NPR's Julie Rovner and Father Thomas Reese of Georgetown University's Woodstock Theological Center talk to Steve Inskeep about how abortion remains an obstacle to passing health care legislation. They also discuss the influence of Catholic bishops on the health care vote.

CHICAGO (Reuters) - U.S. regulators on Tuesday approved the use of Allergan Inc's wrinkle smoother Botox to treat spasms of the elbow, wrist and fingers in adults.

CHICAGO (Reuters) - Healthy Americans who donated a kidney were not at higher risk of dying afterward, which may reassure potential donors and help shorten the long waiting list for an organ, U.S. researchers said on Tuesday.

VIENNA (Reuters) - Motorists under the influence of drugs are a growing threat on U.S. roads, while the number who drink and drive has fallen thanks to education and law enforcement, a top U.S. drug control official said on Tuesday.

NEW YORK (Reuters Health) - It may not be surprising, but a new study offers some proof that patients who are worried about their medications are more likely to have side effects from them.

WASHINGTON (Reuters) - The U.S. Senate Finance Committee is seeking information from long-term care hospital operator Select Medical Holdings Corp after a New York Times report raised concerns about patient care, the committee said on Tuesday.

WASHINGTON (Reuters) - Comparing medical treatments to find the best and the cheapest may be a pillar of U.S. healthcare reform efforts, but very little such research is being done, according to a report published on Tuesday.

CHICAGO (Reuters) - Inoculating children against flu protects more people of all ages in the larger community, probably because young people tend to spread viruses through physical play, Canadian researchers said on Tuesday.

WASHINGTON (Reuters) - About 16 percent of Americans between the ages of 14 and 49 are infected with genital herpes, making it one of the most common sexually transmitted diseases, U.S. health officials said on Tuesday.

Demonstrators flocked to a meeting of insurance executives in Washington, D.C., to press the case for health overhaul. Former Vermont Gov. Howard Dean challenged Congress to put legislation to a decisive vote.

NEW YORK (Reuters Health) - Although studies in Africa have shown that circumcision can lower the spread of HIV among heterosexuals, it may not do much to prevent infections among gay and bisexual men in Western countries, a new study suggests.

WASHINGTON (Reuters) - An experimental approach that looks for the DNA leaking out from dead and dying cells may provide a route to a blood test for breast cancer, U.S. researchers reported on Tuesday.

President Obama traveled to Acadia University in suburban Philadelphia on Monday to make the case one more time for Congress to pass legislation to overhaul the nation's health care system. He went after Republicans for their unified opposition, and attacked big insurance companies.

Since the Senate passed its version of a health overhaul Christmas Eve, most of the debate has focused on the politics of the effort. By now, many people have forgotten — if they ever knew — what the bill would actually do.

Although Dave had been a patient of mine for five years, I first met him when he was repairing the health centre roof. I first saw him as a patient a few months later when he had a painful left shoulder. As we talked, I was putting his notes in order and noticed that there was an 11 year gap. A common enough finding in people who move around the country. I asked him about the gap. He said he had been in jail. I asked him why. He paused and then said, quietly, that he had killed his wife. “Manslaughter”? I asked. He shook his head. Another pause. “I’ve been out on licence for seven years now.”

He was living with his partner, a much younger woman, who was originally from Wales. She was also a patient of mine. “Yes, she does know” he said. I wasn’t going to ask. They had a three-year old girl. It had taken him two years to get regular employment after he was released but since then he had been in the same job and he was not the sort of person to take time off. We retreated to the safe ground of his shoulder and the tension eased. The shoulder problem was not serious and settled over the next week or two.

It’s the only time I have knowingly met a “lifer”. There was nothing in the notes about the murder. Just a gap. If he had not told me himself, I would never have known. I did not ask him about the details. Was it any of my business? Dave had, as we say, “paid his debt to society”, if 11 years can be regarded as a sufficient payment. We are remarkably tolerant of murder provided always that the victim is not a child. More tolerant than we are, for example, of what is technically the much lesser offence of keeping paedophile pornography on a computer. The paedophile offender is never allowed to pay his debt to society. It does not seem logical. Is not murder the worst crime of all? And yet, few people have not, once or twice, said, “I’ll kill him” and, somewhere in the deep recesses of our mind, somewhere where the “id” lurks, or where Wat keeps "the major", we can all imagine killing someone. But none of us can imagine being involved in paedophilia.

High-profile “lifers” are once again in the news. Peter Sutcliffe was, I am sure, incorrectly convicted of murder. The judge should never have put it to the jury. It is beyond credibility that he was a normal, sane man, going about the macabre business of serial killing and then, entirely co-incidentally, developed schizophrenia whilst in prison. It is an important medico-legal point but, whether it is “life” of “her majesty’s pleasure”, one thing is clear. He should never be released.

Prison staff fear an attack by other inmates as it is revealed that pressure of keeping his name and background secret led James Bulger's murderer to fights, and drink and drug abuse


The Guardian

Poor, sad Jon Venables. He never had a chance, did he? Desperately bad social circumstances and upbringing, an appalling crime, incarceration until he reached adulthood and then, suddenly, we give him freedom. Freedom of sorts, that is, with an assumed identity and intrusive restrictions. If he has now been involved in paedophile pornography, he will not see the outside world for a very long time. The more interesting question is whether he should have been prosecuted in the first place. We have a son who is Jamie Bulger’s age and so, all those years ago, Mrs C and I followed the case with particular anguish. But still I say that John Venables was only 10 years old. An age below criminal responsibility in civilised countries. What, precisely, has our treatment of Jon Venables achieved?

Most “lifers” have committed more mundane crimes and will eventually be out and about amongst us. You can fantasise about The Shawshank Redemption if you like, but “lifers” are not all Morgan Freemans.

A double killer who was freed after serving 15 years of a life sentence was found guilty yesterday of murdering a teenage prostitute after his release.

I wondered if I should put an entry on the medical summary of Dave’s notes. “Convicted murderer - out on licence”. I wondered how I would fill in a life insurance medical report on him, but I was never asked. I did not see Dave again. A few months later he moved to Wales to be closer to his partner’s family. I never did put anything in the notes. No one will know about his past unless he chooses to tell them.

NHS BLOG DOCTOR has just had the following comment sent in by a female reader:

Ive just been invited to have a colpocopy following test result of CIN1. I read it up on the net, of course, and find that it is considered quite appropriate managment to simply do a follow up smear test in 6 month, even in the good old risk averse US of A. I look up the website of my local colposcopy clinic. It says if I have any questions to ring the colposcopy nurse called F. So I ring her and am told that's not right, to ring someone called Dawn instead. I assume that Dawn is a nurse replacing F, but no. Turns out Dawn is a secretary. She is rather shocked that I want to speak to F. F is very busy. Can I tell her what the question I want to ask are. I say no I want to speak direct to someone with clincial knowledge. I offer to email questions. She declines. So I offer my questions. Dawn the secretary tells me everyone with CIN1 "must" have a colposcopy. This is despite the leaflet I have been sent saying it can be dealt with either way (at the doctor's choice, though, nothing about me having any choice.)She says that it isnt their leaflet it is the area HA screening Programmes leaflet. Duh??


Is it any wonder we do not trust what the NHS tells us? I now have no faith whatsoever of being dealt with honestly as an intelligent adult by this unit. Paranoid? maybe but how would I know?

Shortly after the death of Jade Goody, I wrote the following:

At present, if a cervical smear has any significant abnormality, a letter is sent directly to the patient offering her a free appointment at a gynaecology clinic. Until a couple of years ago, the letter was sent to the GP who then took responsibility for tracking down the patient and making the appropriate referral. I don’t much care for this new system which cuts me out of the process. I preferred to talk with my patients so that I could explain the significance and the seriousness of the smear. A few smears, presumably like Jade Goody’s, show potentially dangerous changes. Most show a bit of this and a bit of that. In this medico-legal day and age all have to be followed up but , frankly, most of the problems are due to over-reporting. Often one can provide a lot of reassurance to a worried patient. I have to accept, though, that impersonal though it is, and despite the additional worry it causes, this direct referral system may mean that fewer patients with abnormal smears slip through the net.

