Dr No's Editor's Choice

A selection of Dr No's posts, ordered by number of page views. Older posts tend to have more weight because they have been around longer, and so have more time to gain page views.

Re-order by date (latest first), number of comments (desc), no particular order (random) or return to order by page views.

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 Secret Nail in the NHS Coffin

Sometimes a picture is worth a thousand words, and the photograph on the left – taken covertly last weekend at a top secret boot camp for Tory operatives soon to be charged with ‘fixing’ the NHS – tells us only too clearly what the Tories have in mind for our health service. But illuminating as such images are, to gain a fuller picture we have also to look at the legal framework on which such proposed activities hang, and the legal framework on which the National Health Service hangs is the National Health Service Act 1946, and its derivatives, temporal and spiritual, including the National Health Service Acts 1977 and 2006, and most recently the proposed Health and Social Care Bill, currently at committee stage before Parliament.

The first notable change is the name: gone are the references to ‘National’ and ‘Service’; instead we now have ‘Health’, conveniently bundled with that great Tory fiscal irritation, ‘Social Care’. At a stroke, the National Health Service has lost its special status, and been teamed up with just another drain on the public purse.

Most Drugs Don’t Work

Just over three years ago, when few had heard of him, Dr No wrote a post called The Collapse of the Probability Function. At its heart lies the troublesome paradox that, while we might know how a group of patients might fare, we have no way of knowing how individual patients will fare. We might know that of a hundred patients, five will die in the next ten years from a heart attack. What we don’t know is who of the hundred will be the five; and the flip side of that is, when as doctors we choose to intervene, as increasingly we do, there are ninety five souls now tangled in our medical web, with all that that entails, be it tests, treatments and general apprehension, who were never going to have a heart attack anyway, let alone die from one in the next ten years. That’s a whole lot of medical intervention without any benefit whatsoever – but what the heck – overall, we might save a handful of lives - or so the hopeful reasoning goes.

Alma Mater

Today is Mothering Sunday, the day when we thank and honour the mother who has nurtured us. Dr No has been doing his filial duty - when it comes to Mothering Sunday even Dr No says 'Yes' - but thinking of nurturing set him thinking of the other nurturances and influences that have shaped the way he is. There are a number, but without doubt many cluster round his years as a medical student, when a young, volatile, opinionated, yet still malleable teenager was transformed at the anvil of apprenticeship into a brash and brittle junior Dr No, who walked the wards burning bright from the heat of the forge.

Malicious Seeds of Mischievous Doubt

“[Most] patients would much rather be a live problem than a dead certainty.”

—Lord Cohen

There are those who say that holocaust denial is a crime; and those who say that the BBC had no business allowing the BNP leader Nick Griffin space on Question Time. Giving air to vile thoughts, they say, allows those thoughts a legitimacy they do not deserve.

Snuffed Goose Recipe

We shall probably never know whether Ray Gosling was an inspired stage name, or the portentous real name for a lad who, after a TV life rich in sauce and stuffing, would spend much of his later life stuffed and trussed, before – in a final defiant gesture – spatchcocking himself on camera in a lonely graveyard.

Last Monday, early evening BBC viewers in the East Midlands region were greeted by Gosling, decked out in a fetching overcoat, ambling through the tombstones. Speaking in his best bus driver documentary voice, he mused: ‘Maybe this is the time to share a secret that I’ve kept for quite a long time’. Viewers expecting a homely confession that he rigged a past documentary were in for a shock.

Tick Box Medicine

Dr No’s mother, a fit 80-something year old, recently attended an ophthalmology clinic, on the advice of her optician, and was told – out of the blue, by a nurse – she hadn’t even seen a doctor - that a bed had been arranged for her to come in two days later to have her cataract removed. The nurse was most put out when Dr No’s mother – who knows her mind very well – said she had no intention of coming in for an operation she neither knew about, nor did she need. Yes, she does wear reading glasses – but otherwise her eyesight is fine.

Ain’t Turning No Machine Off

“I ain’t turning no machine off” said Kelly, as if she was a teenager talking about shutting down her Playstation. In fact, she was a mother talking about turning off the life support for her very premature baby.

And so it was that last night's BBC2 documentary 23 Week Babies: the Price of Life exposed one of the central dilemmas at the heart of the medical and ethical minefield that is whether to resuscitate very premature babies. Kelly was clearly up for not turning no machines off. Whether she was up for understanding, let alone navigating, the medico-moral minefield was another matter altogether. She hadn’t even in fact been asked to turn no machine off, only what her views were on aggressive resuscitation should her baby take a turn for the worst. The program’s presenter, Adam Wishart – a thoughtful cove whose brief onscreen appearances featured averted eyes, even if the eyes of his cameras probed mercilessly – asked: is it right to place such a burden of responsibility on the parents?

Medical Truants

Dr No has Boots down as an otorhinolaryngologist - an ear nose & throat surgeon, but then the Greek always sounds better in the plush of private practice. These are the chaps who mount CDs on their foreheads, the better to peer into your orifices. Quite why the tonsil baggers need to mount a CD on their forehead to see what they are doing baffles Dr No. Gynaecologists seem to manage very well, without resorting to shining Abba’s Greatest Hits up the old hoo ha.

One might suppose all that peering through CDs might narrow both mind and vision, but Boots has clearly escaped a constricting fate. He has cast his surgical presence wide on the Borsetshire stage; and few indeed are the pies that have escaped the Boots finger. He is very bright, reads widely, and has the natural gift of synthesis to Boot. And so it is that when we come to survey his blog, we find well crafted posts, always finely written, invariably most interesting.

Smedley Cans Himself

Last night, the Incredible Dement shocked the nation. Appearing on BBC2, armed with only a Euro-Rover ticket and a large hat, he toured the Continent, boldly seeking out destinations where others fear to tread. Everywhere he went, it was either raining or snowing, for these were the lands that God forgot. Soon it became apparent that, when the ID was on the road, all roads led, not to sun and the Eternal City, but to snow, and an another altogether different type of Eternity. They led to Zurich, to a dapper blue house tucked away on an industrial estate – a planning requirement, you understand – where a Mr Peter Smedley, late of the canning concern, was about to do to himself what his family had spent decades doing to peas. The only difference was that Smedley would emerge not in a can, but an urn. He had come to Dignitas, to die.