House M.D. : 95% vs 5%

In one of the episodes of House M.D.
Inspector: Okay. The rules exist because 95% of the time, for 95% of the people, they’re the right thing to do.
Question: And the other 5%?
Inspector: Have to live by the same rules. Because everybody thinks they’re in that 5%.

In recent days medical tragedies hit the news with regular frequency. What has happened to medical training?

Being brought up in the older medical tradition I have found it engaging to watch the ever so popular House M.D.

It was a relief to hear from my classmates that they too like watching it.

It would not surprise anyone to find that House M.D. has made it to Medical Humanities, a BMJ Journal:Medical paternalism in House M.D.
M R Wicclair Medical Humanities 2008
Deborah Kirklin in the editorial of the same issue commented:

"Fear and pity are not emotions that Dr Gregory House, star of the popular television series 'House M.D.', acknowledges or accommodates in either his professional or private life. He is arrogant, rude and considers all patients lying idiots. He will do anything, illegal or otherwise, to ensure that his patients—passive objects of his expert attentions—get the investigations and treatments he knows they need. As Wicclair argues, House disregards his patients’ autonomy whenever he deems it necessary So why, given the apparently widely-shared patient expectation that their wishes be respected, do audiences around the world seem so enamoured of House? Wicclair’s answer raises interesting questions about the extent to which patients trust the motivations of their doctors. Perhaps, he suggests, for the many viewers drawn to this arch paternalist, there is something refreshing about a doctor willing to risk all—job, reputation and legal suits—in order to fulfil his duty of care to his patients: the duty to take care that his actions or inactions do not harm his patients. Because, for good or for bad (your call), once you’re House’s patient there is nothing he won’t do, no inaction he will tolerate, if he believes that by failing to act he will harm you.”

First do no harm.

Wicclair stated:“Paternalism is clearly against the norms of mainstream medical ethics. Informed consent—the principle that, except in emergency situations, medical interventions require the voluntary and informed consent of patients or their surrogates—is a core ethical principle in healthcare. A corollary of informed consent is that patients who are able to decide for themselves have a right to refuse treatment recommendations. Another core principle is that when patients lack decision-making capacity, surrogates should make decisions in line with the wishes and values of the patient. Both of these principles reflect a strong opposition to paternalism in contemporary medical ethics.”
Contemporary medical ethics! Except perhaps in Anorexia Nervosa where the Mental Health Act could be used to force feed in a number of countries. The fact that such force feeding did not seem to reduce mortality is a different matter as some deaths are not by direct starvation.
Wicclair asked:
“Yet House repeatedly acts paternalistically without giving it a second (or even first) thought. Is he right, and is the antipaternalism of mainstream medical ethics wrong; or is House mistaken and is a strong moral presumption against medical paternalism justified?"
To prevent House M.D. from becoming God they have to make him out to be rude and full of personal problems and he even rides a motorbike.
Wicclair offered a way out:
“In the world of House M.D., choices typically are life-or-death choices: if a patient doesn’t receive a certain medical intervention, the patient will die.
“However, in the real world, choices are not always so stark. ……If, after careful consideration, a competent patient decides against having the procedure, it would be unwarranted for a physician to insist that the patient needs it.”
You can read it here (may require subscription).
Yet my personal view is this, you may be rich, famous or even well educated, but you may not know all that you needed to know to make that judgment.
As Dr Crippen pointed out there are just three medical procedures that can be dramatically live-saving. You might also want to read Dr Grumble’s personal account here.

At the Hudson Plane Crash earlier this year a quick thinking ferry captain Brittany Catanzaro came quickly to the rescue of passengers in near freezing water. She was not a doctor.