Jady Goody : the lesson to be learnt

There is a detailed and excellent description of cervical cancer screening smears at CancerHelp UK Please read it. Much of this lady's anguish would have been avoided if we still had the old system of women going to see their GP to discuss their most recent smear. I know all about the supposed benefits of protocols, and commissars, and cutting out the middleman but, in reality, what the commissariat is doing is cutting out the human face of medicine. If a patient came to see me with a recent smear report given as CIN 1, I would first of all take a history. There may be howls of anguish from the feminists, but a sexual history is relevant. Multiple partners, a history of STDs, a history of bleeding after intercourse, a history of bleeding in between periods are all relevant. I was brought up to believe that a cervical smear was only part of an assessment which should also include a pelvic examination and a visual inspection of the cervix. One of the problems with cervical screening at the moment is that it has been passed down the food chain to "health care professionals" who just "do a smear" and nothing else. Our practice has seen two cases of women with a "solid pelvis" due to ovarian cancer being reassured by a so-called "well-woman" clinic that their smear was normal. As it was.

If the patient with a CIN 1 report had no worrying features in her history, and if visual inspection of the cervix was normal, and if the pelvic examination was normal, I might be prepared to do an interval smear rather than referring her immediately for a colposcopy. But I would do it much sooner than six months, and I would do it myself.

I feel enormous sympathy for this patient. She should not have had to phone the commissariat. She should not have had to deal with bad-tempered comrade typist.  She should have had a sensible and sympathetic explanation from someone who knows what they are talking about. Medico-legal considerations mean that smears are over reported. Many so called "abnormalities" would, in years gone by, have gone unmentioned. The protocol obsessed commissariat has once again left no room for judgment, no room for discretion and removed the opportunity for advice orientated to a specific patient. In all those circumstances, if I were a female receiving a letter recommending a colposcopy, I would go for it. (See "What can I expect at the colposcopy clinic?") Yes, that is buttressing a system I hate, but the downside is too worrying.

This is it, or so the White House claims: closing arguments on President Obama's effort to overhaul the nation's health care system. Obama asked Congress for a final vote this month, and to persuade Democrats to stick with him he was in suburban Philadelphia on Monday making his case.

President Obama says during a speech in Pennsylvania that insurance companies will keep raising premiums "for as long as they can get away with it," as he embarks on his latest push to build support for a health care overhaul. Obama wants Congress to vote on a bill later this month.

Runaway rate increases for health coverage provided familiar applause lines in a speech President Obama gave at a college outside Philadelphia Monday.

Under the health bills being debated in Congress, young adults would be required to buy insurance - but they could buy low-cost "catastrophic" plans, requiring high deductibles. That's igniting a fierce debate whether young adults — sometimes known as "young invincibles" — would benefit from such plans.

Long excluded by Medicaid programs in most states, millions of low-income adults without children could qualify for coverage under Democratic health overhaul proposals.

More than 4 in 5 Asians say they get a good night's sleep at least a few nights a week. Only two-thirds of Blacks say the same.

Placebos play a useful role in drug testing: They help scientists determine just how effective a drug is. But a comparison of studies of antidepressants finds that patients find placebos twice as effective today as they did in the 1980s. Researchers aren't entirely sure why this is happening, but they say these findings could complicate medicine.

 A short while ago, I retired.

It's a strange business. In many ways, I had been looking forward to it but, when the day came, it was...well, strange. You do not really wind down. You finish an afternoon surgery on a Friday (well, that's what I did) and the new, young doctor takes over on the Monday. He is frighteningly well qualified  and I'm sure my patients will be in safe hands.

In days gone by, retired doctors used to keep dabbling in medicine by doing locums. I've made the decision not to do that. For several reasons. I would worry about getting out of date. Yes, you can go on courses, and read the journals,  but the only way properly to keep up to speed is to work fairly regularly and I don't want to do that.

Even if I did, there too many logistical difficulties. To do locums you have to pay professional indemnity insurance. That's expensive. Doing three or four sessions a week would mean an annual premium of £2265. Is it any wonder doctors get cross with the independent midwives who practise without insurance?  Take a look here if your are interested in the details of the cost of professional insurance for doctors. Then there is the vexed issue of  GMC fees. (Details here) There used to be a middle ground so that you could keep dipping your toe in the water. Post Shipman, that has all gone. Even doing one session a week means full GMC registration, costing £420 a year. You can, if you wish, pay £145 to maintain registration "without a licence to practice" but the purpose of that escapes me. Finally, there is the threat of regular revalidation looming. It is absolutely right and proper that doctors should be revalidated but, as yet, no one knows how to do it.  The system that is approaching is post-Shipman, and theoretically designed to trap the next Shipman. It won't. There is no system that will identify plausible psychopaths. Shipman would probably have been Chairman of the Appraisal Committee. As revalidation comes in, a lot of more senior doctors will retire. Maybe that's a good thing, but the NHS will lose a lot of experience. So, after much thought, and some regret, I have resigned from the GMC. I'm no longer registered. I am no longer a practising doctor and I am not allowed to practise. Irritatingly, this means I can no longer write out a prescription for my annual 100g tube of Betnovate Ointment for the contact dermatitis I occasionally get on my hands. I shall have to see my doctor instead. Mind you, since retirement, I am no longer washing my hands dozens of times a day, and my skin is currently unblemished. Apart from that, I do not see any problems about no longer being a registered medical practitioner.

The GMC tell me I'm still entitled to call myself "doctor" -  even if you are no longer registered with the GMC, they cannot take your qualifications away from you. You are still a "doctor" albeit non-pracitsing.  I've never been the sort of doctor who signs in at hotels using the title, so that is of little interest to me.

I have retired earlier than many doctors, and that has had repercussions on my pension, which is not as big as it might have been. It's hard to get 40 years in as a doctor anyway and, because I had done law before medicine, I was a particularly late starter. But I will not starve, and I am luckier than many. It will, and already does, mean much more time for books and music. I'm re-reading Bleak House at the moment.  It was "inserted" into me when I was 14 by a pushy English teacher and I hated it. Now, it's a joy. There ought to be a law about forcing young children to read "good" books when they are not ready for them.  I'm also reading "Race of a Lifetime : how Obama won the White House"  I have just bought the new Martin Amis. He's a few years older than I, and the most articulate curmudgeon currently writing in the English Language. That will be next week's pleasure. And I am battling with Welsh moles (and am grateful for the numerous suggestions I have been sent  - I particularly liked the one from Eric) but so far I am too squeamish to go out and kill them myself.  I am targeting my favourite composers - currently working my way through the Mahler symphonies. Joy.

Finally - and here I need some advice - I am going to buy a scooter. Or maybe even a small motor-bike. Mrs Crippen is horrified and is talking about psychiatric treatment or maybe even divorce. I rather doubt she will be appearing on the pillion. The children are having fits of laughter. They have bought me a Quadraphenia DVD and are threatening to buy me a parka with a large target on the back. There is little advice in magazines and on the internet about the best sized engine to get.  I do not know anyone who has a scooter, so I've talked to friends who have motorbikes.  Sadly, as soon as you say the word "scooter" to them, they put a look on their face as though there is a bad smell in the room. I shall persevere. I don't need to do a CBT or test to ride a 50cc scooter but a scooter-riding patient said avoid a 50cc engine; too slow, and you can't get out of danger quickly enough. So it should be a 125cc or even a 250cc engine.


