Posts tagged with Dodgy Practice

Medical Unemployment

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 Apothecary: You’re Fired

Once upon a time, there were no GPs, only apothecaries. These corner-shop chemists evolved over time into today’s GPs, but their shop-keeping origins are still present even in today’s super-surgeries, and all the more so in the small lock-up single handed surgery. The short appointment times (it’s usually only a shopping trip, for Heaven’s sake), and expectation that the shopper-patient will not walk away empty-handed (what shop-keeper would so disappoint his or her customer?) are two leading characteristics of today’s general practice that stem directly from its apothecarial trade roots.

The Curious Case of the Coales that Burnt in the Night

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.

Snake Oil

Yet another study has been published showing that prescription antidepressants are no better than snake oil - that is to say, placebo, or sugar-pill - for treating mild to moderate depression. Yet in 2008 - the latest year that figures are available for - UK doctors doled out a staggering 36 million prescriptions for antidepressants to patients - almost enough for one prescription for every adult.

How can this be? To answer this question, we have to go a bit further than the usual – and highly important – profit motive of Big Pharma. We have to ask the question: why is it so easy for Big Parma to shift 36 million prescriptions a year? The answer lies in the history and nature of General Practice - which is of course where the vast majority of these prescriptions are issued.

Trust Me, I’m a Whistleblower

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.

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.

The Royal College of Pharisees

That smuggest of colleges, the Royal College of Physicians of London, already infamous for its part in the MMC/MTAS disaster, has of late been cozying up ever more closely to the Department of Health, and its chief pongo, Sir Liar Liar Pants on Fire Donaldsong. Earlier this week it moved still closer, issuing an right-on report damning callous smokers who kipper their kids.

The report, featuring a cover photo of a prole caught in the hideous act of kippering a bairn, contains shocking figures and urgent recommendations in bountiful supply. Passive smoking, it estimated, caused children over 300,000 UK GP consultations and almost 10,000 hospital admissions every year, at a cost to the NHS of about £23.3 million. An alarming list of childhood illness caused by passive smoking includes old favourites such as asthma and wheeze (22,000 extra cases) and middle ear disease (120,000 extra cases), as well as the reliable media magnets meningitis (200 extra cases) and cot-death (40 extra deaths).

Supping With a Short Spoon

Just as there is gold for drug companies in them thar pills, so there is gold for GPs in them thar patients. Historically, GPs were paid chiefly on a patient head-count basis, topped up with item of service fees for ‘extras’ such as vaccinations and contraception. The simplest way for GPs to boost income under this system was to increase list size, sometimes to absurd levels where the GP could not hope to provide adequate care for all the patients on the list. Some even gamed the system, by sneaking ghost patients on their lists. Governments disliked crude head-count based pay, not least because it offered no scope to influence GP activity. Item of service payments were an attempt to change that, but the capitation fee was still paid whatever the doctor did, or didn’t, do. The below par golfing GP trousered the fee in equal measure to his more conscientious colleague on the other side of town.

Poldark by Gaslight

Dr No approached last Sunday evening’s Lady Chatterley’s Lover (BBC1) in a bad mood, having just had his computer freeze up in the last moments of an ebay auction he was particularly keen to win. Maybe there’s an app out there baddies can use to freeze up other bidders’ computers at the critical moment. Any road, he hoped some good old fashioned rumpy pumpy would distract him from his ebay woes, all the more so as the BBC’s adaptation was by Jed Mercurio, once upon a time a doctor, and known more recently for dramas such as Line of Duty. He was up against stiff competition, not just in the trouser department. For Dr No, Ken Russell’s Women in Love is the defining big or small screen adaptation of DH Lawrence’s work, with a none too bad 1980s BBC adaptation of The Rainbow definitely in the running. How did Mercurio do?

Patient Abuse - A Bad Case of Management Blowback?

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?

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