Have been pigging out on Yes Minister clips on You Tube. While doing this, I came across this. Is Ian Duncan Smith channelling Yes Minister? Or did he simply get the idea watching old clips?
Sunday, 21 November 2010
And the Answer Is..
So which book had this stingingly elegant introduction to its Fifth Edition? The Oxford Textbook of Medicine. Note to politicians; when you get critised in exclamation marks, no need to worry. When you get critised in subordinate clauses, semi colons and colons, be afraid. Be very afraid..
Saturday, 20 November 2010
Who Said It? (And Could It Be Said Any Better?)
What august tome has the following as its preface in this, its Fifth Edition?
I'll give the answer tomorrow, if you don't already know.
The Teaching and Practice of Medicine; A Fine Tradition Betrayed
Irrespective of the political dimension of medicine, the care of patients and the prevention of disease depend on practicing clinicians; the medicine of the future relies not only on scientific advances but on the education of doctors. Since the last edition, leaders of our profession have presided over, and in some cases acquiesced to the partial dismantling of arguably one of the finest systems of medical education. The implementation of a national process for the appointment of junior doctors has disaffected many trainees and their clinical mentors, who feel they have become pawns in a bureaucratic political game..
More important if they understood the full implications, we believe the British public and patients would be horrified. Within Europe, matters have been compounded by implementation of the European Working Time Directive, which threatens the professional apprenticeship and mentoring relationships between junior and senior doctors that best nurture young colleagues. The frequently heard mantra of the ‘consultant led service’ is all very well, but the ideal will be short –lived if training is put in jeopardy.
We, the editors of this textbook, learnt how to practice as clinicians from such ‘hands-on apprenticeships and ask : how can young doctors accumulate adequate working knowledge and acquire essential skills if their clinical work is restricted to 48 hours each week? One might pose the question: would a patient prefer to be treated by a fully rested but inexperienced doctor whom they had never seen before, or a tired doctor with immense medical experience who know them and their illness? We know whom we would prefer. Short hours and other radical changes in the organisation of clinical teams impair the continuity of medical care, an element of key importance for the patient but also critical for clinical education through time honoured individual experience. Many countries are seeking to improve their systems of medical education but for those who might consider adopting the current UK training timetables, we humbly offer advice- don’t. It would be better to provide their medical students and young doctors with sufficient time and resources to acquaint themselves with the principles and practice of modern scientific medicine that are emphasised in this book.
Bureaucratic Targets
Well chosen targets are a good way of managing complex systems, but there is grave danger when those who set targets for clinical practice are intrinsically suspicious of doctors, take very selective advice, choose inappropriate limits and compound the error by specifying crude and inappropriate mechanisms by which they should be achieved. What is being measured becomes of overwhelming importance, and the patient with the most pressing clinical need may not get the priority that he or she deserves. Many will suffer unless this state of affairs is remedied.
I'll give the answer tomorrow, if you don't already know.
The Teaching and Practice of Medicine; A Fine Tradition Betrayed
Irrespective of the political dimension of medicine, the care of patients and the prevention of disease depend on practicing clinicians; the medicine of the future relies not only on scientific advances but on the education of doctors. Since the last edition, leaders of our profession have presided over, and in some cases acquiesced to the partial dismantling of arguably one of the finest systems of medical education. The implementation of a national process for the appointment of junior doctors has disaffected many trainees and their clinical mentors, who feel they have become pawns in a bureaucratic political game..
More important if they understood the full implications, we believe the British public and patients would be horrified. Within Europe, matters have been compounded by implementation of the European Working Time Directive, which threatens the professional apprenticeship and mentoring relationships between junior and senior doctors that best nurture young colleagues. The frequently heard mantra of the ‘consultant led service’ is all very well, but the ideal will be short –lived if training is put in jeopardy.
