Posts tagged with Working in the NHS

Affection Love and Duty, These Three

Dr No’s mother is a heartsink patient, and she happens to be dying. Unpalatable as they may be, Dr No says these two things as matters of fact. On one level, as a doctor, he cannot not see his mother as he would see a patient – and the hallmarks of heartsinkery are undeniably present. Although Dr No has had a hunch about prognosis for some time, it was his mother’s consultant who gave it form, in a measure of months. She is a heartsink patient, with only months left to live. Those who care to opine that heartsink is a term of derogatory abuse might also care to reflect that the term is not so much a patient label, notwithstanding the inescapable fact it is one, as a useful term from the lexicon of countertransference, under the general heading of those feelings and emotions engendered in a doctor by his or her patient. Countertransference matters: those who choose to ignore it do so at great peril, not just for the patient, but also for themselves.

The Strike That Passed in the Night

At the eleventh hour, the BMA suspended the junior doctors’ strike. It hasn’t been called off entirely, it may still happen, but probably won’t. As a conspiracy theorist, Dr No suspects the whole shebang was a clever ruse by the doctors: a strike that was not a strike, a neat foil to Absolutely Stilton’s tanks lining up in the hospital car park; as a cock-up theorist, he suspects the whole bang shoot is further evidence that, even if it wanted to, the BMA couldn’t fire a rocket on Guy Fawkes Day. Apart from some bizarre even by Daily Mail standards doctors’ leader in love nest in Neasden style hackery, not to mention its doctors on dark web exposé, media coverage has been thin for what is after all serious domestic news. At the coming up of the sun, the Today programme looked the other way, and at the going down of the sun, Hoo Wedwards and his harem of squawking reporterettes hardly ever mentioned the conflict. There was some coverage of the ‘overwhelming’ 98% in favour ballot result, but few pointed out that 98% of those who voted is about just over half of all junior doctors, though even that is still an eye-watering result. For the BBC in particular, the junior doctors’ contract was, like the Health and Social Care Bill before it, to be just another ship that passed in the night.

A Dark Nurse

Dr No’s mother has been admitted to hospital – at home. This NHS wheeze is a worthy idea, which Dr No supports. On paper, it is win-win: patients stay in their beloved homes, and the NHS saves money. In practice, it has one minor but fatal flaw. The hospital has a matron, kit in abundance, OTs, you name it, but no ward nurses. It is a hospital without nurses on its wards, and like all hospitals without nurses on the wards, it doesn’t work. Ironically, the money saved by not admitting patients to real hospitals could fund these nurses, but no one in the NHS has spotted this, and so the idea remains worthy, but doomed to fail. One supposes that were Crippen still blogging, he would have done hospital at home full justice, as he once did for another NHS corker, the hospital at night, a hospital whose defining characteristic was not an absence of nurses – rather the opposite in fact – but an absence of doctors.

The Young Dr No

Now that Dr No is out, he can write more freely of his past. Details he before kept back can now be brought forward, free of the anxiety of unintentional exposure. Indeed, this was one of a number of reasons why Dr No lifted the veil. He can now write of where he trained, the places he has worked, and the doctors, some outstanding and some rather less so, that he has known over the years; and of the capers and calamities that have lightened and darkened his career. For with a name comes the history. Anonymity, like virginity, once lost, is forever gone; that which was hidden has now become known. And – he might add, for those who detected a valedictory note in Dr No’s last post – let him assure them that, just as the ex-virgin rarely forsakes future carnal knowledge, so the ex-anonymous Dr No has no plans to forsake further appearances. Rather the opposite, in fact, but never, of course, to the extent of wanton promiscuity…

Shakin’ Stevens

Yesterday’s news was bob-a-job docs, £55 for each and every dementia diagnosis, with old hands who should know better – they have been handbagging item of service fees in various shapes and forms since the beginning of time – decrying the idea as bribery, likely to cloud professional judgement, possibly even unethical. Dr No will believe their wails when they start handing back the contents of their handbags. For his part, Dr No thinks the idea, though crude, is not without merit, even if the sum is paltry for what is rather more long-term work than a snap diagnosis, because it sends a signal in terms the ex-apothecaries have always understood – payment for an item of service. Dementia is under-diagnosed, and patients and carers who want to know and plan miss out on help that is or at least should be available. Indeed, upping the recorded prevalence might even push up dementia funding. So all in all, though a bit grubby, the idea gets Dr No’s approval.

