Wednesday, 25 July 2012

I love my job, I like seeing patients but I have had enough . . .


If you are a GP or a hospital doctor who has been in the game for a number of years, or a medical student or a doctor in training you will have heard, or will hear at some point during your career, the above statement or something similar from one of your colleagues. Who makes such a statement?

It is usually a senior doctor approaching retirement. Note what they say and its implications:

1) I love my job.

Most doctors' do but only if it is just confined to providing medical care something they were trained for, have spent years refining as a professional and hopefully getting it right.

2) I like seeing patients.

Most doctors like to see patients and discover their as yet undiagnosed illnesses. It is challenging and rewarding even though we know we sometimes cannot always treat our true enemy disease.

3) I have had enough.

Have had enough of what?

Well lots of things each in isolation a mere irritant but when such crap as appraisal, revalidation, protocols, NICE, QOF, tick box medicine not good quality patient care, care pathways, CQC, pathetic targets, yet another rearranging of deck chairs on the NHS Titanic called "reform" etc.etc. get in the way of and make treating patients harder not easier then something has to give.

An analogy we heard of is that of the bamboo curtain. A single piece of bamboo is easy enough to snap and walk through. But if you have many thousands of such pieces of bamboo arranged around you row upon row of retarded centrally determined government policy, locally enforced by PCT morons over many years that are medically of no use to patients you will realize why GPs and hospital doctors cannot wait to retire.

Some retire early and use their reduced pension to support themselves and also work as locums where they get paid better to do less and avoid the administrative burden that hampers their provision of good care.

Such statements are not said the day before they leave. Often it is a few years before they do so and by that time they have lost the urge to resist the institutionized retardation that increasingly gets in the way of good quality patient care. So they quietly plod on shrugging their shoulders as the next layer of bureaucratic retardation comes along counting the days until they can get out.

Most will yearn for a return to the past and almost all are fearful of the future for they know that at some point they will become patients and they like not what they see being done to their patients but they are powerless to change it. They can only protest but no one listens for the power is no longer with the clinicians.

In a younger doctor people would call this burnout but what would you call this pre retirement? Is a form of Stockholm syndrome?

We have seen it many times at ND Central over the years and also when we worked in hospital. It is like looking at a brightly burning Olympic torch and watching the flame go out. The torch is still there but the light has gone out.

The doctors' job is no longer an inspiration it is a once proud inspiration which when they retire will be put out onto NHS eBay for the next highest bidder for the job who will go exactly the same way given time.

Praise be to the Party for ensuring that highly experienced medics both in hospital and general practice can't wait to get out. It is a sad reflection of how little NHS society values its doctor's, and other workers' experience in the work place not by making it better but by making it harder for them to do what they are good at.

And the Party wants to make people work longer? Bet you that retirement on ill health rates due to mental illness go up.

Tuesday, 17 July 2012

The NHS taking the p***.




There has been a very popular charity called Help for Heroes in the United Kingdom which you can read about here. We will not dwell on it too much save to say that it seems to fill in the gaps for those servicemen and women who are injured between what the Forces' and NHS medical and social care provide.

On our travels we frequently see people raising cash for them in all sorts of ways. Sometimes even if you walk into a colleague's surgery staff there will be collecting usually because someone they know or know off is serving or has served in the armed forces. It was only founded in 2007 and seems to have caught the public imagination.

Well the Party has followed this trend and come up with its own idea in he last few days and we would not suggest that they have no imagination and are copying a successful idea but have a look here and at the official website here.

Who would you nominate to receive a "recognition certificate"? Will Mr. Lansley be signing them personally and touring the troops to award them to the "heroes" in the glare of national press coverage? Perhaps it will go a stage further and a Lansley Star or Nicholson Cross be issued as well that staff could pin to they uniforms for state visits?

Of course the question is who would you nominate? Given the recent announcements about the reductions inchildren's cardiac surgery our minds here at ND Central were drawn back to the person who blew the whistle at Bristol and suffered great personal loss as result of going above and beyond the call of duty, Surely someone who should receive such a recognition certificate?

Unfortunately he cannot, as you have to work for, not have worked for, the NHS. So if you have nothing else to do if you know someone who has a cup of tea, a hand to hold, a shoulder to lean on who always goes the extra mile visit this website.