Should it be a retro- Vespa to fulfull my Gregory Peck fantasy, or the more pratical, prosaic, ever reliable large wheeled Honda SH125? I don't see Audrey Hepburn on the Honda and anyway I doubt our elf & safety commissars would approve of riding sidesaddle.





Advice on this would be much appreciated. 50 cc seems too underpowered. 125 may be OK. Or maybe I should get a 250 cc. Then there are the limo-scooters. Like driving round in a three piece suite:




I am going to do the CBT and the formal motorcycle driving test. I must say most of the motorcycle training schools I have talked to have been friendly, helpful and positive but they all recommend doing the test on a geared bike. I'm steeling myself up for a day with teenagers doing the CBT and will see how I feel after that. Maybe a Harley to live out my Easy Rider fantasy. Has anyone any personal experience of talking up scooters and motor bikes in advanced middle age or should I, as Mrs C recommends, see a counsellor?

President Obama told Congress this week that the time for debate is over and that he wants a vote by the end of the month. The president said health care deserves a simple up-or-down vote, but by the end of the week, the Democrats still didn't have the votes they needed. NPR National Political Correspondent Mara Liasson updates host Liane Hansen on health care, the Democrats' ethics woes and their latest retirements.

Is there any line we should not cross when it comes to invading a patient's right to privacy?  The dangers of heavy drinking in pregnancy are well documented, and the more awareness there is about foetal alcohol syndrome, the better. And of course we should offer advice and information to all pregnant women and it is reasonable to ask them how much alcohol they drink.  Now, however, there is talk of testing women to see if they are telling the truth:

Pregnant women are being asked to take new blood tests that reveal their drinking habits and could leave them accused of putting the health of their unborn children at risk. The test, which gives results in an hour, allows midwives to construct a picture of how much a mother-to-be has drunk over the previous fortnight, even if she has avoided alcohol in the days before the appointment.


The Times

I suppose that if it is genuinely consensual it is hard to argue against it. But somehow I know that there is a danger of the test being done routinely by the midwife with little prior discussion. Apart from anything else, midwives are grossly understaffed and may not have the time to do the necessary proper counselling. I lost count of the number of pregnant woman I used to meet who were shocked to find that they had been screened for syphillis without discussion. And how do you feel about routine HIV screening?

In his weekly address, President Barack Obama Saturday made yet another push for health care overhaul and called on Congress for support. For the latest political calculations on health care legislation, host Scott Simon talks with NPR news analyst Juan Williams.

The blogosphere and the main stream media are for once at one in being aghast at the latest bit of top down micro-management from Gordon Brown and his quangocracy.  I'm grateful to JuliaM (Another Day, Another Front in the Obesity War) and the DK (For the love of chips) for pointing me at this story. And this led me to a new discovery:

Nanny knows best


A site dedicated to exposing, and resisting, the all pervasive nanny state that is corroding the way of life and the freedom of the people of Britain.


"Oh, and by the way, I have never forgiven the EU for banning newspaper as a means of wrapping my chips!"


Nanny wants thicker chips

This interference with our lives is nothing to do with health. It's nothing to do with the NHS.  Dear God, when will they leave us alone. As the DK says,

In order to win the election by a landslide, all David Cameron has to do is to promise (credibly) that this kind of shit will not happen under a Tory government...

Uh, Dave...? Dave, that was your cue...

Hello...?

There's a bumper crop of iPhone apps to help you lose weight. We try a couple and find some nifty features.

If you looked closely at the people in white lab coats behind President Obama during his health care speech Wednesday, you would have seen the president of the American Academy of Physician Assistants.

A contaminated batch of an obscure but ubiquitous flavor enhancer sparked recalls of foods ranging from dips to flavored tofu. The Food and Drug Administration said the recalls are a precaution to prevent illness.

Myelodysplastic syndrome (MDS) is a rare condition of the bone marrow. The bone marrow is, if you like, the factory that makes your blood. In MDS, the production goes haywire. The condition often develops into a full blown leukaemia but even before that the patient may die due to a lack of certain blood cells. The condition can be contained for a while by giving frequent blood transfusions but these still leave the patient feeling weak and debilitated. There is a fairly new treatment available with a drug called axacitidine (Vidaza). The cost of treatment is around £45,000 a year. The National Institute of Clinical Excellence has decided not to make the drug available to NHS patients. Decisions have to be made, lines have to be drawn, and the economy is weak. It is galling, though, to MDS sufferers that axacitidine is available in Europe and North America and, of course, to private patients. So what are English sufferers from MDS to do if they cannot pay for private treatment?  Perhaps they should go to see a homeopath. The BBC suggests they can cure cancer.



The House of Commons says that homeopathy is of no proven value, and yet the BBC gives a platform to this absurd woman,  allowing her to tell the country that she believes that homeopathy cured her brain tumour. It gets worse. Gemma Hoefkens runs a homeopathy practice in Sutton Coldfield, near Birmingham. The website is here.  This was not news. It was an advertorial. Does Gemma Hoefkens say she can cure cancer? Not in so many words, but she sails close to the wind by displaying her own tabloidesque life story. It's a criminal offence under the Cancer Act to claim to be able to cure cancer as Rachel Roberts, another homeopath, knows only too well. (See "Rachel Roberts tries to defend homeopathy but breaches the Cancer Act"  in DC's Improbable Science)

The NHS continues to give credence to this hocus pocus. Homeopathic treatment is still available under the NHS. The BBC continues to allow eccentric practitioners free air time to flog their dubious wares and, worse of all, the Quacktitioner Royal continues to give his name to it.

In the next few weeks, lawmakers will be under intense pressure from both sides in the health care debate — and voters will be witness to the crossfire. The president is hitting the road to reassure nervous House members and shore up support for his plan. Republicans are taking their opposition to the bill directly to the voters, too.

Do you remember the Nigel Molesworth "self-adjusting thank-you letter"?  OK, OK, most of you are not that old, but it amused a very young Dr Crippen. I cannot find a copy of it, but it went something like this:

Dear (Aunt) (Uncle) (Stinker) (Gran) (Clot) (Pen-Pal)


Thank you very much for the (train) (tractor) (germ gun) (kite) (delicious present*) (sweets) (space pistol) (toy socks).


It was (lovely) (useful) (just as good as the other three) (not bad) (super)
And I hav (played with it constantly) (busted it already) (no patience with it) (given it to the poor boys) (dismantled it)


I am feeling (very well) (very poorly) (lousy) (in tip-top form) (sick) I hope you are too.
My birthday when next present is due is on . . . . . .




Love from . . . . . .

All good fun. Medical and other journalists have a similar, stereotypical approach to healthcare problems. Few journalists are medically trained and so, when they come across a health problem, they have to research it. Because they did not about it before, they automatically assume that that the main cause of the problem is that British family doctors did not know about it either. Medical journalists do not expect GPs to know about anything, because they think that the 40,000 + GPs in the UK are all incompetent. Hospital "specialists" are viewed differently. They are (usually) held in awe by the journalists. Above even "the specialists" are a wonderful, undefined group of people called "scientists". If a medical journalist wants to give additional gravitas to on opinion piece, he will write "Scientists have said...". Medical journalists are pleased when someone (anyone) says "GPs need more training on...". If a hospital specialist or a "scientist" makes the statement, the journalist is delighted. And as many (not all) hospital specialists, "scientists", and the assorted medical "czars" love to criticise GPs, most journalists are in a state of perpetual delight.

Let us take an ever topical condition. Cancer of the Prostate. Rarely a week goes by without a newspaper article such as this:

Fifth of men turned down for prostate cancer screening
A fifth of men in at-risk age groups who ask their GP for a test used in the diagnosis of prostate cancer have their requests turned down, a survey has revealed.


Daily Telegraph

That sounds scary. Men, desperate to have a test that is widely available, being refused it by uncaring, incompetent GPs. They must surely need more training. The article is in fact a little more balanced than that, but many readers do not get past the headline and first paragraph.

