tag:blogger.com,1999:blog-25200961.post2499022090681209455..comments2024-03-14T09:50:40.819+00:00Comments on Dr Grumble: Wants and needsDr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.comBlogger20125tag:blogger.com,1999:blog-25200961.post-50207135823447836832010-12-28T14:18:18.970+00:002010-12-28T14:18:18.970+00:00As a patient who has been proven correct in their ...As a patient who has been proven correct in their own diagnosis of their condition <i>twice</i> which conflicted with a doctors, who had to listen to approximately an hour of literal scorn and ridicule from the medical profession before being proven correct on these occasions: I'm startled to discover on this blog that there are doctors who <i>listen</i> to their patients.<br /><br />It makes me laugh when you see on the news that men should go to the doctor more and such, then immediately see in another news report a GP moaning about the "400 people they see who don't need treatment for the 1 who actually does".<br /><br />Not sure if this puts any of the 400 off going to see their doctor, but it puts me off, as does the constant bickering and moaning about patients wasting their time at A&E, even sitting there waiting for an operation or to have a cast put on broken bone it makes me feel like a little bit of scum that left my estate by mistake and accidentally dirtied your shoes.<br /><br />We can't be both ignorant, indigent little peasants, with no intelligence or insight into the bodies that we have inhabited for our complete existence that you do not have, yet simultaneously medically trained professionals who must diagnose ourselves as not needing a doctor when we don't, then when we do, come and see you [but don't you dare mention anything other than symptoms little peasant, self-diagnosis is blasphemy] so that the crude impulse of our grossly swollen limbic systems can be converted into human thought by your lofty lobes.<br /><br />Doctors are people I'd love to look up to, yet mostly they are people I look up at. Giving patients more choice might be a headache for some workers in the field, but shockingly you aren't always right and the patient isn't always wrong.<br /><br />Now M'Lords and Ladies, I must beg your leave. Forgive my disturbing you, for I am but a simple peasant. Perhaps one day there might be some joy to be found in withholding from us what you really think of us and we will return to looking up to you, not at you. Happy new year and thanks for saving lives! For all that is wrong with the health service, we do appreciate the work that you do.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-66262789658088871092010-12-23T18:51:47.082+00:002010-12-23T18:51:47.082+00:00Spot on Dr G as usual I'm a lowly commissioner...Spot on Dr G as usual I'm a lowly commissioner and when I say things like this at work I get looked at as though I am totally insane .Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-45530784128808875992010-12-21T21:52:47.340+00:002010-12-21T21:52:47.340+00:00I wish that I could find an optician with whom I a...I wish that I could find an optician with whom I am as comfortable as you are with your dentist.The last time that I visited our local branch of a well known chain (which I find is in fact a franchise), I got the impression that his advice was based more on the profit that he would make than my real needs and I won't be going back.<br />I was even less impressed when I got a reminder letter in which he signed himself (disguising the names)<br />"Mr Joe Bloggs,<br />Branch Manager, <br />Smith & Jones Ltd"<br />To me this seemed to emphasise his priorities, especially as the branch comprises only him and a receptionist. I was always taught that it was out of order to refer to yourself as "Mr", as that was the privilege of others. There was no indication of his professional qualifications in the letter, whereas I, in a totally non-medical field, would always state my professional qualifications in business matters and leave the letter heading to define my position.<br />How things change!English Pensionerhttps://www.blogger.com/profile/15271488641341955140noreply@blogger.comtag:blogger.com,1999:blog-25200961.post-88053955572909490552010-12-21T01:31:02.376+00:002010-12-21T01:31:02.376+00:00Let's face it: Most people spend way too much ...Let's face it: Most people spend way too much money on things they don't really need. The more money we make, the more we tend to spend.I really thank http://jewelsnistico.com help me with my Small Business.Small Businesshttp://jewelsnistico.comnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-24364695253798769692010-12-20T20:48:26.772+00:002010-12-20T20:48:26.772+00:00No, I'm not paid by the government but merely...No, I'm not paid by the government but merely a student in a health profession.<br /><br />When I speak of choice, I can only mean of the options that would be available for me to draw upon in my practice and those which are actually available to the patient.<br /><br />I can't offer that which isn't available: such is the imperfect world we live in.<br /><br />If I am able and may send them towards something better then of course I must.<br /><br />As for telling them by how much their choice is restricted I do not know. People are not all idiots and will have some inkling as to how health care is effected by the disease, disease severity, local policy and men in ivory towers.