On the other hand it if you know someone who can't hold a cup of tea because they have no hand, who has no shoulder and who would love to walk the extra mile but cannot you may like to consider another website we have mentioned and do something useful instead.

Praise be to the Party for its complete lack of imagination and for taking the urinal by doing so.





Monday, 16 July 2012

Friends.



In general practice all our patients have friends and lots of them as a lot of our patients never attend of their own volition. Someone, a friend, a relative or sometimes an anonymous complete stranger always tells them to attend.

However a recent consult made us think about just how many friends our patients have and how much work these friends generate for us as GPs. Our patients' friends advise them daily on health care surely obliterating the need for Big Party NHS (re) direct and 111 interventions?

Take last week and a few examples of what our patients' friends advising them:

A friend said I ought to see you because I have had a car accident (and they said can you make sure something is in my notes?).

Friend = money grabbing patient/lawyer or claim's management company.

I could not sleep and a friend gave me a couple of these tablets and suggested I have a few more weeks of these to help me sleep.

Friend = drug dealer or drug user who is using you to get currency. No deal.

A friend said if I get a letter from a doctor I could get a holiday in Barbados/get a new house/a new television like they did from the social/council etc.   . . .

Forget it.

A friend said I did not look well and should have a few weeks off as they thought I had (insert) name of disease after reading (insert name of learned journal) magazine . . .

Isn't it amazing how many friends our patients have in general practice all of whom have given such considered opinions and worthy advice to our patients to attend their primary care physicians urgently to address their health needs?

Praise be to the Party for ensuring that as a result of all the friends our patients have GPs and their staff will never ever be lonely. Best of all it doesn't cost their friends a penny.

Thursday, 12 July 2012

Dave's big society, little charities and big commerce.



For those of us old enough to remember such TV series as Quincy and MASH there was a perenniel message of the Golden Hour whereby if a seriously ill casuality was transferred to a trauma centre within an hour after resuscitation their chances of survival were greatly increased. In the Korean and Vietnam wars the use of helicopters had pioneered this before it was transferred to civilain practice.

Unfortunately the United Kingdom is very backward in introducing new technology that works. So what was available in Korea in the 1950s, in Vietnam in the 1970s is only now available in the UK via charitable donations or commercial sponsorship. It is not provided for by the Party unless in the form of the Air Sea Rescue or Coastguard service. That is right dear reader a once first world country cannot afford to provide air ambulances for its population charities do it for them instead.

So the story we refer to is about how a hairy, our affection term for our biker breathern fellow road using friends, discovered an anomaly in the way that the air ambulances provided by charitable donations are taxed on fuel. So a Mr Ken Sharpe started an epetition which has attracted over 150,000 signitures and several mentions in Parliament.

Air ambulance charity VAT in fuel.
RNLI another charity no VAT on fuel.

Both are charities and provide assistance to those in extremis often staffed by volunteers.

Commercial aviation private enterprise no VAT on fuel.

Paid staff often providing excessive luxery to those able to pay.

So we thank our hairy friends for exposing that while big profit huge consumers of fuel have 0% VAT on their fuel a charity that has to employ volunteers to raise its income to try and help injuried persons attempt to receive first world medical care NOT provided by Big Dave's State are charged a VAT premium for the priviledge of doing so.

Big Dave's big society is increasingly looking like care on the cheap and you can look after your own at your expense unless you can go private when we will give you tax breaks.

Just goes to show you always have to respect the hairies. As for Big Dave's Big Society . . .

Praise be to the Party for ensuring that when when it comes to Big Society we all have to pay and pay some more in addition to the tax we have already paid to ensure that the "State" provides its citizens with an air ambulance service.

Thanks, call me Dave and his little buddy hopalong Clegg, for showing how you expect the big Society to work for your Chancellor's benefit.

Sunday, 8 July 2012

The dangers of free wheelers.


There has been a lot about the excesses of unregulated financial speculation in the last few days and we suspect this will smolder on for a while but a lot will get away Scot free. For those of us who daily do work on the golf course of UK general practice we have encountered a new threat provided by some other unregulated free wheelers in this country. While exiting the confines of Shiteton's vast sprawling urban metropolis we encountered an as yet undiscovered hazard on Northernshire's roads.