The Prostate Cancer Charity has a similar sort of headlined story:

Max Clifford adds voice to concerns that men are facing a ‘two tier system’ of access to the PSA Test following new research by The Prostate Cancer Charity. Men concerned about prostate cancer may have to overcome opposition from their doctor to access the PSA, the most widely available test for the disease - with one in five GPs saying they do not support a man’s right to make an informed choice about whether to have it, new research has revealed.


Prostate Cancer Charity

If only GPs would get their act together. If only they were better trained. If only they knew as much about prostate cancer as Max Clifford and those caring people at the Prostate Cancer Charity. Look at their front page. They even give you a number to phone to speak with someone who really knows about prostate cancer. Their nurse-specialist.

Why are GPs sometimes reluctant to do the test? Because no one really knows how to deal with the answer. The test may indicate the presence of early cancer cells but what it will not do is tell you if it is necessary to remove those cells. Having a prostate biopsy is unpleasant and has both a morbidity and mortality rate. Having your prostate surgically removed has a significant mortality rate, and some unpleasant morbidity : like impotence and urinary incontinence. Unlike Max Clifford, GPs see the morbidity all the time. This is not an operation you want to have if you do not need it. So yes, most GPs pause a while before routinely offering a PSA blood test. Of equal importance to a PSA blood test is a physical examination of the prostate.


A DRE. A digital rectal examination. When I say to a patient that, if he needs a PSA, he also needs a DRE, he stops smiling. There is no demand for this equally important test. Strange, isn't it. Most women tolerate smear tests - and they are done frequently, not just once - but men are more squeamish. But, if you need a PSA, you need a DRE. Dr Mark Porter, the Times GP, wrote a balanced article on prostate cancer last year. Read it here. Whatever the science may tell us, GPs are between a rock and hard place when it comes to making the decision. Many now just do the test on request, on all comers and, sad to say, they do not always do a DRE. It would be pleasing to see a GP being sued for doing the test when it was not necessary. That is not likely to happen. But we should at least take the time to discuss the pros and cons of the test with the patient. As did an American family doctor, Daniel Merenstein. He was sued. Read Dr Merenstein's full account of what happened:

I saw a 53 year old man for a physical examination. I discussed with him, and documented in his chart, the importance of colon cancer screening, seat belts, dental care, exercise, improved diet, and sun screen use. I also presented the risks and benefits of screening for prostate cancer and documented the discussion.


Winners & Losers : Time Magazine

The media bandwagon is building up and I suspect that soon the government will be forced to introduce a PSA screening program, and this will result in death, incontinence and impotence in a group of patients who would have been best left alone. It's the old Chinese proverb. Be careful what you wish for; you might get it. More training for GPs? On the subject of PSA, the more training you have, the more knowledge you acquire, the more difficult the question is to answer.

There is no easy answer to this, nor to many other problems with which GPs are faced every day. Do we get it wrong sometimes? Of course we do. But we get it right most of the time and, whatever you may read in the paper, most people who see their GPs on anything like a regular basis are happy with them and trust them. The Nigel Molesworth style media campaign continues unabated. It is having a dreadful effect on GP morale. Hard to avoid the conclusion that the campaign is not being encouraged by the government. I suspect that GPs will gradually be phased out and replaced by intermediate practitioners of one sort or another. They will be cheaper and they are unlikely to pause to consider the merits of doing a PSA test. They will just do it. They won't do a DRE because they won't have the training.

Ho hum. To cheer myself up, I did a little Googling. Didn't get far searching for things like "GPs doing a good job" so instead I tried "GPs + need more training". 438,000 hits in 0.23 of a second. Nigel Molesworth has won. We are done for. I selected a few of them:

The charity Target Ovarian Cancer said it was launching this week an online GP ovarian cancer learning tool, to help GPs make quicker and more accurate referrals.


Eating Disorders
Nearly nine out of 10 people with eating disorders say their GP didn't know how to help them.


Over the counter medication
GPs need to be more aware about the use of over-the-counter drugs and possible side-effects


GPs “need more training to manage abusive patients”




GPs need more training in writing sick notes




GPs and nurses need more training to help terminally-ill patients choose where to die


GPs need more training in order to spot the symptoms of rheumatoid arthritis more quickly and effectively, according to a report from the Committee of Public Accounts.


Most GPs need more training to help them spot the signs of autism, according to a report.




GPs need training and funding in caring for refugees and asylum seekers




GPs 'overlooking' problem gamblers




Thousands of women with breast cancer are being denied swift treatment because GPs fail to recognise the symptoms.


We also need more dermatologists, more dermatology provision and more training for GPs so that they can spot skin cancer to




All NHS GPs in England are to be trained to spot the early symptoms of dementia, under government plans.


Thousands of young women with possible symptoms of cervical cancer are having their chances of survival put at risk by GPs who do not examine them properly, the cancer czar warned yesterday.


GPs need “telephone” lessons
GPs must be better trained to meet the growing demand for telephone consultations, according to academics. Professor Aziz Sheikh said doctors lacked the confidence to give advice over the telephone, a method that accounts for a quarter of all GP consultations in the US. The professor said doctors must overcome professional inertia to adapt to this new form of consultation, which is expected to become increasingly popular in the UK.

Ethnobotanist James Wong believes there is no reason to always use conventional medicines when you can find relief from the plants in your garden. Wong, who wrote Grow Your Own Drugs, says that herbal medicines can be a useful complement to conventional drugs.

Researchers found that young people discounted the notion that bad things could happen to them when drinking excessively. Messages of shame and guilt seemed, paradoxically, to encourage more alcohol consumption.

Sen. Debbie Stabenow (D-MI) says the Senate reconciliation process on the health care bill will deal with dollars not policy. The comments come amid opposition from House Democrats over the measure's language on abortion. Stabenow says there aren't enough votes in the Senate for the measure to include what the opponents want.

Rep. Bart Stupak (D-MI) says he is concerned the health care bill could contain what he deems lax language on abortion. But he says he's waiting to see the final language in the bill before he decides on his vote. Stupak says he won't support a measure that changes current law on federal funding of abortions.

More women are forgoing the hospital when it's time to give birth. The medical establishment doesn't endorse the idea, but some groups say deliveries at home and in birthing centers are fine for low-risk pregnancies.

Imagine your child is born with life-threatening cardiac abnormalities. Without intervention he is going to die. With intervention - major reconstructive surgery - there is a 50/50 chance he will pull through. You want the best cardiac surgeon in the country to do the operation. A surgeon who specialises in operations such as this. Let's suppose your chosen surgeon, Mr Patel, really is the best. In his hands the operative risk of death is not 50/50, it is only 30/70. Sadly, he is not available because, since that article in the Daily Mail in which an investigative journalist showed that 30% of his patients have died during surgery, he has been suspended. Whilst there is an enquiry. To protect the public, you understand. Catch-22

An oversimplification? Maybe.

A hospital in Oxford has suspended children's heart surgery after four recent deaths during operations. The John Radcliffe Hospital said the fatalities involved some "very sick children" and happened in procedures during the past three to four months. A trust spokesman said patients were being informed and urgent cases were being transferred to other hospitals.
He said a review of each of the deaths would be carried out but other patients would not be put at risk by any delay.

BBC

The John Radcliffe is one of the leading postgraduate teaching hospitals in the world. Or it used to be. Now it's crap. Simple as that. It is wise to shoot an admiral from time to time. It encourages the others

One reason colleges have a hard time stopping sexual assault is a misconception about who is committing these crimes. The assumption is that rapes are often committed by young men whose judgment is impaired by drinking. But one researcher says many rapists are serial predators and intentionally look for vulnerable women.

