GRUMBLE TRYING HARD NOT TO GET RUMBLED
Unsuccessfully.
Look
He’s locked himself up.
Maybe he needs peace to meditate again.
Maybe he’s about to write something really, really, controversial.
Maybe he’s in hiding.
Maybe next time it’s The Tower of London.
Try and find a spell that will open the door, My Black Cat.
a red apple ……………………
Categories:
Dr Grumble has indeed been rumbled in that it has proved possible to work out who he is. In the early days of his blog Dr Grumble put in far too many details that identified him. People who know him recognised him quickly and one reader who has never met him worked out who he was. His students quickly discovered him and told some quite senior nurses. At least four senior people in the hospital where he works know who Dr Grumble is. Dr Grumble realised that the blog needed to end and he planned to just stop at the end of 2007 without any announcement. He did this not to cause concern but avoid any discussions about whether or not he should stop - since his mind was made up that this was the only safe thing to do.
By the way Mrs Grumble likes your picture of Dr Grumble.
Keep at it Witch Doctor. This blogging thing is quite healthy for society but there are potential risks to individuals so be careful.
Happy New Year to you and the Black Cat.
By: Dr Grumble on January 4, 2008
at 8:30 am
I was wondering too! I will definately miss my daily visit to your site Dr G, the blogsphere won’t be the same without you 
Who’s gonna get the news ‘others can not reach’ now good Dr G?!
However, your peace of mind is much more important so, all the best to you and Mrs G and hope to ’see’ you again sometime 
By: Sam on January 4, 2008
at 7:49 pm
Well, Dr Grumble, My Black Cat and I will both miss you, but perhaps this is as good time as any, for you to note down lots and lots of secret NHS observations.
The Witch Doctor seems to remember you saying you are a rather ancient doctor (centuries younger than The Witch Doctor, of course). That being the case, maybe you’ll rise like a phoenix as pension time is nigh and bombard society with your pensive observations once more.
They wouldn’t dare threaten you with the Tower of London then.
What a powerful force that would be.
Wouldn’t it, My Black Cat?
And if you do end up in the tower, you’ll find us all waiting there for you with the kettle on.
Wonder if that’s where Dr Crippen is hiding, My Black Cat……..
By: witchdoctor on January 4, 2008
at 9:30 pm
Notice witch doctor, Mrs G likes your picture of Dr G! Why? Maybe because you are psychic? Maybe because it really looks like him? In which case, Dr G is sort of a quite man, not very tall, not very thin but not very fat, has a ‘dark’ beard and a pair of glasses … not that old but not that young … fifty something .. early .. maybe? Or, was it the nose .. maybe? IMO, a combination of all is most likely … 
Am I right Mrs G?
By: Sam on January 4, 2008
at 11:13 pm
Hello Sam,
This “psychic” witch is sure Dr Grumble is a quiet contemplative sort of doctor. I don’t think the T-shirt is Dr Grumble though! His thoughts and observations will be sorely missed on the Medical Blogosphere.
My Black Cat thinks the Blogosphere needs more senior doctors - consultants and GPs. They are slightly less vulnerable to threatening advances by their masters if they are “discovered.”
But Dr Grumble is right. It is very easy to let things slip in so that a blogger is recognised. Medicine is really quite a small world. This is one of the reasons that My Black Cat and I talk such gibberish and throw in so many red herrings at times!
By: witchdoctor on January 5, 2008
at 2:51 pm
Mrs G doesn’t read blogs, Sam, so you won’t get a reply from her. She did however see the picture of Dr Grumble and expressed her approval. And only today she has passed on some ‘complaints’ from her colleagues about the end of the Grumble blog. To Mrs Grumble’s colleagues and others who miss the blog I apologise.
A strong UK medical presence in the blogosphere is healthy and important. It worries me quite a lot that most doctors do not seem comfortable to express their honestly held views about their concerns for the NHS in anything other than a whisper to close colleagues. Although I have frequently pointed out that I am not a manager, there was a time in my life when I read a few management books and I remember learning about staff in organizations only telling the most senior people what they wanted to hear. This is potentially very dangerous for organisations as those in charge will just get reassurance even if the organization is heading towards catastrophe.
