Friday, December 23, 2011

NHS Reform & Hospital Consultants: Private! Private! Private!

There is a good deal of time and effort wasted in discussing GP commissioning and some lip service paid to integrating Primary and Secondary Care.

Yet, those in power had little regard for Parliamentary democracy and all the signs are that Privateers are waiting in the wings like the Barracuda for its yummy meal.

Great Barracuda waiting / ©2009 Am Ang Zhang

Is it really that difficult to grasp! I wrote a little while back:

Most people in well paid jobs (including those at the GMC) have health insurance. GPs have traditionally been gatekeepers and asked for specialist help when needed. If we are honest about private insurance it is not about Primary Care, that most of us have quick access to; it is about Specialist Care, from IVF to Caesarian Section ( and there are no Nurse Specialists doing that yet), from Appendectomy to Colonic Cancer treatment (and Bare Foot doctors in the Mao era cannot do the latter either), from keyhole knee work for Cricketers to full hip-replacements, from Stents to Heart Transplants, from Anorexia Nervosa to Schizophrenia, from Trigeminal Neuralgia to Multifocal Glioma, from prostate cancer to kidney transplant and I could go on and on. China realised in 1986 you need well trained Specialists to do those. We do not seem to learn from the mistakes of others.

When there are not enough specialists to go round in any country money is used to ration care.

There is unfortunately little realisation that soon, a large number of consultants would no longer be working in NHS Hospitals. 

Stent, Hips and others

They will be working for Private Hospitals that initially will be offering services to NHS patients. But because of shortage of the said consultants, those that are concerned that at 78% obstruction, their heart and life may not last the wait and they will pay for the job. 

My friend just did in some other country: a bargain at US$ 50,000.

What about your painful hips, the Consortia decided to impose a wait time to limit cost. So you too paid for it. That is what my golfing friend did in Flroida for a bargain US$90,000 as he paid a co-pay of 25%.

So there are not enough Consultants and shortage creates demand and you can name your price. Consultants do not really want to waste time in consortia arguing about the price of Stents or Hips. 

Private patients will now have priority and NHS patients will fill in the slack. Very clever indeed. 
Reform will not save any money but it will make a few City people very rich, very rich indeed.

Some very clever people indeed are working for the government.  Some will be elevated to the upper House soon. 

Is it Conspiracy or Cockup? You decide.

Monday, December 19, 2011

Portrait Photography: Wistfulness

©1988 Am Ang Zhang

Hasselblad 500CM 150/F4

Ilford Pan F/Rodinal

Paper: Record Rapid Selenium Toned.

Sunday, December 18, 2011

MRSA & E Coli: British Milk & Antibiotics

Remember the Plague? Was it bad air? Witches? Jews?

Or is there a simpler explanation.
The Independent:
Friday, 3 June 2011
A new strain of MRSA has been discovered in British milk, scientists report today.
The superbug, resistant to antibiotics, has been isolated from samples of milk taken from farms around the country and has also infected humans. It is the first time MRSA has been found in farm animals in the UK.
…… The discovery is the result of a chance finding by researchers at the University of Cambridge, who were investigating mastitis in cows, an infection of the udder. Their results, published in The Lancet Infectious Diseases, show cases of the new strain are increasing but account for less than 1 per cent of all human MRSA detections. Less than 3 per cent of dairy herds are thought to be affected.
Mark Holmes of the Department of Veterinary Medicine at the University of Cambridge, who led the study, said: "It is still not known for certain if cows are infecting people, or people are infecting cows. This is one of the things we will be looking into next."
Asked if the routine use of antibiotics in livestock farming was a factor in the emergence of the new MRSA strain, he said it was a "credible hypothesis".
"Farmers are under tremendous financial pressure from the super- markets. It does mean they are the most efficient milk producers but that means they have more mastitis and use more.”
E. Coli continue to dominate health news across the globe:

Chicken and other animals can grow up to twice as fast as 30 years ago when antibiotics were not in the feeds. Scary!

The use of antibiotics in farm animals is widespread and is not restricted to the treatment of infections but for the enhancement of weight gain. In business terms it is the conversion ratio of feed to weight that matters. The Obama government may well be taking steps to control it due to the rising incidents of Hospital Infections. (See 
MRSA & Antibiotics: Obama & Farmers.) 

