Saturday, April 9, 2016

Best Views & Advice:FREE!










All photos©Am Ang Zhang 2016

The best advice is often free. Yet our government would prefer to spend millions (or was it billions) to buy them from people whose only motive is to get the easiest money they can lay their hands on: government money. Just look at Greece. Here in the UK, despite the fact that we have failures like Metronet, we still have other PPP/PFI projects.

We might get new hospitals that look like airport lounges but what about the doctors and nurses when we cannot afford them. Or are these places only there to house the ever increasing numbers of managers. What about the patients? Patients, did you say?

One Professor of Medicine was giving out his free advice in the Times: 
Scalpel! This NHS red tape needs removing
The internal market has been a costly disaster. Let the professionals manage medicine
Jonathan Waxman
This may sound familiar to those of us that were brought up the old fashion way in Medicine:

“……When I started in medicine, the hospital was run by about three people. Things were so much more simple when doctors and nurses treated patients, doing their best without the guidance of guidelines and targets, doing their best ... yes ... to make the patients better. How did we manage without forms to fill and waiting times compliance? Quite well actually. The medical director ran the medical side of things while matron and the accountant handled the rest.”

“It wasn’t much of a business then: it didn’t have to be, because there was no internal market to manage.”

“The internal market ……..has wreaked havoc. It has spawned a nation of administrators, here today and gone to another post tomorrow — while doing nothing to bring costs under control.”

“There are savings to be made. It is alleged that there are just 75,000 administrators at work in the NHS but this figure is laughably mythological. Doctors and nurses know that there are many more than this. They look around and see the numbers increasing.”

“One report by the Centre for Policy Studies published in 2003 indicated that there were 250,000 administrative staff employed in the NHS: at least one administrator for every nurse. In recent times the rate of increase of admin staff within the NHS has exceeded that of nursing staff.”

“……The principle of care for all from cradle to grave is worthy and wonderful. But the current reality is a cradle rocked by accountants who are incapable of even counting the number of times that they have rocked it……..” These are the very same people we pay market rate or they will go elsewhere!!!

“……Over the years politicians have made dramatic changes to the way that the NHS has been run. Recent changes have caused fragmentation and not led to any cost saving……”

“Moving patients from one place to another does not save the nation’s money, though it might save a local hospital some dosh.”

I have personally experienced a Trust buying a house for a family to move them to a neighbouring Trust.

It is still the same NHS paying for the care but the CEO of one trust will get more bonus.

“……So the internal market has failed because it does not consider the health of the nation as a whole, merely the finances of a single hospital department, a local hospital or GP practice…….”

Here is the advice:

“……Let us go back to the old discipline of the NHS. Let the professionals manage medicine, empower the professionals, the doctors and nurses and shove the internal market in the bin and screw down the lid…….”

Professor Jonathan Waxman is a consultant oncologist and he is unlikely to be joining Lord Mandelson.


Photography : Best & Free!
Photography: Bokeh & Multiple Night Shots!
Photography: Spring Tulips.
Photography: Pictures at an Exhibition
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Wednesday, April 6, 2016

Anorexia Nervosa: Let Her Die!



A reprint:

©2016 Am Ang Zhang 

Can a patient be allowed to die? 
Can a seventeen year old patient be allowed to die?
Can a seventeen year old Anorexia Nervosa patient be allowed to die?

Are we not supposed to save lives?

Could doctors be held to ransom? By?

Here is a Play: Let Her Die!

The Players:

The parents:
Father used to run a business security agency specialising in industrial counter espionage. Or was it espionage? I cannot be sure.

Too often there is this bizarre desire by some parents to make sure that if they cannot do it, no one else should either. We need to recognise it early enough. We are doomed otherwise, and so is the patient.

The patient: Nicola
It was really quite painful to sit there and talk to someone who looked worse than the worst they showed from Auswitz. Why could Nicola not realise that if she wanted any man to like her she would need to look a lot better, which involved doubling her weight for starters.

The Doctors:
Dr Hillman:

This was a family given up even by Dr Hillman, my most fervent supporter of family therapy. Father used to run a business security agency specialising in industrial counter espionage. Or was it espionage? I cannot be sure.

The Consultant:
        I did not go round looking like a hippie or pretending that I liked the music the teenagers listened to. I told them to me it was trash. I did not pierce my ear or have a tattoo. I certainly did not wear trainers to work.
       
        In short, you do not have to gain respect by becoming like them or worse, by pretending that you are like them.

The Experts:

Salvador Minuchin & Jay Haley
I spent one session with them and agreed with Dr Hillman. They were good. We looked like a bunch of amateurs dealing with professionals. None of the family therapy tricks work, Minuchin or Haley.
        Impenetrable!

