Wednesday, February 24, 2010

Mid Staffordshire: The Modern Witch Hunt

The Mid Staffordshire report came out today
February 24, 2010

This is a disaster directly lying inside Number 10 Downing Street. It was they that created Foundation Hospital trusts (plus the spineless MPs). They that created the purchaser-provider split. They that founded Monitor who were only interested in financial success.

No, Messrs Brown, Blair, Burnham and all the others: this is not a local problem. It is being replicated at a hospital trust near you.

The fault lies with policy and the labour Government. It is people at the top that need to resign. Except that they won't, of course.
Patients were “routinely neglected” at an NHS hospital where hundreds of deaths resulted from appalling care, an independent inquiry found today.
Mid Staffordshire NHS Foundation Trust lost sight of its responsibility to provide safe care because it was preoccupied with cost-cutting and meeting Government targets, a report said.
The inquiry, by Robert Francis, QC, made 18 recommendations for the trust and the wider NHS after hearing evidence from more than 900 patients and families.
Regulators revealed last year that between 400 and 1,200 more people had died at Mid Staffordshire Trust than would be expected between 2005 and 2008, in one of the worst examples of poor care in the history of the NHS.
The trust said that it would consider whether individual nurses or doctors should face further disciplinary action.
He said evidence gathered during the inquiry into events at the trust between January 2005 and March 2009 had shown clearly that for many patients the most basic elements of care were neglected.
Patients were left unwashed, at times for up to a month, and food and drinks were left out of reach of patients.

“We understand both the sadness and sorrow of the relatives who lost their loved ones,” he said. “It was a management failure and completely unacceptable.”
He added that the Government was taking steps to better regulate hospitals and would introduce the power to “strike off” managers who were unfit to work in the NHS.

The report criticised the "ineffective" management which was too often concerned with hitting targets, particularly in A&E, as well as the "lack of compassion" and "uncaring attitude" of staff.

But staffing levels were also said to be too low because the trust was trying to slash costs by £10m.


Concerning Mid-Staffordshire NHS Trust, the chairman of the Healthcare Commission indicated that warnings existed about some of its problems for years before the problems became publicly known.11 Why should staff accept the risks of whistleblowing if warnings are ignored?
The chairman of the Care Quality Commission has criticised staff at Mid-Staffordshire NHS Trust and elsewhere for operating in a "culture of silence."9But the commission’s plan to assess progress at Stafford does not mention whistleblowers. The secretary of state for health has stated: "I do not understand why clinicians whose primary role is the safety of their patients are somehow concerned about whistleblowing."12

T8. [265644] Michael Fabricant (Lichfield) (Con): Two constituents came to my surgery a few weeks ago to talk to me about a hospital in the west midlands— not Mid-Staffordshire hospital. They showed me photographs of mouse holes, mouse droppings in the operating theatre and blood smeared in wards. One is a consultant surgeon and both were frightened of being whistleblowers and feared for their jobs. What sort of ethos exists in the health service if people like that can be afraid of revealing the truth?
Alan Johnson: I know about that case, because the hon. Gentleman dropped me a note about it after the debate last week, and I am looking into it. As he did not mention the hospital, neither will I, but the fact that he has now placed the matter on record allows me to respond to him more formally than I would otherwise have done.

I do not understand why clinicians whose primary role is the safety of their patients are somehow concerned about whistleblowing. Indeed, knowing the number of people in various occupations who are not slow to make people aware of such difficulties, it amazes me that that did not happen at Stafford. The hon. Gentleman has taken a great interest in the matter, and I shall make absolutely sure that the issue that he has raised with me is thoroughly examined. Incidentally, I would also like to talk to the consultant concerned to find out why they were so frightened to raise the matter.

The General Medical Council (GMC) said several doctors involved in Mid Staffs had been referred to it for investigation but would not disclose how many.

The Nursing and Midwifery Council (NMC) has also opened a case file and is investigating at least one nurse. It is also considering whether other nurses should be investigated.

It has indeed started!!!

Other related posts:
Jobbing Doctor: Poor bloody infantry.