<br /><br />Finally, it has not been unheard of for clinicians, particularly those in primary care, to know who is good and who is not for any given service and refer accordingly. <br /><br />How much this is possible now, again, I do not know.Anna Spannanoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-66249182100774017022010-12-20T17:23:51.597+00:002010-12-20T17:23:51.597+00:00Oh, BTW Anna Spanna - let's say you know a col...Oh, BTW Anna Spanna - let's say you know a colleague is not performing as well as they used to, or that you are unlucky enough to be lumbered with a sociopath for a boss - do you factor those sort of variables into the consultation equation?the a&e charge nursenoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-12565347282955602672010-12-20T16:45:47.634+00:002010-12-20T16:45:47.634+00:00"We as clinicians should break down choices f..."We as clinicians should break down choices for them" - that sounds good, but as a matter of interest do you tell patients how far their 'choice' is constrained by financial realities, DoH policy, and so on?<br /><br />In effect 'choice' has never been just about the pros/cons of a particular procedure - there may be other options but options that not readily available in a given environment.<br /><br />Let's say you are out in the sticks and clinical standards in your given setting are rather ordinary - do you advise your patients to trundle 30 miles down the road to avail themselves of a specialty service that is known to offer more advanced treatments?<br /><br />In other words do you offer real choice, or choice as determined by the limited menu of options that exist in some parts of the NHS?the a&e charge nursenoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-63163424229729156942010-12-20T10:41:12.600+00:002010-12-20T10:41:12.600+00:00Loved the post Dr Grumble. How very true and as me...Loved the post Dr Grumble. How very true and as mentioned before how little understood by the Department of Health and PCTs. All the expensive walk in centres for people you feel a bit iffy in their lunch break!Surrey GPnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-77853096146133769682010-12-20T08:37:23.174+00:002010-12-20T08:37:23.174+00:00Gosh! Is Anna Spanna paid by the government. Dr Gr...Gosh! Is Anna Spanna paid by the government. Dr Grumble is flattered.Dr Grumblehttps://www.blogger.com/profile/04417731064007601504noreply@blogger.comtag:blogger.com,1999:blog-25200961.post-74815085417767974032010-12-20T07:21:35.755+00:002010-12-20T07:21:35.755+00:00Last comment, Before 1990 I (a GP) could refer my ...Last comment, Before 1990 I (a GP) could refer my patients to any consultant in the NHS. That's impossible now because of the internal market.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-3541281356436916602010-12-20T01:22:13.876+00:002010-12-20T01:22:13.876+00:00A betternhs,
Apologies. You're not what I tho...A betternhs,<br /><br />Apologies. You're not what I thought you were. I should check before I shoot..Julienoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-83545264758250040142010-12-20T01:19:10.338+00:002010-12-20T01:19:10.338+00:00Dr Aust,
It's my understanding that Europe to...Dr Aust,<br /><br />It's my understanding that Europe told Britain a couple of years ago that it could no longer use PFI and the like to keep the expenses off the national spend sheet. That's probably why it's starting to fall out of favour.<br /><br />Anna Spanna and abetternhs; I think you should take a wee look at this article.<br /><br />http://www.monbiot.com/archives/2010/12/13/reclaim-the-cyber-commons/Julienoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-76362659780244825592010-12-19T19:47:27.009+00:002010-12-19T19:47:27.009+00:00Patient choice links
1.http://abetternhs.wordpress...Patient choice links<br />1.http://abetternhs.wordpress.com/2009/08/21/the-problem-of-choice/<br />2.http://abetternhs.wordpress.com/2009/08/25/more-problems-with-patient-choice/<br />3.http://abetternhs.wordpress.com/2010/11/10/more-problems-with-patient-choice-2/<br />Lanchester's book is called "Whoops!" it fits very well in a stocking.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-4858050751892317312010-12-19T18:41:54.020+00:002010-12-19T18:41:54.020+00:00Thanks for this lovely clear as spring water examp...Thanks for this lovely clear as spring water example. I've been writing about patient choice for some time. There are 3 articles on my blog, The problem with patient choice, and More problems with patient choice<br /><br />I'm reading John Lanchester's book about banksters and the credit crunch. There's an interesting idea that economists are so wedded to their clever mathematical theories that they fail to take into account common-sense knowledge about human behaviour (i.e. we ain't rational) and so their theories failed spectacularly. Market advocates are victims of exactly the same folly. Could the close associations between politicians, bankers and economists have anything to do with the non-sensical assault on the NHS?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-32319804004742767152010-12-19T03:02:06.183+00:002010-12-19T03:02:06.183+00:00To the nursing student above.