In Hong Kong a man died outside a medical centre because a nurse receptionist was following guidelines, Guideline V to be precise.
Kevin M.D. was charitable about Canadian Health Care when he looked at the tragic death of Natasha Richardson. A number of papers only picked up the fact she turned away the earlier ambulance, but then this happened:
"After picking her up from the hotel, there was a 40-minute drive to the community hospital, the Centre Hospitalier Laurentien. She did have a CT scan there, and the decision was made within 2 hours to transport her to a tertiary care center, another hour away in Montreal."
And still no burr holes after the CT scan?
Dr. Crippen said that the brave physician would have drilled the burr holes without the benefit of a CT scan:"It would be a career making or career breaking decision. Few American doctors are brave. Defensive medicine is the order of the day. You cannot have a migraine in the USA without someone ordering an MRI scan."
Has modern medical training managed the unthinkable of producing a new generation of doctors and other medical staff forgetting that they should use their brain? Or have they all been “guidelined” out? Has the 5% finally become the 95% too?
3212009
Grand Rounds 5.27: Code Blog 5:29 Getting Closer To Myself
A simple bump on the head can kill you,Natasha Richardson’s Brain Injury
The wussification of the American medical profession.
Related: House M.D.: Modern Tyranny
Links: Covert Rationing Blog Better Health

Where were you when we needed you, Dr House M.D.?
House M.D. must have the last words:
Question: "Isn’t treating patients why we became doctors?"
House: "No, treating illnesses is why we became doctors."

NHS: Business Model? Spare Us Please!!!

As many in our government were bent on changing the NHS, should we not take a step back after the apocalyptic disaster in the financial world of 2008 and ask the simple question: Can we continue to trust and pay financiers and consultants to run our banks and other institutions and even our NHS?

Ahead of the Curve/Philip Delves Broughton

I was reading a book by Philip Delves Broughton on Harvard Business School (HBS): Ahead of the Curve.

He may not be the first to observe that HBS loves Marines, Mormons and Mckinsey. Kim Clark  must indeed be the most famous sons of The Church of Latter Day Saints and PDB’s article in The Sunday Times: “Harvard’s masters of the apocalypse” may indeed be aptly titled.

He opened with:

If his fellow Harvard MBAs are all so clever, how come so many are now in disgrace?

From Royal Bank of Scotland to Merrill Lynch, from HBOS to Lehman Brothers, the Masters of Disaster have their fingerprints on every recent financial fiasco.

We MBAs are haunted by the thought that the tag really stands for: Mediocre But Arrogant, Mighty Big Attitude, Me Before Anyone and Management By Accident. For today’s purposes, perhaps it should be Masters of the Business Apocalypse.

Harvard Business School alumni include Stan O’Neal and John Thain, the last two heads of Merrill Lynch, plus Andy Hornby, former chief executive of HBOS, who graduated top of his class. And then of course, there’s George W Bush, Hank Paulson, the former US Treasury secretary, and Christopher Cox, the former chairman of the Securities and Exchange Commission (SEC), a remarkable trinity who more than fulfilled the mission of their alma mater: “To educate leaders who make a difference in the world.”

It just wasn’t the difference the school had hoped for.

Business schools have shown a remarkable ability to miss the economic catastrophes unfolding before their eyes.

In the late 1990s, their faculties rushed to write paeans to Enron, the firm of the future, the new economic paradigm. The admiration was mutual: Enron was stuffed with Harvard Business School alumni, from Jeff Skilling, the chief executive, down. When Enron, rotten to the core, collapsed, the old case studies were thrust in a closet and removed from the syllabus, and new ones were promptly written about the ethical and accounting issues posed by Enron’s misadventures.

Let us stay with the UK:

Much the same appears to have happened with Royal Bank of Scotland.

When I was a student at Harvard Business School, between 2004 and 2006, I recall a distinguished professor of organisational behaviour, Joel Podolny, telling us proudly of his work with Fred Goodwin at RBS. At the time, RBS looked like a corporate supermodel and Podolny was keen to trumpet his role in its transformation. A Harvard Business School case study of the firm entitled The Royal Bank of Scotland: Masters of Integration, written in 2003, began with a quote from the man we now know as Fred the Shred or the World’s Worst Banker: “Hard work, focus, discipline and concentrating on what our customers need. It’s quite a simple formula really, but we’ve just been very, very consistent with it.”

