Posts tagged with Miscellaneous

The Chauffeur Must Decide

In Downton Abbey (ITV1), a good many scenettes – most are too brief to be scenes - are set up to climax with the wonderful Maggie Smith delivering a punch line. She has perfected the art of delivering these dénouementettes, which she does with a little shudder, as if a Tantric feather had tickled her G-spot. Last night she delivered a perfect corker: the decision lies with the chauffeur. In just six words, she encompassed a hundred years of medical and social history.

The dramatic tension at the heart of last night’s episode was the ancient clash between the GP and the specialist. It was as high concept as high stakes go: the life of a young mother was at stake. From the early moment a throwaway mention was made of swollen ankles, a pall-bearer of toxaemia, or pre-eclampsia, the obstetrician in Dr No knew it was going to end in tears. Fits would follow, and death was indisputably on the cards. The only question was how Julian Fellowes would deliver not the baby, but the eclampsia.


One of the more noisome phrases in the air today is ‘one should not speak ill of the dead’. The sentiment, both spoken and unspoken, is everywhere, and the dead we should not speak ill of is of course Mrs Hacksaw, the Iron Lady who famously decreed and then ensured ‘there is no such thing as society’. But we shall not speak ill of the dead. Labour leaders stand as pupils before Miss Jean Brodie, the better not to speak ill of the dead. In the Today coven, Humph and Jimbo cackle away at each other, reminiscing about conviction politicians. No, we shall not speak ill of the dead, oh no. April is the cruellest month. Mistress Thatch – she dead! wail the hollow men, heads filled with deathiquette. De mortuis nihil nisi bonum. And yet, between the desire and the spasm, between the potency and the existence, between the essence and the descent, falls the shadow. But we shall not speak of the shadow, oh no: de mortuis nihil nisi bonum.

The Union Jarred

Despite the crack in the Union that threatened to appear as things got tighter and tighter in the run up to the vote, the headlines this morning are Scotland Says No. This result is both a golden example of democracy at its best, with the turnout a credit to the Scots, but also a reminder that democracy, though the best of those that have been tried, is not necessarily a good form of government. Instead, it is the least bad. The headlines are misleading: Scotland, the nation, is an abstraction that can no more decide its fate than it can decide what socks to wear in the morning. Instead, it is the people of Scotland who decided, individually, with the referendum result a binary outcome based on counts of millions of individual decisions. The outcome is pure democracy, rule by the majority in the interests of the majority, but as always, and starkly in this case, where for every fifty-five Scots who voted no, forty-five voted yes, there is a substantial minority for whom the outcome is not what they wanted; the result not, as they see it, in their interests. The Union Jack may still be intact, but the Union has been jarred.


Powering a juggernaut through a minefield of metaphors, Professor Sue Bailey last week achieved a spectacular pileup. Describing the dire state of mental health services, the outgoing Chief Pongo of the Royal College of Psychiatrists said, ‘It’s a car-crash that we are sleepwalking into’. Never mind the grammar being of the kind up with which we will not put, the utterance revealed what psychiatrists once called a word salad is now so old hat; instead, word-stir-fry is the new black. Bailey then took a punt at Health Secretary Hunt, but Punt was saving his powder for later in the week, when his chum Cammers was scheduled to get up in a crate, pop over the Brussels, and take a shufti. In the best English losing tradition, Punt reckoned that crashing and burning with only a Hungarian in tow was a swell show. Cammers himself appealed to an inverted – and so imploded - Pyrrhic logic, averring that sometimes one has to lose a battle to win the war. In the political fallout, only one thing was certain: Cinderella was still out in the cold.

What’s God Got To Do With It?

November is the sombrest month. As the leaves complete their fall, we Brits go through two very different but very British annual events, Remembrance and Children in Need. Both have at their heart charitie, in the King James sense of the word, but the tone of each could not be more different. On the BBC, Remembrance commentary comes from National Treasures, Huyuwoo Wedwards and Dimblebug D currently standing in, while Children in Need is forever stamped with the ebullience of a National Buffoon, one Terry Wogan. Heaven forbid that, in the current rush - 1459 comments - to secularise Remembrance, Wogan be ballooned in to Remembrance, or, for that matter, Wedwards be wheeled in to Children in Need. Instinctively, we know neither would do; instead, each to his time and place. Wogan’s 1978 Eurovision commentary, caught all those years ago by Clive James, ‘not by any means full’, simply wouldn’t do at the Royal Albert Hall. Neither would the second half of the phrase, ‘possibly for security reasons’, given that most of what is left of our Armed Forces, and a good few fierce looking Veterans armour-plated with medals and bristling with whiskers if not weaponry, were packed into the Hall for the night. Any sharp-shooters dropping by could be sure of a hot reception.

