21 June 2008

One stop shopping and medicine

Dr Grumble runs a one stop shop. It's very successful. The patients like it. Dr Grumble likes it. It was Doc G's idea. Medicine these days has to be like shopping. And best of all in the managers' eyes is the one stop shop. Dr Grumble knows the way managers think. He knows the buzz words that set the management alight. But even Dr G was surprised by the alacrity with which his idea was adopted.

So, you see, Dr Grumble has nothing, in principle, against adopting some ideas from the world of shopping. It can work. But is this really sensible for, say, a cholecystectomy? Lord Darzi regularly gives this as an example. He catalogues the numerous trips a patient has to make to get her gall stones fixed. In Sainsbury's you wouldn't make several trips for your shopping. That, anyway, is the Darzi line. He really can be quite beguiling. But then in Sainsbury's they won't fix your gall stones. Not yet anyway. And you don't have your gall stones done every week.

Not only do you not have your gall stones done every week, you don't actually go to your GP with gall stones. You go to your GP with symptoms. Galls stones may present in different ways and the same symptom could have a number of different causes. Abdominal pain could be gall stones. It could be a heart attack. It could be nothing much at all. It could be numerous other things. It could even be cancer. That's why you need a GP. You can't just look up which expert to see on the internet. You really can't.

But if Lord Darzi had his way you would enter the one stop shop with tummy ache, have an ultrasound to confirm your gall stones and leave with your gall stones in a jar. And, of course, there would be no need for any follow up just to tell you that Lord Darzi has done a good job. This is brain stem thinking. A lot of people have tummy ache. A lot of people have gall stones. Quite a few people who have their gall stones removed still have the tummy ache. The gall stones, you see, were not the cause. It's just not that simple. But if you are a one stop surgeon you will never find that out.

Please, Lord Darzi, medicine is just not like this. Surely you know. Have your political masters bamboozled you with the results of their focus groups? If you ask people if they would like their gall stones done in a one stop shop instead of several visits, they will answer yes. But this does not mean they have thought it through. It doesn't make it sensible. Your job, Lord Darzi, is to put some sense into this madness. Please.


Jobbing Doctor said...

Dear Dr Grumble,

About half of my patients with gall stones don't want surgery at all!

I admire Lord Darzi as a surgeon. I despise him as a politician.

Do you think he'll listen?

Dr Grumble said...

Quite so JB. I nearly spelled this out but I thought I could make the points without. I also nearly mentioned that making a decision on any sort of surgery is something that you do not want to rush. It is not in any way appropriate to the one stop shop.

And you can always change your mind if you decide not to have anything done.

Lord Darzi will listen. He will listen to his political masters but not to us. This government is heading for the cliff like a bunch of lemmings. It baffles me why.

Yesterday I saw a patient, a nice elderly Armenian lady, who had consulted Lord Darzi. Out of curiosity I asked what he was like. I never heard the answer. She let forth an eloquent tirade against what he is doing as a politician. The whole ward heard and was nodding in agreement. I said nothing. It's not appropriate as Mr Nicholson (whom I have met and is a nice northerner) says:
But what this encounter on the ward shows is that the public are not in any way taken in by Lord Darzi and his blandishments.

As you may know, JB, I nearly completely stopped this blog because of the risks. But Mrs G thinks it's worth the potential problems. You see, the DoH does read blogs and I expect Lord Darzi does get some sort of summary of what we are trying to tell him. It won't make any difference though.

Some claim that Sir John Tooke has read this blog. There is some evidence that perhaps he did.

When I was much younger I made the mistake of thinking that those with the power knew what they were doing. It's taken me decades to realise that Dr G and thousands like him are right and those in power are just being driven by a blind dogma.

Anonymous said...


Here is an audio link to your post Dr G

Dr Grumble said...

Thanks, anonymous, for providing the evidence. Interestingly, it seems Lord Darzi diagnoses gall stones with an X-ray!