Friday, June 13, 2014

Doctors: Kind Heart & Kind Skills!

As the NHS faces the greatest scandal regarding CQC; it became clear that the idea of putting a non-doctor as its regulator is akin to getting a butcher to check on a top passenger aircraft. The Cockroach Catcher is of the opinion that despite the rhetoric, no SoS would put a doctor there. 

Why? A doctor might, just might have a heart.

The Case: The Guardian 7 June 2011

A coroner has criticised hospital staff in Cumbria over a succession of missed opportunities to treat a newborn baby for an infection that later killed him.
Joshua Titcombe died at nine days old from a common infection that could have been cured by antibiotics after medical staff repeatedly ignored his parents' fears for his health and told them "not to worry".
Ian Smith, the Cumbria south and east coroner, said Joshua died of natural causes, but cited a number of failures by the hospital in relation to his care.
They included failing to recognise the symptoms of an infection, failure to act on those symptoms, failure to listen to the couple's concerns, inaccuracies in records made by staff, a lack of record keeping, an absence of continuity of care and a lack of special training for midwives on the postnatal ward.

The coroner also found a "strained and dysfunctional" relationship between midwives and paediatricians.
Smith said he believed 11 midwives at the hospital - all of whom gave evidence at the inquest - had colluded to cover up knowledge that low temperature is a common sign of infection. He said "incriminating" notes containing observations about baby Joshua's condition may have been deliberately destroyed.
The inquest heard there was an 80% chance Joshua would have survived if antibiotics had been administered in the hours after he was delivered. He was transferred by air for emergency care after he became seriously ill at Furness hospital in Barrow, and died in November 2008.
Joshua's father, James Titcombe, said he and his wife, Hoa, had urged staff at the hospital to treat their son with antibiotics, but were told he seemed well and did not need to see a doctor. He said they were told a paediatrician was "too busy" to deal with them.
Titcombe said: "The day after he was born I had come to take my wife and baby home when they found him not breathing well. It was a horrific shock. They told us he had a problem with his heart, then with his oesophagus. All the time I just suspected he had the same infection as his mother."
The baby was transferred to a paediatric centre in Manchester and then to a hospital in Newcastle for specialist treatment. Consulants there said his problem was an untreated pneumococcus infection, the same condition as his mother.

One should perhaps ask the question: who put the head of CQC there and who is there now. Certainly not a doctor.

In the new world of doctoring, money comes into it and with that many doctors are losing their hearts. But we did have the infra structure to preserve it.

It would be such an irony if the new SoS be drawn in and become the unlikely and perhaps unwilling hero that Bevan used to save his NHS: a sort of reverse curse.

The Guardian:

Jeremy Hunt has said the Care Quality Commission's alleged cover-up of failings at a Cumbria hospital are shocking, and he will back appropriate action against those responsible "absolutely to the hilt".
 The health secretary told BBC Radio 4's Today programme: "These are very, very serious allegations and they should have very, very serious consequences if they are proved. "I know the CQC are looking into disciplinary procedures and what can be done: what sanctions are available; whether you can have forfeiture of pensions, all those things. There has to be due process, but … it is totally appalling that this kind of thing should happen." Hunt said such failings damaged the NHS and undermined "the millions of doctors and nurses who do an amazing job day in, day out". The health secretary also acknowledged serious systemic flaws with how the CQC was set up in 2009, saying it was wrong to have the same regulator charged with both identifying and rectifying problems. He said the CQC's "generalist" system meant that the same inspector would visit such different facilities as a dental practice, a GP surgery, a hospital and a care home.  

This is from one of my earliest posts:

In my book The Cockroach Catcher, I wrote:
“… in this cutting edge work everything counts and the trust and respect of your patient and his or her parents is of paramount importance, just like the trust and respect my parents used to have for the Chinese doctor that they used to take me to.”
When I was growing up, the Traditional Chinese Doctor was possibly the most respected person a child was ever going to meet. More so than his teacher, grand-father, or father. That was the pecking order of respect.

In the unfortunate event of a child having a fever and needing to visit a doctor, he would be taken to the consulting room of a Traditional Chinese Doctor. The room was generally sparsely equipped, with a redwood consulting desk in the middle, set with some calligraphy brushes, an ink well and Chinese rice paper. On the wall behind the doctor you could expect a giant calligraphy piece extolling his skills – literally translated as “kind heart, kind skills”. On another wall there would perhaps be a Chinese water-colour with a theme relating to doctoring. Doctors were said to have the “heart of a parent”.

This is a Chinese painting that used to hang in my consulting room. The Chinese characters can be translated as "the warmth of spring in almond groves". In the Chinese tradition, "almond groves" signify medicine, originating from a Chinese legend of a doctor who lived in the Three Kingdoms era. Instead of paying him, his patients were asked to plant almond trees, five for a serious illness cured, and one for a minor ailment and so on. Both the painter and calligrapher were leading figures in the literary/art world of their times.

The doctor himself usually had a solemn and yet kind look and wore a traditional Chinese costume. No, the mother did not have to tell him anything. All he had to do was to check the child’s pulse and his tongue. There would be no listening to the chest, or any other examination, and definitely no X-ray or ECG.The respected doctor would write his prescription of around ten to twelve medicinal herbs. 

The mother would thank him and then get the prescription from the Herbal Counter outside his consulting room. Each herb would be carefully weighed and individually wrapped in paper. Back home, the herb mixture would be boiled in water in special pots. Generally three bowls of liquid had to be reduced to eight tenth of a bowl. During the boiling process the pungent stench could be smelt from a block away. The sick child who was kept in his bed could certainly smell it. I always thought that was part of the treatment. 

A black bitter tasting liquid would eventually be presented to the sick child. How we ever managed to down these potions I was never quite sure. The one possible inducement could be the two preserved plums at the end, given as a sort of reward for the child who managed to drink the full portion. These preserved plums came from the Herbal Counter with the medicinal herbs.

One thing was for sure. Children did not fake illness. Not often anyway unless they wanted to drink that black potion.

In my first ever visit to Beijing, one member of our tour group consulted a famous Traditional Chinese Doctor in the Capital City. Seeing that I was a doctor myself, he told me what happened. He was in awe. He really was. The doctor only checked his pulse and looked at his tongue. Then he told him he had gall bladder problem. My new found friend pulled out some X-ray films from his doctor in Reunion Island. There were gall stones.
I too was impressed.

Alas, I fear that the respect for and trust in doctors in today’s world is waning fast. In my book, I wrote:

“…. Those were the days when doctors in U.K. were amongst the top three most respected professions and Members of Parliament shared the bottom ranking with Estate Agents.

The doctor’s position had over the last ten years moved nearer the bottom end with no such counter moves by Politicians….”

I would love to hear from any reader who disagrees.

18 July 2013

Health regulator bosses accused of covering-up a review of baby deaths will not face a police inquiry.
The Care Quality Commission (CQC) will not be investigated for failings noted in an independent report that suggested an internal review had been suppressed.
The review highlighted the CQC's failure to investigate a spate of baby deaths at Furness General Hospital.

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