The Food and Drug Administration is taking food companies to task for misleading claims. The problems range from unsubstantiated health benefits to contradictory nutritional information.

For Dawn Chapman, going back to school opened new doors in her nursing career: “I’ve had the most exciting last few years as a result of choosing, in my fifties, to get a degree.”


After completing her State Registered Nurse (SRN) training in 1971, Dawn went to work and by the 1990s was a ward sister managing a 66-bed unit. At the end of the decade, she changed her job and became a Nurse Practitioner at Cambridge’s Addenbrookes Hospital’s breast unit, training under two consultants and examining symptomatic patients. Her expertise in breast examination was put to good use in reducing waiting times. In preparation for the new role, Dawn attended an A11 breast examination course at London’s City University and this experience, along with the Project 2000 initiative, prompted her to enrol for a B.Sc in Women’s Health.


“It was hard work, studying and attending courses in the evenings after a day in the breast unit. But I’d decided I wanted to become a nurse consultant – and I was passionate about my studies and my work,” she said.


In 2006, Dawn became a Nurse Consultant – one of only a handful in the country – and again went back to her books, this time enrolling at Anglia Ruskin University for a Masters course: “It wasn’t easy but it has given me standing and credibility”.


Since becoming a nurse consultant in 2006, she works autonomously in the clinic for new symptomatic patients leading a team of six clinical nurse specialists. Her role also encompasses audit and research, and a recent study showed that the service has been well received by patients.

From the Prime Ministerial Mawk report : "Patronising nurses"

It sums it up, doesn't it? Dawn was a ward-sister responsible for the hands-on nursing care of 66 patients. But she felt that caring for patients was not "exciting" and that it gave her no "standing and credibility", and so she gave up the job for which she trained in order to become Doctorlite.  In the process she has gathered a specious title and, even worse,  a train of six obedient, putative doctorlites.  That's another seven trained nurses lost to the profession.

So who is providing hands-on care for those 66 in-patients now, Dawn? Probably an untrained, albeit well-meaning, 19 year old Polish teenager who speaks no English.

The American Cancer Society says doctors and patients need to decide together on whether to test for prostate cancer. The balance of benefits and risks for a PSA test hinges on a man's health particulars.

LONDON (Reuters Life!) - Most Britons are "all talk-no action" when it comes to health and wellbeing, according to a survey for the NHS.

A new analysis puts the annual cost of foodborne illness at $152 billion. Problems with fruits and vegetables cost $39 billion. The figures underscore the need for better regulation of food safety, says the nonprofit group behind the report.

Oh! Dear. I just happened to mention in the Guardian today that I do not know what "fibromyalgia" is. They did not teach me about it at medical school. It is not a diagnosis I have ever made and, not knowing what the condition is, I shall not be making it in the future. Truth is, I rather doubt it exists at all.

Above all, we need to protect vulnerable people from alternative quacktitioners who make a living out of conditions such as "chronic whiplash" and "fibromyalgia", and will keep rubbing a patient until his wallet is empty.

The Guardian

The tone of some of the comments is reminiscent of the comments that flood in when one attempts to discuss certain topics : Myalgic encephalomyelitis, chronic Lyme Disease, homeopathy, acupuncture and so on. For believers in all of these, it is a question of faith; blind faith. People do not like to have their faith challenged. So, time for a little research on "fibromyalgia". Google it, and you get this. Let's start with NHS Choices:

Fibromyalgia is a chronic condition that causes pain all over the body. The condition affects the muscles, tendons and ligaments (bands of tissue that connect bone to bone), resulting in widespread pain, fatigue and extreme sensitivity to pain.
NHS Choices

There is a long entry in Wikipedia, and a helpful illustration:





If you read the Wikipedia entry in full, you begin to see the problem, and begin to understand why most doctors doubt that fibromylagia is a real clinical entry. It causes pain "all over the body" but there are no objective physical findings. It also appears to cause a huge variety of disconnected physical symptoms. So many symptoms that there is a dedicated website entitled Fibromyalgia Symptoms. So many symptoms, in fact, that it is hard to find any medical symptom that is not attributed to fibromyalgia. Try this exercise. Put FIBROMYAlGIA + ......................  into the Google search box, inserting any medical symptom or problem you can imagine. I started with obvious ones; chest pain, joint pain, shortage of breath, weakness, aching, poor sleep. They all came up. Next, I tried opposites. Constipation/diarrhoea. Feeling hot/feeling cold. Dry mouth/excessive saliva. Vaginal discharge/vaginal dryness. They all came up too.

There is (of course) a website. It is called Fibromyalgia Association UK.  They have a magazine and a selection of products to sell you. Their contact address is an anonymous PO Box in Stourbridge. However, if you spend a little time looking, you will find some names, including Ruth Raymer who is the Association's  Tarot Reader.

Hmm. Time to stop.

A national survey of parents found more than 1 in 10 had refused a vaccine over worries about safety. Twenty-five percent agreed with the proposition that "some vaccines cause autism in healthy children." Researchers conclude better communication is needed.

The plight of the doctors to be from Bart's continues to be mismanged in the usual bureaucratic, shambolic way. Apologies have been offered (apologies are cheap), no one has resigned (come on, this is the NHS; if the managers responsible for the slaughter in Stafford are still in post, you can hardly expect someone to resign, or be sacked, for merely messing up a few medical careers) and the poisoned chalice of responsiblitiy has passed to Fiona Moss, who must now be cursing the day she agreed to act-up when her boss was seconded elsewhere.

Fiona Moss is the Acting Dean Director of the London Deanery This role involves commissioning, managing and quality controlling postgraduate training for over 13,000 doctors and dentists.

Everyone may be sorry but as yet no one seems to be prepared to find jobs for the young men and women who have been so unfairly treated. It's musical chairs. The music stopped. There were not enough seats. No one cares for those who have been left standing. Are we going to find some more seats? Not if it means more expenditure. It's all a bit complicated, but Dr Crippen has the following email:

The UKFPO do not hold the money for these extra posts which is why a lot of the work has been left to him, despite this being trans deanery. FIONA MOSS, the Dean Director for the London Deanery ...holds the purse strings and is able to write the cheque needed to create the extra...posts. Put simply, she is refusing to do this. Dr Glynn therefore suggests that we apply as much pressure as possible to Fiona Moss to make sure that these posts can be created. He is confident that these students will get jobs in their preferred deanery, the question is when, the sooner the better so that students can decline the jobs they have currently been offered and be formally accepted by their first choice deanery. Dr Glynn is meeting the 21 affected students tomorrow to discuss with them what can be done with regards to programme placements, however, it looks as though this will largely be based on jobs becoming available in year 2 (of which both Dr Glynn and Prof Roberts assured us there are many due to people dropping out/moving abroad/changing ideas about preferred specialties etc.) and giving preference to those affected at swap shop. Similarly, with F1 he proposed that students may be able to swap as jobs become available by tracking prefered jobs.

It's not the kind of stress you want after years at medical school. You can follow the turmoil at Barts MTAS Fiasco.

Failings by the Nursing and Midwifery Council have resulted in fitness to practise cases being closed even where this has left the public “at serious risk of harm”, a highly critical audit has revealed. Investigations of case notes between April 2008 and March 2009 revealed “very poor file and case management, with poor control of delegated decision making and poor practices in gathering and analysing information”.

Nursingtimes.net

This is the same Nursing and Midwifery Council who have just decided to allow Deborah Purdue to start practising midwifery again.

What is going on?

More guff from the Royal College of Nursing. I never cease to be amazed at their naivety. Our care-cutting, cost-cutting government has the RCN wrapped round their little finger.  It's bought them off with a few specious titles. It's expensive to train a Consulant Physician. But you can go to the medical equivalent of Primark and get yourself a "Consultant Nurse" for a fifth of the price.  She can't do the job, but she is so intoxicated with her new 'we are all equal now' title that complaints fall on deaf ears.

