Dr Grumble can remember when doctors (but not managers) had a real concern about MRSA. He can remember having his orifices swabbed to make sure he was not a carrier. Microbiologists of that era felt that MRSA was something that we could and should control. Dr Grumble can remember how seriously the problem was taken. There was concern in the lab and concern on the wards.
Swabbing of the Grumble orifices has not happened for decades. In fact it didn't happen for long because doctors found to be carriers were not allowed to work and pretty soon so many were sent off work that the managers felt that we were making too much fuss. At that time Dr G used to work up to 168 hours a week so losing a doctor was equivalent to losing 4 staff working normal hours.
Dr Grumble, as some will know, left clinical work for 6 years. Over twelve years ago he returned to do a locum in a deprived district general hospital. When you leave and return changes hit you. And he can remember noticing, not without some horror, that the authorities had in the intervening 6 years given up the battle against MRSA. Patients with MRSA were being nursed in open wards and lip service only was being paid to barrier nursing. The hospital was a mad frenzy of busyness. MRSA was low on the list of priorities. There were not the resources to do things properly. Given the lack of resources the loss of control of MRSA was not really the fault of those at the coalface. They had not been given the tools they needed to tackle the problem.
Could things have been any different? The answer is yes.
United Kingdom 44.5%Quite a difference. Now why should that be?
Dr Grumble once tried to transfer a Dutch patient to a hospital in the Netherlands. When he tried to negotiate this he could detect the shock at the other end of the telephone when the Dutch staff realised they might have to take an inpatient from the UK. They would not even begin to consider this until he had been screened for MRSA - which is not part of our routine. In the Netherlands and parts of Scandinavia in most hospitals they have an aggressive MRSA search and destroy policy. They even screen exposed healthcare workers. It can be done. It works. It should have been done in the UK. Dr Grumble can remember those that understand these things shouting their concern from the roof tops. Nobody took any notice. And, unsurprisingly, these same people then seemed to just give up. You do. You get worn down if the management ignores you. And when the cat is out of the bag is there any point any more? It's odd that the management are now running around like beheaded chickens telling us off about this problem.
Can the management be blamed? After all, controlling MRSA would be costly. Of course they can and should be blamed because almost every analysis that has ever been done has shown that it is cheaper to control MRSA than to let it run wild. The cost of caring for patients infected with MRSA is so great that it makes screening look cheap.
Doctors are not much to blame for this. Those that knew lobbied hard. But loan voices can do nothing. The fault was with managers, managers who failed to heed the warnings of doctors, experts who knew what they were talking about. And now these same people are blaming the doctors for this. It makes Dr Grumble angry, very angry indeed. The ignorance of these people about the history of all this is breathtaking.
By the way there are more practising doctors in the Netherlands than in the UK - 57% more (2004 figures). Do you think that might help? Not from the viewpoint of managers. After all it's doctors that are to blame.
This post was first published on 3rd November 2007. It attracted some interest from Chris Vallance at the BBC who asked Dr Grumble if he would be interviewed on the radio. Dr Grumble declined. Others then expressed doubts about the truth of Dr Grumble's story. Anybody in medicine who is as old as Dr Grumble will know that the story is essentially an accurate account of how the battle against MRSA was lost in the UK a very long time ago. At that time no member of the public had ever heard of MRSA. Nor, probably, had any NHS managers. They weren't interested. They weren't listening to the concerns of doctors. By the time they were forced to listen it was too late.
Dr Grumble's story has to be true. Otherwise how can anybody account for the different prevalence of MRSA in the cleaner countries of Europe?