28 March 2013

JG speaks up

Here is a comment written by an anonymous doctor in response to the GMC guidance on social media. I am grateful to Dr Anne-Marie Cunningham for drawing my attention to it. I have to say that I agree with everything this doctor, who calls himself JG, said:

There is no way I would ever write to the GMC about this but I'm happy enough (at the behest of Anne-Marie) to comment here - which, of course, shows the value of social media.
My first thought is that this advice comes much too late. A quick check shows I first blogged in 2006. That's when I needed this advice.

My second thought is that this advice doesn't really facilitate anything. I learnt the hard way that it was difficult to put clinical vignettes online without risking a breach of confidentiality. At first I started changing dates/times/sex and I kept myself anonymous but if the condition is rare that doesn't help much. As a result, I concluded that using a blog as a way of teaching on real clinical cases was unwise. Yet we have been publishing such cases for centuries. The GMC provides no solution – not with this guidance anway. My guess is that most patients would not mind and might even be pleased to have their case publicised but how do I get their permission reliably without falling foul of the regulator?

As for identifying oneself when acting in a professional capacity, I am not too comfortable with that. But what is meant by a “professional capacity”? Even if I did put my real name how would anybody know that I am really a doctor and really who I say I am? There are people on Twitter who claim to be well-known people who are imposters. None of this has been addressed. And what is a “professional capacity”. Is moaning about the GMC or Mr Lansley’s policies operating in a professional capacity or do they just mean things related to patient care? And if I used my real name wouldn’t that be inviting patients to contact me in my area of special expertise (which I hope I have kept largely under wraps)? That’s not something I want to do and, it would seem, nor should I.

The GMC tells us not to give medical advice so why do we need to identify ourselves? Requests for medical advice are, in any case, surprisingly rare. Patients as well as doctors seem to know where to draw the line. But only days ago somebody asked urgently whether an overdose of a particular drug was dangerous and whether he should take action. Thinking of the GMC advice that “you must not use social media to discuss an individual patient”, I held back. Fortunately others did not and promptly gave appropriate advice. I think if they hadn’t I would have done the same. It was the GMC that deterred me. As it happens the police were called and hopefully the patient was OK – though I don’t know.

What if somebody tweets: “I have severe crushing chest pain”? Do you tell them that you cannot discuss their problem and that they should call their doctor for advice? Or should you tell them to call an ambulance? Or do you pretend, as I did, that you hadn’t seen the tweet. These issues have always been around. I was taught as a medical student how to deal with requests for medical advice at a cocktail party. Twitter is not very different really. The advice I was given then holds good for Twitter now.

I don't welcome this advice at all because it won't be long before the GMC start prowling around the social media. Doctors won't be able to be people. They will have to be professionals. The only safe thing to do will be to stay away. Doctors will become social media lepers.


I think this JG chap makes some good points though not everybody agreed with him. You can read the views of others here.

03 March 2013

My political foray

It's gradually been dawning on me that we all need to seize control. I know some of you think I'm wasting my time and money supporting the National Health Action Party. But I don't think I am. I've never been a member of a political party before and, until Eastleigh, I had never been canvassing. It's never too late to learn.

And I have learnt a lot. The hostility shown on the doorstep was an eye-opener. The people of Eastleigh came over as utterly disenchanted with the political process. Who can blame them? I feel the same way. We are in the era of disenchantment. We don't feel we have any control. The politicians just plough on regardless. And their direction of travel is wrong.

The other thing that dismayed me was how the propaganda originating from our masters and spewed out by our complacent and compliant press is actually believed. The badmouthing of the NHS has been so widespread and sustained that the public now think that the good care they themselves may have received has been the exception rather than the rule. You can't overturn entrenched views. Evidence cuts no ice on the doorstep. Politics is about belief.

A comment on my previous post mocks the efforts of the NHA Party in Eastleigh. Mocking is easy. Doing nothing is easy. But trying to do something to improve matters is difficult - especially if you make no progress and are ridiculed.  But today I feel that there are signs that the tide is turning. I awoke this morning to news that the prime minister himself is claiming that his is the party of the NHS.  Later came a tweet from the Labour Chief Whip in the Lords telling me that "doctors have rumbled the Govts Trojan horse, sneaky regulations that marketise & privatise health care in the NHSby forcing CCT". I'm not sure which planet the Chief Whip's been on over the past year but it's better late than never.