We are well used to early morning pigeons, pheasants, deer, tanks, fallen trees and more recently floods as a result of the idle Brown turd's dump on general practitioners and their staff which is reflected daily in his work avoidance schedule but what we encountered on a 400 yard straight recently bettered all of these hazards and dereliction of duty.

We were firing up the Ferrari for a 0-30mph sprint when the onboard hazard proximity radar detected slow moving incoming from 1 o'clock. The target was on a linear course which did not deviate and at 400 yards away was on a direct head on collision course with the Ferrari. The deflector shields were instantly activated and the photon torpedos armed and readied.

As we approached to visual contact we were met with a silver haired surfer preceded by a three wheeler rollator (pictured above for the benefit of readers as a hazard avoidance learning needs exercise for your PDP after your have filled in a SRT) who was giving us no ground as they continued undeterred along the white line provided in the middle of the road for the navigational assistance of elderly drivers. You will be pleased to know that the middle wheel of the rollator was kept on the white line in an undeviating military fashion despite the flashing lights and horns of oncoming motorists traveling either side of the hazard.

This Ethelocet missile topped with a dark blue all weather woolen cardigan and woolly hat tastefully off set by a white night dress and slippers below in a torrential midsummer downpour suggested something was not quite right. Even white van man took evasive action most impressive as he was on his mobile at the time complying, as did the Ethelocet with all current UK motoring and other legislation.

Now three wheeled vehicles are traditionally the preserve of the very young in the form of tricycles or a fad of middle-aged eccentrics or a necessity for mobility for the very old.

A three-wheeled Ethelocet must surely be more hazardous than a rogue banker or free wheeling dealer and is clearly a failure of the health and social care system and not the financial regulator or the responsible politicians? Clearly we GPs need increased dementia awareness to stop this new scourge of unregulated free wheeling Ethelocets?

Mr. Speaker, it is only a matter of time before an Ethelocet hits a white van and causes their driver immeasurable harm and, as a result irreparable economic harm to this country.

Mr. Speaker, we need an Ethel's law now or else. I commend Ethel's Law to the house . . .

Praise be to the Party for continuing to allowing expression by the individual at the expense of the masses' safety. Protect the public from unregulated Ethelocets now and leave the bankers and others involved in other mischief alone.

Thursday, 5 July 2012

Proud to be British.



While busy sitting in the Ferrari that all UK GPs drive and listening to the Steps Ultimate Collection album on a stationary downhill facing dual carriageway we did espy in our rear view mirror the blue flashing lights of one of the local ambulance service vehicles at full pelt followed a few seconds later by the sounds of the sirens.

The traffic was nose to tail and going nowhere fast as due to road works it was being channeled into a single line and all lights were at red. Still having spent many happy hours in the back of ambulances transporting critically ill patients between various locations we thought we would do our bit and help create a clear passage.

As we checked our mirrors we became aware that the two lines of stationary traffic we were stuck in had parted to form a clear passage through the middle and the single line of cars ahead had pulled in between the coned off section of carriageway in a organized chevron like pattern.

As a result the ambulance sailed through the congested roadworks unimpeded before everyone got back to their former postions. All in a few brief seconds before the business of queing recommenced as usual.

Now we know that this does not always happen. With less than fond memories of ambulances and their police escorts screeching to a halt and the air turning blue from the comments of their crews expressing opinons about some driver's abilities while we struggled to stay in a seat and at the same time prevent a ventilated patient from being disconnected from their ventilator, it was a pleasure to watch as people with no knowledge  of what the emergency was cooperating to enable an emergency vehicle through.

We are sure the crew must have thought all their Christmases had come at once and we certainly recall being overseas where commercially run ambulances were frequently ignored in congested traffic. While that ambulance was more likely than not on its way to a non emergency like a little old lady in 5 layers of womble wear who had had a faint due to being over heated in the muggy conditions it could equally have been a paediatric cardiac arrest where seconds do count.

Certainly up here in Northernshire road manners are usually better than our southern cousins but what we saw made us proud that for a few brief seconds a group of individuals who did not know each other acted independantly and correctly and may even have helped someone they did not know as a result.

And then we were able to continue listening to Steps with only the briefest of interruption too.