Auric’s Law

Regular readers will know that Dr No is an advocate of Auric’s Law of Causes – happenstance, coincidence, enemy action – and it so happens that Auric’s Law has been met, indeed exceeded, in four out of four recent NHS encounters by family and friends of Dr No. In each case, the care provided was either partly or wholly inadequate and/or incompetent; and, by Auric’s Law, he concludes these adverse experiences did not arise by chance, but by malevolent force. The malevolent force was the NHS, or more specifically the doctors who provided (or in some cases did not provide) the care. All four cases happened in, or were related to, secondary (hospital) care, but more often than not the GP was also involved in, or at the least complicit with, the deficient care. In all four cases, either the patient or a relative was a doctor, and so an ‘expert witness’, able to ‘read’ what was going on. How much more poor care, one wonders, goes on, but is unnoticed, because the witnesses are lay, and lack the knowledge to read the signs?

A Midsummer Day’s Madness

The doctors' strike, or ‘industrial action’, as the strikers prefer to call it, has happened. On the day after the longest day (2012 is a leap year), a smaller than expected number of striking doctors turned up for work sporting ARP style armbands declaring ‘I’m caring for patients’, which was a bit rich if you happened to be a non-urgent patient, and smugged their way through their day. As own goals go, it was a corker, more Rear Admiral Hamish McMayhem taking his entire fleet the wrong way up the Windward Passage, than a solitary cocoa bean going the wrong way up Bournville Boulevard. On the radio, you could hear Langho rubbing his hands with glee at the gift of anti-doctor propaganda, while the media at large took turns to shy coconut after coconut at the ‘my pension or your life’ protesters. If proof was needed that Dr No’s former colleagues had lost the plot, then this was that proof.

Breaking Bad

Like a pair of blind impotent bulls, Humph and Jimbo crashed about the Today studio this morning, breaking bad, but not much in the way of news. The programme reverberated to the dull thud of blunt horns getting stuck in wooden stories. Humph deployed his standard technique of exclaiming ‘Ha!’ every time an interviewee started to answer a question, to put the interviewee off balance, while Jimbo has extended his extended question technique by inserting…long…pauses. More crotchety than ever, Jimbo has even started to avoid questions altogether, preferring instead to crochet together a long series of statements…and pauses…and…assertions, more waffle, more saccharisms, more Jimboisms…before delivering a final semi-triumphant statement, leaving the by now stunned hapless interviewee little to do except to agree.

Making Friends and Family of Us All

Paul Corrigan, whose posts show a worrying trend towards titles so long they stand as posts in their own right, has declared himself a friend of FFT, the punter-friendly friends and family test based on asking patients at or soon after discharge whether they would recommend the unit they have just left to friends and family. The test is popular with government for its apparent simplicity, resented by managers for the real extra burden it imposes, and derided by front-line staff, for whom the test might be better known as the Flying F*ck Test: the punters don’t give a FF about responding, and we don’t give a FF about the results. Although first announced last year, FF testing was back in the news last week after friendly we’re all in this together Dave announced plans to extend FF testing to general practice. The news got a cool response from senior GPs; others went further. One called the test ‘meaningless’; another dubbed it ‘trite’.

Ill Winds

The other day we had David Cameron getting pumped up about a seven day NHS. Pumped up is the New Tory, but a lot of old hats were still put on pegs, some hats more moth-eaten than others. JC (of the Department of Health Sunshine Band) was wheeled onto the Today programme, sounding about as pumped up as a flat tyre. Despite the ill wind blowing today through NHS General Practice, with more vacancies than currants in a bun, the government’s prescription is five thousand more GPs. Quite which wind these GPs will arrive by has yet to be explained. Historically, the NHS has outsourced, or at least gained, extra doctors from abroad. Pigs, after all, can always fly, if they are pumped up enough.