So on a day when five Sunday papers have an NHS story on the front page, two about privatisation, I am heartened that the views of those with genuine concerns are at last being heard. I think the National Health Action Party is having an effect. Don't dismiss it. Maybe you should even consider given it your support.

25 February 2013

24 February 2013

The last nail in the NHS coffin

We all know that politicians lie but as I have followed the story of the unravelling of our NHS I find it quite difficult to grasp the depths of their dishonesty and duplicity. It's one thing to be economical with the truth but to deliberately mislead the public repeatedly is altogether more serious. If a doctor were to do this in the course of his work he would be struck off the register. Perhaps we deserve the honesty rating accorded to us in public polls. Certainly politicians deserve their ranking at the very bottom.

What's new, I hear you say. We all know politicians lie. We all know it's wrong. We all know this is the way of our world and we are stuck with it. Sadly you may well be right. But what is new is that in recent days yet another enormous political lie has come to light which spells the death knell of the NHS.

If this blog has had a purpose goading me to put pen to paper early on a Sunday morning, it has been to warn and warn again of the plans of successive governments to do away with the NHS as we know it. To begin with I was something of a loan voice. Colleagues I met in the hospital corridor looked at me as if I was deranged when I told them that I thought the NHS was being privatised. If they didn't know, what hope was there that the public would grasp what is happening?

By the time of the Health and Social Care Bill many of my colleagues had woken from their slumbers and were looking for reassurance that the NHS was safe from the fragmentation and privatisation that appeared might be the main intent of the bill. And they got it.

Here are some quotes:

Andrew Lansley MP: “There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector.”
Andrew Lansley MP, 12.02.12, letter to Clinical Commissioning Groups: “I know many of you have read that you will be forced to fragment services, or put them out to tender. This is absolutely not the case. It is a fundamental principle of the Bill that you as commissioners, not the Secretary of State and not regulators – should decide when and how competition should be used to serve your patients interests.

Simon Burns MP: “...it will be for commissioners to decide which services to tender...to avoid any doubt—it is not the Government’s intention that under clause 67 [now 75] that regulations would impose compulsory competitive tendering requirements on commissioners, or for Monitor to have powers to impose such requirements.”
Lord Howe: “Clinicians will be free to commission services in the way they consider best. We intend to make it clear that commissioners will have a full range of options and that they will be under no legal obligation to create new markets....”

 But, despite these reassurances, regulations just published break these promises. These new rules will force through privatisation whether or not the local population want it. Not only that, Monitor will have the power to force through privatisation.

But the purpose of this post is not to tell you what you already know: that politicians do not exactly tell the truth. It is to warn you, yet again, that your NHS is being sold off. It could just be that you think that's a good thing. But, even if you do, be very careful in what you wish for because, once the NHS is gone, we will never get it back.

Now you might think there is nothing you can do and all this is a fait accompli. Ordinarily you would be right as parliament does not usually even debate this sort of secondary legislation - which just shows that it was always the intent to slip this in under the public radar. But fortunately there a just a few worthy souls out there trying to do what they can to save our NHS and they have some ideas about what you can do here.


23 February 2013

The White Rose or Weiße Rose

I'm ashamed to say that I had never heard of the White Rose until the recent 70th anniversary. For those who may still not know, the White Rose was a non-violent resistance group in Nazi Germany. Four medical students, Hans Scholl, Christoph Probst, Alex Schmorell and Willi Graf formed its core. Scholl,  his sister Sophie and Probst were beheaded on 22nd February 1943. Graf and Schmorell suffered the same fate some months later. Their crime was to produce leaflets criticising the Nazis. You can listen to the story here.

My parents took the view that the Germans are easily led. I take the same view. But I differ in that I think we are all easily led. Humans are built to be led. It's what enables us to operate in societies instead of just squabbling with each other for scarce resources.

Since the time of Hitler, the way we are controlled has changed. We are told there's a democracy. And many of us may believe that. But the reality is that we have very limited choice at election time and the main political parties have a stranglehold on the process. In parliament your MP is told strictly how to vote. He's not his own man. Only rarely can a well-meaning independent reach the Commons.

But it's worse than this. The policies of the main parties are not really determined by the wishes of the electorate. We all know of the strong support for the NHS. But the Coalition has changed the basis of the NHS without any public support. And before them Labour was intent on heading the same way.

