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.

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.

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.

Regulators are from Mars, Doctors are from Venus

It is a truth universally acknowledged that a regulator in possession of a dodgy report must be in want of a cover-up.

–Attr: Austen, Miss J.

Yesterday on Newsnight, the Chief Stoat was worrying another victim, on this occasion the Chief Pongo for the time being at Can’t Quite Cope, the body charged for the time being with keeping an eye on the quality of health and social care in England. The story is that CQC had given a certain NHS Trust a green light when it should have flashed a red. On finding the error, senior staff at CQC ordered all lights off, all shredders on, and folk who should have known better started wall-papering their arses. But wall-paper is no match for the brown stuff. As the skid marks appeared, the CQC leadership panicked, turned to its lawyers, and received the extraordinary advice to hide behind the Data Protection Act. It was the absurdity of this advice, not to mention that it was followed, that caused Paxo’s eyes to enlarge in visible increments. Mr Behan, the Chief Pongo for the time being at CQC, responded for the time being by talking up his leadership, but the vigour his assertion was compromised by the fact he spent most of the interview looking like a goldfish about to lead the escape from a wet paper bag.

Savage Life

"Those who, in the confidence of superior capacities or attainments, neglect the common maxims of life, should be reminded that nothing will supply the want of prudence, and that negligence and irregularity, long continued, will make knowledge useless, wit ridiculous, and genius contemptible."

–Samuel Johnson: Life of Savage, 1744

Were it not a hideous truth, the comedically absurd case of the dehydrated patient who dialled 999 from his hospital bed to get a drink of water could have been a scene from Cardiac Arrest, the dark but for those in the know searingly accurate 1990s depiction of life and death on the wards at St Elsewhere’s. By a coincidence, Line of Duty, a police precinct drama in which the leads like Getting Things Done, not in the usual software way, but with hardware, much of it dark blue or grey and involving combustibles, is now running on BBC2. Both were written by Jed Mercurio, and both are about Mercurio’s mojo: the dark and bitter secrets that lie at the heart of two of our biggest institutions: first the NHS, and now the Police. If Cardiac Arrest was Line of Duty with stethoscopes, then Line of Duty is Cardiac Arrest with police badges. Even the protagonists, Andrew Lancel and Martin Compston, look the same.

Toothless Wonder

Dr No gazed in open-mouthed if not toothless wonder as the first episode of Frankie (BBC1) unfolded last night. Not content to be the life and soul of the party, Frankie, a SuperNurse for the time being on the district beat, is the life and soul of the known universe. In a script that pasted it on like a bricklayer mortaring a wall, Frankie was given lines to assist even the dimmest viewer to a full comprehension of Frankie’s awesome powers. When cutbacks have ordinary doctors and nurses quivering, what does Frankie do? Why, she laughs at the cuts! When a cut of a literal sort threatens to come her way in the hands of a demented war veteran, she turns the other cheek. Nothing is beyond the toothless wonder’s extraordinary powers. When a child arrests in her car, Frankie becomes paramedic and then emergency ambulance driver; later, she turns her hand to a spot of midwifery. Dr No suspects Frankie has a fold-up operating theatre in the boot of her car, and in later episodes will turn her hand to a spot of surgery. Nothing is beyond Frankie for, as she told at least one gagging viewer, ‘the world is her patient’. When not fixing the world, Frankie likes to turn up the stereo, and dance, turning the show into a musical: Frankie Goes To Bollywood. Truly, nothing is beyond Frankie, but then, Dr No supposes, that is what happens when you have done Torchwood. Even Captain Jack has been turned into a shadow of his former self, a hapless plod who’s always got the wood, but never gets his way, because every time he gets his pecker out, Frankie’s away.