My own feeling is that the NHS by a process of piecemeal privatisation is feeling its way to a rather worse system than we have at present. The view is being put about that governments can’t run anything, that private organizations do things better and that anybody who thinks otherwise is a dinosaur. Big US and other businesses have a strong interest in propagating such views and almost certainly spend considerable sums lobbying to ensure their views are in the ascendancy. But this may well not be in the interests of our patients and we need the bloggers out there to ensure that the counter arguments are at least aired.
Oh dear, I can’t stop. Somebody did comment that I am addicted to blogging. That was another reason why I decided to stop.
By the way consultants are not as all powerful or invincible as they may seem.
By: Dr Grumble on January 5, 2008
at 3:33 pm
Thanks for passing by again, Dr Grumble.
The Witch Doctor too has observed medical staff in particular giving inappropriate reassurance to managment and, in a way, is rather intrigued by the phenomen. In fact, this is the reason why The Witch Doctor felt MTAS was unbelievable - the whole concept was so ridiculous it should have been stopped in its tracks by the medical profession - not at the endstage by the juniors, but in it’s infancy by the seniors. The fact it was not, is probably worth a PhD or MD thesis in its own right! Maybe a medical historian with a bit of a background in psychology will analyse it all one day.
It seems to me that the “MTAS effect” is happening in other areas too e.g the privatisation of the NHS, doctors being “put down” at every opportunity, others groups defining the role of doctors for them. But always, there are senior doctors around ratifying what is being done, as there must have been with MTAS regardless of what is being said now.
The Witch Doctor really does believe the GP’s and consultants do have enormous power to change things, but the phenomenon above is what gets in the way.
And, The Witch Doctor has a theory about the deep rooted cause of this phenomenon within the medical profession - but it’s probably wrong.
Yes, My Black Cat, I think we’ll introduce “The MTAS Effect” as a Blue Bottle Spell - see if you can find a decent committee we can visit so we can initiate it!
By: witchdoctor on January 5, 2008
at 8:24 pm
Most consultants and GPs are preoccupied with their clinical work - in other words looking after their patients and the day-to-day problems related to that. GPs find it difficult to leave their practices to work on anything else. If they do they must pay for a locum. The academics are mostly busy climbing academic ladders. Some of Dr Grumble’s academic colleagues are on short-term contracts and feel very vulnerable. The others are more interested in their status within their global expert community rather than parochial matters. Those relatively few doctors climbing managerial ladders see their role as toeing the line and are largely sidelined by the professional managers that find doctors threatening. It’s been claimed that some doctors within the BMA are looking to a future elsewhere and are minded to facilitate the wishes of government. Certainly some individuals who have been criticised have gone on to work for government bodies. The Colleges were seen by government as being powerful pressure groups though I think that in reality they currently have interests more related to protecting professionalism than anything else. And as far as professionalism was concerned, a major interest of the Colleges was in the training and examination of doctors. They did this largely off their own bats with resources partly provided by their members and from exam fees. They did the job so well that doctors came from all over the world to train in the UK and to do the UK exams. But the government wanted none of this and created PMETB to do a job that was already being done extremely well.
Of course senior members of the profession must take responsibility for this but there is quite a lot of evidence that those with the real power were not minded to listen to the profession and the whole intention was not to take any notice of the views of organizations like the Colleges. Now that the views of the profession have been genuinely sought it’s clear that many think that the traditional system we had before was not all bad. Incidentally I was told repeatedly that that MMC with the escalator to a consultant post was ‘what all the juniors wanted’. Of course it was. Every junior would like to be given a job in one part of the country which would train them to consultant/GP standard without their ever having to reapply for a post. But it was always obvious to me that that could never happen without either doctors failing to get on the bottom of the training ladder or reaching the top with no job to go to. The biggest problem of all underlying this was the idea that we should achieve self-sufficiency in the supply of doctors. This might have been alright but for the fact that foreign doctors still want to come and work here and many are already here.