The authors of the case, two Harvard Business School professors, described the “new architecture” formed by RBS after its acquisition of NatWest, the clusters of customer-facing units, the successful “buy-in” by employees. Goodwin came across as a management master, saying: “A leader’s job is to create the conditions that enable people to believe, in their hearts and minds, in the value of what they are doing.”

Then just last December, Harvard Business School revised and republished another homage to RBS – The Royal Bank of Scotland Group: The Human Capital Strategy.

It is tragic to read now of all the effort put in by those under Goodwin, from “pulse surveys” to track employee performance to “the big thank you”, a website where managers could recognise individual excellence in customer service.

Every trendy business school idea was being implemented, it seemed, while what really mattered – the bank’s risk assessment, cash flow and capital structure – was going to hell. To be fair, neither Podolny nor the authors of the case studies were finance professors, but it’s still pretty shocking that a school that purports to teach general management should fail to see the gaping problems at a firm they studied in such depth.

Last October, Harvard Business School celebrated its 100th birthday with a global summit in Boston. While Wall Street and Washington descended into an economic inferno, Jay Light, the dean of the school and a board member at the Black-stone private equity group, opened the festivities by shrugging off any responsibility.

“We all failed to understand how much [the financial system] had changed in the past 15 years or so, and how fragile it might be because of increased leverage, decreased transparency and decreased liquidity: three of the crucial things in the world of financial markets,” he said.

“We all failed to understand how that fragility could evidence itself in a frozen short-term credit system, something that hadn’t really happened since 1907. We also probably overestimated the ability of the political process to deal with the realities of what could happen if real trouble developed.

“What we have witnessed is a stunning and sobering failure of financial safeguards, of financial markets, of financial institutions and mostly of leadership at many levels. We will leave the talk of fixing the blame to others. That is not very interesting. But we must be involved in fact in fixing the problem.”

You would think after failing on so many levels, the school that provides more business leaders than any other might feel some remorse. Not in the least. It’s onwards and upwards, with the very people who blew apart the world’s financial plumbing now demanding to fix the leak.

Given the present chaos, shouldn’t we be asking if business education is not just a waste of time, but actually damaging to our economic health?

If doctors or lawyers wreaked such havoc in their own professions, we would certainly reconsider what is being taught at medical and law schools.

He said of Light’s statement:

He was like a drunk driver emerging from a wreck asking for the keys to the police car so he could drive home. Don’t worry about who’s to blame, let’s just all run along, shall we?

Light, told his audience in October: “The need for leadership in the world today is at least as great as it has ever been. The need for what we do is at least as great as it has ever been.”

A bold claim to which many might say:

“Please, spare us.”

A fairly straightforward book to read with real names and real people that one reads about in the business section of the major papers and often in the front pages too.

What is happening now in the US is very frightening: at the top some very rich CEOs and below them a highly dispensable workforce. The book talked about 30 million. No more job security for these.

If we are not careful, the NHS will move towards the same model of NHS Trusts and PCTs with highly paid CEOs and their management staff. Below them a number of highly dispensable doctors, nurses and other workers. Firing of staff is the norm to balance the books in the NHS.

Look at what happened to Out Of Hours service and hospital weekend and holiday manpower levels and you will know what I am talking about.

Unfortunately, it may be too late to try and bring back the good will that has kept the OLD NHS going for so many years. The good will that was slowly destroyed by modern management ways and silly Pavlovian bonus culture.  

“Please, spare us.”

Banks: Northern Rock, HBOS, RBS, Bonus at RBS

Out Of Hours service, bonus culture, Hospital Dr

Related:

To Intervene Or Not: A Colossal Failure Of Common Sense.