Hospital Infection: Quorum Sensing

Old & Young: E. Coli O157

Thursday, December 15, 2011

French President, French Justice & French Health Care!

The French President is spared jail by the French Justice system:

The former president's doctors said he has irreversible neurological problems which cause memory lapses & is spared jail.


Jacques Chirac may have hoped to be remembered as the dapper president and diplomatic heavyweight who retired from the world stage to become the unofficial grandfather of his nation. A man of "flesh and blood and principles … employed in the service of his country," as he put it.

Instead, his place in French history has been seriously tarnished after a Paris court convicted him of embezzling public funds and gave him a two-year suspended prison sentence on corruption charges.

Chirac, 79, who led France between 1995 and 2007, was not in court to hear the ruling. He had been given a special dispensation to be spared appearing at the trial in September and the reading of the verdict on Thursday after a medical report found he had "irreversible" neurological problems that had caused "an important loss of memory".

Anh-Dao Traxel, Jacque Chirac's daughter, speaks outside the court 
after he was given a two-year suspended sentence. 
Photograph: Bertrand Guay/AFP/Getty Images

Speaking outside the courtroom, Chirac's adopted Vietnamese-born daughter, Anh Dao Traxel, fought back tears as she said: "The justice system has been very severe, but this is a fair and independent justice system. For the family, it's a great pain we have to accept."

His other daughter did not do too well under French Health Care system:
In Ahead of the Curves, the author told of the story he heard of Jacques Chirac and his pact with West African marabouts, witch doctors. He was told to sacrifice one of his daughters if he wanted his presidency. Soon after his younger daughter, began suffering from anorexia nervosa.

So, I Googled Chirac’s daughter:

Telegraph: By Colin Randall
Published: 07 Dec 2004
President Jacques Chirac's wife has broken a 30-year silence to talk publicly about the anorexia that drove their elder daughter to try repeatedly to kill herself.

"A mother who fails with a child, who cannot bring a sick child back to health, always feels guilty," Bernadette Chirac said on French television. "And a father, too."

Laurence Chirac, now 46, was a promising medical student and worked for a short time after her studies with Samu, the emergency medical service, in Paris.

But she had suffered from an acute form of the eating disorder since she was 15, leading to several stays in hospitals and clinics.

Sixteen years ago, during her father's second presidential campaign, she was taken to hospital amid widespread rumours that she had died.

"Being famous can be harmful when one is faced with illness," Mrs Chirac said. "Confronting this kind of difficulty, you just want to hide from the gaze of others."

Laurence, whose younger sister Claude is a key member of the president's team at the Elysée, continued to suffer from the condition. In 1990 she tried to commit suicide by jumping out of the window of her fourth-floor flat.

A nurse assigned to her round-the-clock care was unable to stop Miss Chirac, who survived with a broken pelvis and head injuries.

Little has been heard of her since and Mrs Chirac said merely that she always kept the hope "pinned to my heart" that her daughter would recover.

Mrs Chirac has been the president since 1994 of a charity seeking to create better conditions for children and teenagers in hospital, enabling them to listen to or play music and play sports. She agreed to talk about her daughter on a France 3 discussion programme, “You Cannot Please Everyone”, to help publicise a new clinic for adolescents, La Maison de Solenn, funded by her charity.

"These children need some gaiety in their lives, to be able to see the sun," said Mrs Chirac,

She contrasted this ideal with the conditions in which her daughter was sometimes treated, "enclosed behind brick walls in a bedroom with a small window". She added: "That is why this mother wants to create a facility specific to adolescents' needs.

French Health Care as experienced by the President’s daughter.
We did not do too badly with our own Adolescent Psychiatric Units.


Wednesday, December 14, 2011

Democracy: Lessons from the Commonwealth

There is much the Con-Dem government can learn form the Commonwealth. Yes, lessons in Democracy.

CBC News, Canada:
December 4, 2008 

Decision gives Tories reprieve, thwarts imminent attempt to topple government.


Gov. Gen. Michaëlle Jean has granted a request from Prime Minister Stephen Harper to suspend Parliament until late next month, a move that avoids a confidence vote set for Monday that could have toppled his minority government.



