Cosmetic surgery under the NHS

Dr Grumble has rarely been to a doctor. He hasn't even met his GP though he did know the previous one who used to be his house physician. It's a very long time since Dr Grumble's blood pressure was measured. The last time was as part of the protocol for an experiment Dr Grumble was a volunteer for. Doctors are not very good at looking after themselves. But Dr Grumble has had cosmetic surgery. And it was carried out under the NHS. Dr Grumble is not really much of an advocate for cosmetic surgery. He thinks that the masked elderly American women look worse than if they had been allowed to grow old gracefully. But it's up to them. If they want to pay to have their skin stretched that's their affair.

There was never any question about whether or not Dr Grumble could have his cosmetic surgery done under the NHS. The top plastic surgeon in the Wales even offered to fix his stick out ears at the same time. But this was a long time ago when the NHS had only been going for about 7 years. What was the cosmetic problem? Dr Grumble had a mole the size of a man's thumbnail bang in the middle of his forehead. It looked peculiar. If he had lived in Tibet at the right time it would have been seen as a sign and he would surely by now be the Dalai Lama. But being in the UK at a time of the wonderful new NHS, the view was taken that the young Grumble should have the mole removed lest he was picked on when he went to school. And so the mole was duly removed. It was the worst experience of Dr Grumble's life - after deaths in the family. In those days, you see, children were kept locked in a strange ward and families were not allowed to visit because it 'upset the children'. It's very very frightening if you are just four. Especially when they drag you under force to remove your stitches. Dr Grumble still has flashbacks.

Lou and her breasts.

But when does cosmetic surgery become something that the NHS should take on. Who decides? Not doctors it seems. Take the case of Lou in the picture above. You could argue about the rights and wrongs of the state paying for her surgery to deal with the intertrigo and other problems related to her large appendages. But surely managers should not just have a blanket ban - easy though that is? The same applies to moles. Surely a child with a large mole right in the middle of his forehead still merits NHS treatment - or does he? But what about a child with a smaller mole on a cheek? Who decides?

Female circumcision

Dr Grumble came across female circumcision first in Ethiopia where he spent three months as a student. He comes across it still. Many of his patients come from Somalia. The idea of old witches carrying out this operation on poor young girls in a remote African village makes his blood turn cold.

Here's a picture of the equipment the old hags use.



Meet a girl who is about to be circumcised in the video below taken in the Omo valley in Ethiopia. (The video was too awful to watch and has now been removed.)



Doc Grumble was pleased, very pleased, to learn that Egypt has now banned the practice.

The cost of medical care for a hamster

How much should GPs get paid compared with, say, vets? They plainly get less - or so Dr Grumble thinks. Dr Grumble knows quite a few GPs and he has been in their homes. Mostly they are very modest. He knows where his vet lives (Mrs Grumble once had 22 pets to care for). He has not been in the vet's house. It's up a very long drive and there are big electric gates at the end. There's usually building work going on there - new swimming pools, that sort of thing. It's very grand.

Dr Grumble has only been to the vets' practice once. Mrs Grumble goes quite often. But once it was urgent so Dr Grumble had to go. As regular readers might know, Dr Grumble used to work for the military. Some years ago an ex-SAS man, hired to do some work in the former Yugoslavia, asked Dr Grumble to look after his dog while he was away. Now you might expect an SAS soldier to have a decent dog, something big, perhaps the sort of mutt a skinhead might have in tow. But no. This SAS man had a Norfolk terrier. And it had its own toothbrush!

A Norfolk terrier.

Needless to say the pooch duly arrived - along with a sponge bag and the toothbrush. Now there was no way Dr Grumble was going to clean its teeth - despite the canine halitosis. But, other than that, Dr Grumble felt that he had a duty of care to this apology of a dog. So when one day Dr Grumble noticed that the dog had rigors he thought he had better get the creature to the vet before it, well, died. Dr Grumble described the signs and thought that the vet would do the rest. He wasn't going to tell the vet that he thought the dog obviously had pus somewhere. But the vet, the one with the very big house, just reassured Dr Grumble. 'Little dogs do shiver a lot,' he said. A morning delayed to work and somebody else's sick dog on his hands - Dr Grumble was not happy. Needless to say the unfortunate dog had pus in its anal glands. Mrs Grumble took him back and found a vet that would listen. One quick squeeze and the pus was ejected. The mutt was then as right as rain. Next time Dr Grumble will do it himself.

A good squeeze puts them right.

Now what has all this got to do with how much GPs get paid? Well how much do you think your GP gets paid for looking after you compared with how much your vet gets paid for looking after your hamster? The answer is given by Dr Prit Buttar in today's Telegraph. Here's what he has to say:

Per patient, per year, I am paid approximately £50, regardless of how many times I see them. That's a year's unlimited cover. The cheapest policy I could find for pet insurance - for a hamster - was £65 a year, plus £50 excess. So your health care costs less than your pet rodent's. GPs are excellent value for money.

Mrs Grumble used to be a GP. The figure has gone up a lot since then. But it's still only a modest sum.

By the way the vets around here are doing so well they have bought a vineyard. You can read about this in Dr Grumble's first ever post [Well you can't any more. Several people identified Dr G from this naive start to the blog so it is now offline.]

Sex change surgery: do it yourself

April Ashley, something of a pioneer

There is an amazing ward in Dr Grumble’s hospital where the patients enter as men and go out as women. It’s not actually quite like that because the men enter disguised as women. Living as a woman is a prerequisite for male to female gender reassignment surgery. Dr Grumble sees quite a few of these patients. The surgery has been going on for such a long time that some of these patients are now elderly and the elderly often have the need to see Dr Grumble. Very occasionally he sees them shortly after their surgery.

