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.



More Stackery

stackery n., – the art of confounding people about statins.

Just when you thought it was safe not to take your statins, another report hits the fan. Or rather three. The Oxford academic Sir Rory Collins, who does for statins what Viagra does for old men, has been banging on BMJ editor Dr Fiona Godlee’s back door – curiously he declined to provide an open letter for publication - demanding she retract two articles published in the journal recently. Both articles claimed, as part of their arguments, that statins had high rates of side-effects, affecting up to 20% of all patients taking the drugs. The gist was that not only were statins pretty useless for primary prevention of cardio-vascular disease (folk with no prior history of CVD: NNT’s in the high tens if not hundreds), they also caused unacceptably high rates of side-effects, some of which were serious. The implication, though not stated in such lurid terms, was that peddling statins to low-risk folk was little short of institutionalised quackery.

The Baby and the Bath Water

The night before last, the Section 75 Regulations slipped through The Lords like a U-boat, silent and deep. A limpet mine attached to the hull by one Lord Hunt failed to go off, and the boat got through unscathed. The crew even found time to loose off a few tin fish at 38 Degrees, but, on the whole, anyone watching the surface of events would have seen nothing remarkable. Certainly the BBC saw nothing remarkable, and reported nothing. The recent Reynolds analogy, that if the Health and Social Care Act was an aeroplane, then the regulations were the engines that would enable it to fly, failed to take off, leaving no scope for engines on fire, or jumbo-jets falling out of the sky. The health service revolution said to be so large it can be seen from space is all but invisible on earth. There has been no bang, not even a whimper, just the night time passage, silent and deep, of some regulations through the Lords. Nothing has changed - except that the U-boat is now on the inside, torpedoes armed and periscope at the ready. The lumbering ships of the health service convoy still steam across the healthcare seas, unaware of the peril that now lurks in the deeps.

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.

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.

NHS – The Apprentice

Opening Titles: Camera swoops across London teaching hospital rooftops – St Thomas’, Guy’s Tower, the cruciform Royal Free. The second half of Mars from Holst’s The Planets throbs loudly. Cut to UCL’s Accident & Emergency entrance at night. A large NHS blue Roller, Registration Mark NHS 1, arrives, with what appears to be a Belisha Beacon in the back seat. The door opens, and Lord Sugar steps out, looking very grim. He points at an Ambulance Paramedic.

Sugar: You’re Fired.

Paramedic: Thank you, Lord Sugar. (walks off, trailing a defibrillator trolley on wheels, towards a waiting taxi. The Belisha Beacon gets noticeably oranger).

Voiceover: The NHS. A decayed, inefficient state monopoly that consumes money as a waterfall does water. Waste is everywhere, and indifference is rife. Even nice Gerry Robinson couldn’t fix the NHS. Lord Sugar has had enough.

Sugar (to camera): It’s a shambles, a bloody disgrace.

Carry On Commissioning

Dramatis Personæ

King Field, out-going Chief Pongo.
JD, a Jobbing Doctor.
The Darzi of Dagenham, a Stooge.
Sir Sidney Ruff-Grumble , a Hospital Doctor.
Queen Enchilada, Chief Pongo elect.

ACT I

Scene I—The Tudor splendour of Richmond House, a GP commissioning group hide-away deep in the heart of the Essex countryside.

Enter King Field, in a silly red and yellow hat.

Field. Infamy, infamy! They've all got it in for me!

The Lies of Others

Twenty five years ago, the General Medical Council’s Annual Retention Fee for doctors to remain on the Medical Register was £20, and the “Blue Book” – the Council’s code of professional conduct for doctors – ran to some thirty pages. Today, the same fee is £410, and the code, which is now issued in several volumes, runs to hundreds of pages.

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.

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.

Commissioner – The Apprentice

Medium shot. Sixteen business types strut across London’s Millennium Bridge to the accompaniment of a revved up version of Prokofiev’s Dance of the Knights. The business types are not ordinary business types – they are GP business types.

Voiceover: It’s the job interview from hell. From across the country, Britain’s brightest GP commissioning prospects head for London.

Cut to smug GP business type, large phallic buildings in background.

Smug GP: There’s absolutely nothing mediocre about me. I’m supremely intelligent, ambitious, I’m an all round gifted individual.