Happy New Year
The video is for Dr Aust who will understand its relevance. The rest of you will probably be baffled.
We may have the same procedure next year.
The video is for Dr Aust who will understand its relevance. The rest of you will probably be baffled.
Posted by Dr Grumble 9 comments
Posted by Dr Grumble 8 comments
It was about a week ago when friends came round to pick up their dog. Mrs Grumble looks after Fido while they are on their yacht. Not many of Dr Grumble's friends have yachts but these friends do. Miriam is a housewife and Timothy works for a large accountancy firm. You would all have heard of this firm. It's big. It's global and from time to time it is called in by the NHS for audits or to tell us we are inefficient and need to sack staff. That's how they make their money. That's why Timothy has a yacht.
But this is not about jealousy. The weather is too cold for yachting. Dr Grumble would prefer to walk the dog in the snow than be out on the sea. Besides Mrs Grumble gets seasick. This is about something seasonal which irritates Dr Grumble year after year after year.
About a month ago Edward Grumble, who is an F1 doctor, phoned up and in a bewildered voice explained to Dr Grumble that he would have to work over Christmas. Not just a bit of Christmas but all of it. It seems that even Edward Grumble, Dr Edward Grumble, thinks the patients go home for Christmas. This expectation of having Christmas Day off is a new thing. Dr Grumble's own staff seem perplexed that they might have to work on Christmas Day. When Grumble was a house physician he knew he might well have to work at Christmas because we all worked virtually all the time. That may sound bad but things are much worse now. You see in Grumble's time there was a doctors' mess where they really looked after you. On Christmas Day you would get a turkey. An enormous whole roasted turkey to carve. And before your Christmas lunch you would be on the ward with more proper turkeys that the consultant surgeons wearing chef's hats would expertly carve for their patients. Christmas in the hospital was fun. The consultants came in laden with presents. Sherry was drunk on the ward. Nobody minded if you had a tiny glass. There was a wonderful camaraderie.
Fun has long gone from the average NHS hospital over Christmas. Things have changed. Thanks to Timothy's company we now run lean wards. Lean is, of course, a euphemism for thin. Skeletal would be more accurate. The juniors can't stop for a moment any more. Skeleton staffing means they have too much work. Traditional firm structures have been destroyed. There is just no time for fun. Especially not at Christmas. There's no way you will get a turkey to carve. You will be lucky if the food vending machines are filled. Where Edward Grumble works in a large university hospital it must be the same. When Mrs Grumble telephoned him yesterday she asked what he was doing. He was in Marks and Spencer buying a Christmas dinner ready meal for one. How sad is that?
Anyway Timothy and Miriam came back from their day's yachting last week and said they were thinking of throwing a party on 29th December and they might not hold the party unless the Grumbles could come. Now that's a wonderful compliment but it started making Dr Grumble's hackles rise because it was clear that Timothy's company had given him the whole week off. Dr Grumble immediately apologised and explained that he had a ward round followed by a clinic. He would not be back in time for the drinks. The 29th is a normal working day in the NHS; getting to a party is just not on. A look of utter bewilderment went over Miriam's face. It was as if she had never heard of a ward round. She almost seemed suspicious that this was a quickly thought up excuse. Nobody could possibly have work to do between Christmas and the New Year. Mrs Grumble gently explained that she too was working. Like Dr Grumble she has targets to meet. In her case the target is two weeks which is tight. You can't have a week off over Christmas and meet your targets.
Who are these people who tell us that government services are inefficient and their employees mollycoddled? Try telling that to my neighbour whose daughter will be fighting in Afghanistan over Christmas. Compared with some, Dr Grumble and his family are lucky. Very lucky.
Posted by Dr Grumble 24 comments
Here is what one such clinician, an acute admitting physician, told the Joint Committee on the Draft Mental Incapacity Act.
What is the doctor to do if the patient is not incapacitated but merely distressed because of life circumstances? They may have discussed it with friends and relatives, may have written down their request in the form of a suicide note and gone on to take the overdose. We know that the majority of such patients, 19 out of 20, live but regret having taken the overdose. Any clinician will tell you, any psychiatrist will tell you that this business of taking overdoses is part of the very natural history of how distressed and depressed individuals behave. They want out. They want to get out of the situation into a different environment and there are all sorts of feelings of guilt and concern about it. I know from my clinical experience that the next day many of these patients are glad to be alive. It would be a tragedy if suicide notes were deemed valid advance directives. Why do we treat them? For the reasons I have stated. We know that their views are not fixed. Indeed this is part and parcel of the way that distressed individuals behave. They want help, they want a different environment and they want to be surrounded by people who can help them. We know that but at the time that they take the overdose on the Friday or Saturday night their intention may very well have been to kill themselves and they may have thought about that for two or three weeks or even months. I think there are dangers in having advance directives which will freeze in time individuals' so-called wishes when we know in practice that they change over time.
Posted by Dr Grumble 60 comments
There you have it. If you live in Westminster you live 7 years longer than if you live in Canning Town. Clearly healthcare in Westminster is better than that in Canning Town. Whose fault is this? As Lord Darzi realised it has to be the fault of GPs. What else could possibly cause such a difference in life expectancy? In Scotland the differences are even worse.
Posted by Dr Grumble 1 comments