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December 2014


Burning Bad News

Only yesterday, Dr No was working on a post noting that the GMC had still not published its internal review of doctors who died while under Fitness to Practice investigation. He noted that publication was originally slated for July 2014, then November 2014, and, as of earlier this week, possibly sometime in 2015. He even noted that at the very time the GMC is consulting on doctors’ duty of candour, it was showing a striking lack of candour in its own conduct. The last sentence of the first paragraph of the post said ‘In the absence of certainty, it is not clear whether the review is still incomplete, or is complete, but currently too hot to handle, with Stilton’s PR goons waiting – sorry – for a good day to bury bad news’. It now seems they were: the review has been published today, the last Friday before Christmas.

A Bill to Promote Innovation in Advertising

Imagine for a moment Dr No is now a peer, Lord No (of Nowhere), and it has come to his fancy that there are a lot of worthwhile advertising folk out there who are being cruelly frustrated in their attempts innovate by a constant fear of litigation. Radical campaigns to sell coals to Newcastle, defy gravity and achieve eternal life, these two possibly at the same time, though the Church has had a protected monopoly on promoting that particular proposition for the last two millennia, have remained but twinkles in the eyes of advertising executives. Those pesky anti-free market types have got too big for their boots; and every day, another regulator leans forward to breathe down the necks of advertising executives. A chill hangs over the corridors of innovative advertising; brilliance lies stunned into submission. All in all, it’s enough to make a right-thinking peer weep.

No Easy Answers

There’s not much to say, even if Dr No is going to say a bit, about Atul Gawande’s third 2014 Reith Lecture, except that he blew it in the title – overweening confidence, Gawande’s definition of hubris, is not the problem, striving officiously in hopeless desperation is - and then spent thirty or so minutes stating the bleeding obvious. Called The Problem of Hubris, the lecture dealt with doctors’ failure to deal with the inevitable, the appointment we all must keep when our bell tolls, the appointment not with a doctor, but with death.

Time for a Gawande anecdote, this time about a friend called Peg. Emotional strings were taughtened by casting Peg as piano teacher to Gawande’s 13 year old daughter. Given Gawande’s subject, one knew Peg’s cards were marked: at some point, Peg would peg out. Best be grateful for small mercies: at least Peg wasn't called Sue.

Discipline Makes Daring Possible

When the Chief Medical Officer feels uncomfortable, should the nation tremble? Probably not. Certainly, Dr Atul Gawande didn’t, fielding Dame Sally Davies’s troubled comments after giving his second 2014 Reith Lecture, broadcast this morning on Radio Four. Speaking in his now familiar, you know, George W Bush style “Our people done a really good job…of, you know…hauling in a lot of the key operators”, Gawande extolled the virtues of getting systems right. Goaded by air industry experts baffled at the casual approach of surgeons to their work, Gawande developed The CheckList. Depending on viewpoint, the CheckList is either strictly for the dumb-assed, or a sort of systems alchemy that transforms the inept into the ept, and experts into super-experts. Doubters are stumped and declared out for a duck by asking them a simple question: “If you’re having an operation, would you want the team to use the checklist?” Unsurprisingly, ninety four percent did, though that leaves the intriguing question what did the other six percent want? Dr Frankenstein? A one armed blind surgeon with a prosthetic hand and Parkinson’s disease? We’ll probably never know, because by now they will have maimed or killed themselves some other way.