Ottawa From Thursday's Globe and Mail
Dec. 30, 2009

Prime Minister Stephen Harper has shut down Parliament for two months, killing a pesky inquiry into Afghan detainees, stalling government bills and allowing the Conservatives to take control of the Senate.

Mr. Harper called Governor-General Michaëlle Jean yesterday morning to ask her to give a Speech from the Throne on March 3 – delaying Parliament's return by 22 sitting days – and allowing the government to table a budget on March 4.

CANADIAN ministers, it seems, are a bunch of Gerald Fords. Like the American president, who could not walk and chew gum at the same time, they cannot, apparently, cope with Parliament’s deliberations while dealing with the country’s economic troubles and the challenge of hosting the Winter Olympic games.

Mr Harper is a competent tactician with a ruthless streak. He bars most ministers from talking to the media; he has axed some independent watchdogs; he has binned campaign promises to make government more open and accountable. Now he is subjecting Parliament to prime-ministerial whim. He may be right that most Canadians care more about the luge than the legislature, but that is surely true only while their decent system of government is in good hands. They may soon conclude that it isn’t.


The Independent:

Friday, 25 March 2011
The Labor government of Australia's largest and most populous state is facing an epic defeat after 16 years in power, following a string of scandals possibly unrivalled in the Western world.
Corruption, pornography, drugs, gay sex romps, marital infidelity – the government of New South Wales (NSW) has had them all, and more, in the past two years alone. Now long-suffering voters are determined to wreak revenge, and not even a photogenic premier related to a Booker prize-winning author will be enough to save Labor from its worst post-war electoral drubbing.
No matter: voters would rather elect a stuffed monkey than endure another five years of Labor sleaze and incompetence.
 She shut down Parliament two months early so that the upper house could not investigate her government on the matter of the Government's power sell-off.
The dark side of the gods: (it is sometimes easier if one take GODS in the Ring to mean those in POWER. For the characters read here.) In fact, the gods need not work at all, the Nibelungs work almost all the time.

Born liars
Thieving & Misappropriation 
Incest and other illicit sex
Greed, greed, greed!

Monday, December 12, 2011

OCD: Life & Art

From a doctor friend:

The Cockroach Catcher has evoked many images, memories, emotions from my own family circumstances and clinical experience.

My 80 year old Mum has a long-standing habit of collecting old newspaper and gossip magazines. Stacks of paper garbage filled every room of her apartment, which became a fire hazard. My siblings tricked her into a prolonged holiday, emptied the flat and refurbished the whole place ten years ago. ……My eldest son was very pretty as a child and experienced severe OCD symptoms, necessitating consultations with a psychiatrist at an age of 7 years. The doctor shocked us by advising an abrupt change of school or we would "lose" him, so he opined. He was described as being aloft and detached as a child. He seldom smiled after arrival of a younger brother. He was good at numbers and got a First in Maths from a top college later on. My wife and I always have the diagnosis of autism in the back of our mind. Fortunately, he developed good social skills and did well at his college. He is a good leader and co-ordinator at the workplace. We feel relieved now and the years of sacrifice paid off.

Your pragmatic approach to problem solving and treatment plans is commendable in the era of micro-managed NHS and education system. I must admit that I learn a great deal about the running of NHS psychiatric services and the school system.

Objectively, a reader outside of the UK would find some chapters in the book intriguing because a lot of space was devoted to explaining the jargons (statementing, section, grammar schools) and the NHS administrative systems. Of course, your need to clarify the peculiar UK background of your clinical practice is understandable.

Your sensitivity and constant reference to the feelings, background and learning curves of your sub-ordinates and other members of the team are rare attributes of psychiatric bosses, whom I usually found lacking in affect! If more medical students have access to your book, I'm sure many more will choose psychiatry as a career. The Cockroach Catcher promotes the human side of clinical psychiatric practice in simple language that an outsider can appreciate. An extremely outstanding piece of work indeed.

Waste Not: Projects 90 MOMA /©2009 Am Ang Zhang

In psychiatry, sometimes patients do not want any help. Often they positively refuse help and family members collude. At other times the “help” may not be all that good.

