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.



Dropping Like Flies

The Inquisition known for the time being as the General Medical Council is under fire. Its fitness to practice procedures, which for doctors caught on the sharp end of one of Stilton’s prongs feel much like being popped into a beaker of dilute sulphuric acid with a rack of Bunsen burners arrayed underneath, have come under scrutiny because of an apparently high mortality attached to being left to simmer in warm sulphuric acid. Figures available online suggest that there were at least 92 deaths between 2004 and 2012 in doctors under investigation. The denominator – which Dr No suggests should be the number of GMC cases referred to panel investigations – stands somewhere in the region of 2300 (see footnote), giving an approximate average annual mortality rate of 4%. Working age (25-64) mortality in the same period was around 200 per 100,000, or 0.2%. Something is clearly going on. If we apply some crude ‘observed over expected’ numerology to these figures, we get a (very) crude mortality ratio, on the normal 100 base, of around 2000: that is, where we would expect 100 deaths, we find 2000.

Merely Potential Persons

An extraordinary paper published in that hot purple-top The Journal of Medical Ethics has ignited a storm of controversy. The naïve authors argue that a newborn is morally no different to a foetus – both being ‘merely potential persons’ – and thus infanticide – renamed after-birth abortion by the authors – should be permitted on the same grounds as those used for abortion. The pro-life lobby reacted predictably, and demonstrated forcefully that for many of them, pro-life sentiments do not extend to academic philosophers who espouse eugenic arguments. Quite the opposite, in fact: the authors, and the JME for publishing the paper, have been subjected to a torrent of hate, abuse, fire-crackers and death-threats.

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.

Be Careful What You Vote For

Next time you meet a nurse, ask him or her what the NHS reforms are about. Almost certainly the answer will be ‘I’m not really sure…I don’t really understand them’.

Next time you see your doctor, ask him or her what the NHS reforms are about. A few might know, and give their version, seen through their political prism, but from the rest, the answer will be: ‘Waterworks OK?’ Sub-text: stop asking me stupid questions I don’t know the answers to.

Email your MP and ask them what is his or her position on the NHS reforms, and nine times out of ten you will get his or her party’s standard issue response. Probe further, and it will become clear that he or she hasn’t the foggiest.

The XX Factor

Were it not for the genuinely sad nature of the case, the last few hours of Lynn Gilderdale’s life could almost have about it the air of a grotesque Benny Hill sketch. In a surreal speeded up video, complete with that memorable theme tune, one might see Kay Gilderdale rushing around their home, searching out pills and potions, furious grinding in pestle and mortar, frantic googling, over-size syringes full of air…

…and all in very bad taste, Dr No fully agrees. But sometimes he wonders whether it isn’t necessary to look a little harder at the current wave of mother-love hysteria that has risen on the back of the Inglis and Gilderdale trials for murder and attempted murder of their respective children.

Lest We Forget: A Poppy for the NHS

Dr No observes Remembrance. Last Friday, the day before yesterday, at the eleventh hour on the eleventh day of the eleventh month, and this time as it happens of the eleventh year of the century, he fell silent and still for two minutes, and remembered those who have given their lives for the freedom we enjoy today. It is a moment of solemn awe for the sacrifice made, and of great humility in the face of such selflessness.

Remembrance was made that bit more poignant this year by the breaking news that Circle Health had signed the long foretold contract to run Hinchingbrooke Hospital. This contract is a clear challenge to the authority, competence and perhaps most of all to the values of the NHS; a challenge which, if not seen off, will in short order threaten the very life of the NHS.

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.

Unnatural Selection

By way of a reply to WD and Dr Boots' latest comments on Dr No's last post.

In Dr No's medical student days, most medical students were WASP males. There was a lot of rugger, and high jinks, à la Daily Hail, only in those days, having studied Latin and so Roman habits, we knew how to throw up properly.

About fifteen years later, about ten years ago from now, Dr No had already noticed a shift away from WASP medical students towards more BME and more female students. He even remarked on it during a tea and biscuits break on a ward round - and a health service fattie, a psychologist of all things, all but exploded, but thankfully didn't, because all the tea and biscuits inside her would have made a terrible mess.

Death Bandits

The Hospital Manager’s Association

Top Secret – Eyes Only

The Hospital Manager’s Guide to Massaging HSMRs

Members will be aggrieved to hear that the Doctor Foster Intelligence Unit and its lottery hospital standardised mortality ratios (HSMRs) are here to stay, despite several recent papers showing the methodology to be unsound.

Members will appreciate that they supply the raw data used by Dr Foster, thus providing opportunities to ‘cook’ the figures before they are passed to Dr Foster. The Association does not condone directly tampering with the data; however, faced with the intractable use of flawed statistics, the Association does believe members are entitled to ‘game’ the system to their advantage.

The Oxygen of Morality

Kerrie Wooltorton is dead. But she isn’t going to go away. Her sad suicide, and the aiding and abetting of that suicide by her doctors, have opened a door to a cesspit of legal incompetence and medical Eichmannship.

For those who have been frying fish for the last few days, KW was a woman with both depression and emotionally unstable personality disorder who wanted to kill herself. That’s what she said, anyway.