We, the editors of this textbook, learnt how to practice as clinicians from such ‘hands-on apprenticeships and ask : how can young doctors accumulate adequate working knowledge and acquire essential skills if their clinical work is restricted to 48 hours each week? One might pose the question: would a patient prefer to be treated by a fully rested but inexperienced doctor whom they had never seen before, or a tired doctor with immense medical experience who know them and their illness? We know whom we would prefer. Short hours and other radical changes in the organisation of clinical teams impair the continuity of medical care, an element of key importance for the patient but also critical for clinical education through time honoured individual experience. Many countries are seeking to improve their systems of medical education but for those who might consider adopting the current UK training timetables, we humbly offer advice- don’t. It would be better to provide their medical students and young doctors with sufficient time and resources to acquaint themselves with the principles and practice of modern scientific medicine that are emphasised in this book.
Bureaucratic Targets
Well chosen targets are a good way of managing complex systems, but there is grave danger when those who set targets for clinical practice are intrinsically suspicious of doctors, take very selective advice, choose inappropriate limits and compound the error by specifying crude and inappropriate mechanisms by which they should be achieved. What is being measured becomes of overwhelming importance, and the patient with the most pressing clinical need may not get the priority that he or she deserves. Many will suffer unless this state of affairs is remedied.
Thursday, 11 November 2010
Remembrance Day
When I was a young man I carried my pack
And I lived the free life of a rover
From the Murrays green basin to the dusty outback
I waltzed my Matilda all over
Then in nineteen fifteen my country said Son
It's time to stop rambling 'cause there's work to be done
So they gave me a tin hat and they gave me a gun
And they sent me away to the war
And the band played Waltzing Matilda
As we sailed away from the quay
And amidst all the tears and the shouts and the cheers
We sailed off to Gallipoli
How well I remember that terrible day
How the blood stained the sand and the water
And how in that hell that they called Suvla Bay
We were butchered like lambs at the slaughter
Johnny Turk he was ready, he primed himself well
He chased us with bullets, he rained us with shells
And in five minutes flat he'd blown us all to hell
Nearly blew us right back to Australia
But the band played Waltzing Matilda
As we stopped to bury our slain
We buried ours and the Turks buried theirs
Then we started all over again
Now those that were left, well we tried to survive
In a mad world of blood, death and fire
And for ten weary weeks I kept myself alive
But around me the corpses piled higher
Then a big Turkish shell knocked me arse over tit
And when I woke up in my hospital bed
And saw what it had done, I wished I was dead
Never knew there were worse things than dying
For no more I'll go waltzing Matilda
All around the green bush far and near
For to hump tent and pegs, a man needs two legs
No more waltzing Matilda for me
So they collected the cripples, the wounded, the maimed
And they shipped us back home to Australia
The armless, the legless, the blind, the insane
Those proud wounded heroes of Suvla
And as our ship pulled into Circular Quay
I looked at the place where my legs used to be
And thank Christ there was nobody waiting for me
To grieve and to mourn and to pity
And the band played Waltzing Matilda
As they carried us down the gangway
But nobody cheered, they just stood and stared
Then turned all their faces away
And now every April I sit on my porch
And I watch the parade pass before me
And I watch my old comrades, how proudly they march
Reliving old dreams of past glory
And the old men march slowly, all bent, stiff and sore
The forgotten heroes from a forgotten war
And the young people ask, "What are they marching for?"
And I ask myself the same question
And the band plays Waltzing Matilda
And the old men answer to the call
But year after year their numbers get fewer
Some day no one will march there at all
Waltzing Matilda, Waltzing Matilda
Who'll come a waltzing Matilda with me
And their ghosts may be heard as you pass the Billabong
Who'll come-a-waltzing Matilda with me?
Monday, 8 November 2010
A Professional View on the White Paper...
The British Medical Association has weighed in on the new Prime Minister David Cameron’s health care proposals.
The Allergists voted to scratch it, but the Dermatologists advised not to make any rash moves.
The Gastorenterologists had a sort of a gut feeling about it but the Neurologists thought the Administration had a lot of nerve.
The Obstetricians felt that they were all labouring under a misconception.
Ophthalmologists considered the idea short sighted.
Pathologists yelled, ‘Over my dead body!” while the Paediatricians said, ‘Oh, grow up!”
