Any clinician will tell you

Here is what one such clinician, an acute admitting physician, told the Joint Committee on the Draft Mental Incapacity Act.

What is the doctor to do if the patient is not incapacitated but merely distressed because of life circumstances? They may have discussed it with friends and relatives, may have written down their request in the form of a suicide note and gone on to take the overdose. We know that the majority of such patients, 19 out of 20, live but regret having taken the overdose. Any clinician will tell you, any psychiatrist will tell you that this business of taking overdoses is part of the very natural history of how distressed and depressed individuals behave. They want out. They want to get out of the situation into a different environment and there are all sorts of feelings of guilt and concern about it. I know from my clinical experience that the next day many of these patients are glad to be alive. It would be a tragedy if suicide notes were deemed valid advance directives. Why do we treat them? For the reasons I have stated. We know that their views are not fixed. Indeed this is part and parcel of the way that distressed individuals behave. They want help, they want a different environment and they want to be surrounded by people who can help them. We know that but at the time that they take the overdose on the Friday or Saturday night their intention may very well have been to kill themselves and they may have thought about that for two or three weeks or even months. I think there are dangers in having advance directives which will freeze in time individuals' so-called wishes when we know in practice that they change over time.

Dr Philip Howard was the doctor who put forward this view on behalf of the Guild of Catholic Doctors. Was that why his views were ignored? Did the committee think he had a religious agenda? Dr Grumble has never revealed his religious views here. He is not going to now. This is not about religion. It is about what is right and what is wrong. It is a shame that the law now views doctors with such distrust that they can no longer act in the best interests of their patients and save their lives when they are in a state of distress.

With thanks to Julie McAnulty

Why we had to have polyclinics

There you have it. If you live in Westminster you live 7 years longer than if you live in Canning Town. Clearly healthcare in Westminster is better than that in Canning Town. Whose fault is this? As Lord Darzi realised it has to be the fault of GPs. What else could possibly cause such a difference in life expectancy? In Scotland the differences are even worse.

Medical students who wave

What will we do with Google Wave? Will it be an important part of our lives or will it be one of those things we don't need? Will we use it all the time or just for special applications? It's difficult to know. It's hard not to be excited by it but just whether it will be useful or not is unclear. Dr Grumble thinks that it might be good for developing ideas - planning a research project, for example. But it might not. It remains to be seen. Others have suggested that it might be useful for meeting notes made by everybody at the same time. But would that be manageable? We don't yet know.

Below is a public wave for medical students:

It's not clear yet to Dr Grumble how you can link to these things. Perhaps you can't. But you should be able to find it if you search the public waves. But whether you will find it of any use is quite another matter.