It might not be so bad if our masters were acting in our best interests but they are not. They are acting in the best interests of themselves and their paymasters.  At least when Hitler was in charge there was a visible unequivocal villain. Now the corridors of power are controlled by a more insidious evil of which few of us are much aware. That evil takes the form of the lobbying industry. Ironically this scandal-in-the-waiting was recognised by the prime minister himself. Judge for yourself whether he has met his promise to stop the lobbyists from influencing government policy.

The effects of the lobbying industry on our lives is all pervasive. Examples are legion. Here I mention only the NHS. I do not know of anybody who does not take the view that, in the NHS, we have had the most cost-effective healthcare system in the world. It may not be the best. But it has been the cheapest. Yet we are told we can no longer afford it. Labour, LibDem or Tory the message is the same. It's the same message because it originates from the same people: the lobbying industry.

The message that so many believe - that healthcare is unaffordable - has to be wrong. But few question it. You cannot, in a civilised society, just leave people to die. You have to look after them. There is no choice. That's why the British people love the NHS so much. There is something uniquely good about ensuring that all one's fellow beings get looked after. And, if you accept that people have to be looked after, it follows, if money is short, that you need to look after them as cheaply as possible. We are not talking about giving everybody everything they might wish for. But we are talking about giving everybody the key care that they really need.

So there is an unequivocal, but largely unvoiced, argument to keep the NHS as it is in order to keep the costs of healthcare down. What though have our governments been doing? They have been increasing the costs of healthcare by introducing markets into the NHS. They have, of course, duped people into thinking the NHS is inefficient - despite all the evidence to the contrary - and, on this basis, have been paying hospitals per item of service instead of en bloc. What's wrong with that, I hear you ask. The problem is that it encourages more work which costs more and not less work which costs less. You see, in health care, not all work that could be done needs to be done.

So how have we got here? We got here because of the lobbying industry. What interest do the lobbying industry have in a government service like the NHS? The answer is none while the NHS is a publicly-provided service. What the outsiders want is to profit from a slice of the money provided by the taxpayer and they want the service run down so that people have to buy health care themselves privately.  And that is why the NHS is being privatised and why we are losing hospital beds.

So where does all this fit in with the White Rose? The answer is that there are still malign influences around today and we, the British people, have been duped into being led in the wrong direction just as the people of Germany were. Worst of all, the British people have largely acquiesced in all of this. There is no excuse. We won't be executed for putting the case for the NHS to the people of Eastleigh. But I bet there won't be many people there tomorrow when I plan to lend a hand to the National Health Action Party. I hope I'm wrong.

18 February 2013

Dr Iain Maclennan National Health Action Pary

If you live in Eastleigh, please give this man your vote.

17 February 2013

NHA Party's Eastleigh Rally

Snaps from today's National Health Action Party Rally in Eastleigh.


I'm off to Eastleigh this morning. I don't really want to go. One of my kids is coming for lunch but I'm hoping that Eastleigh may be something of a turning point.

You see the politics of this country are truly rotten. We are, to be blunt, governed by a bunch of toffs. It just cannot be the case that the only people with sufficient talent to run the country are from the top echelons of society. I wouldn't actually mind if they had the interests of the people at heart but they don't. They are hell bent on furthering the interests of their toffy mates. Things are very little different from the days when only the landed gentry were sent to parliament.

The battle over the NHS is a microcosm if the divide between the toffs and the ordinary British mortals. The NHS is a key feature of Britishness. It is one of the things we most admire about ourselves. It's one of the only things we are prepared to brag about. Bragging is not something we British do. It's just not British - unless you're a British toff. But we feel comfortable in bragging about the NHS because it is not about being elite, it's not about high achievement, it's about fairness.

And now I pause because I realise I have been calling myself British. I do that because I think of myself as British and the NHS is British. The values of the NHS are recognised throughout our small island. Britain and the NHS are inseparable - or they should be. But my concern is focused on the fact that I am actually English and I live in England. Because it is in England that the toffs in Downing Street and the toffs that came before them are embarking on a major change to our NHS.

For those that have not been following what has been going on, you can be forgiven. People argue about when it started because there was no starting gun but in recent history all the main political parties have been following the same policy for the NHS. Without many of you noticing and deliberately operating under the radar, politicians have put the NHS into a cut-throat market. The true purpose of this is to privatise the provision of NHS care - though they never quite say so. Since they don't actually tell you that this is what they intend, they don't actually tell you the reason either. If pressed you will hear something about the NHS being inefficient and getting private companies to get rid of all those inefficiencies that blight our healthcare. The only problem with this is that it is just not true. The NHS is not inefficient. It has been without doubt the most cost-effective healthcare system in the world.

