27 April 2011

22 April 2011

A reader writes

Dear Dr Grumble,

I’m writing to you to raise awareness of an issue that is affecting not only myself, but thousands of prospective medical students across the UK.

Currently, if you are a graduate you are not eligible to apply for a student loan to cover course fees for a degree in medicine (or any other degree). With the sudden increase in tuition fees, graduates are now paying £9000 for year-one of the four-year, graduate entry, medicine course, instead of £3600, (an increase of 150%) without access to a loan. There is also a massive chance that the NHS funding for years 2-4 and year 5 of the five-year undergraduate medicine course is either going to be removed or reduced.

Whilst I can see an argument for not funding course fees for graduates (as we’ve already done one degree), by not allowing us access to student loans, so we can borrow the money and pay it back once we graduate, the government are, in effect, blocking us from continuing our education and becoming doctors. If the government go along with this plan of action then graduate medical programmes may either close down all together, or (which is more probable), end up being for the rich only.

I am a 31 year old, arts graduate, who has worked in education for the past ten years. I would very much like the opportunity to study for a degree in medicine and believe that my life and work experiences will make me a good doctor. I have research skills, developed through previous study and work experience and I have got the relevant health care experience required for medical school entry.

If the NHS funding is removed, the price of a graduate medical degree will have gone from £3600, to £36,000, a 900% increase, in the space of one year. We won’t have access to a loan, from the Student Loans Company or from a bank, as all careers loans have been removed.

Graduates bring to the table both, professional and life experience, research skills, passion and most of all, a drive to succeed. We are more likely to finish the course and we have made an informed, adult decision, to return to education and pursue a career in medicine. To be penalised and blocked from returning to education is backwards thinking and in my opinion, discriminatory. We should have access to bursaries or at the least, a repayable loan.

I’m not looking for sympathy, because that won’t help me. I just want to raise the issue and most of all, I want to study medicine.

If you would like to read other graduates' thoughts on this matter, you can here. Thanks for your time.


Why no action Mr Cameron?

Thank God for the white coat

Sometimes Dr Grumble feels embarrassed when he sits in his clinic in shirt sleeves and a well-dressed patient comes in. Starched white coats are a thing of the past. The evidence is that patients do not worry too much about how their doctor is dressed but if a patient takes the trouble to look smart it can feel awkward. Infection control is not really an issue in the Grumble clinic but our managers don't think that way so, like our Prime Minister, Dr Grumble dresses down.

Yesterday an elderly man can into the clinic. Elderly people sometimes appear to dress up to see the doctor. This man, despite being retired, was dressed unusually smartly. His son who came with him was dressed more casually. Dr Grumble's heart sank a little when he saw the son. The patient had a foreign name. Sometimes younger relatives come to translate. It always takes longer and the history is never quite as good. The referral letter said very little about the patient. There was certainly no mention of a language problem.

As Dr Grumble began to take his history he recognised that there was something a bit special about his patient. His English was impeccable. A few clues suggested that he might be a doctor. He quickly flicked through the notes to check if somebody had had the courtesy to alert Grumble as to this educated man's profession but there was nothing. Grumble listened intently and tried to tease out the diagnosis with carefully directed questions. Then he came to the social bits. Where was the patient from? What had been his job? It turned out that he was a retired surgeon from Iraq - a professor no less. Dr Grumble asked him for his views on the war. You can guess the answer. And then a story unfolded. At the time of the war Grumble's patient was already retired. But surgeons never really retire. If there is a crisis you may have a duty to help and so it was with Grumble's patient. As the battle raged the hospital telephoned the retired surgeon asking urgently for his help. They couldn't cope with the number of wounded and they needed all the surgeons they could get. Patients were bleeding to death and they had little blood. Grumble's patient leapt in his car and headed for the hospital as quickly as he could. The streets were dangerous. There was fighting. But, as a doctor, you have a duty to help even if it means putting yourself at risk. And that's what Grumble's patient did. He raced through the streets eager to return to work and do what he could. He drove as fast as he could down the familiar route to the hospital going the way he had gone countless times before. Then, as he rounded a bend, all of a sudden his windscreen shattered and he was struck in the head by a bullet. Still conscious he grabbed his white coat from the back seat and wave it out of the window. Whether this was seen as surrender or a badge of office is unclear but the firing stopped. Grumble's patient had been shot at by the Americans. Blood was streaming down his face and he asked the soldiers for a medic to help him. But they took no notice and waved him on. Later he counted 16 bullet holes in his car.