NHS & McKinsey: The Professor & 10%

BMJ Analysis: Allyson M Pollock

Dr Am Ang Zhang is the author of The Cockroach Catcher.

Grand Rounds: M D Whistleblower

Grand Rounds: Musings of a Dinosaur

Grand Rounds is up at Musings of a Dinosaur. 

 

A few of my favourites:

Medical Lessons

Elaine Schattner M.D.

She writes regularly on Huffington Post:

I know also, as a patient, that physical examination can be life-saving. Once, when I was in the hospital as a child and had unexplained fevers after surgery, it seemed for a while that no one could figure out what was wrong. I was terrified. The surgical team consulted with an infectious disease specialist, who as I recall ordered a whole bunch of unpleasant tests, and then my dad – a physician — noticed that one of my legs was more swollen than the other. He realized, based on my physical exam, that I might have a blood clot. It turned out that he was right.

So I agree that the physical exam is humanizing. So much so that, later in my career when I routinely donned space suit-like gowns and masks on rounds for the leukaemia and bone marrow transplant services, I became frustrated by those barriers, and by the very lack of touch which, I think, can help patients heal.

But what’s also true, in a practical and bottom-line sort of way, is that a good physical exam can help doctors figure out what’s wrong with patients. If physicians were more confident – better trained, and practiced — in their capacity to make diagnoses by physical exam, we could skip the costs and toxicity of count less x-rays, CT scans and other tests.

Recently I wrote a piece on medical education and going back to basics. The physical exam should be included, for sure.

Read the entry here>>>>>>>>>

other things amanzi

In the meantime, I’ll leave you to read about bongi (the South African guy allergic to capital letters) and his adventures with, who else, the urologists.

He found himself the accidental assistant to the Professor of Urology. I will give you a taste of what real medicine is like in some parts of the world: (unedited)

"i think i have torn the ivc." he said it as if it wasn't a problem, as if it wasn't something that often was followed by the ending of life. i was amazed that he could be so calm when faced with such a calamity. and then i found out why. he looked at me.

"that's why you are here," he said, "it's your job to fix the ivc." he was calm when faced with such a calamity for the simple reason that he was not faced with such a calamity. i was. the realization set into my heart like a pick axe. i felt nauseous. i thought of that beer that i was busy not drinking because i was required to somehow perform a miracle on a patient that was never mine. but it didn't help to bemoan my position or to shy away from this immense responsibility that had been thrust upon me. i had to put my head down and fix it.

i fixed it. i remained calm on the outside and got to work and got the job done. but i think i shaved a few years off my life during that operation. when i was finished i was exhausted. i left the junior to close and finally went for that long overdue beer.

I just hope that in the future we still have doctors like “bongi”

Read all of it here >>>>>>

ACPHOSPITALIST

Dr. Kimberly Manning, we get to end Grand Rounds with a grand slam home run of a post, beautifully written, Life at Grady, to Admit or not to Admit.

“What I learned from this situation:
--When patients say that something "just isn't right", listen.
--When one part of the history is odd, like soiling your pants with blood, listen.
--Look at the whole picture.
--Listen.
--Recognize when you're in a position to advocate for a patient with just the stroke of an ink pen. --I still hate crack cocaine.
--Even though I hate crack cocaine, even those who use it deserve the benefit of the doubt.
--And most important, even when your patient uses crack cocaine, is homeless, missed his last appointment, and thinks differently from you...sometimes you just have to roll with it. Because many times the patient is, in fact, right.”

Humanity, that is what medical practice is about: read the full post here>>>>

Then there is the one about Porsche:

Best Health Care: Private Medicine, Porsche & The NHS

Obama Health & The NHS: Patients Trading

President Obama signed major health care legislation into law on Tuesday.

Doug Mills/The New York Times

It would be interesting to see how universal health insurance will pan out in the Obama health care reform.

It made sense that insurers should not be allowed to “cherry pick”. The Cockroach Catcher just realised that perhaps there now will be a new commodity: patients.