Praise be to the Party for continuing to educate the Public about what to do when they see ambulance blue flashing lights. Ignore them obstruct them at your will but remember one day you might need them for real.

Sunday, 1 July 2012

CQC Watch - the absurdity of bureaucratic regulation.



The Party loves to control and nowhere is that more obvious than with the CQC (Care Quality Commission) whose current leader is a failure as he comes from the same background as its former great leader Cynthia “1200 deaths did not register on my radar” Bower in social services. If you did not go to a Northernshire comprehensive school you will not be aware that in order to be a social worker you have to be in the same bottom third of such a school that they recruit NHS managers from.

So dentists and now doctors are to be inspected by a retarded bureaucracy that is itself under performing in order to bring standards down to their retarded level. Such professionals in order to make the grade are usually examined by people far better qualified than they are. A simple example of how retarded centralized bureaucracy was bought home to one of the team who recalled a conversation from many months ago from a victim of a CQC inspection who did not lie down and say I am wrong you are right. So look at the image above.

This was taken by one of the team on a holiday at a remote outpost somewhere in Northernshire’s vast hinterlands. Now if you showed that to a retarded CQC inspector you would probably follow your own gut reaction which is that is disgustingly dirty throw it away NO-ONE could drink any water out of that kettle and live. Now if your holiday accommodation was inspected by a retard unaware of local circumstances you would expect them to fail it based on such “evidence“ and a moronic tick box mentality.

However if you think beyond the amoeba brain size of the average tick box this kettle’s appearance might be impossible to avoid. Large areas of the UK are covered by moor land with a peaty soil. Large areas of the UK do not have mains water and so other sources are utilized for example springs or water taken from streams which flow off peat moor land.

The water may be microbiologically pure but will contain small fragments of peat - think what happens if you garden and split peat- which even though the water is filtered will be present in the water. A lot of people have slightly brown coloured water which is safe to drink and we have even stayed in places where the water has been blue but in both cases was completely safe to drink.

If you repeatedly heat water in a kettle in the same way that lime scale forms in hard water areas you will over time get a coating hence the picture above. Not harmful to health but not nice to look at.

Now back to CQC retardation. We spoke to a doctor in training who was present during a CQC inspection which had failed their ward. The reason? Not crap medical care but the CQC botmoron found that there were clean urine bottles placed on the bedside tables of elderly male patients which they also ate off. Disgusting you may say so the hospital management removed them.

The result? Not a massive drop in infection rates as a result of removing  the clean bottles but a massive increase in the need to wash bed linen and pyjamas, clean floors all essential requirements of a CQC “approved” ward which pulls staff away from real patient care to tick a botmoron’s box. Add in  relatives complaining about patients, sorry their relatives, sorry CQC clients, who had previously been dry sitting in pools of urine and wet clothing and think how much time can be wasted by a botmoron.

All this was the result of a CQC inspection which no doubt improved the “quality” of the “care” provided. After all the boxes had now been ticked and as a result of an “inspection” and a hefty fee (page 3) onwards for the privilege of a botmorons’ visit.

According  to the junior doctor to whom we spoke after a lot of aggravation the urine bottles were reinstated. And all of the care “improvements“ which resulted in the increase in “quality “of “care” which were dictated by the botmoron CQC inspectors disappeared.

Now why might that be so? Well remember the top of the tree at the CQC is a social worker and they are in the bottom third of the UK in terms of academic ability. Their inspectors won’t be as bright and so they could not put 2 and 2 together to make four while holding their best crayon they just looked at the box and found it wanting so they signed with their usual signature a great big X. and they felt epic!

The bottles were on the tables because this was a geriatric ward full of frail old men who could only walk slowly to the centralized toilets 2 four bedded ward bays away for there were not enough staff there to help them. Coupled with the prostate problems they would have they need to go frequently and with urgency but could not make the toilet in time. Hence the positioning of the bottles.

Praise be to the Party for ensuring that whenever you want to improve “care” and “quality” you employ a social worker to bring us all down to their high standards.

This might be the start of a little series of CQC watches as it is such a fit agency for purpose is it not? Just watch the news as it tries to justify its existence but scratch below the stories and it is very different.

No Care no Quality just another Commissariat YOPS scheme for those who have always failed and that started when they were at school, in their first jobs which led them to NHS management and where they are today.