You might think that in war soldiers would have a duty to help the wounded whichever side they are on. Apparently not. Not the Americans anyway. Doctors are different. Whatever you think of your patient you must help. Friend or enemy, it doesn't matter. You have a duty to your patients whoever they are and whatever their cause.

If, for example, you happen to be a doctor in Bahrain you have an inalienable duty to help the wounded whether they are protesters against the government or on the side of the government. Those are the rules that every doctor must follow. It is an essential fundamental rule. Doctors must be trusted by patients everywhere whoever they are and whatever their beliefs. So if a government takes the view that doctors are helping protesters by treating them and decides to lock up doctors, this is a particularly evil act. Which makes the government of Bahrain look pretty evil to Dr Grumble - especially if it is true that surgeons are being dragged out of operating theatres while treating protesters. So why does our shirt-sleeved prime minister not do something about it? Or would that mean yet another useless war? Or could it be that there is one rule for Libya and another for states close to Saudi Arabia?

Take action.

17 April 2011

The Plot Against the NHS

If you detected an element of despair in Dr Grumble's last post you would be right. Dr Grumble has just read The Plot Against the NHS. To be frank the picture on the cover says it all.

For years now poor old Grumble has been banging on about what he has seen being planned for the NHS. For years he has been incredulous at the disparity between the official position on the health service and what is clearly the intended direction of a multitude of policy documents that have emerged from our political masters. For years he has been wrestling to understand the real meanings of deliberately vague words such as contestability and plurality.

Grumble likes evidence. When data are massaged and the whole truth is kept secret, you do begin to wonder if perhaps you have misunderstood or are a victim of a pathological obsession. Can it really be that successive governments have deliberately kept their intentions for the health service a tight secret? Can it really be that the staff in the Department of Health no longer have the ethos of traditional British civil servants and do not ensure that the public know what is going on? Can it really be that we have a government that promises no top-down reorganisation of the NHS but is actually hell-bent on privatisation of our NHS?

If you want the answer to these questions and much more you need to buy this book. If you work for the NHS you need to buy this book. If you are an English NHS patient you must buy this book.

In case anybody's wondering, Dr Grumble bought this book with his own money. He has received no inducements. You can order it here. Grumble's copy arrived the very next day. Order it now. It's a good read.

16 April 2011

Before and after the NHS

It's strange how history repeats itself. Life is short. It takes time to learn. Teenagers always know better than their parents. Sometimes you have to allow your children to make mistakes for themselves. It happens to whole generations. New generations make the mistakes of the generations before. Wars fought years ago seem futile and meaningless while today's wars seem essential and unavoidable. The same mistakes are repeated. That's how the world is. It is only when you are as old as Dr Grumble that you realise that older people have the advantage of experience. By then it is too late.

Before the NHS there was a patchwork – a ragged sprawl of private, charity , voluntary and council-run hospitals. Doctors saw the creation of the NHS as a socialist conspiracy, a power grab. The doctors organised an offensive against the government.

The national health service changed the country. Patients no longer feared the humiliation of being unable to pay for treatment. According to Marr, no government of any stripe has dared try and take it away from us ever since. Unfortunately he is wrong. Recent governments have all been trying to take the NHS away from us but they have gone to great lengths to conceal their true intent. Not all of us are taken in by the party posters.

Doctors see the Lansley dissolution of the NHS as a neoliberal conspiracy, a power grab. Doctors will organise an offensive against the government. After the NHS we will be left with a patchwork - a ragged sprawl of private, charity, foundation and partnership-run hospitals.

Do you see how history repeats itself? We go on fighting wars that will be seen to be futile in the future and we go on destroying the things that matter most to us.

Man hands on misery to man.
It deepens like a coastal shelf.
Get out as early as you can,
And don't have any kids yourself.

13 April 2011

NHS listening exercise: how to get involved

Make your views on the Lansley reforms known here. Let's hope they really mean to listen. And are they asking the right questions?

12 April 2011

NHS Downfall

07 April 2011

02 April 2011