Past Posts...

The Computer Says You Have Schizophrenia!

In his zeal to declare the NHS open for business, David Cameron announced in December 2011 that it was ‘simply a waste’ not to flog off anonymised NHS data to the pharmceutical industry, to help development of new drugs and their testing on hapless patients. Dr No has presented this somewhat tongue in cheek: the NHS does have vast amounts of data, albeit of varying quality, and there is legitimate and useful research to be done on that data. Indeed, Dr No has in the past done just such research. The red rag to Dr No’s bull was the sale of data to commercial concerns. Here, on the other side of the public-private divide, the rules such as they are, are different. We are advancing on Libor country. Profit, not patients, now rule, and it is remarkable how bendy the rules can become. Recently, the life insurance industry poked a sharp stick in GPs’ eyes by using subject access requests to obtain customer (subject) medical records, shaving the best part of £100 off the cost. It may not be illegal, but it is certainly tacky.

British Professional Medicine: RIP 2013

Everyone, but everyone, is a professional these days. Even benefit scroungers like Dr No are professional benefit scroungers. Sociologists over the years have woven so many strands and threads through the social construct of professionalism that the term has become so broad and debased as to be meaningless. To borrow from a line attributed to the poet John Lydgate and later famously adapted by Abraham Lincoln, you can professionalise some people all of the time, perhaps even others some of the time, but you definitely can’t professionalise all people all of the time. If everyone is a professional, then no one is.


The school most at large in government today of the science that makes numerology appear rigorous is that known as Etonomics. As much a sect as a school, Etonomics holds that austerity is the one true path. Governments, according to its theories, must grip the economy as a giant python might a fat pig, and squeeze it back into shape. Those parts of the economy that fail to get back in shape face cuts, savage cuts. Not just an ear here, or a trotter there: whole limbs have to come off. These are the teachings of Etonomics, and, strangely enough, they don’t work. The python may enjoy a snack, but the economy dies.

These musings arose as Dr No read a seriously erudite assessment of the failing of Etonomics here. The assessment is long, but a one line summary might be ‘you ain’t seen nothing yet’, perhaps suffixed with ‘and you may never, because Tory austerity is unachievable’. To reach this conclusion, Lanchester, the author, makes a distinction between ‘cuts’ and ‘austerity’. Cuts, says Lanchester, are real, and do the damage, while austerity is an orchestration, and a con.

The Lollipop Men

A journey of a thousand miles begins from the spot under one’s feet.

–Lao Tzu, Tao Te Ching

Two of the lollipop men NHS grunts most love to hate put their heads above the parapet recently. The anti-GM crop man who is himself part of a GM crop said doctors had lost the human touch, and must in future care more. The minister whose brains if extracted and compacted would make a passable mothball fumed about the normalisation of cruelty in the NHS. The familiar vistas of patients managed like battery hens, caged in their beds and kept in the dark, were rolled out across the media. A picture was conjured of the NHS as a giant sausage machine, taking live patients in at one end, and extruding a grotesque string of body-bags at the other. In between, moths of death flit in and out of the shadows, undaunted by ministerial mothballs. If the NHS, by these accounts, can be summed up in one word, it is Hades, realm of the eponymous Lord of the Underworld, a dark realm which all may enter, but none may leave.

59m in the Life of an Ambulance Control Centre

These days, nothing really happens until it happens on social media. Apart from curmudgeonly old duffers like Dr No, anybody who is anything is busy on twitter. Why, even HRH is on twitter! The NHS, it seems, is all over twitter like pigeons all over Trafalgar Square. Hospital trusts, ambulance control centres, continence control services, you name them, there they are on twitter, tweeting away, like pigeons all over…

In case he is missing something – perhaps he is, since everyone is at it – Dr No decided to observe in real time the emerging tweets of one NHS twitter account over a period of one hour. In the interests of openness and accountability, he presents his observations and, being twitter, it should be read from the bottom of the post upwards. But then, Dr No has never suggested twitter ever made any sense…

Hot Burning Clouseau

Hot Burning Coales, the enigmatic London GP who has for a time been a thorn in the side of the Royal College of GPs, is showing signs that she is about to start hammering at them like a pneumatic drill. She is alarmed by the absurd pattern of results from the College’s Clinical Skills Assessment, the ‘exit’ exam for trainee GPs. Her concern is that white British candidates go through on the nod, while Asian International (non-UK medical school - IMG) graduate candidates are systematically failed, on the grounds that they are not ‘one of us’. Certainly the raw figures appear to back up the suggestion that there is a case to be answered. The College’s own statistics (page 28 here) largely (she has skimped a bit on the detail) confirm those reported by HBC: 96.1% of white UK graduates pass on their first attempt, while the figure for Asian non-UK graduates is 36.9%.