Raising the Bar

Justin Wood, the Today programme’s Useful Idiot, was let out of his play-pen this morning to tackle a story with real numbers in it. He promptly crashed and burnt. So spectacular was the crash and burn that the erudite Prof McManus’ erudition flat-lined and later all but crashed and burnt too. At issue was the distinction between pass mark and pass rate for the Professional and Linguistic Assessments Board test used to assess clinical and English language skills in the - as the media would have it - foreign devils more formally known for the time being as International Medical Graduates. In Woodie’s upside down world, the great secret was to up the pass rate, the better to weed out those with forked tongues. In the real world, of course, upping the pass rate, rather than the pass mark, would have the effect of letting though not fewer but more IMGs.

Important Announcement!

As from 15th April 2020, all new Dr No posts will be on a new, more mobile device friendly website. This website,, has served Dr No well for over a decade, but it struggles at times, and is not easily converted to a responsive website that works on desktops, tablets, ipads and mobile phones.

All future posts will be just as if they had been posted here — the same Dr No style and content as before, but just posted on the new website. This website will remain as an archive of previous posts.

If you are a Dr No subscriber by email, Dr No suggests you follow him on twitter, as all posts are announced there. The emails will cease, as they are triggered by a new post here, and that isn't going to happen.

The new website (appropriately enough can be found here.

Update 2nd May 2020: the handful of 2020 posts that were first published here and then on the new website have now been removed from this website, to avoid double posting of content.

Zombie Lawyers

Established readers of Bad Medicine will know that Dr No takes a dim view of m’learned friends, considering them to be a verminous infestation in the lives of normal folk. In Dr No’s ideal world, lawyers would be deported to burrows on the fringe of an unknown desert, where they could live out their wretched litigious lives fighting each other, while the rest of us get on with our lives, unimpeded by lawyerly interference. For the time being though, back in the real world, lawyers are still with us, an inconvenience to be lived with, like a pimple on the bum that won’t go away. The day before yesterday, the 18th, Dr No had occasion to email one such pimple, only to get back one of those pesky out-of-office auto-replies. The reply, of course also dated the 18th, stated “I am away from the office until Monday 16th June.” The pimple, it appeared, was a zombie pimple, stuck in a limbo the Devil knows where. Dr No was left with a worrying thought: if lawyers don’t even know where they are, how on earth can we be confident they know what they are talking about?

Discipline Makes Daring Possible

When the Chief Medical Officer feels uncomfortable, should the nation tremble? Probably not. Certainly, Dr Atul Gawande didn’t, fielding Dame Sally Davies’s troubled comments after giving his second 2014 Reith Lecture, broadcast this morning on Radio Four. Speaking in his now familiar, you know, George W Bush style “Our people done a really good job…of, you know…hauling in a lot of the key operators”, Gawande extolled the virtues of getting systems right. Goaded by air industry experts baffled at the casual approach of surgeons to their work, Gawande developed The CheckList. Depending on viewpoint, the CheckList is either strictly for the dumb-assed, or a sort of systems alchemy that transforms the inept into the ept, and experts into super-experts. Doubters are stumped and declared out for a duck by asking them a simple question: “If you’re having an operation, would you want the team to use the checklist?” Unsurprisingly, ninety four percent did, though that leaves the intriguing question what did the other six percent want? Dr Frankenstein? A one armed blind surgeon with a prosthetic hand and Parkinson’s disease? We’ll probably never know, because by now they will have maimed or killed themselves some other way.

Full Tank of Gas

Unbeknownst, presumably, to today’s Tory sound bite chefs, in Dr No’s youth to be full of gas had other meanings: to be full of wind, puff or bombast. These earlier meanings recurred in Dr No’s mind over the weekend, as the BBC’s news zombies trotted out Dave’s full tank of gas sound bite time and again. Presumably, like Camilla’s use of wicked, gas is meant to sound groovy. LOL! Where, Dr No wondered, was Little Nellie when you needed her? Dr No’s earlier scheme to pour sugar in Dave’s petrol rapidly gave way to an overwhelming wish to drop a match in the tank.

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