Posts tagged with General Medical Council

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.

Council to Survey Turkeys about Christmas

For Immediate Release:

Council to Survey Turkeys about Christmas

GTC Press Office, London, UK

Thousands of turkeys are to be invited to take part in a survey of their views about Christmas, the General Turkey Council has announced.

The survey is part of a new piece of research examining whether turkeys think the GTC is operating in a fair and objective way and whether turkeys from different backgrounds have different views of the Council’s processes.

Indicative of Tendencies Dangerous

Ploughing through General Turkey Council Fitness to Practice data with a tractor ever more bogged down in numerical mud, Dr No got distracted by another question: what do ‘erased’ – the chilling term used by the GTC in place of the plebeian ‘struck off’, chilling because where the plebeian leaves a name albeit with a line through it, erasure effects obliteration, total obliteration, for not even a name remains – doctors get erased for? In the past, one was encouraged to suppose it was the three As, alcohol, advertising and adultery, a supposition borne out by the General Medical Council’s, as it was then, 1965 ‘Blue Book’ guidance, which does indeed list the three As (alcohol comes under splendidly archaic ‘Offences Indicative of Tendencies Dangerous to Patients’ heading), along with other examples of ‘infamous conduct’ likely to bring a doctor to the Council’s attention. But over time, as two of the capital As have become, so to speak, of lower case severity, we might suppose that ‘gross neglect in diagnosis or treatment’, the 1965 heading for clinical failings, might have risen in prominence, such that today most doctors are struck off for substandard treatment. But what are the facts?

The Last Junior Doctor

As the post nuclear option Heremy Junt/BMA contract row rumbles on behind the scenes – the top hit on google news today for junior doctor contract is a three day old blog post on Conservative Home by a psychiatrist sorely in need of Photoshop if ever there was one, and the BMA’s ‘latest update’ is weeks old, a thoughtful post by JT reminds us that the opposing comedy duo of Junt and the BMA Junta are not the only threats to junior doctors. The SPECTRE known for the time being as NICE, the National Institute for Clinician Evisceration, has produced yet more guidelines on statins. Commendably dense with the rhetoric of patient choice, the general thrust is nonetheless on upping the uptake. JT’s gripe is three fold. The first is that clinical guidelines, statistical tools, algorithms, call them what you will, become wet paper bags when they attempt to contain the complexity of real life. The second is that guidelines alongside variations of payment by result tends to get, well, results, ie more people on statins, without care for whether they want them or need them. The third, touched on more briefly, but just as important, is that, up against the hour glass of surgery time, thoughtful deliberation never stood a chance. It is the dead duck floating feet defiantly up, but head drowned in the time-hoopered barrel of clinical complexity.

No Profession for Old Men

Dr No made no secret of the fact that Dropping Like Flies was a quick and dirty assessment of whether the apparently very high number of deaths among doctors subject to GMC Fitness to Practice investigations was something to be concerned about. He concluded it certainly was, because on that crude assessment – crude because there was no attempt to adjust the figure for factors that might influence the death rate – it appeared that these doctors were at least fifteen times more likely to die than ordinary members of the working age population. The ratio of fifteen to one was, he believed, an approximate answer to the right question rather than a precise answer to the wrong question. It was, he argued, so gross in scale as to make it very unlikely, though not impossible, that the finding had arisen either by chance, or by a sufficient number of unadjusted for factors, such that being caught on Stilton’s prongs was not one of them.

Constructive Erasure

Dr Helen Bright is an extrovert, capable consultant psychiatrist who, for lifestyle reasons, chooses to work as a locum. Or rather did, for she has now been constructively erased from the Medical Register.

Hack Attack

Anna ‘Opposing Views’ Raccoon – who is to blogging as shit is to the fan – has picked up on the General Medical Council’s latest Big Idea. Doctors who admit medical wrongdoing and accept sanctions, and those convicted of serious crimes – helpfully enumerated by the GMC to include murder, rape and child molesting – will no longer have to face Fitness to Practice hearings. Instead, they will be dealt with clandestinely by the GMC, and a note of their wrongdoing and sanction posted discreetly on the GMC’s website. The idea is both to curb the exponential rise in FTP hearings (and save a bob or two in the process), and to reduce unnecessary ‘stress and anxiety’ for doctors and witnesses caught up in the GMC mill.

Racca-Anna is outraged, claiming that the proposals will muzzle the main stream media, and prevent punters from hearing salacious gossip about gung-ho doctors who – to quote from the post - ‘despatch a patient prematurely whilst singing Rule Britannia and smoking a hookah pipe, or stitch the patient’s left arm onto someone else’s right leg, or are simply stark raving bonkers’ only to be allowed, ‘through some technicality’, to continue to practise.

Resident Pathogens

“At that moment in time, a human error occurred…” intoned Count Rubin on yesterday’s Today programme. Uttered as it was with an air of omniscient mastery, it seemed some great catastrophe, like a jumbo jet crash, had occurred. The truth turned out to be rather more commonplace: a study had revealed that nearly one in ten prescriptions written by hospital doctors had been found to be wrong.

Pax Pemberton

Dr Max Pemberton – Apology

GMC Statement – For Immediate Release
22 Apr 2013

Earlier this morning, Count Rubin (not his real name) appeared on the Today programme opposite Dr Max Pemberton (not his real name), defending the General Medical Council’s decision to implement new guidance requiring doctors who use social media to reveal their identities.

By appearing alongside Dr Pemberton, and not challenging Dr Pemberton’s identity, Count Rubin gave the impression that the Council knew who the real Dr Pemberton was, had got his number, and furthermore the Council knew where he lived.

Burning Bad News

Only yesterday, Dr No was working on a post noting that the GMC had still not published its internal review of doctors who died while under Fitness to Practice investigation. He noted that publication was originally slated for July 2014, then November 2014, and, as of earlier this week, possibly sometime in 2015. He even noted that at the very time the GMC is consulting on doctors’ duty of candour, it was showing a striking lack of candour in its own conduct. The last sentence of the first paragraph of the post said ‘In the absence of certainty, it is not clear whether the review is still incomplete, or is complete, but currently too hot to handle, with Stilton’s PR goons waiting – sorry – for a good day to bury bad news’. It now seems they were: the review has been published today, the last Friday before Christmas.

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