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January 2013


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’.

Full Tank of Gas

Unbeknownst, presumably, to today’s Tory sound bite chefs, in Dr No’s youth to be full of gas had other meanings: to be full of wind, puff or bombast. These earlier meanings recurred in Dr No’s mind over the weekend, as the BBC’s news zombies trotted out Dave’s full tank of gas sound bite time and again. Presumably, like Camilla’s use of wicked, gas is meant to sound groovy. LOL! Where, Dr No wondered, was Little Nellie when you needed her? Dr No’s earlier scheme to pour sugar in Dave’s petrol rapidly gave way to an overwhelming wish to drop a match in the tank.

Commissioned Work

Now that Dr No has retired from clinical practice, he is keen to expand his published work.

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.