The Report:

Tuesday, February 23, 2010

Anorexia Nervosa: Eating Disorder Awareness Week

A Brief History of Time: Anorexia Nervosa

First published March 1, 2008


Il faut manger pour vivre et non pas vivre pour manger.
(One should eat to live and not live to eat.)
Moliere (1622 – 1673): L'Avare (The Miser)

Some hae(have) meat and cannot eat,
Some cannot eat that want it:
But we hae meat and we can eat,
Sae let the Lord be thankit.
Robert Burns (1759 – 1796): The Kirkcudbright Grace
This is not about Stephen Hawking’s famous book that sold over 9m copies world-wide, but a collection of material that relates to Anorexia Nervosa in a chronological order. You see, I believe in free sharing of knowledge.
First introduction of the term Anorexia
Sir William Withey Gull (1816 – 1890) first used the term:
“In… 1868, I referred to a peculiar form of disease occurring mostly in young women, and characterized by extreme emaciation…. At present our diagnosis of this affection is negative, so far as determining any positive cause from which it springs…. The subjects…are…chiefly between the ages of sixteen and twenty-three…. My experience supplies at least one instance of a fatal termination…. Death apparently followed from the starvation alone…. The want of appetite is, I believe, due to a morbid mental state…. We might call the state hysterical.”
Source: Anorexia Nervosa (apepsia hysterica, anorexia hysterica).
Transactions of the Clinical Society of London, 1874, 7: 22-28.
Classic description of Anorexia Nervosa.
Earliest published accounts
Richard Morton (1637-98), a London physician: The Treaty in his book Phthisiologia, or a Treatise of Consumptions, first published in Latin in 1694.
Ernest-Charles Lasègue (1816 - 1883), a professor of clinical medicine in Paris: “De l’Anorexie Hysterique” containing descriptions of eight patients.
More recent views
Girl in a Chemise circa 1905 Pablo Picasso (1881-1973)
Tate Collection

Anna Freud’s psychoanalytic view (1958):
  • Adolescent emotional upheavals are inevitable
  • Anorexia Nervosa is the outward manifestation of the battle between the ego and eating, with the former struggling for it’s very survival
Bruch (1966): relentless pursuit of thinness
Crisp (1967 - 1980):
  • Anorexia nervosa serves to protect the individual from adolescent turmoil.
  • Anorexia nervosa reflects a phobic avoidance of sexual maturation.
  • Unsettling effects of sexual maturation at puberty may drive the female adolescent to a pursuit of thinness leading to greater acceptance, self-control and self-esteem.
  • Anorexia nervosa tends to appear in families with buried, but unresolved, parental conflicts.
Palazzoli (1978) on women’s role (not just Anorexia Nervosa)
  • Women are expected to be beautiful, smart and well-groomed.
  • They are expected to have a career and yet be romantic, tender and sweet.
  • They are expected to devote a great deal of time to their personal appearance even while competing in business and professions.
  • In marriage, they are expected to play the part of the ideal wife cum mistress cum mother.
  • They are expected to put away her hard-earned diplomas to wash nappies and perform other menial chores.
  • The modern woman is therefore exposed to a terrible social ordeal, and the conflicting demands and dual image of the female body as sex symbol and as commodity.
  • An adolescent girl may develop feelings of insecurity and alienation toward her changing body.
Finally, it is appropriate to close with two quotes:
L'appetit vient en mangeant.
(The appetite grows by eating.)
Rabelais (1494 - 1553): Gargantua

One hath no better thing under the sun than to eat, and to drink, and to be merry ...
- Ecclesiastes 8.15

Monday, February 22, 2010

Diabetes & Dolphins: What If?

When I was in Hong Kong recently I had dinner with a doctor friend who had Type 2 diabetes. He told me that he now uses insulin. He finds he could think and function better.

Imagine my surprise when I read:

The New York Times:

Published: February 19, 2010
Hundreds of people taking Avandia, a controversial diabetes medicine, needlessly suffer heart attacks and heart failure each month, according to confidential government reports that recommend the drug be removed from the market.

