton (not his real name), defending the General Medical Council’s decision to implement new guidance requiring doctors who use social media to reveal their identities.

By appearing alongside Dr Pemberton, and not challenging Dr Pemberton’s identity, Count Rubin gave the impression that the Council knew who the real Dr Pemberton was, had got his number, and furthermore the Council knew where he lived.


One of the more noisome phrases in the air today is ‘one should not speak ill of the dead’. The sentiment, both spoken and unspoken, is everywhere, and the dead we should not speak ill of is of course Mrs Hacksaw, the Iron Lady who famously decreed and then ensured ‘there is no such thing as society’. But we shall not speak ill of the dead. Labour leaders stand as pupils before Miss Jean Brodie, the better not to speak ill of the dead. In the Today coven, Humph and Jimbo cackle away at each other, reminiscing about conviction politicians. No, we shall not speak ill of the dead, oh no. April is the cruellest month. Mistress Thatch – she dead! wail the hollow men, heads filled with deathiquette. De mortuis nihil nisi bonum. And yet, between the desire and the spasm, between the potency and the existence, between the essence and the descent, falls the shadow. But we shall not speak of the shadow, oh no: de mortuis nihil nisi bonum.

Stilton’s New Prong

Earlier this week, Stilton published a new edition of Good Medical Practice, the lance of many prongs which he and his goons use to skewer hapless doctors. Stilton’s premise is that doctors are a lawless reckless lot, and left to their own devices they will get up to all manner of mischief. From their hidden position behind the net curtains, Stilton’s goons have perceived a new mischief: the menace of doctors who appear incognito on social media. A prong – a somewhat bent prong, since most content on social media is publicly accessible – has been added to Stilton’s lance. New explanatory guidance alongside GMP warns: ‘If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name’. Although framed as a ‘should’ rather than a ‘must’, this bent prong has its sights clearly set. For doctors foolish enough to carry on the anonymous caper, Stilton is coming to get you: ‘You should also be aware that content uploaded anonymously can, in many cases, be traced back to its point of origin’. Dr No is not entirely persuaded that GMC goons can trace their arses from their elbows, let alone trace Dr through the complex web of shared internet service provision; but, be that as it may, anonymous medical bloggers are up in arms.

The Ghastly Passage

Without so much as a hint of irony, a character in one of Susan Howatch’s novels gives orders that under no circumstances should that ghastly passage by Scott Holland be read at her funeral. The ghastly passage is Death Is Nothing At All:

“Death is nothing at all. It does not count. I have only slipped away into the next room. Nothing has happened. Everything remains exactly as it was. I am I, and you are you, and the old life that we lived so fondly together is untouched, unchanged. Whatever we were to each other, that we are still. Call me by the old familiar name. Speak of me in the easy way which you always used. Put no difference into your tone. Wear no forced air of solemnity or sorrow. Laugh as we always laughed at the little jokes that we enjoyed together. Play, smile, think of me, pray for me. Let my name be ever the household word that it always was. Let it be spoken without an effort, without the ghost of a shadow upon it. Life means all that it ever meant. It is the same as it ever was.”

A Dark Nurse

Dr No’s mother has been admitted to hospital – at home. This NHS wheeze is a worthy idea, which Dr No supports. On paper, it is win-win: patients stay in their beloved homes, and the NHS saves money. In practice, it has one minor but fatal flaw. The hospital has a matron, kit in abundance, OTs, you name it, but no ward nurses. It is a hospital without nurses on its wards, and like all hospitals without nurses on the wards, it doesn’t work. Ironically, the money saved by not admitting patients to real hospitals could fund these nurses, but no one in the NHS has spotted this, and so the idea remains worthy, but doomed to fail. One supposes that were Crippen still blogging, he would have done hospital at home full justice, as he once did for another NHS corker, the hospital at night, a hospital whose defining characteristic was not an absence of nurses – rather the opposite in fact – but an absence of doctors.

Affection Love and Duty, These Three

Dr No’s mother is a heartsink patient, and she happens to be dying. Unpalatable as they may be, Dr No says these two things as matters of fact. On one level, as a doctor, he cannot not see his mother as he would see a patient – and the hallmarks of heartsinkery are undeniably present. Although Dr No has had a hunch about prognosis for some time, it was his mother’s consultant who gave it form, in a measure of months. She is a heartsink patient, with only months left to live. Those who care to opine that heartsink is a term of derogatory abuse might also care to reflect that the term is not so much a patient label, notwithstanding the inescapable fact it is one, as a useful term from the lexicon of countertransference, under the general heading of those feelings and emotions engendered in a doctor by his or her patient. Countertransference matters: those who choose to ignore it do so at great peril, not just for the patient, but also for themselves.

Making Friends and Family of Us All

Paul Corrigan, whose posts show a worrying trend towards titles so long they stand as posts in their own right, has declared himself a friend of FFT, the punter-friendly friends and family test based on asking patients at or soon after discharge whether they would recommend the unit they have just left to friends and family. The test is popular with government for its apparent simplicity, resented by managers for the real extra burden it imposes, and derided by front-line staff, for whom the test might be better known as the Flying F*ck Test: the punters don’t give a FF about responding, and we don’t give a FF about the results. Although first announced last year, FF testing was back in the news last week after friendly we’re all in this together Dave announced plans to extend FF testing to general practice. The news got a cool response from senior GPs; others went further. One called the test ‘meaningless’; another dubbed it ‘trite’.