Firstly, let me con...To the nursing student above.<br /><br />Firstly, let me congratulate you on your ramble which, whilst clearly impassioned, was a waffle-y less concise retelling of that which had been imparted upon us by Dr Grumble. It did not need repeating.<br /><br />Secondly, whilst for some patients being told what to do and which treatment to take is clearly the best way forward: it is by no means ever acceptable to implement this 'policy' across the board. What patients don't know can and will hurt them despite what you think.<br /><br />People have a right to make the choice that is best for them and we have no right to not offer them a choice. We as clinicians should break down choices for them, extoll the virtues of each and the opposite. We can even suggest to them what 'we' would do or what 'we' think if they were to ask us.<br /><br />We cannot just tell them you are having X,Y or Z for just because.<br /><br />If we did this we'd have to base treatment on our judgements of a person and our assumptions. This is a folly that will lead to a poor outcome for any of those involved.<br /><br />An example pour vous:<br /><br />69 year old lady with urinary incontinence, caused by a pelvic organ prolapse. Lady goes for surgery after trying all other available treatments.<br /><br />Surgeon makes an assumption;<br /><br />"This lady is 64, no chance she's having sex with anyone. I'll therefore do what I think is best and do a really tight Vaginal tape so that it will last".<br /><br />Patient ends up with vaginal stenosis, can now longer enjoy the copious amounts of sex she has and is in fact dealt a lot of pain in the trying.Anna Spannanoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-9804367153060334732010-12-19T00:34:07.833+00:002010-12-19T00:34:07.833+00:00Brilliant blog Dr Grumble. It is all too much abou...Brilliant blog Dr Grumble. It is all too much about choice and wants rather than fuffiling immedite needs. When I was in my second placement (outpatient department which was consultant-led) there was alot of that, and not alot of much else going on. Patients were torn between wondering what to do alot of the time when there were several different options (all of which had the exact same outcome: cure the patient) that patients do not know what was best for them and struggle to make the decision when esentially it is the doctors who know what is best. Some patients will just say "do whats right" and some patients will make decisions that aren't always in their interest, but it is what they "want" so it is what they get and they are given options that aren't always as beneficial to them as others. When NHS services are being throttled up and down the land perhaps it's in everyones interest that less "choice" should be given if patients needs can be met by simply letting doctors run the show. What patients don't know won't hurt them. <br /><br />I go to skin cancer clinics on a regular basis for check ups by a dermo consultant and nurse practitioner, whenever something arrises like a dodgy-looking mole I don't want to be given a choice, I just want it dealt with the best way possible and thankfully the doctor I have and NP know what to do. If something terrible was to ever occur (and it has in the past as I have had two melanoma-in-situ's excised and more dodgy-looking moles and marks than I can count) it would be an unbeliveable burden on me as a patient to make choices over the matter in such a manner that I would go home later feeling responsibile over the outcome. But it happens, patients are given too much choice and it is esentially their burden to bear.NHS Nursing Studenthttp://www.nhsnursingstudent.blogspot.comnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-48951826090914087952010-12-18T18:20:40.520+00:002010-12-18T18:20:40.520+00:00"What is the point of loans that so many will...<i>"What is the point of loans that so many will never be able to pay back? It's mad."</i><br /><br />My understanding is that, like the ridiculous PFI schemes that did so much to discredit New Labour, the answer lies in where the borrowing is counted for audit purposes.<br /><br />By not being DIRECT Govt borrowing (as it would be if the Govt were borrowing money to give to the Univs for teaching the students, as hitherto), but rather badged as a <i>"money with which we will make repayable loans"</i> (even if in reality they won't be repaid) the borrowing will miraculously become <i>"off balance sheet"</i>, as the accountants say. So it won't count as part of public sector borrowing, the kind Govts don't like when they have to do it to fund the NHS, fight idiotic wars and bale out pocket-stuffing bankers.<br /><br />Apparently this is A Good Thing.<br /><br />Or Not.Dr Austhttp://draust.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-19461676801304856022010-12-18T17:48:29.262+00:002010-12-18T17:48:29.262+00:00The other day Grumble was having his hair cut and ...The other day Grumble was having his hair cut and a journalist for the Independent came in and sat in the next chair. He and the barber moaned about the student loans. According to the journalist a large proportion of the students (I think he said half) will never earn enough money to pay back the loan. Your comment, Dr Aust, reminded me of this chance encounter and I see that there is indeed and article in the Independent which roughly tallies with what I recall. Apparently only a <a href="http://www.independent.co.uk/news/uk/politics/only-a-quarter-of-all-graduates-will-pay-off-loans-2158168.html" rel="nofollow">quarter of all graduates will pay off their loans</a>.<br /><br />What is the point of loans that so many will never be able to pay back? It's mad.Dr Grumblehttps://www.blogger.com/profile/04417731064007601504noreply@blogger.comtag:blogger.com,1999:blog-25200961.post-50005335463121336542010-12-18T17:21:34.318+00:002010-12-18T17:21:34.318+00:00And so, of course, the Browne Review of HE.
"...And so, of course, the Browne Review of HE.<br /><br />"Our recommendations in this area are based on giving students the ability to make an informed choice of where and what to study."<br /><br />"Choice is in the hands of the student."<br /><br />“Students are best placed to make the judgment about what they want to get from participating in higher education.”<br /><br />Er... not they're not. They would be in a position to make that judgement, IMHO, about 5-10 years after they've finished University and joined the workforceDr Austhttp://draust.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-30227637646865260812010-12-18T16:01:43.632+00:002010-12-18T16:01:43.632+00:00very very true and sadly completely unappreciated ...very very true and sadly completely unappreciated by those in favour of the magical mystery of the market!Garth Marenghihttps://www.blogger.com/profile/07373175498875348430noreply@blogger.com