The financial world has been about risks and derivatives were designed to minimise risks. All very laudable until some smart ones realise that much money could be made from such instruments.

Health Insurers are a special group of such financial institutions and no doubt they will want to minimise the risks. In the past, it is very simple: exclude risky patients. 

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Reuters: Insurer targeted HIV patients to drop coverage

“Insurance companies have long engaged in the practice of ‘rescission,’ whereby they investigate policyholders shortly after they've been diagnosed with life-threatening illnesses.”

It would not have been possible to run the Obama reform without tackling the “cherry picking”. Well by 2014 in any case:


"One of the central reforms of the bill won't start until 2014, when the exchanges open. From then on, insurers will not be able to turn away people with medical problems or charge them more."         The Associated Press

The problem is that you may not be allowed to exclude, but you can certainly devise ways to encourage high risk patients to go to other insurers.

How?

Simple! Money!

As with my parenteral feed patient: pay them to go elsewhere. One insurer paying the patient to go to another one!

It is suddenly very interesting as having a chronic illness or a novel one may become an asset rather than a burden: in other words, it is a new commodity.

At a financial level, re-insurance may become the norm. A sort of “subprime” for Health and of course we all know what happened to the other “subprime”.

At a medical level, it might encourage insurers to offer the best treatments as anything else might prove more expensive.

Of course the unthinkable might happen: patients being paid to go elsewhere.

In England, if Health Insurers cannot “cherry pick”, there is nothing to stop the PCTs (Primary Care Trusts: public bodies that are responsible for funding public patients) insuring NHS patients to limit the cost. 

Who would still want to run Private Health Care then, I wonder! Especially if PCTs insure all their long term medical and psychiatric conditions.

We may get back our NHS!!!

Grand Rounds: See First

Health Care 101: A consumer primer on Obama's bill

£200 voucher

New York Times: Details

Related:

Obama Health Reform: Lessons For The NHS.

Obama & Health: Would you like to move?

Others:

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Three Doctors & The NHS

Public Enemies: Three Doctors, Patients Association & The NHS

An Entrepreneur!

Psychiatry: A Floundering Discipline

R

A real flounder©2007 Am Ang Zhang

I can well remember my Psychiatry Specialist Examination question about what 5 different major drugs we would pick if those were all that we were allowed to use. It was the early 70s and one would struggle to find the 5^th one if you were not going to include an anti-epileptic.

It was strangely reassuring to read that diagnoses in psychiatry have grown foggier and drugs more ineffective. It was not the view of a journalist either but that of a Professor of Psychiatry.

Why Psychiatry Needs Therapy

A manual's draft reflects how diagnoses have grown foggier, drugs more ineffective

WSJ FEBRUARY 27, 2010   By EDWARD SHORTER

To flip through the latest draft of the American Psychiatric Association's Diagnostic and Statistical Manual, in the works for seven years now, is to see the discipline's floundering writ large. Psychiatry seems to have lost its way in a forest of poorly verified diagnoses and ineffectual medications. Patients who seek psychiatric help today for mood disorders stand a good chance of being diagnosed with a disease that doesn't exist and treated with a medication little more effective than a placebo.

He went on to say that despite the DSMs our lingo of today was not really an improvement to the days of psychosis and psychoneurosis as the so called modern treatment is now limited to one or the other group of drugs. Making the wrong diagnosis did not seem to have any consequence at all on modern medication choice.

To him the differentiation is meaningless and of benefit mainly to pharmaceutical companies that market drugs for these niches.

He went on:

For those more seriously ill, contemplating suicide or pacing restlessly and saying "It's all my fault," melancholia was the diagnosis of choice. The term has been around for donkey's years.

All the serious disorders of mood were once lumped together technically as "manic-depressive illness"—and again, there was little point in differentiating, because medications such as lithium that worked for mania were also sometimes effective in forestalling renewed episodes of serious depression.

Indeed lithium might have worked for some of the recent suicides on the news.

