Saturday, 13 November 2010

Better late than never?

This morning we watched this item on an otherwise news depleted Saturday morning.

It seems that A&E departments are being misused. Never! Must be those idle GP scum again not the ignorance of the British people. After 60+ years of the NHS someone thinks perhaps people, in this case children, need to be taught how to use it.

Well dudes they have already learnt how to both use and misuse the NHS for however many times you misuse it there is no sanction. They have been well educated by their great grandparents, grandparents and parents on how to use the NHS for decades.

So if Tarquin Jr. or Chantelle Jr. get ill they ring the GP for an emergency prescription of paracetamol because the kid is disrupting X-factor or Strictly Come Dancing. If their GP is shut, or they are not considered an amergency (case for a paracetamol prescription) by thier own GP or an out of hours call handler, or doctor, they explore the local NHS “market” and try the local Darzi centre or walk in centre but guess what the market does not allow them to use it!

Chuffing hell somemic will be doing Tarquin or Chantelle (seniors’) heads in, they will have got through a pack of fags, cheaper than the Paracetamol they want from the NHS, so they will be well stressed and will ring NHS reDirect and explain their problem and might, big might, be advised to go to a pharmacist and purchase some paracetamol.

Eventually Tarquin or Chantelle (senior)and “will have no (f**king) choice” but to dial 999 “it is an (f**king)emergency” and get conveyed by the free, no questions asked, executive taxi service to an A&E department.

And get some Paracetamol but at what cost?

This process has been going on for decades and to try and address such behaviour as a healthcare worker will result in complaints against anyone who tries it for the non paying, totally unresponsible NHS customer is king.

Even if you misuse your GP enough you can only get booted off the list. And you can still go onto another GP and so on. Misuse the ambulance service and they still have to attend. And so on.

At least now after 60 years our secondary school children will get lessons about the NHS. This will be useful for given the paucity of sex education in secondary education they will probably need to use it when their kids become ill 2 or 3 years after their NHS sexless education lessons.

Praise be to the Party who no doubt will be preparing lesson plans for a few years time about the fact that smoking is harmful to health some 50+ years too late. Talk about slamming the stable door shut when the horse has bolted all over the UK and is still running unchecked 24/7.

At least the stable door will now be finally shut. Isn’t UK education wonderful?

Thursday, 11 November 2010


One of the great things about a health service where nobody pays the doctor directly is the effect it has on our patients. We had a discussion at our weekly resistance meeting at the CafĂ© Michelle about our collective experiences at one of our more “exclusive” rural branch surgeries.

At this surgery you are immediately out numbered in the car park by the scores of Range and Land Rovers driven by our patients as well as their employees’ tractors and various instruments of agricultural production.

Given that the Ferraris driven by all UK GPs and their staff, are low riding beasts compared with those above us, this is a truly hazardous place to be in. One misplaced dung dispenser dispensing could seriously damage the shine on the average UK GP’s Ferrari.

Still that was just the car park. Worse is yet to come when we deal with the owners of these vehicles our patients whom we allegedly serve. For some unknown reason when a patient sees their doctor in the UK, the National Health Service manages, at no cost to the patient or the State, to perform a partial cerebral lobotomy the minute they walk into their GPs’ consulting room.

Our patients are in effect rendered brain dead but unfortunately still breathing, walking and worse still talking. After their NHS “free at the point of care” partial lobotomy the response to open questions such as “what is the problem?” or “how can we help you today?” is:

I don’t know? You’re the doctor, you tell me!

Oh so original, you can tell a farmer a mile off. They’ll talk to their vet ad nauseam about a speechless animal whom they pay for but come to a doctor, whom they do not pay for, and they will expect a full tank of diesel and a diagnosis before they go off to spend their EU subsidies.

A quick “if you want to play stupid see your vet (they charge)” usually results in the realization that it is not the doctor who has the problem but the patient and the doctor needs something called a history in order to do their job.

In other words talk to us (you dumb animal).

The NHS “free at the point of care” lobotomized patient then usually goes onto refer to their problem as “it”. Even when questioned about every standard symptom of disease for example is “it” chest pain, or shortness of breath and so on the problem is still “it”. What “it” is we sometimes never know especially in the demented when they attend sans relative, an increasing phenomenon.

We are not veterinary surgeons for in the UK they are usually much brighter than we doctors. Their patients do not talk but their owners do in order to get value for their money. However, when patients present to their GPs without their pets which cost, they are allowed to be dumber than your average vets’ patients (the animals that is).

At this stage in the UK, a GP presented with their lobotomised patient inability to communicate may then have to examine their patient. This always presents further problems. Simple instructions like lie on the couch on your back can result in the lobotomised patient assuming a knees elbow position on the desk or lying sidewise facing you in the room next door for reasons beyond our comprehension.

Even if you can get your patient into the correct position you are then faced with the fact that the patient cannot remember what clothes they put on in which order and so 5 minutes can be spent trying to get to an upper arm released, with help from a relative/carer/friend, from the unique combination of bra, bodice, corset, suspender belt, vest, incontinence pad(s), catheters and thermal long Johns. Did we forget the body warmer and hat too and to remove your glasses as well when the ankle is being examined?