The Royal College of Nursing (RCN) is calling for every patient with a long-term condition to have access to specialist nursing care. It wants guaranteed funding to avoid cutbacks in specialist nurses after the general election. It says specialist nurses save money through reduced complications and fewer hospital re-admissions.


BBC

They save money alright. Because they are a barrier to hospital care. Elderly patients are now routinely sent home from A & E departments when they should be admitted. They are told that a 'nurse specialist' will look after them at home. No they won't. They will fiddle and fart-arse around with the medication for a few days and then have to call the doctor in to arrange the admission that should have happened the previous week.

To repeat:

The Royal College of Nursing (RCN) is calling for every patient with a long-term condition to have access to specialist nursing care.

What patients and family doctors want is access to "ordinary" nursing care. It's no good coming out with all this hifalutin specialist stuff whilst elderly patients are starving to death in hospital because no one will feed them and dying of pressure sores because no one will turn them. Do have a laugh at the ridiculous woman in the video but then ask yourself if there might be better uses for her nursing training. I'm sorry, I could not find a video featuring a nurse doing hands on nursing care whilst someone played the guitar.

Scientists used to think teenage brains are just like those of adults — with fewer miles on them. But they're not. Teens' brains are developmentally different. One neurologist mother decided to get to the roots of her son's maddening behavior.

Neuroscientists have found that as we age, our brain's reaction time slows and our ability to multitask diminishes. But maturity also brings an enhanced ability to reason out problems and empathize. And the middle-aged brain can still strengthen neuron circuits associated with memory and decision-making.

Virginia Howes, an independent midwife in Kent, continues to lead the campaign to find someone to pick up the tab for any mistakes that independent midwives, working outside the NHS, may make.

Annie Francis, spokeswoman for the Independent Midwives’ Association, said:

“Most clients understand you can’t insure against things going wrong during childbirth, only against negligence, and negligence is not really an issue for us”

The arrogance is breathtaking but the ignorance is, I'm afraid, only too typical off these blinkered women who are not prepared to work in the NHS. No commercial insurance company will underwrite the risk of providing them with professional indemnity insurance. For obvious reasons. Meanwhile, my colleague, the Jobbing Doctor, draws my attention to an article in the Daily Telegraph. (Does he really read the Telegraph?)

JK Rowling's midwife allowed to practise in NHS again

An independent midwife struck off over the death of a baby boy has succeeded in overturning a ban on her working for the NHS.
Daily Telegraph

It's not the sort of headline to which I warm. The fact that JK Rowling's chose independent midwife, Deborah Purdue, means nothing. JK should stick to something she understands. Deborah Purdue is already on record stating that she works without insurance. Like Annie Francis and Virginia Howes she really does not understand the need for professional indemnity insurance.

As an independent midwife working in the Blackmore Vale area, and covering an area about 60 minutes drive in each direction, my livelihood and way of working is being threatened. There are about 200 of us in the whole country and we had tried to obtain professional indemnity insurance but have been unable to globally.


Deborah Purdue

Less than a year ago, Deborah Purdue was struck off. Read the details of the case here. Who, you may ask, is going to compensate the family who employed her?  Now she is to be allowed to go back to work. And already a comment has come in under the original article:

 Anonymous said...
How marvellous that that this very day, Deborah Purdue has quite rightly, been reinstated! Well done Debs!

FRIDAY, FEBRUARY 26, 2010 7:48:00 PM  

I give up. Maybe I am missing something here. But read the facts of the case again. Deborah Purdue is reported by the Telegraph as saying:

"because of it I am probably one of the safest midwives practising at the moment."

As opposed to what she was before. Can anonymous, or anyone else, explain to me how and why Deborah Purdue has been let loose again?

Early Friday morning, the Celebrity Mercury returned to Charleston, South Carolina, with almost a fifth of its passengers sick with gastroenteritis, euphemistically known as the stomach flu.

I've nothing against little furry animals, but does anyone have any suggestions as to the best way to deal with this? Never had this problem before, and some idle Googling has not been helpful apart from producing some baroque suggestions for extermination which I could not contemplate.

David Nicholson was Regional Director for the old Eastern and West Midlands Regions between December 2001 and March 2002, combining these responsibilities with his Trent role whilst shadowing as Director of Health and Social Care (designate) for the Midlands and East of England. In April 2002 he formally took up the post of Director of Health and Social Care for the Midlands and East of England.



One has to hope that the mid-Staffordshire debacle was the worst example of poor care, but do not for one moment think that similar things, if perhaps not as bad, are not going on in an NHS hospital near you. They are. Not a week goes by without family doctors being told of similarly distressing incidents. How can it go on like this? Target culture is to some extent to blame, but the main problem is the bloated NHS bureaucracy. In the NHS, no one is ever sacked. No one is help to account. No one at the top takes responsibility.


Bower was chief executive of NHS West Midlands from 2006 to 2008 and was criticised for having "accepted without detailed scrutiny" the trust's account that it was taking effective action in response to high mortality figures.



Cynthia "not on my radar" Bower and David "I'm not a communist now" Nicholson were just two of the many senior administrators who must take a share of the blame.  Have they been disciplined? Have they been called to account? No, they have not. In fact, the poachers have now become gamekeepers. Can you imagine, say, Marks & Spencer choosing a chief executive with a track record like this?

But those of us who work in the NHS are used to this. Remember Sylvie Panter? You have probably never heard of her. Let me remind you:

A disgraced Navy woman sailor who was jailed for stealing £11,000 from her ship and deserting with her married Navy lover is now a senior NHS manager. Sylvie Panter, 39, became the first Navy woman to be sent to a civilian jail — for 18 months in 1994 — after she and Petty Officer Ian Luff fled with money from the safe on the aircraft carrier HMS Invincible. She is now in charge of mental health planning at the North Surrey Primary Care Trust

I know that few in the NHS give a toss about mental health and I know it is the twilight zone of the NHS but what was Surrey PCT thinking of? The chief executive of Surrey PCT at the time was Nick Yeo. What did he have to say about this extraordinary appointment? A PCT spokesman confirmed that Ms Panter was employed by the trust and that it was aware of her court martial. Mr Yeo had not been involved. “She has been employed by the NHS in West Surrey since January 31, 1995,” he said. “Ms Panter’s appointment followed the standard NHS recruitment and selection process.”

Good to know that Nick Yeo was not involved in Sylvie Panter's appointment,  for she is his wife. You couldn't make it up.

++++++++

Grateful thanks to Wat Tyler of Burning our Money for the full Panter/Yeo story.

And see Guido

33 new pubmed citations were retrieved ...

It's time for the junior hospital doctors to see their lawyers. Once again, medical careers are in danger of being ruined by yet another administrative cock-up.  Time for the doctors to consult their equally high flying but much better paid friends in the legal profession. See "Looking after junior hospital doctors"

Comments under the original article please.

Gordon Brown’s promise to give the elderly the “right” to treatment at home is not quite what it seems.

The Guardian, Tuesday 23 February 2010

Getting a place at medical school is not easy. Even if you have eight or more A* at GCSE and three or four As at A-Level you still have to fight off a dozen or more students with similar qualifications. Bart's is one of the most famous medical schools in the world. It should be. The original St Bart's Hospital was founded in 1123. Bart's can select la crème de la crème of applicants. The young men and women training at Bart's are chosen from the best this country has to offer. If these young men and women had gone into nearly any other profession, most would become very high earners. Look at the salaries offered by leading London law firms. Look at the work conditions. Look how excellence is rewarded:

For students choosing to take the two-year LLB course we offer a maximum of £6,000 towards course fees. Future trainees taking this course also receive a one-off maintenance payment of £6,000 for courses in London, Oxford & Guildford and £5,000 for courses elsewhere in the UK. If you accept your training contract after commencing the GDL, LPC or two year LLB we will pro rata your maintenance award, but your course fees will be refunded in full.


