Posts tagged with Dodgy Practice

Hoping no doubt to capitalise on New Year temperance sentiments, David Cameron chose last week to announce a review of alcohol pricing. Westminster officials have been ordered to develop ‘a scheme in England to stop the sale of alcohol at below 40p to 50p a unit in shops and supermarkets’, akin to similar but further advanced Scottish plans. The idea behind these neo-Prohibitionist proposals is the so-called ‘single distribution theory’, expressed rather alarmingly some time ago in the title of a seminal BMJ paper as ‘The population mean predicts the number of deviant individuals’. The notion is that, not only can the tail wag the dog, so too can the dog wag the tail. Reduce overall alcohol consumption, and the number of deviant (i.e. heavy) drinkers will also reduce. Like most neo-Prohibitionist clap-trap, it is pure poppy-cock.

It was, of course, Batman who back in the eighties first let the Tory notion that the health service should be not a service but an industry out of the bag. This quaint right-wing notion is still very much alive and well today. Lambo’s Health and Social Care Bill, with its recently highlighted provision that NHS trusts can now devote up to (just one percentage point shy of) half of all their activities to privately funded work, is part of the cold steel of this reckless policy. Those who doubt the extent of Tory industrial intent need look no further than Cambo himself. Only last November, he told us – during a speech that was meant to be about exports and growth – that he wanted to ‘drive the NHS to be a fantastic business’. No doubt that will include some token assurances about the importance of customer service, but there, plain for all to see, the emphasis is on business.

Ian Hislop spent much of last night’s Have I Got News for You looking like un lapin apeuré caught in the headlights. Kirsty Young, the thinking Jock’s crumpet, kept both hands on the wheel. The man behind the wheel behind the headlights was one Lord Justice Leveson, chief pongo at the eponymous inquiry into, inter alia, the culture, practices, and ethics of the British press. The fear is that the headlights will turn into ray-guns, and before too long Hislop not to mention other upstanding members of the Great British Press will go up in flames, to be left standing, like smouldering stumps after a bush fire, the charcoaled reminders of a once free press.

There has arisen, it seems to Dr No, a certain class of doctor, typically female and in their thirties or forties, maybe a GP, but not in full time clinical practice, perhaps instead involved in medical education in some guise or other, or perhaps not, who number, amongst their many duties, that of patrolling the internet. They patrol other, often male, members of their profession for what they consider to be misdemeanours, great and small, and when they find such misdemeanours, they feel driven to act, in the name of decency, correctness, and the final eradication of all victimisation, bullying and harassment; and for the greater good of the name of a modern caring profession. Dr No calls them The Furies, after the Roman version of the Greek Ερινύες, the avenging goddesses of wrath, who arose, fittingly enough, from drops of blood spilt at the castration of Uranus.

Those who follow the UK medical blogosphere will already be well aware of the curious case of Dr Una Coales, the Korean Missile currently disguised as a locum GP. A prolific, out-spoken, self-promoting and self-publishing writer, with ambitions to become the RCGP’s next president (small fry, given that she is already, according to her twitter page, ‘Conservative Health Secretary’), she has brought a world of fury upon her shoulders for – allegedly – shopping the identity of a person or persons unknown as the real Dr Rant, late of the blogosphere, to the police – or perhaps the GMC, or even both. Within hours, other bloggers started going out, like bulbs on a set of Christmas tree lights. A better known Heat Seeking Missile has weighed in heavily, and told us in no uncertain terms that it is our own stupid, indolent fault that our lights are going out. Her comments as of now lie, steaming like elephant dung roadblocks, at the bitter end of more than one post on the matter. No doubt a similar steamer will be dumped here before too long.

Is there more patient abuse in the NHS today than there was, say, thirty years ago, or are we just better at exposing it? Dr No does not know for certain. He chose a thirty year comparator because it was about that time ago that he was a medical student, and then a junior doctor, and so frequently exposed to different wards and hospitals. His recollections from that time are more of starched white sheets, and of course the starched but very beguiling nurses who smoothed them out, than of beds doubling up as commodes. He does recall once seeing a cockroach on the polished wooden floor of a ward, but it was a one-off sighting of a very lonely cockroach. Today, it seems, the cockroaches have grown in both size and number, many now standing on two legs as they mishandle and maltreat the patients on their ward. Has it come to pass that the once occasional failing has now become normal practice?

Monday’s Channel Four Dispatches programme featured Squeeze Esmail, a sharp professor of general practice, now turned part-time undercover Taliban operative. He lined up some stooges with a collection of red flag symptoms – so-called because they should indicate to any doctor the possibility of serious disease – and fitted them with spook-cams before sending them off to see dodgy GPs, most of whom had un-pronounceable names, and/or worked out of shady lock-up retail premises. The dodgy doctors duly obliged, failing to spot the suicide vests so visibly strapped to their patients chests. Jon Snow presented, with a mixture of knight’s move reporting and come-off-it interviews with Stilton, the chief pongo at the GMC. All in all, the programme raised some important questions, which Dr No may return to another day, but that didn’t stop the Jobbing Doctor from wailing, and hammering yet another nail into his already shattered foot on the cross.

There has been something of a trumpet voluntary on the whistleblowing front over the last week. The King, Queen and Godfather of medical whistleblowers have co-authored a paper, which the JRSM has foolishly – it’s about whistleblowing, for Heaven’s sake - hidden behind a paywall – only to allow its publication, via Queen Blow’s own website. Radio Horlicks simmered away on Thursday, with a half hour Report featuring the shimmery voiced Dr Kim Holt. And the Eye (related website here) has produced a Shoot The Messenger NHS Whistleblowing ‘Special’, an eight page dossier of gagged and stuffed doctors hung out to dry, complete with red borders and menacing target images. Queen Blow, however, is conspicuous by her absence from this report – apparently following an iPal tiff - so leaving the Eye a Wonderbra short on the sex appeal front.

The Daily Hail may constantly portray doctors, especially GPs, as lazy golfing fat-cats, and no doubt more than are few are, but there are other corners in the medical universe that are not so cosy, corners closer to the dark side of the moon than the sunny terrace of the nineteenth hole; and one of those corners is that of medical unemployment: doctors who are in a position to work, but for some reason cannot find work.

To those outside the profession, medical unemployment is inexplicable, bizarre, even disturbing and unsettling. Doctors are both committed and driven individuals, trained to the highest standards (at considerable tax-payers expense, some would add), with a ticket to work in a rewarding – both personally and financially – profession. And we are, so the story goes, always short of doctors. How, possibly, could medical unemployment be a reality?

The libel wars are hotting up. Rodial, purveyors of High Class Snake Oils to the lunching classes, have fired the first libel shots across the bows of a Ms Dalia Nield FRCS (Ed), for daring to question Rodial’s claims that their revolutionary ‘Boob Job’ gel ‘plumps up the bust’ – by up to 8.4% in a couple of months – if you believe the spiel.

A number of commentators, including Dr Ben Goldacre of Bad Science, would have us believe that this battle is about science, and science alone. There is hot talk of transparency, replication, and open discussion; and of the crassness of using libel law to stifle scientific debate. All this is without doubt true, but the smoke generated in the heat of indignation has partially obscured a somewhat unfortunate fact. Ms Dalia Nield FRCS (Ed) is a Plastic, Reconstructive and Aesthetic (Cosmetic) Surgeon, who numbers amongst her procedures breast augmentation.