So what is the real reason they want to privatise the NHS? One reason is that we are run by toffs and toffs want to help other toffs. The private companies that will run the NHS ensure that this happens by nefarious schemes to influence the political class.

There are other reasons. They want to move the NHS away from tax funding to insurance funding. Instead of paying your taxes and relying on the NHS to be there when you need it, they will be requiring you to insure. Nobody has yet told you this. I cannot point to a document where you can find any evidence to support my view. But trust me that this is the only thing that makes sense of what they are doing.

Now I could go on but I need to get to Eastleigh. But let me say this: when the forests were threatened, people went into their woods, tied ribbons to the trees and the woodlands were saved. When local hospitals are threatened, people do the same. When the whole NHS is threatened, people don't seem to notice.

So please wake up out there. Realise what is happening and get on down to Eastleigh and persuade those people of middle England to turn the tide by voting for the National Health Action Party.

14 February 2013

A sad old dog

Mrs Grumble's dog is getting old. It's sad when your dog gets old. She has begun to get those sorts of terrible things old people get. One of the worst is wetting the carpet. She never used to do this. She's also been panting a lot. It's a different sort of panting from usual - almost a breathlessness. She climbed the stairs yesterday and was gasping at the top. Another curious thing is that she has been drinking a lot - vast quantities. Yes, Dr Grumble thought of diabetes. Mrs Grumble managed to catch some urine and there was no glucose. Even odder she has become ravenously hungry and has begun stealing food. She never used to do this. Not once. Now that is very odd. She's also had difficulty jumping into the car and like old people she has developed a bit of a pot belly. Old age is bad. And the dog is only 9. In her breed (she is a Newfoundland) old age comes on early. They rarely live to 13.

What you don't want to do when your dog gets decrepit is prolong the decline too much. It's really not fair on the dog. So Dr Grumble was a little concerned about where the inevitable trip to the vet (who does extremely well from the Grumble household) might lead. He was not looking forward to an incontinent, gasping dog on heart failure pills.

If you are a vet reading this you might by now have made a diagnosis. If you are a doctor you probably won't have. Certainly Dr Grumble hadn't. But then he's not a vet. And the disease Mrs Grumble's dog has is a rare one in humans but common in dogs. Mrs Grumble's dog has Cushing's Syndrome.

And Dr Grumble thought it was old age. But Dr Grumble is now becoming an expert on canine Cushing's and according to the textbooks 'the most common signs are very similar to those of the normal ageing process'. But Dr Grumble feels a bit bad because, looking back, Mrs Grumble's dog has obviously had this problem for at least a year or two - perhaps longer. This too is typical.

(This post was first published in 2007 and has been republished because I was thinking about our poor dog who eventually got weaker and weaker and died.)

10 February 2013

The National Health Action Party

OK, I'm back. The reason? It's because I want to give a plug to the National Health Action Party. If you've never heard of them, quite honestly I'm not surprised. They are new. They have been set up by a small clique of people concerned about the way things are going with our NHS. "Clique" sounds a bit pejorative. It's not meant to be. The people at the top are very committed and their concern is for our NHS.

Despite their youth and not really being ready for an election, the National Health Action Party were the first to announce their candidate for the Eastleigh by-election. Unsurprisingly, this failed to get a mention on the BBC. Even the redoubtable Jon Snow didn't seem to know. Which shows that modern journalists don't find things out any more, they wait to be told.

So I'm now telling you all direct: The National Health Action Party is up and running and has an excellent candidate for the Eastleigh by-election.  His name is Dr Iain Maclennan. It's remarkable that such a brilliant local candidate has been found so quickly. Dr Maclennan lives in the borough in Bursledon. He was a GP for some years and more recently a consultant in public health with the local Hampshire Primary Care Trust. For ten years he was a medical officer in the Royal Navy.

In brief the National Health Action Party could not have found a better candidate. If you live in Eastleigh he deserves your support. If you don't live in Eastleigh the National Health Action Party deserves your support. If you are a journalist, we need your support.  Please at least give Dr Maclennan a mention - even though I've been a bit rude about journalists!