As a result many children grow up in very “unusual” environments. Yet we sometimes get very “unusual” outcomes as some individuals can turn such an experience into something ……well, something quite extraordinary.

Obsessional Compulsive Disorder (OCD) is one such condition that many families prefer to cope with secretly and often for many many years.

In a chapter in The Cockroach Catcher called: Who Is The Real Patient?
Wayne is a teenage boy I had been seeing because he could not face school:
“……After nine months, Wayne finally opened up to me.
Mother never threw away anything. Nothing at all!
Except wet waste, which was a relief. 

This was a serious case of OCD (Obsessional Compulsive Disorder). It was still a great shock to have the full extent of the things that were kept detailed to you. Even a five bedroom house soon ran out of space.

Wayne told me that as far as he knew, mother had always been reluctant to throw away anything but it seemed to get out of control about five years ago when she discovered that father kept a woman in a port in the Far East. She moved out of the master bed-room and the rubbish moved in. Everything was neatly put in big rubbish bags and properly tied up. Some were in apple or other supermarket boxes. Even vacuum cleaner bags were kept.

Mother did a good job of it so that there was no bad smell at all, Wayne would reassure me. Just no space.

All these months, I had been thinking that the bullying was the cause of Wayne’s problem. Did I get it wrong? All the time I spent trying to improve his self esteem, was it time wasted? Was there something I could have done earlier? Why did he take nine months?

Perhaps he needed that time to find out if I was going to send his mother to an asylum. Perhaps he needed all that time to trust me enough to talk about the sickest person in the family. Perhaps he never had any plan but the secret just came out.

Perhaps these were all valid explanations, but what could we as a clinic do?”
                                                                     Chapter 19 The Cockroach Catcher

Waste Not: Projects 90 MOMA /©2009 Am Ang Zhang
Recently, I visited The Museum Of Modern Art ( MOMA) in New York and saw something that reminded me of my patient’s mother.
Mr. Song Dong is the artist and his mother is called Ms. Zhao.
Here is a write up in The New York Times:
“Mr. Song was born in Beijing in 1966, on the very eve of the Cultural Revolution, a period of ideological danger and economic want. His mother came from a wealthy family that lost everything after one of its members was jailed as an anti-Communist spy. His father, trained as an engineer, spent seven years in forced labor after being accused of counterrevolutionary activity.
“When Mr. Song’s father died, in 2002, his mother was inconsolable. She continued to live in the jammed Beijing house, throwing nothing away and obsessively bringing more stuff into it, as if continuing to feather a nest for a now-absent family. And despite the threatened destruction of the surrounding area, she would make no move that entailed parting with her possessions.
“Finally, in 2005, Mr. Song proposed that they turn the accumulated junk into an art project. In this way, he argued, nothing would be discarded and lost; everything would be meaningfully recycled and preserved. His mother agreed to this and together, with the help of Ms. Yin and Mr. Song’s sister, Song Hui, they emptied the premises.

Waste Not: Projects 90 MOMA /©2009 Am Ang Zhang
“Seen in the museum’s immaculate surroundings…….it is disturbing to imagine anyone growing up, as Mr. Song did, in so smothering a physical environment. Finally, it is deeply moving to see the span of one person’s life — his mother’s — summed up, monument style, in a work of art that is every bit as much about loss as it is about muchness.
“And five years after the piece was conceived……..mother agreed to collaborate with her son, empty her home and effectively let go of her past, she moved into the more manageable setting of a Beijing apartment near a park, where she died last winter after falling from a step ladder while trying to rescue a wounded bird in a tree.”
Life could be cruel.
Waste Not: Projects 90: Song Dong
June 24, 2009–September 7, 2009
The Donald B. and Catherine C. Marron Atrium

The book is free too.
NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.

The Cockroach Catcher on Amazon Kindle UKAmazon Kindle US

Dr Zhang had a common sense approach to the children in his care, intuitively finding the answer to their problems, cases ranging from sleep and toileting problems to those of anorexia, autism and psychosis - although towards the end of his career, red tape and ‘guidelines’ were to impact on his practice.

His book also gives insight as to how we as parents may influence the mental health of our children and how childhood is being medicalised when behaviours are due to lack of parental authority and/or guidance and are not psychiatric illness at all.