We believe in recognising your achievements - if you achieve a first class degree and/or a distinction in the LPC after accepting our offer, we'll reward you with a prize for each of £500. The current salary for first year trainees is £38,000 rising to £42,200 in the second year of training. From September 2009, the salary on qualification will be £60,000.


As well as financial rewards, working at Allen & Overy offers an exceptional range of benefits including insurance (life, permanent health and private medical), pension scheme, an interest-free season ticket loan, as well as a range of on-site facilities including a gym and sports hall, medical, dental and physiotherapy service, beauty treatment centre, dry cleaners, and two restaurants.


Allen & Overy Careers

Six years after leaving school, the new young solicitor at Allen & Overy is earning £60,000 a year. And he was paid, on average, £40,000 a year during the last two years of his training. The Bart's student was paid nothing during the last two years of his training. After six years, he will, if he is lucky, become what is now known as an F2, and have a basic salary of around £26,000. There may be some overtime. His colleague at Allen & Ovary has finished his post-graduate education. The F2 is just starting his. Lots more exams to come and all must be studied for whilst doing a demanding job. If, for example, he wishes to become a physician, he will have to pass the MRCP (UK) exam. It comes in three parts, costing £379, £379 and £595 respectively. And no, the NHS does not pay for the exam. The junior doctor has to pay out of his own pocket. And no, he does not get private health insurance. As for a ‘beauty treatment centre’, well, that’s so far from the mundane reality of junior hospital medicine that it makes me giggle.

It gets worse. The late unlamented Patricia Hewitt was responsible for introducing a characteristic New Labour, top-down, micro-managed career management structure for junior hospital doctors. It was called MTAS. It was like an on-line dating service. Doctors fed in details of all their qualifications, skills, attributes and career ambitions and the computer matched them to the job that most suited them. Perfect. Except it did not work. Doctors got the wrong jobs or, worse, no jobs at all. There was a desperate shortage of hospital doctors and, at the same time, thousands of unemployed doctors.

Watch the appalling Hewitt squirm and wriggle under pressure.

Not only did MTAS not work, but the security was so lax on the system that all the personal details of the young doctors could be viewed on line. It was this final appalling security breach, revealed by NHS BLOG DOCTOR, that finally put an end to the MTAS system down. Within two hours of the revelation on NHS BLOG DOCTOR, the computer was closed down.



Hewitt did not resign but it was this catastrophe that finished her political career.


You would think that lessons had been learnt and that it would never happen again. Sadly, it seems that is not the case. This time, though, it is not a security breach. It all gets a bit technical now. UKFPO is yet another plausible micro-managing organisation, with yet another plausible website, designed to help doctors with their careers. It may be that it is an innocent computer cock-up but the suggestion has now arisen that some junior doctors' application forms have been tampered with. NHS BLOG DOCTOR has received the following information:

Just dropping you a line to let you know about the currently developing massive fuck-up UKFPO's made of this year's MTAS process. A number of my final year friends have found out that UKFPOs changed the academic rankings given to them by our medical school (Barts and the London), which has either cost them jobs or foundation schools. The commonest trend seems to be top quartile students who've been ranked in the bottom quartile by UKFPO, despite the medical school confirming that they sent the right data to UKFPO. There's been some students who've had their MTAS question scores changed, with one student claiming he went from a score of 34 to a score of 1. Some have been lucky and managed to get a job they're happy with in their foundation school of choice but others have ended up in foundation schools they don't want.


I've let RemedyUK know and we've gotten our BMA rep involved, for what that's worth. I have a feeling UKFPO will try to sweep this under the carpet because it's a colossal fuck-up and there's no way they'll be able to place these students in the jobs and foundation schools they rightfully deserve this close to August so I think it's important to get as much media attention on this as possible.


They've recently gotten their MTAS breakdown so they can see what marks they got and they've noticed the quartile mark they got doesn't match up with the ranking the medical school's given them. For some that's been a shift from the top quartile to the bottom quartile whereas for others its only been a few lost marks. One friend lost 6 marks from being put in the wrong quartile and lost out on a place in NW Thames - given that was the most competitive foundation school this year (only 30% of Imperial students got in despite it being their home foundation school), it's quite probable that those 6 lost marks cost her a place.


A few others have noticed their MTAS question scores aren't right - one person was given 34 by the medical school but UKFPO changed that to 1. The affected people have passed their scores onto the medical school, who've confirmed they don't match the data they sent UKFPO, which suggests that there's been a mistake somewhere along the way. I'm not aware if this has affected other medical schools but those affected from Barts applied to a variety of Deaneries, which places the fault more towards UKFPO. Heather Norris is the administrator at Barts who deals with MTAS and she sent this email to one of the affected students:

"Thank you for your email. I've had a few more emails from students who don't appear to have been given the correct academic score, but at the moment I haven't been able to find out why this has happened...


After I have ranked the students according to their exam results, my involvement in the process ends. I've tried to contact the Foundation School, but there wasn't anyone in the office today who was able to help, so I will get in touch with them again first thing on Monday.


I'm sorry I can't give you any more information at the moment."

It's all rumour with nothing concrete now but it certainly seems that people haven't been ranked correctly. As with anything in life concerning students, there's already a Facebook group about it and someone on there has noted that everyone who's been affected so far has a surname beginning with a letter between B and G. The current line of thinking is maybe UKFPO screwed up data entry in their database in a spreadsheet or whatever but that's completely unsubstantiated rumour at the moment.

Remedy UK, an organisation set up by hospital doctors after the BMA failed to take action on the MTAS catastrophe, has been advised and is following the case. Dr Crippen has not as yet been able to find out any further information, but will keep you posted as it comes in. Whatever is happening, though, try to imagine the stress this is causing the young men and women who have just qualified from Bart's. I can say what they cannot say. They are some of the most talented young professionals in the country. They should not be treated like this.

+++++++++

Yep, there was indeed a cock-up. Apologies and "explanations" are starting to appear. See here.

Dr Michael Glynn, Foundation School Director for NETFS, said; “We apologise unreservedly for this error. This has not been an error made by the UKFPO, or by the online application system. It was human error, plain and simple, between the medical school and local foundation school. This does not excuse it, certainly, and NEFTS will do everything it can to help those students affected. We are also working with Barts and the London to ensure this does not happen again.

Well, OK, but WHO made the error? Has he/she been sacked? Why was there no failsafe? Who designed the system? Why were checks not made before the damage was done?  Will Dr Michael Glynn be resigning? If not, why not? And it's all well and good to say that NEFTS will "do everything it can to help those students affected." How will it do that? What does he have in mind? A little counselling? Some CBT maybe? CBT is all the rage now.  The jobs of which those young doctors have been deprived will have been given to other highly skilled doctors. They will be strong candidates too. Their second choice jobs will have gone to someone else. This is like musical chairs. The music has stopped and those who should be seated are not seated. The doctors who have been unfairly treated may lose six to twelve months on their career ladder. How are you gong to compensate them? It's time for those young Bart's doctors to consult my learned friends and sue the pants of Dr Glynn and his colleagues. An apology is not enough.

Reform of the NHS is a difficult nettle to grasp as a general election approaches. The public may easily but inaccurately assume that much needed reform is a threat to the NHS principle of a decent standard of medical care being available to all, independent of means and status. They easily forget that such medical care has not been available to all for a decade or more. For those of us who work within the NHS, and experience the catalogue of waste that surrounds us, it is deeply depressing to see that there is a bi-partisan policy that can best be summed up as “leave the NHS alone”...

continued here

I must apologise to NHS BLOG DOCTOR readers and, in particular, to an old NHS BLOG DOCTOR favourite, Tubby Tritter. In Embedding Patient Experience metrics I referred once again to the NHS Centre for Involvement. A reader points out that the NHS Centre for Involvement closed last year. I must apologise to all for suggesting that this egregious money-wasting drivel was still in existence. I would be pleased to feel that NHS BLOG DOCTOR played a small part in it's downfall.

