Saturday, 22 September 2012

The dangers of iPhone medicine.

We are sure that most UK GPs will have had patients bring pictures of various aliments to them in their surgeries. These are not usually now on the old format of photographic paper but are usually on a variety of electronic devices most usually a phone. 

The common ones we see are usually skin rashes or swellings that often come and go before they can see a doctor or ones acquired overseas. We also get the privilege (?) sometimes of images of bits of the body that would normally be found only on the top shelf of one of those so called private shops and sometimes that is all we are allowed to see as the patient is too embarrassed to reveal more than their iPhone to their doctor. 

Traditionally it is said that the camera does not lie although the advent of photochop has altered this statement somewhat and perhaps it is fairer to say now that the camera does not always tell the whole truth. 

The first of the above eye images if seen by a doctor doing a routine baby check would normally strike terror into a doctor seeing it for it is a) rare and b) not usually good news. So when a concerned parent shows you an iPhone photograph like the one above, one picks up the ophthalmoscope with dread. 

However when you see the image below using the simple ophthalmoscope, not the high tech iPhone the mind goes into this does not compute mode. To refer or not to refer? The team member concerned erred on the side of safety as they had been consulted by a highly capable doctor in training who had asked them for a second opinion. 

However, after some lateral thinking combined with consumption of a few of our fermented five a day fruit juices at the infamous CafĂ© Michelle this led us to google iphone white eye (on a mobile device) and it appears that this may be artifact. Or is it? 

We wonder if there has been an increase in referrals for white eye due to modern technology? And if any such increase is artifact or real disease or technology induced disease? 

Will a parent with an iPhone do the same as we did and ignore the image they see?

Praise be to the Party for advising us all of these potential hazards of modern technology long before we figure it out for ourselves.


Murkeet musings # 3.

The political workings of the NHS never stay still for long which causes the image makers here at ND Central extra work hence a new furry figure "head" at the top of our NHS murkeet musings one of Andrew's little friends.

What follows is a little bit about how the NHS retardocracy is working under the current NHS Tripartite "murkeet" system. It has been gleaned from conversations we have had with those who are engaging in the dark arts of GP commissioning over the last few years.

The first of our newfound facts is that each PCT in meant to make a 2% reduction year on year on expenditure. No doubt through efficiency "gains", not savings comrades, or "surpluses" for that is the new Party speak. No balancing the budget here comrades we must make a "surplus" each year perhaps akin to a "profit" in the private sector?

What has come to our attention is the fact that one of the biggest efficiency "gains" is to be achieved by the fact that the cost paid by the NHS centrally dictated tariff system is being reduced centrally by the all loving all caring Party, year on year in certain areas. Not only do the prices change but so do the names of procedures so try finding a hip replacement on this year's tariff.

In the NHS tariff 2007-8 using the find facility in Excel we came across Primary Hip Replacement Cemented and Uncemented by typing hip. Could we find this in the 2011-12? No.

Could a hip replacement now be a Major Hip Procedure  for non trauma category 2 with major CC? Perhaps the answer lies somewhere here on slide 6 and a little twiddle of your mouse wheel may be required to reveal the whole answer. If you have problems sleeping or are sad and lonely we suggest you read the whole document.

Now we are not suggesting that a centrally controlled fixed price market for all services is in anyway anti free market or anti competition or even remotely similar to a Soviet market system, nay dear reader, thrice nay but surely it must be that that all of these savings/gains/surpluses are all derived from the Tripartite new health care markets built in efficiency via competition and the internal market system?

A monopoly perhaps in a free market or a Soviet state controlled murkeet, in a free market or are we just thick up North?

So inflation goes up, oil prices go up and NHS payment by results prices go down year on year? Classic supply and demand graph stuff from sixth form economics or state monopoly manipulation of the NHS murkeet?
Now while the Party feels an investigation is required into why petrol prices don't go down, of course tax will not be an issue here, there is to be no formal investigation into NHS murkeet logic. Should there not be an inquiry in to the fact that NHS prices are going down despite increasing inflation?
What a shambles.
Praise be to the Party for allowing us all in healthcare to bask in a wealth of efficiency gains through the Tripartite health policies that we all as patients see daily. If centrally dictated costs are going down year on year and the budget is fixed we should be able to do more year on year?

Sunday, 16 September 2012

Wasting our money or value for money?

Most doctors in the UK will, or more importantly should, be part of a a medical defence organization. In the UK there ae 2 major players the Medical Defence Union established in 1885 and the Medical Protection Society established in 1892.
For those less bright, like our 2 previous Prime Ministers, there is also the Medical and Dental Defence Union of Scotland established 1902 whose premiums are a lot less than elsewhere presumably because the standard of medicine, or more importantly the standard of knowledge there, is less?
(In house joke before you reach for your claymores but it is a mute point at ND Central that some GPs' costs are more equal than others for the same job).
So for all of us idle GPs who spend 5 days a week on the golf course ignoring our patients a full time golfing GP will pay between £ 5,600 to just under £ 6,000 a year depending on which society they are with and when their subscription is renewed (tax deductable of course comrades).
The money we GPs pay is usually well spent but an article, nay two articles, one in the opinion section of one of the defense unions' rags one week and then a second in the next edition made some of us wonder whether their usual true objectivity in providing us with medicolegal good practice and advice has become watered down?
A doctor, whose true role within in the medical profession is not well known, has given his "informed" opinion on online reviews. What is even more worrying is the fact that the page before a "content lead" from NHS Choices gives their "expert" advice on responding to online reviews. Both articles are of dubious or doubtful benefit to your average GP on the links. NHS Choices we have commented on before here and here.
We will not give a direct link to the doctor's own website but would say that using it (or using NHS Choices) is a bit like reading the Dead Sea Scrolls to find a good doctor today. Years out of date with large gaps and pieces missing and references to the then living being erroneous.
What is more this doctor is also speaking to conferences organized by one of the above defence organizations. So the question we have here at ND Central is in the title of the piece.
Are we as doctors getting value for our annual subscription monies from one particular defence organization's spending for what we are sure are works of medicolegal excellence (not) and speeches to conferences that we are sure will be being provided as charitable works from which we we will all benefit from?
Praise be to the Party for continuing to provide the NHS with IT services that the rest of the world laughs at. Using them isn't that funny or that useful for frontline medical staff and reading articles from those taking the proverbial that we have paid for isn't funny either.