The NHS Trust & GMC

To me, suspension on full pay is a risk every doctor takes nowadays, as the basis is no longer limited to bad practice. It is no longer a reflection on whether you are good or bad clinically. Many psychiatrists are no longer prepared to use techniques that might upset their patients or parents of their patients.

The Main Action:

A family meeting was called and it lasted only a few minutes.
          I was in top form.

          “Nicola has been eating but after two months has not put on any weight. I cannot see any reason for her to continue to stay here. She might as well do the eating at home. She can then sort out for herself why she is not gaining weight without the pressure from us.”
          I tried to put it in the calmest way possible.
          “You mean you will let her die?” Father sounded a bit annoyed.

        With that father got up and left the room without saying another word.

          “What do I do now? You have upset him!” said mother.
          Good, something got to him at last, but I did not say it.
         
Nicola gave a wry smile to me as if to say, “You found me out.”
          She turned to mum, “Let’s pack and leave this dump.”
          We all kept still.
         
Six months later, one of the nurses bumped into Nicola in a nearby town. She was kicked out by father and moved in with another ex-anorectic. She was with a boy friend. More importantly she was wearing a very sexy dress to show off her then very good figure.
          She did not die.

                                           Based on an extract from my book The Cockroach Catcher

Other Posts:
Anorexia Nervosa: Bach
Anorexia Nervosa: What If!
Anorexia Nervosa: a cult?
Anorexia Nervosa: Chirac & Faustian Pact

A Brief History of Time: Anorexia Nervosa

Review on Amazon
Readers' views.
The Cockroach Catcher on Amazon Kindle UK, Amazon Kindle US
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2 comments:

Dr No said...
CC - Dr No rather suspected that if you didn't turn up and comment on badmed, then you were probably doing a post of your own!

Dr No reads the moral of your post as less is more, ie the more doctors try to control patients (admission, section, forced feeding), the more the patient resists. Do the opposite (patient can go home, even die if the want to) and the patient still resists - in Nicola's case by gaining weight...even if she did do so rather rapidly...and, of course, having a spook for a dad is enough to put anyone on edge...

E's case (the one recently in the news) is very different. She was almost twice N's age, very different family by the sound of things, significant co-morbdities and a long history of failed forced feeding attempts (albeit with one early success). She was, if such a concept is meaningful, in end-stage anorexia nervosa.

Can a patient be allowed to die? Yes - we do it all the time.

Can a seventeen year old patient be allowed to die? Yes - we reluctantly and with great sadness do it from time to time.

Can a seventeen year old Anorexia Nervosa patient be allowed to die? Not if we can possibly help it. But anorexia nervosa is truly pernicious illness, and sometimes it defeats us all - although usually a bit later in the patient's life.

Would Dr No have discharged Nicola as you did? Almost certainly, and probably for the same reasons! 
June 19, 2012 4:25 AM
Cockroach Catcher said...
It is perhaps The Cockroach Catcher's own experience with young Anorexia Nervosa Patients that has coloured his views. There is in him a genuine feeling that doctors should be allowed to doctor pure and simple and in that sense he feels that psychiatrists should be doctors too, real doctors.

Remember the early days of treating phobia when bus loads of phobic patient from none other than the Maudsley were taken to Piccadilly Circus and dumped there. It was known as implosion therapy. then later suicidal patients were given the sharpest razor blades so that they can get on with it.

In Psychiatry, the best treatment is without doubt Placebos. But placebos only works if neither the patient nor the parents knew.

In reading DN's blog I reposted my patient where I let her die.

Well, did I or was that part of Haley/Minuchin treatment? You can decide.

No the early day psychiatrists did not mean harm to come to the Picadilly or Razor patients, but when non-doctors are involved, good luck to the said patients.

Perhaps DN;s patients was of Millennium Trilogy quality and ooops, what was the state doing?

Please let the real doctors or better still the real psychiatrist get on with their real work, if only they are allowed to remember how to give all the guidelines floating around.

The Cockroach Catcher retired partly because he sensed he would not be allowed to carry on his own doctoring ways. 
June 19, 2012 5:29 PM
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Friday, April 1, 2016

NYBG: Orchids Show!











New York Botanic Garden©2016 Am Ang Zhang 


Orchid Show: Youtube.

Book I am reading:

Natalie Angier: The Canon

THE CANON is vital reading for anyone who wants to understand the great issues of our time—from stem cells and bird flu to evolution and global warming. And it's for every parent who has ever panicked when a child asked how the earth was formed or how electricity works. Angier's sparkling prose and memorable metaphors bring the science to life, reigniting our own childhood delight in discovering how the world works. "Of course you should know about science," writes Angier, "for the same reason Dr. Seuss counsels his readers to sing with a Ying or play Ring the Gack: These things are fun and fun is good."