As for Professor Tritter, he is alive and well at the University of Warwick Business School:

Jonathan has recently returned to the Institute of Governance and Public Management in Warwick Business School after being seconded to establish and lead the NHS Centre for Involvement. His main research interests relate to public participation and lay experience in health and policy making particularly in relation to cancer, mental health and environmental policy

Warwick Business School

How's that for an honest c.v.?

Lord Digby Jones was on the Today programme this morning, talking a lot of common sense. Despite the UK being in the middle of the worst economic crisis ever, both political parties have pledged that expenditure on the NHS is ring fenced. There will be no cuts in NHS funding which ever party wins the election. Crazy. There is more money wasted in the NHS than in any other organisation in the country, possibly in the world. Take a look at a few excerpts from the NHS catalogue of waste here.  So many cuts could me made, so much money saved, without having any impact at all on patient care. Make your own list of five things that could be cut from the NHS. Here is mine:

I've got a little list, I've got a little list

Of NHS offenders who might well be underground

And who never would be missed, who never would be missed.

Embedding patient experience metrics

Tubby Tritter

Cupboard tidying initiatives

National College for School leadership

Pharmacist reviews

PFI

An American physician writes in to NHS BLOG DOCTOR today to say he is utterly baffled by two stories in the Daily Mail. Well, OK, it's the Daily Mail, so we should all be ready for a pinch of salt. But the Daily Mail is hardly a hot-bed of communism and so, if they are expressing outrage at the latest failure of the NHS Private Finance Initiative, what would a left-wing newspaper make of it?

A flagship hospital is facing an investigation as patients told of their nightmare stays in tiny windowless ‘broom cupboard’ treatment rooms. Elderly women described being transferred to 12ft by 16ft store rooms in the middle of the night – where they were surrounded by blood-stained bins, bandages and shelves of medical supplies. Some missed meals because they were not on proper wards while others described sleepless nights as nurses continually entered to collect stores. It has emerged that Norwich and Norfolk University Hospital has 27 cupboards – labelled ‘treatment rooms’ and regularly used to house patients – attached to wards. NHS watchdog the Care Quality Commission has launched an investigation into the £229million hospital, built less than a decade ago with private funding, after a flood of complaints

Daily Mail

It does not make for happy reading, and one can only feel a sense of shame that these pictures are being viewed around the world. Dr Crippen has long since put political doctrine behind him when it comes to looking at the best way to provide health care. There are advantages to the American system which many tend to ignore, and similarly there are advantages to the British system which many (particularly right-wing Americans with their knee jerk "we don't want socialized medicine in our country") also tend to ignore. We need to take the best of both worlds.  Over the last twelve years, the Labour government has further entrenched the worst aspects of a nationalised monolithic industry. It gets worse. You will not get rich working for the NHS, but you can get very rich indeed by selling things to an NHS which has no concept of quality control nor of financial accountability. The NHS encapsulates the worst of both the public and private sector. The NHS does not need to be ring-fenced. It needs to be broken down and rebuilt.

God, I am bored with Ray Gosling. I wish this tiresome, elderly exhibitionist had never opened his mouth. I am grateful, therefore, to my ageing Greek friend for bringing some humour to the topic.

Why Patricia Hewitt is fighting for the right to die with dignity

It was a very busy morning surgery. I was already running forty minutes behind. The second patient I had seen had had an acute psychiatric crisis, was suicidal, and needed a detailed assessment and immediate referral. Getting through to the hospital psychiatric services is never easy. One is usually fobbed off by some junior, medically unqualified, member of the CMHT (see Shocking Psychiatry) who will ask you to fax a referral through and mark it urgent.  This patient was so disturbed that I was determined to speak with the duty psychiatrist which, finally, I did. The fifth patient in, who was three weeks post-heart attack, was short of breath and clearly going into heart failure. Whilst I was examining him, the receptionist phoned to say that there was a couple at the desk who had just arrived, without an appointment, with their toddler who had a developed a high temperature over the last few hours. They wanted him seen immediately. I told the receptionist that I would see him next, and asked her to seat them in the waiting room. It took me another fifteen minutes to sort out the patient with heart failure. I called the toddler in, but he had gone. His parents had been so worried that they had called 999 on their mobile from the waiting room. An ambulance was taking them to hospital. As they had left the health centre, they told the receptionist that they were going to make a formal complaint about the delay, and about my failure to see their toddler immediately.

It's the kind of pressure under which we all work. No family doctor can be in two places at the same time. Each and every week, we are asked to see large numbers of small children with high temperatures. There is no way of excluding meningitis in the early stages. Any child with a high temperature could have meningitis but it is a rare condition. I have seen meningitis on average about once every five years. The facts as given above are fictional. They did not happen. Or not to me. But they can happen. Something similar happened here.

Parents forced to call 999 from outside GP surgery 'because doctors were too busy to see dying baby'

source

We all know how it reads. The dragon of a receptionist "protecting" her doctors. But general practices cannot function as "walk-in", immediate attention facilities. "Ah, yes" you may say "but this was a meningitis, and the parents were worried".  We may have a dozen such parents arriving every day. How  can we make sure that there is a doctor available at all times to see these children immediately?  A common claim is  that, "This would never happen if parents took their children straight to hospital."  Wouldn't it? It happened here. And here. And here. And here.

The ambulance-chasing lawyers are already buzzing around this recent tragic case:

Five month old baby dies after NHS said no one free to examine him

The Injury lawyers blog

The  "NHS said no one was free"?  How disingenuous to use the case of one doctor's surgery to represent the whole of the NHS. This is a tragic case, a case that makes all parents (and I write that more as a parent of four children than as a doctor) shiver and say, "there but for the grace of God...".

Meningitis does not discriminate and can affect anyone, of any age, at any time. The UK public surveillance agencies report that every year around 3,000 cases of life-threatening bacterial meningitis occur in the country. Those most at risk are children under the age of 5, 16-19 year olds, and people over 55.

Meningitis UK

We can talk about better training, and better availability, but the sad fact remains that a child can go from being entirely well to being critically ill within a matter of a few hours, and the initial symptoms are often mild and common-place. Happenstance and misadventure is not ipso facto medical negligence. When a child dies of meningitis, crucifying the doctor who last saw the child may please Daily Mail readers, and may fill the wallets of the ambulance-chasing lawyers, but will it help us deal appropriately with the next child who presents with a temperature?

Lawyers are pocketing £1 in every £2 paid out to victims of NHS blunders. Legal firms are bringing in a total of more than £3million every week as the compensation culture booms.

Ambulance chasing lawyers

Take the emotion out of the problem, and this is in fact another example of risk management. If all children with temperatures were routinely and immediately admitted to hospital for in-patient monitoring, we could virtually eliminate deaths from meningitis. But we are not prepared to do that, any more than we are prepared to stop using our motor cars. Far more children are killed every day on the roads than die of meningitis. And yet there is no outcry about these equally tragic deaths. Why not?

A fascinating clip. David Cameron caught on the hop and squirming so much that he forgets Lord McColl's first name.  Once, long ago, Dr Crippen was Lord McColl's houseman. I can still remember his first name. It's Ian, not Hugh.


Yesterday, in Andrew Lansley caught troughing, we looked in detail at some of the activities of Care UK, and at Andrew Lansley's acceptance of large sums of money, given by the wife of the Chairman of Care UK, to help him run his private office.

Today, I have put the question "Should Andrew Lansley take money from the private health care industry" to Tim Montgomorie's Conservative Home. The response is here.

We await Cameron's response to Andrew Lansley's office finance with interest.

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