Those doctors that grew up
here may not know but those of us from overseas looked forward to coming for
our specialist training in this country. A number of us went to the US Hong
Kong or the rest of the commonwealth.
Why?
We provide World Class Medicine without
trying. A quote from a fellow blogger, Dr. No.
What many politicians may not know is that pride in what we do is often more important than money or anything else. Our pride is one sure way to ensure quality of practice.
Do we really want to take that away now? Years of heartless
re-organisation has left many of us dedicated doctors disillusioned. Many
young ones have left. Poorly trained doctors that have no right to be
practising medicine now even have jobs in some of these well known
hospitals.
Can we continue to practise World Class Medicine even if we
wanted to?
Here is a reprint:
Tuesday, May 24, 2011
NHS 1978: Hope, Faith & Supermarket
It is well known that we as doctors do
not have all the answers and we can only base our diagnosis and treatment on current
knowledge.
Patients or their relatives are used to trust
the judgement of doctors and always hope for a better or even miraculous
outcome. Their faith in their doctor is often supplemented by their own
religious faith.
David Cameron is no different and he has
stated so on record.
I am not here to analyse his faith.
I am here to re-tell one of the stories of
hope and faith I have experienced as a very junior consultant in 1978
The Mayo of the
The year was 1978 and I was employed by one of the fourteen Regional Health Authorities. The perceived wisdom was to allow consultants freedom from Area and District control that may not be of benefit to the NHS as a whole so the local Area or District Health did not hold our contracts. Even for matters like Annual Leave and Study Leave we dealt directly with RHA.
Referrals were accepted from GPs and we could
refer to other specialists within the Region or to the any of the major London
Centres of excellence. Many of us were trained by some of these centres and we
respected them. They were the Mayos and Clevelands and Hopkins of the United
Kingdom
Money or funding never came into it and we
truly had a most integrated service.
We used to practice real, good and economical medicine.
We used to practice real, good and economical medicine.
The unusual cases:
Child Psychiatry like many other disciplines
in medicine does not follow rules and do not function like supermarkets.
Supermarkets have very advanced systems to track customer demands and they can
maximise profit and keep cost down. In medicine we do sometimes get unusual
cases that would have been a nightmare for the supermarket trained managers.
As it is so difficult to plan for the unusual
it will become even more difficult if the present government had its way (and
there is every sign that they will), not only will the reformed NHS find it
difficult to cope with the unusual, it will find it extremely difficult to cope
with emergencies.
Supermarket:
Why? These cases cost money and in the new
world of Supermarket Styled NHS, they have to be dealt with! For that reason,
not all NHS hospitals will be failed by Monitor. Some will need to be kept in order
that someone could then deal with unprofitable cases. They will be the
new fall guys.
But supermarkets can get things wrong too. In Spain
©Am Ang Zhang 2010
Back to the patient:
Would my patient be dealt with in the same way
in 2011?
GP
to Paediatrician: 13 year old with one stiff arm. Seen the same day.
Paediatrician to me: ? Psychosis or even Catatonia.
Seen same day and admitted to Paediatric Ward, DGH.
Child Psychiatrist to Gynaecologist: ? Pregnancy or tumour. Still the same day.
Gynaecologist to Radiologist: Unlikely to be pregnant, ? Ovarian cyst.
Radiologist (Hospital & no India
Gynaecologist: Operation on emergency basis with Paediatric Anaethetics
Consultant. Still Day 1.
Patient unconscious and transferred to GOS on same day. Seen by various
Professors.
Patient later transferred to Queen’s Square (National Hospital
Seen by more Professors.
Regained consciousness after 23 days.
Eventually transferred back to local Hospital.
None of the Doctor to Doctor decisions need to
be referred to managers.
We did not have Admission Avoidance then.
How is the new Consortia going to work out the
funding and how are the three Foundation Trust Hospitals going to work out the
costs.
The danger is that the patient may not even
get to see the first Specialist: Paediatrician not to say the second one: me.
Not to mention the operation etc. and the
transfer to the Centres of excellence.
Here is an extract from my book The Cockroach Catcher: Chapter 29 The Power of Prayers
…………Something else was going on here, and I was not happy because I did
not know what it was. I was supposed to know and I generally did. After all I
was the consultant now.
Thank
goodness she could breathe without assistance. That was the first thing I
noticed. I saw mother in the corner obviously in tears. She asked if her
daughter would be all right. I cannot remember what I said but knowing myself I
could not have said anything too discouraging. But then I knew I was in tricky
territory and it was unlikely to be the territory of a child psychiatrist.
A
good doctor is one who is not afraid to ask for help but he must also know
where to ask.
“Get
me Great
Ormond Street
“I
already did.”
She
is going to be a good doctor.
“Well,
the Regional unit said that they had no beds so I thought I should ring up my
classmate at GOS and she talked to her SR who said “send her in”.”
Who
needs consultants when juniors have that kind of network? This girl
will do well.
“Everything
has been set up. The ambulance will be here in about half an hour and if it is
all right I would like to go with her.”
“Yes,
you do and thanks a lot.”
I
told mother that we were transferring her daughter to the best children’s
hospital in England
“........Ten years later mother came to see my
secretary and left a photo. It was a photo of her daughter and her new baby.
She had been working at the local bank since she left school, met a very nice
man and now she had a baby. Mother thought I might remember them and perhaps I
would be pleased with the outcome.
"I was very pleased for them too but I
would hate for anyone to put faith or god to such a test too often."
David Cameron, if it was your
plan not to have an integrated service, then there is not much we ordinary
people could do except pray. If it was not your intention, then could you let
us have an integrated service! That way you would not need many accountants and
you will save money in doing so.
Just like Mayo Clinic:
“…….Mayo offers proof that when a like-minded group of doctors practice medicine to the very best of their ability—without worrying about the revenues they are bringing in for the hospital, the fees they are accumulating for themselves, or even whether the patient can pay—patients satisfaction is higher, physicians are happier, and the medical bills are lower.”
But it is probably too late:
Pulse: GP consortium chairs
are overwhelmingly opposed to any requirement to include hospital consultants on
their boards, viewing it as a serious conflict of interest that would undermine
the commissioning process, finds a Pulse survey.
King’s Fund: Million £ GP.
See also:
Comments:
Dr No said...
Excellent post - and yes, that is exactly how it used to be. World
class medicine without even trying - we just did it, because that is what we
did, just as the dolphin swims, and the eagle soars. A key, even vital feature
was that the doctors looking after their patients did not need to worry about
money or managers. They just got on with it. There was no market to get in the
way of truly integrated care. Some may point out that 13 year olds with
teratomas are rare, and that is true, but what this case shows us, precisely
because of its complexity, is just how capable the system was. And most of the
time (of course not always), it dealt just as capably with more routine cases.
"How is (sic) the new Consortia going to work out the funding and how are
the three Foundation Trust Hospitals going to work out the costs."
Exactly. And then: who is going to pay for the staff and their time to work out
out all those costs and conduct the transactions?
Panic Attacks said...
Hope and faith will keep the patient alive. Patients do worry
about the money and how they can continue paying for their bills. What Dr. No
said is fantastic, "World class medicine without even trying - we just did
it, because that is what we did, just as the dolphin swims, and the eagle
soars."
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