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Lies Damned Lies and the GMC

Any lingering hope that Parliament’s Health Committee could hold the GMC to account at its annual accountability hearing earlier this week over doctor suicides while under GMC FtP investigation has now disappeared as sand in the desert. Though delayed for a few days, the transcript of the hearing is now available online. It makes grim and depressing reading. On the matter of FtP doctor suicides, the Chair of the committee – a doctor – came to the proceedings with a regrettably light grasp, if that is not too strong a term, on the facts. Stilton, the GMC pongo who answered the questions on these deaths, turned out to have an even lighter grasp. Indeed, so poor were these grasps that Dr No has no hesitation in saying that they were, and are, an insult to democratic process.

A Crack at The Afghan, Sir!

A medical school somewhere in England. A panel has assembled to interview prospective candidates. In the centre is Professor Sir Turpentine Stephenson, newly appointed Chair of the GMC. On the left sits Stilton, Chief Executive Pongo for the time being of the GMC; on the right sits His Honour David Fake-Pearl, Chair of the Medical Students Tribunal Service. Fake-Pearl appears to be reading a catalogue of some sort, possibly of spring bulbs. Stilton repeatedly inspects his finger nails. Stephenson gets out a fountain pen labelled ‘MI6 100% nitric acid, emergency use only’ and twirls it in his fingers. Bored observers sit behind the panel.

A bell rings, the panelled door opens to reveal a young lad standing on the threshold. The lad has wing-nut ears.

Developing Magna Carta Medicorum

There are those who want to torpedo the GMC using the Human Rights Act, or even the European Courts, but it must be remembered that such processes are always time-consuming, often futile, and inconveniently prone to blowback, like trying to clear a blocked drain with a toothpick. Instead, we have Magna Carta. As Lord Bagg continues to develop his history of the 1215 Charter, Dr No has been working on Magna Carta Medicorum, a present day Charter to ensure fair treatment of all doctors facing and under professional disciplinary regulation.

Magna Carta Medicorum

2015, as the wonderful Lord Bagg reminded us this morning, is the 800th anniversary of Magna Carta. The speech of the once melodious Melvyn is maturing into the voice of the English Establshmnt, in which later vowls are largely discardd, and each utternce is gaspd, as f’twere speakers last, though never is. Over those 800 years since the first Magna Carta, the Gods of ye mystries have placed the Charter firmly in the mythical sphere, and lodged it anywhere between the Ye Olde Scroll of Ye Commone Law, to a scrap of parchment that was binned shortly after it was penned. Somewhere in the middle ground it is seen, primarily, as the first declaration in English history that the King be subject to the same laws as his people, and that furthermore the laws must be both just, ordered and decided by one’s peers. It was a momentous change.

UKIP If You Want To…

Doing his best to out-kip UKIP, a British surgeon has come under fire for blowing the wrong sort of raspberries in that esteemed organ of Middle England thought – if that’s not too rich a word – known to its readers as The Daily Mail, and by various other non-printable names by its non-readers. The gist of ex-Prof – his professorship ‘expired’, however that happens, though the Mail continues to provide its man with a fictitious chair - Joseph Meirion Thomas’s jam is that the time has come to round up health tourists, nice lady doctors and GPs and shoo them back from whence they came, preparatory-like to re-staffing the health service with proper male hospital doctors.

The Lights Are Going Out

Faced with the GMC’s latest antics, Dr No was tempted to do an RDJ (rapid demolition job) on some of its sillier notions, such as ‘emotional resilience training’ for doctors to prepare them for fitness to practice investigations (‘General Turkey Council: toughness training for turkeys facing Christmas process’), but instead he offers another variation on a favourite line of his, borrowing from great orators of the past. Three quarters of a century ago, Britain stood against the Nazi menace; today the medical profession stands against the regulatory menace. What would Mr Churchill have said had he been the leader we so clearly lack today as our profession prepares to face the greatest menace in its long illustrious history?

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.