Avandia, intended to treat Type 2 diabetes, is known as rosiglitazone and was linked to 304 deaths during the third quarter of 2009.

Then on the same day in the National Geographic News:
Dolphins Turn Diabetes Off and On -- Hope for Humans?
Victoria Jaggard in San Diego/Published February 19, 2010
Bottlenose dolphins have what could be called type 2 diabetes, but unlike humans, the animals are able to turn it off and on—perhaps an evolutionary adaptation to maintain their big brains, new research suggests.
Bottlenose Dolphin. NOAA image
Diabetes may have arisen in Ice Age humans for similar reasons, so the newfound dolphin on-off switch may be a key to curing type 2 diabetes in people.

Like humans, dolphins have relatively large brains compared to their body sizes—in fact, dolphins are second only to humans in the ratio between body and brain size. 

Scientists know that humans need plenty of a sugar called glucose to keep their 
.brains functioning. Some researchers think  the same might be true for dolphins, since both species send high amounts of glucose through their bloodstreams.

Dolphins, however, primarily eat fish, which are high in protein and low in sugar. To get enough glucose from this diet, dolphins have evolved a mostly harmless form of insulin resistance, according to Stephanie Venn-Watson, director of clinical research for the U.S. nonprofit  National Marine Mammal Foundation(Press Release).

Is it indeed possible that we try to feed our brain at the cost of other organs? Has evolution done away with our ability to switch?

Could further studies on the dolphin throw more light on humans?

In the mean time, it may be best to do what the doctors do, not what they tell you!!! Just like my doctor friend.

Sunday, February 21, 2010

Anorexia Nervosa: Chirac & Faustian Pact

Reading a new book sometimes brings you the unexpected.
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.


Thursday, February 18, 2010

Three Doctors & The NHS

“It's a strange irony that it is managers who seem intent on trying to turn us from public servants with a genuine interest in patient care into the money grabbing people the HSJ likes to portray us as. Managers were the ones who essentially forced new contracts onto consultants resulting in our being paid for the very first time (on paper anyway) for all the work that we do. Doctors who were reluctant to move from a professional and vocational contract are now being paid more. Did our masters expect us to be paid less? Perhaps they really did. Perhaps managers just cannot grasp that doctors do whatever is necessary to meet the vital needs of our patients whether we are paid or not. And the same people made similar mistakes with GPs. For it was managers who forced GPs to jump through ever more hoops to be paid - which they promptly did. The BMA dutifully told the government that it would result in their being paid more. But the BMA was not believed. Yet the HSJ continues to distrust them.

Every so often, one comes across someone who puts into the discussion the argument that needs to be put.

One such is Dr Clive Peedle:

The BMA represents 70% of all doctors and the vast majority oppose a market based healthcare system (there are several surveys that prove this). As a member of BMA Council, I and my fellow Council members were mandated to mount a campaign against the market based reforms by several motions passed overwhelmingly at consecutive Annual Representative Meetings (ARM). I also happen to passionately believe that this was the right thing to do. Even Gordon Brown (SMF speech 2004) understands that markets don't work well in some situations and healthcare is one of the best examples of this.

As for big business profiting from the NHS, why not take a look at the Forbes website, Mr Vize:

US companies involved in the NHS (all FESC approved for example):
Current CEO: Michael.B.Mccallister

Compensation 2009: $5 million and has $50 million stock options

CEO: Stephen J Helmsley

Compensation $3 million and stock options worth $660 million
n.b previous CEO, Dr Bill McGuire was involved in $1.6 billion stock options scandal. Please see the US Securities and Exchange Commission (SEC) website for more details.

CEO: Ronald A Williams

Compensation 2009: $24 million and stock options worth $170 million
n.b Former Aetna CEO John Rowe earned $175 million in 65 months ($225,000 per day!!)

Here are some further astonishing figures including other top execs (see further down page):  The Industry Radar

The HSJ should be investigating these characters instead of slagging off the BMA. These companies want to expand their markets into the UK and their number one priority is to their shareholders, not the English taxpayer and patients. That is why the BMA is fighting so hard against this.