THE CANON is a joyride through the major scientific disciplines: physics, chemistry, biology, geology, and astronomy. Along the way, we learn what's actually happening when our ice cream melts or our coffee gets cold, what our liver cells do when we eat a caramel, why the horse reveals evolution at work, and how we're all made of stardust. It's Lewis Carroll meets Lewis Thomas—a book that will enrapture, inspire, and enlighten.

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Sunday, March 27, 2016

Hello Spring 2016: Brooklyn Botanical Garden

House M.D. : Canon 5D Mk II


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Friday, March 25, 2016

Passion and Easter

First posted March 10, 2008

Passiflora alata

In the early 1600s, a Jesuit priest came across a Passion flower in South America and was taken by its complexity and beauty. That night he had a vision, so the story went, that the flower's trio of stigma resembled the three nails used in the crucifixion; the stamens represented the wounds; the spiky purple crown above the petals, the crown of thorns; and the tendrils of the plant were the scourges. The name was a direct reference to the Passion of Christ. I find it peculiar that the plant has been found in the wild in every continent except Europe and Antarctica.

In England the Victorians loved it and then fell out of love with it. Now it is making a comeback possibly due to the fruits’ popularity in modern gourmet cooking. 

There are many varieties and some are edible. Of the edible kind there are two big groups, the one with the dark skin one and the one with the yellow skin.

The plant itself, from the stem to the leaves and the flowers, have been used by South American natives for various medicinal purposes, none currently approved by the F.D.A.




The fruit has some of the most concentrated fragrance of any fruit species. The charm is in its acidity which enhances the intense flavour and natural sweetness. With fine vanilla ice-cream it is a delight. It can be used as a topping for many desserts and famously for Pavlova. It is made into soft drinks and is often used in tropical cocktails. The golden variety is best eaten fresh and the dark skin ones can be left to mature as the flavour intensifies further.

With the golden to near blood red seeds, the fruit qualifies as a colourful non-green fruit, with all the necessary anti-oxidants. To me it is just flavoursome.


The other passion of course is Bach’s St Matthew’s Passion, appropriate for this time of the year. The biologist Lewis Thomas when asked what message he would send to aliens famously said: “……Bach, all of Bach……”. Richard Dawkins picked it as one of his eight desert island discs. Now you know.

On the Easter music note, it is perhaps appropriate to mention Mahler’s Second Symphony: The Resurrection. The text of the music made no biblical reference and it was Mahler’s very personal view of life and his life was full of tragedies and suffering, with the premature deaths of his siblings and daughter, and his own heart disease. There has not been a greater composer to emerge since his death. 

Also:

The Guardian:
Why we are shutting children out of classical music.
April 2, 2009 Tom ServiceTom Service is a 33-year-old classical music critic. For 25 years of concert-going he found himself to be amongst the youngest in the audience.

But there is something else that is strange:
“I've noticed that bus and train stations now pipe canned classical music, day-in, day-out, through their speakers as a way of stopping young people hanging around. So toxic have the associations become, that this experiment actually works: there is evidence that playing Beethoven and Mahler has reduced antisocial behaviour on the transport network.”
He went on:

“An entire generation, aged between 10 and 30, seems radically disenfranchised from classical music. How, and when, did this happen?”
Then in Finland:

“A couple of years ago, I saw a class of seven-year-olds in Helsinki enthusiastically learning Finnish and maths by performing sophisticated little songs with astonishing tuning and rhythm. And this wasn't a music school - just a typical Finnish state primary. Finland only developed its curriculum in the postwar period, but it works: today, the Finns are classical music world-beaters, and their education system has produced more great instrumentalists, conductors and composers per capita than any other country on earth.”

Esa-Pekka Salonen is of course the Principal Conductor of the Los Angeles Philharmonic Orchestra and Finland’s most famous music export in recent times.
I was at a concert recently and a large numbers of players in the orchestra were Koreans. Well apart from steel and TV and cars, the Koreans are now into golf and music in a big way. The LPGA is certainly dominated by Koreans. Could it be that music gave them the edge in golf as well, not just the chopsticks?

Tom again:

“Here is a ready-made answer to the problems of renewing classical music's role in society. Make them statutory requirements for every local authority, and give them the responsibility for rebuilding the network of classical musical possibility that used to resound throughout the country.”

And perhaps throw in golf for good measure.

It was in 1990 that American troops played deafening pop and heavy metal music day and night outside the Vatican Mission to Panama City that Noriega surrendered.

In future, this strategy might have to be changed, Beethoven, Mahler and God forbid even Bach.

Tom Service’s last words:

“We've already lost one generation - we can't afford to lose another.”




Easter Passion: Bach, Beethoven and Mahler
Walnuts & Music: Mozart & Mahjong
The Cockroach Catcher: Berlin Wall, Appassionata & The Lives Of Others
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