06 May 2006

Bring out your dead

Anatomy was never Dr Grumble's favourite subject. Learning anatomy is a bit like committing a very complicated 3D road map to memory. He found it so awful that he very nearly gave up medicine after just a term. But if you are going to be a doctor anatomy is important, very important.

Has the work of Guenther von Hagens put donors off?

Bodies for dissection are now in short supply. Imperial College, better known for technology than medicine, has cancelled hands-on dissection for its first year medical students. In Oxford, when Dr Grumble trained, there were plenty of bodies. At one time they used cadavers from executions though it has to be said that this was long before Dr Grumble's time. One such unfortunate was 22 year old Ann Green who was hanged in the Cattle Yard on 14th December 1650 for the murder of her newborn baby. Her body was then carted off for dissection. As Thomas Willis and his colleagues were about to start work they noticed she was still breathing. They tickled her throat with a feather and she soon made a full recovery. Now you might think that they would have taken her back and done the job properly but Dr Grumble is happy to relate that she ended up being pardoned. Some say she went on to live well into old age which is a nice story but others say she died aged 31.

Thomas Willis who resuscitated Ann Green.

Things may be bad at Imperial College but they appear to be even worse in Australia. There students can't tell a heart from a liver. Some now think this is part of a dumbing down of training with too much focus on the touchy feely subjects that the politically correct insist on squeezing into an already overloaded curriculum. Dr Grumble could have told them that. But nobody listens to doctors.

Patients should be concerned. Dr Grumble is very concerned.

Dr Grumble was so wrong

Many years ago senior nurses told Dr Grumble that nurses should never be taken away from the hands on provision of basic nursing care. Dr Grumble thought they were crackers. They told Dr Grumble that it would be the beginning of the end of nursing. Dr Grumble took the view that as nursing was becoming more technical and there was a need for nurses to take on technical tasks usually done by doctors, it would be better to get others to do the chores like washing bottoms. How wrong he was. Basic nursing care is important. Nurses, very senior nurses, used to tell that to Dr Grumble. They were right. And basic nursing is, yes, nursing. It is not anything else. It should be done by a nurse and a senior nurse should ensure that it is done properly.

Nursing as it used to be. Note the staff patient ratio.

Now nurses are trained away from the wards. Some are too clever to care, others too posh to wash. See what the lovely Amy Wilkins, [the link is now broken but there are others saying much the same] a student nurse, has to say on this. Her more senior colleagues agree with her. But for how long?

Dr Grumble was so very wrong.

01 May 2006

Thought for the day

Dr Grumble's children have all been educated entirely in state schools. He couldn't have afforded otherwise. But he's glad to support state systems at a time that they are under threat. Today's leader believes that anything that is not run like a market is defective and will not work. This might be right - but it might not be. Just because the Soviet Union fell apart because of its dire economic state does not necessarily mean that you cannot make these systems work. Certainly our leaders are not able to make them work as they should. That's why they want to privatise them. You see privatisation puts some distance between the political masters and the deliverers of the service. Dr Grumble doubts whether this will work in the case of hospitals. If hospitals get closed on grounds of efficiency will the companies running them in the future get the blame or will the government? The answer is clear. Hospitals need to be closed but politicians rarely stand up and say so. Where Dr Grumble lives is a hospital. It's really a sticking plaster station. It may be that it should be closed. But no local politician will ever say so. The local newspaper has horror headlines. No local politician ever supports the closure. Quite the opposite: they pledge maximum support to fight the closure.

A half pulled down hospital.
Half-pulled down because they then decided it was beautiful and left the rest!

One way of making schools and hospitals work is to set targets, keep measuring performance and have audits and inspections. The inspection report for the local state school has just arrived. For parents these inspections tell them what they already know. It must say something that millionaires send their children to the local state school - though most of the local millionaires probably don't. But the fact that some do probably says something.

Two things caught Dr Grumble's eye in the latest Ofsted report. The first thing was the silly mission statement. It reads 'Better education and care'. Why do they have to have these things? There's a hospital in London which has a mission statement pasted onto it's lavatorial white-tiled wall. It reads something like ' Serving the community 24 hours a day'. Goodness knows how much it cost to paste this on the walls. And it tells the people what they already know. Who first dreamed up the concept? Why did management gurus propagate it and tell our masters that we must have these things. And why did our masters listen to them? This, of course, does not matter. That's why nobody runs a campaign against mission statements. If there is one, do let Dr Grumble know because he might just sign on.

It was the other thing that caught Dr Grumble's eye that caused him to think. It was under What the school should do to improve. Well, 'improve further' was what they actually wrote because that's politically correct. So pretty important you might think. This was what was last on the list:
  • Enhance spirituality in the school and meet statutory requirements on collective worship

Now Dr Gumble seems to remember seeing this before so it seems there has been no progress. And the fact that it was last on the list implies that even the inspectors consider it least important. Curiously, a previous headmaster was a man of the cloth so you might think he would have sorted this out long ago.

Today is a Bank Holiday in the UK. Dr Grumble is normally at work before 7.30am so today he had a lie in. This meant that, unusually, he heard Thought for the Day on the Today programme. Today it was a rabbi. Quite a nice old buffer. Gay so I'm told. Can you be a rabbi and be gay? Apparently so. What the rabbi said really doesn't matter. What does matter is that it was a rabbi. It always seems to be somebody with a religious axe to grind. Why is this? Isn't the BBC funded by, essentially, the whole community. Don't people without a religion have any interesting thoughts? And why is worship, collective worship, a statutory requirement in our schools. This seems to be quite the opposite of what is the law in the US. If Dr Grumble has any US readers perhaps they could inform him on this. Was it the founding fathers that had this far-sighted view?

Dr Grumble is perplexed.