As for GPs being small businesses, that may be the case, but they are a vitally important part of the communities they serve. Most GP partners work in their practices for their entire working lives and therefore have unprecedented knowledge about their patients and patients' families, which is vitally important for continuity of care. The vast majority are wedded to the ideal of the NHS and most are very innovative. Mr Vize's comments about GP's IT illiteracy are unfounded. In fact, GPs are miles ahead of the hospital sector in terms of successful use of IT.

Poor GP services do need sorting out, but Polyclinics are not the answer. The for-profit GP outfits will try to increase profits by employing cheaper staff on short term contracts. This will have dreadful consequences for continuity of care. It will be the poorest and most vulnerable patients with chronic long term illness who will lose out to the worried well who want to pop into clinic after work, who don't really mind who they see.

Related Posts:

Wednesday, February 17, 2010

Ancient Myth: Modern Havoc

One of my early gurus is Jungian and is very fond of Greek Mythology:

“There is a God for everything! Everything!”

Plutus, the Greek god of wealth, did not have an easy life. As the myth goes, Plutus wanted to grant riches only to the "the just, the wise, the men of ordered life." Zeus blinded him out of jealousy of mankind (and envy of the good), leaving Plutus to indiscriminately distribute his favours.
I read that in the weekend Wall Street Journal:

The Greek Tragedy That Changed Europe

Greece's dysfunctional economy is now at the heart of a rescue effort that could be disastrous for the entire continent—and the rest of the world.

Modern-day Greece may be just and wise, but it certainly has not had an ordered life. As a result, the great opportunity and wealth bestowed by European integration has been largely squandered. And lower interest rates over the past decade—brought down to German levels through Greece being allowed, rather generously, into the euro zone—led to little more than further deficits and a dangerous build-up of government debt.
Now Plutus wants his money back. Europe is entering unprepared into a serious economic crisis—and the nascent global recovery could easily collapse due to the unsustainable and Ponzi-like buildup of government debt in weaker countries.
At the end of the G7 meeting in Canada last weekend, Treasury Secretary Tim Geithner told reporters, "I just want to underscore they made it clear to us—they, the European authorities—that they will manage this [Greek debt crisis] with great care."
But the Europeans have not been careful so far. The issues for troubled euro zone countries are straightforward: Portugal, Ireland, Italy, Greece and Spain (known to the financial markets, and not in a polite way, as the PIIGS) had varying degrees of foreign- and bank credit-financed rapid expansions over the past decade. In fall 2008, these bubbles collapsed.

Tuesday, February 16, 2010

NHS Doctors: Count Your Blessings!

The Cockroach Catcher has been away to some very varied parts of the world: Chile, Argentina and even Cambodia.

Today I read in Jobbing Doctor about something that should be very disturbing: You will obey orders

I followed the link to PULSE:

GPs told to ignore choice and refer to Care UK services
16 Feb 10
By Ian Quinn
Exclusive: GPs are being told to refer thousands of patients to the private sector to bail out a Government scheme to outsource services from hospitals, Pulse can reveal.
A group of 10 PCTs is insisting practices send patients to services run by the company Care UK, after it emerged they were currently seeing fewer than a third of the projected number of referrals.
GPs have been warned they could even face action from the GMC if they refuse to refer patients en masse to the company.
Trusts who will foot the bill from the Department of Health’s contract, which pays Care UK a block sum even if services are under-used, are warning they face dire financial consequences if they cannot ensure GPs refer to the private facilities rather than local services.
It comes after Derby City PCT admitted offering payments to GPs to send patients to an independent sector treatment centre in its area.

“Face action from the GMC!!!”
For doing what all doctors have been trained to do: the right thing!!!

Angor Wat, Cambodia © 2009 Am Ang Zhang


Then I remembered what I heard and saw in Cambodia: that all the doctors were slaughtered during the Khmer Rouge era together with other intellectuals. It was not easy to determine the number of people killed.  Most put it at 2 million and right now there are very few over 65s and even fewer people wear glasses in the country.

In the NHS, you are only going to face action from the GMC!!!

Count your blessings!!!