The Curse of a Fortunate Man

Over the years Dr No has encountered a number of single handed general practices. His first encounter was on a Scottish island, as a student, in a practice made memorable by two things: the sweet malt smell from the oil drum sized barrel of beer that brewed beside the kitchen range, and the loan of the practice Land Rover, with a licence to roam the island. Later, as a locum, he found single-handed GPs on leave a reliable source of work: he could be transported, as if by a revolving door, to the seat of a single handed GP. For a week or two, he had eyes-only access to almost every aspect of the practice. He saw the intimate details first hand, not as a squinting sociologist might, but as a living participant. And living practices they certainly were, but pretty rum many of them were too. Too often for comfort, opening a drawer in search of a prescription pad, Dr No was greeted not with a jumble of papers, tongue depressors and broken tape measures, but with the clink-chink of bottles of high proof but non-surgical spirit.

If Only

A good traveller leaves no track

–Lao Tzu, Tao Te Ching, Ch. XXVII

JT, the well known member of the London Aesculapian Fracture Club, has written another excellent essay, on the feelings engendered in doctors by their patients. This is a taboo but utterly central part of all medical practice, but it is in the over-lapping theatres of general practice and psychiatry that it regularly achieves elephant in the consulting room status. Just as we doctors all love – and that is a word we shall come back to – our good patients, so too do we struggle not to shun, displace and avoid those patients we find distasteful. For many doctors, this one included, it is often the patients we have rejected and failed that we remember most vividly. A chill shudder of shame still strikes Dr No when he recalls some of his more disgraceful moments, like the time he berated a little old lady for insisting on a unnecessary home visit, when he should instead have seen a lonely soul in need of a hug.

Left Shit

The title for this post arises because Dr No has idly been playing Shorter Titles, the I’m Sorry I haven’t A Clue game in which panellists are invited to submit film (or song) titles where a single letter omission changes the meaning – Oldfinger, The King’s Peech, Rear Widow, The Godfarter, The Tird Man, that sort of thing – but as Jack Dee would say, they don’t work in print - the original title here being Left Shift, the hypothetical statistical fancy much beloved of the medical Islingtonistas who favour alcohol minimum unit pricing. Left shift is the notion that in populations the body wags the tail: the mean determines the extremes. Applied to alcohol minimum pricing, left shift has it that if average consumption falls because of raised minimum unit prices, then so too will heavy consumption fall. Populations, according to this hypothesis, behave like a blancmange made with excess gelatine: a nudge in the middle, and the whole pud moves across.

Exception Report

Twitter health news of the weekend was iDoc, a Department of Health initiative to slash surgery visits by replacing them with technology, and so save nearly £3 billion. The fire was started late on Saturday evening at 11:11pm - 11 minutes, Dr No notes, after the end of The Killing (BBC Four), the Danish villains in high places procedural - by the ever vigilant Dr G, who tweeted ‘High hopes for IT at the GP's surgery’ and linked to the next day’s Sunday Expresso front page: “END OF THE DOCTOR'S SURGERY”. By Sunday morning the story was crackling nicely round twitter. Doctors would be replaced with iDocs, noctors by iNocs, and patients by iPocs. Skypesults and tweetsults would replace consults, and hashtags like #squits and #spotteddick would trend, allowing the @CMO to gauge at any time the #healthofthenation. It was not, it is fair to say, a vision which was warmly welcomed by medical tweeters and bloggers. Dr No even wrote a post, but choose not to publish, unlike McMargo, who rounded the day off with a heartfelt post that warned over-adoption of medical IT risked throwing granny out with the tea leaves. Dr No couldn’t agree more.