Last week Dr Grumble was called to see a patient in the gender reassignment ward. ‘Gender reassignment’ always seems a strange term to Dr Grumble. ‘Sex change operation’ is probably what the tabloids call it but these days we are too prudish to use the word ‘sex’. So the patients have ‘gender reassignment surgery’. It sounds a bit as if Patricia Hewitt has deemed that you are of the wrong gender and it has been decided by the NHS to assign you to another one. But it’s not like that. Dr Grumble is no expert on gender reassignment but the concept does interest him. It’s not a prurient interest. It’s more an amazement that people have this problem and that any man might want to be turned into a female. If you are a male and comfortable with your role, the thought of being reassigned does rather makes the blood turn cold. Another thing that impresses Dr Grumble is the technical skills of the surgeons who achieve such good results. So Dr Grumble was interested when he had to see a patient on the sex change ward.

He was greeted on the ward by a tall young blonde doctor. She offered to present the patient to Dr Grumble. This is unusual these days. As the juniors’ hours have been slashed there’s less time available to them in the daylight hours to interact with senior staff who tend to be less nocturnal in their working habits. It’s nice not to have to wade through notes and just be quickly brought up to speed.

The story went something like this. A couple of days ago the patient had had his gender reassignment surgery. It’s easy to think of these patients as men and Dr Grumble made a mental note to be sure that he referred to him as ‘she’ and not ‘he’. It is an easy mistake to make but not one that would be well received by the patient. The ‘lady’ in question had coughed up some blood post operatively and ‘she’ had also passed some blood per rectum.

Dr Grumble went to see the young ‘lady’. He took a careful, though not full, history. There was no need. He had heard most of it from the helpful junior doctor. He then began his examination. He was stunned. The patient had well formed normal breasts. It is unprofessional to describe them as stunning but, given that this patient was a man not long before, Dr Grumble is happy to admit that he was, well, stunned.

Now, if you remember, there was a problem with bleeding from the tail end. This meant that to do the job properly Dr Grumble needed to examine the more private areas and he can only say that following the examination the surgeon concerned with the operation had shot up in Dr Grumble’s estimation. The results were truly remarkable. Without genetic testing Dr Grumble can honestly say that he could not have told this ‘lady’ from, well, a lady.

Having completed his examination Dr Grumble went to talk to the patient’s mother who was understandably concerned about the setback. It’s never a bad idea to build up your colleagues and Dr Grumble expressed his amazement at what surgeons can do nowadays and what remarkable results had been achieved. The mother seemed herself to be somewhat unimpressed. People just expect these things these days. Men into women – no problem. They just expect it - and on the NHS. But Dr Grumble still felt it was quite quite amazing. Then, over the mother’s shoulder, Dr Grumble caught sight of the attractive young blonde doctor. She was gesticulating. She was quite wildly gesticulating. There appeared to be some urgency about the gesticulation. Dr Grumble made an excuse to the mother and went over to the other end of the ward.

And then the bombshell. The patient had not had a sex change operation at all but something much more minor. No harm done. But Dr Grumble came very close to being embarrassed. Sometimes it's better to do it all yourself.

Hospital parking: doctors fined

You have to pay to park at Dr Grumble's hospital. If you don't you get clamped. Dr Grumble has been clamped. The receipt to have his car released is below. This sort of thing happens all the time but for some reason it has become newsworthy recently. Thirty-five pounds is not much given that some patients get charged £30 per day to park.

Some years ago a friend of Dr Grumble asked him if he might like to join him working for the largest pharmaceutical company in the world. He was invited to visit the headquarters and was liberally wined and dined. Dr Grumble, out of curiosity, asked how much his friend paid to park his car. Nothing at all was the answer. When Dr Grumble was a civil servant he too paid nothing at all. He even parked in Whitehall for nothing at all. And, quite often, he had a driver or a hire car. So it was not a great surprise to find that he wouldn't have had to pay had he chosen to work for the world's largest drug company. But what was even more amazing was that he wouldn't have had to pay for the car either. That would have been thrown in as part of the package. And not the sort of car that Dr Grumble drives but a very much better and newer model. Looked at against this background the NHS seems rather stingy. Dr Grumble is not complaining. He is quite sure that he is a lot happier in his present job than he would have been working for the pharmaceutical company but a free car with the job seems odd to Dr Grumble with his NHS pedigree. But it is, of course, commonplace.

A nice car with the job. Who knows what other fringe benefits there might have been?

Cancer patients having to pay to park causes particular concern and in some places Trusts, stung by criticism, have now made parking for cancer patients free. Dr Grumble wonders how they choose these deserving patients. Does a small rodent ulcer count? And if you have some other disease requiring frequent attendance with a prognosis worse than for some cancers, do you get any similar dispensation?

And is it really alright to make low paid hospital workers shell out for parking? It's not cheap. And if you are working odd hours alternative transport is not necessarily that easy. Dr Grumble pays £860 per annum to be assured of a parking space. That's very nearly as much as he pays to the Medical Defence Union lest he makes a costly mistake. And it's not tax deductable. Dr Grumble can afford it. But what about Dr Grumble's secretary? What percentage of her salary does this mop up? No wonder we have to get our letters typed in India.

RemedyUK White Coat March

There were about 12,000 on the White Coat March so Dr Grumble couldn't photograph them all. But here are some snaps.