He then covered a selection of new ailments in the planned manual.

Hoarding

This is defined as "persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items."

Mixed Anxiety-Depression

"The patient has the symptoms of major depression…accompanied by anxious distress." The combination of depression and anxiety has been recognized clinically for years; only now does it make it into the handbook.

Binge Eating

This means eating "an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances," in addition to having "a sense of lack of control over eating."

Minor Neurocognitive Disorder

"Evidence of minor cognitive decline from a previous level of performance," a commonplace occurrence for anybody over 50.

Temper Dysregulation Disorder With Dysphoria

A new definition for all children with outbursts of temper. It is seen as a way to avoid using the term "bipolar."

Major depression became the big new diagnosis in the 1980s and after, replacing "neurotic depression" and "melancholia," even though it combined melancholic illness and non-melancholic illness. This would be like incorporating tuberculosis and mumps into the same diagnosis, simply because they are both infectious diseases. As well, "bipolar disorder" began its relentless on-march, supposedly separate from plain old depression.

New drugs appeared to match the new diseases. In the late 1980s, the Prozac-type agents began to hit the market, the "SSRIs," or selective serotonin reuptake inhibitors, such as Zoloft, Paxil, Celexa and Lexapro. They were supposedly effective by increasing the amount of serotonin available to the brain.

The SSRIs are effective for certain indications, such as obsessive-compulsive disorder and for some patients with anxiety. But many people believe they're not often effective for serious depression, even though they fit wonderfully with the heterogeneous concept of "major depression." So, hand in hand, these antidepressants and major depression marched off together into the sunset. These were drugs that don't work for diseases that don't exist, as it were.

The latest draft of the DSM fixes none of the problems with the previous DSM series, and even creates some new ones.

DSM-V accelerates the trend of making variants on the spectrum of everyday behavior into diseases: turning grief into depression, apprehension into anxiety, and boyishness into hyperactivity.

Where is psychiatry headed?

What the discipline badly needs is close attention to patients and their individual symptoms, in order to carve out the real diseases from the vast pool of symptoms that DSM keeps reshuffling into different "disorders." This kind of careful attention to what patients actually have is called "psychopathology," and its absence distinguishes American psychiatry from the European tradition. With DSM-V, American psychiatry is headed in exactly the opposite direction: defining ever-widening circles of the population as mentally ill with vague and undifferentiated diagnoses and treating them with powerful drugs.

Related:

DSM-5: Childhood Bipolar Disorder, Stigma & Inappropriate Treatment.
Bipolar Disorder: Lithium-The Aspirin of Psychiatry? Lithium Bipolar and Nanking

Bipolar Disorder in Children

“Wake-up Call” to British Psychiatry

The Cockroach Catcher: Readers' views.

Grand Rounds: Health Business

NHS & McKinsey: The Professor & 10%

Professor Allyson Pollock is at it again and this time in The Guardian:

Professor Allyson Pollock

The NHS is about care, not markets

The Guardian Thursday 3 September 2009

Downsizing the workforce is a business response to loss of profit – but it doesn't account for the NHS goal of universal healthcare.

I will attempt to look at Professor Pollock’s article in detail especially as we come up to the anniversary of the failure of Lehman Brothers.

Healthcare in the market place:

The core goal of universal healthcare and services planned on the basis of need and not ability to pay is being jettisoned by the turnaround teams and management teams brought in to manage anticipated reductions in NHS budgets. Downsizing the workforce is a traditional response of business to loss of profit where businesses have to pay the costs of operating in a market and earn surpluses for shareholders. Unlike Scotland and Wales, the NHS in England is continuing to pursue market-oriented healthcare in its reform of the NHS. So it should be no surprise that management consultants firm McKinsey have come up with market-oriented solutions to anticipated budgetary shorfalls. They have advised ministers to cut 10% of the NHS workforce in England by 2014, a reduction that will affect services provided primarily to the old and the poor who have among the highest healthcare needs. But strategies to reduce the NHS budget need to pay attention to the role of market structures and how they reduce the ability of the NHS to pool the risks and costs of care across its population.