And that is just in those patients called John. Jane Does are worse. Which bits of the English language they missed at school we know not but our medical students frequently comment on how thick our lobotomised patients are. For even as medical students they know the difference between up and down, left and right, arm and leg. Remarkable.

Following the “history” and “examination” part, one may then have to prescribe a treatment.

This is fraught with hazards as such questions as “Do you have any allergies to any medications?” will result in answers such as “Yes it is something with an A in it. Or is it a C?” or “Are you on any other medication?” are usually met with responses such as:

Yes I am. You will know what I am taking.”

You are asked to prescribe a drug, a poison, which they take regularly but don’t know what it is? The hospital, or you, “just” gave it to them and “it will (always) be in the letter” you have not yet got as they only saw the consultant yesterday.

Notice the “it” word again?

If this isn’t the case they will have of course taken all the tablets and disposed of all boxes, any discharge letters or prescriptions but the patients and their relatives will always say:

You will know what it is it will be ON YOUR RECORDS."

Whatever a patient does not know it is always ON YOUR RECORDS.

You will know my case. I am a new patient it will be ON YOUR RECORDS”.

I have seen a doctor at the hospital and rang the labs and they tell me the results are there. Can you get them for me? It will be ON YOUR RECORDS the hospital said so”.

Top tip if a doctor in hospitals says a letter will be with your GP in less than 2 weeks ignore it.

2 weeks is a BARE minimum so don’t waste an appointment try, if you can bringing the drug boxes, or the discharge letter for the helpful phrase heard so often in General Practice of “They are THE little white tablets” is about as helpful to a GP as “it was a blue car with wheels on” is to a Police officer.

Which doctor, which hospital, which department? Which car?

"I don’t know? It will be ON YOUR RECORDS."

In reception you will hear the following “I would like my tablets”.

Which one? (of the twenty you take)”

"I don’t know it will be ON YOUR RECORDS." Now this is the NHS, which is free, but try asking the same lobotomised patients what car they drive?

They will have already clocked your car, told you how Top Gear have rated it and how their relatives have something so much better than your NHS Ferrari. They can complain about how much petrol costs per litre to the nearest tenth of a penny when its MOT is due and how much a full service costs. You will get the full spec and any problems they have ever had with their vehicle without you ever hearing them say “I don’t know it is ON YOUR RECORDS”.

The amazing thing about the NHS “free at the point of care” partial lobotomy is that once the patient leaves the surgery they suffer from instant recall about the whole of the consultation and leave with super uber enhanced memory powers. You then hear them saying in the supermarket:

“My doctor could not tell me what was wrong with me and I told them everything . . .”

“My doctor did not even know what tablets I was on . . .”

“The doctor didn't have a clue I don’t know what they are paid for. . .”

This is especially so when they sniff the quick buck of litigation and enhanced memory goes into overdrive. People who could not remember the 1 times table at school can suddenly quote pi to a billion digits to a lawyer.

We have been trying to find the origin of a quote we once heard that we thinks may explains this (almost) universal amnesia of the UK population when it goes to the GP and we think it goes something like this:

That which you do not pay for, you value not.

That which you value not, you respect not.

That which you respect not, you despise.

That which you despise, you abuse.

Anyone working in healthcare disagree? We bet none of you have had patients like ours?

Praise be to the Party for free healthcare and education. One of them works despite the other failing completely. Problem is we at ND Central can’t remember which is which.

Curious that? Must have breathed something in, it must be very infectious . . .

PS Anyone who can help us with the original quote above we would be grateful. Over a century of collective medical experience gets a bit forgetful . . . you will know what it is doctor it will be ON YOUR RECORDS!

Tuesday, 2 November 2010

The third of possibly many ways?

A few days ago the good Dr Grumble reproduced an article which pretty much sums up what many feel is slowly happening to the NHS. The Ferret Fancier, welcome back you have been missed by we heathens up North, also commented on the piece. Now there is a phrase called the Third way (possibly more in this process?) and we wonder if this is already happening within the NHS.

Imagine a scenario where a PCT devolves responsibility for a service to a sub section of its staff and puts them in a separate unit let us call it Bletchley Park and runs it for a while. If the PCT decides as a result of “budget constraints” or a “service redesign” it can no long afford to run it what does it do then?

Perhaps it could set it up as a private concern using a variety of guises for example a limited company or a corporation or a federation. This "private" entity could then run the same service while being paid by the PCT and later even have it bid against a “competitor” by submitting a tendor which the PCT would consider.

If this “independent” business entity wins then they hold the contract. All good and ethical business’ practice.

Now consider the state of PCTs which will be disappearing soon. Their staff will be fearful of their jobs. What better way of preserving some of them than by farming out certain services to this “private" sector?

Consider next what will happen when GPs start commissioning. If there are good local services up and running cheaply GP consortia will properly use them rather than go through a long and complex commissioning process.

There is another aspect in that it might be conceivable that the true private sector might want certain services in a particular area and might offer to buy out the “private” former PCT provider.

Look carefully at your own area for this process may already be occurring albeit slowly and by stealth, or as the Witch Doctor blogger puts it by “creep”.

Could it be a case of PCT self preservation by creep and in doing also the selling of the family silver?

Praise be to the Party for giving us the Third Way but where that Way will lead nobody knows. Or do they?