The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it.
Surgeons decided to wash their hands of the whole thing. The ENT specialists wouldn’t hear of it.
The Internists though it was a bitter pill to swallow, and the Plastic Surgeons said, “This puts a whole new face on the matter..
The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea.
The Anaesthesiologists thought the whole idea was a gas and the Cardiologists didn’t have the heart to say no.
The Wheelchair service and the Prosthetists thought that it couldn’t stand on its own feet.
In the end the Proctologists won out, leaving the entire decision up the the a***holes in London.
The Allergists voted to scratch it, but the Dermatologists advised not to make any rash moves.
The Gastorenterologists had a sort of a gut feeling about it but the Neurologists thought the Administration had a lot of nerve.
The Obstetricians felt that they were all labouring under a misconception.
Ophthalmologists considered the idea short sighted.
Pathologists yelled, ‘Over my dead body!” while the Paediatricians said, ‘Oh, grow up!”
The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it.
Surgeons decided to wash their hands of the whole thing. The ENT specialists wouldn’t hear of it.
The Internists though it was a bitter pill to swallow, and the Plastic Surgeons said, “This puts a whole new face on the matter..
The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea.
The Anaesthesiologists thought the whole idea was a gas and the Cardiologists didn’t have the heart to say no.
The Wheelchair service and the Prosthetists thought that it couldn’t stand on its own feet.
In the end the Proctologists won out, leaving the entire decision up the the a***holes in London.
Monday, 1 November 2010
NICE and the Franchising of the NHS
It was with great dismay that I read that NICE is to be divested of its power to act as regulator for drugs for the NHS. This is to be handed to GPs as part of the commissioning deal and will leave NICE as a pretty toothless organisation, ready to be thrown on the quango bonfire.
Those who read me regularly will know that I have a chequered attitude to NICE. On the one hand, I was furious about the blatantly political attempt to remove all dementia medicines from prescriptions. At the same time, I do recognise its value as a negotiator with pharmaceutical companies about the price of their drugs. Drugs in America can cost five or six times what they cost here, because there is not a national regulator between the companies and the patients. Removing this guard dog is going to make the price of drugs in Britain shoot up and place GPs in the invidious position where they might reject one drug, but the GP next to them might prescribe it.
But there is another element to this move. Some time ago I did an post on the European Cross Border Directive and the dangers inherent in this for the NHS. One of its proposals was for prescriptions written in one country to be recognised in another. I wondered aloud how this would work given that NICE did not permit the same drugs under prescription that other countries did. I think we have just been given our answer. The removal of a national regulator to be replaced with local ones, is turning the NHS into a group of health care organisations along the lines of the American HMO. Many GP practices are run by the likes of United Health and Atos; they also have their favourite drugs companies who pay them big bucks to promote their brands. This move is more dangerous than it looks.
Europe marches on. The franchising of the NHS marches on. The vultures are gathering..
Those who read me regularly will know that I have a chequered attitude to NICE. On the one hand, I was furious about the blatantly political attempt to remove all dementia medicines from prescriptions. At the same time, I do recognise its value as a negotiator with pharmaceutical companies about the price of their drugs. Drugs in America can cost five or six times what they cost here, because there is not a national regulator between the companies and the patients. Removing this guard dog is going to make the price of drugs in Britain shoot up and place GPs in the invidious position where they might reject one drug, but the GP next to them might prescribe it.
But there is another element to this move. Some time ago I did an post on the European Cross Border Directive and the dangers inherent in this for the NHS. One of its proposals was for prescriptions written in one country to be recognised in another. I wondered aloud how this would work given that NICE did not permit the same drugs under prescription that other countries did. I think we have just been given our answer. The removal of a national regulator to be replaced with local ones, is turning the NHS into a group of health care organisations along the lines of the American HMO. Many GP practices are run by the likes of United Health and Atos; they also have their favourite drugs companies who pay them big bucks to promote their brands. This move is more dangerous than it looks.
Europe marches on. The franchising of the NHS marches on. The vultures are gathering..
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