Administration costs:

The diversion of health spending from patient care to paying for a market are not apparently McKinsey's concern. Take for example the costs of the new market bureaucracy; for more than 40 years administration costs were in the order of 6% of the total budget a year, they doubled overnight to 12% in 1991 with the introduction of the internal market. We have no data today for England, but what we know from the US is that the introduction of for-profit providers increases administrative costs to the order of 30% or more.

Different to Scotland and Wales:

So why hasn't McKinsey advocated making savings along the lines of Scotland and Wales by reintegrating trusts into area-based planning structures and thereby abolishing billing, invoicing, the enormous finance departments, marketing budgets and management consultants, lawyers, commercial contracts? In this way one could project savings of anything from £6-24bn a year for England.

PFI:

A second set of savings would be the high costs of PFI where the taxpayer, having bailed out the banks, is now paying almost twice as much as it should for some PFI hospitals through high rates of interest and returns to shareholders. The total money raised from private finance so far is £12.27bn but the NHS will pay out £41.4bn for the availability of buildings and a total of £70bn over the life of the contracts. The irony is that the patient and the public are rebuilding the banks' balance sheets using scarce NHS funds intended for patient care and staff, especially in community-based services.

ISTC:

A third saving could be made by cancelling the contracts for the £5bn ISTCs programme – research in Scotland extrapolated to England has shown as much as £1bn has been wasted by giving money to for-profit ISTCs for work that was not carried out in the first wave.

Then there are all the other contracted out services including the pharmaceutical bill of £14bn. Are these contracted out elements part of the McKinsey scrutiny? It is doubtful since the company travels the world advocating market solutions.

Failures:

And here we run up against the fundamental problem of retaining marketeers to advise on healthcare. Markets mean reducing the capacity of the NHS to pool the costs of care across the whole service, substituting instead hospitals, clinics and practices that have to pay their way like businesses and, like businesses, can fail. Needs-based planning, once the hallmark of the NHS in England, is being replaced by strategies to deal with artificially created market failure.

Solutions are sought from outside consultants and turnaround teams using unsubstantiated assertions that the NHS is inefficient and can increase productivity. What the selective use of data and evidence mask is the failure to view the system as a whole and to remember that its core goal is universal healthcare, not concocted operating surpluses.

Winners and losers should not be what universal healthcare is about:

In contrast to Wales and Scotland, England has established hospitals and services as competing trusts or firms operating in a market; competition has replaced the mechanisms which enabled health authorities to monitor and respond and direct resources to the needs of the populations that are being served. But markets create winners and losers – and the unpublished McKinsey report is an attempt at refereeing.

The moral is that if the Department of Health in England commissions private management consultants that derive their profits from markets you will get market solutions. It is the commissioning, not McKinsey's report itself, that should give offence.

From the Book by Allyson Pollock: NHS plc

“The NHS is being dismantled and privatised. Very soon every part of it will have been ‘unbundled' and commodified...a new business dynamic is taking charge of the ways in which services are provided and patients are responded to. The dramatic costs involved - in terms of loss of equal access and universal standards, as well as of money - are concealed by claims of ‘commercial confidentiality' and by tearing up the once-exemplary systems of NHS accounting”

I just hope the Professor will not be one of the 10%.

Grand Rounds: Vol. 5 No. 52 Suture for a Living

What is wrong with the market approach:

Cars: Rover-MG, GM Europe, US Cars

Banks: Northern Rock, HBOS, RBS, Bonus at RBS

Others:

NHS & the Repeal Of The Glass-Steagall Act

To Intervene Or Not: A Colossal Failure Of Common Sense.

Related: Corruption: Three Doctors and a Professor.

NHS: Business Model? Spare Us Please!!!

Article: The Guardian