As far as the privatization of the NHS is concerned I do not see either the medical profession or the public being much involved in any of this. There are not even any discussions on the topic at my level. Most people’s contact with the NHS is with their GP and where satisfaction levels run at over 90% while for hospitals it is 80%. That surely is not too bad. So why is the government always telling us how bad the NHS is? Do you know the answer Witch Doctor? Perhaps your cat can help?
By: Dr Grumble on January 5, 2008
at 11:03 pm
The Witch Doctor cannot give any firm answers without the help of The Book of Spells. The spell for this has not yet been perfected. My Black Cat, however, has very definite views on why the government is telling the public that the NHS is bad. She often chases her tail with her reasoning processes, or more often she doesn’t reason at all. So anyone listening to My Black Cat must always take her deficiencies into account.
Anyway, this is what she says.
She says since almost all voters are patients, employees, or close relative of patients or employees within the NHS, governments know they can win or lose elections solely on what they do with the NHS. Therefore they must be very careful.
My Black Cat is of the opinion that the government considers a degree of privatization is preferable to a degree of explicit rationing.
Governments have to change the public’s perception first, before they can change anything in this regard. The public must be made to believe that the government is listening to them and acting on their behalf (hence the promotion of citizens juries, for example). The public must be made to believe that GP’s are too lazy to get up at night, that hospital consultants have been given a very generous pay-rise and then cut back on their work, and they have to be whipped by a caring government to get waiting lists down, wash their hands and cut off their ties to stop the spread of MRSA etc etc. No real discussion of privatization yet - just marketing the suggestion that, for some things, the grass might be greener on the other side.
She thinks the other side with green, green grass is the private sector, still in the wings. Ready to pick up the care of the worried well, some of the less demanding chronic sick, some routine procedures that are unlikely to have long term sequellae, screening, some alternative therapy, all paid for, initially, by the NHS but ultimately, from the patients’ pockets or private insurance. The relatively wealthy aging baby-boomers might, for example, be a huge source of income for investors in global healthcare companies. They will be wooed by attractive surroundings and staff well trained in customer service. For those who do not use the private sector then various NHS teams of HCW will operate – some excellent, some good, some bad and some non-existent. And there will be “expert” patients.
So, My Black Cat thinks that by emphasizing the negative sides of the NHS, the electorate is being primed. And soon a groundswell of the electorate will demand private health care. At that stage, she thinks privatization will be talked about but the voters will be prepared and will want it. Then the NHS will be partially dismantled. But it will be what the voters want.
By: witchdoctor on January 6, 2008
at 1:56 am
Hi Witch doctor and Dr G
This type of debate between you above should have taken place long time ago, between all of you, pre Nu Labour and NHS plan 2000, MMC, MTAS, agenda for this and agenda for that .. but it hasn’t because, for some reason doctors do not communicate and their representative do not communicate either, no known leader/s .. etc. This is why you were all caught and attacked while sleeping with your books and caring for your patients. You now know that you have been tricked and want to do something but unless you ‘collectively’ fight this attack, the attack will continue until you are all no more than any other ‘health care professional’ in standing and remuneration. Your profession is, at the moment, really the best in the world and you have the privilege of being its members, you can’t afford not to be politically involved again .. so, fight for your rights.
As for me, if anybody had told me, only a year ago, that I would be ‘blogging’ about post graduate medical education in Britain .. I would have laughed at them, still find bizarre most of the time and promise myself I will leave the blogsphere tomorrow, but then something else happens and I don’t! … that said, what do I know about medicine to write about medical education, no less? Nothing, apart from always wanting to be a doctor when I was younger but never made it .. I know nothing at all .. and still don’t, ignoramus! But with two children now junior doctors and a medic graduating in two years time, the stakes are too high, hence, my presence and thank you for having me amongst you… By the way, I had no idea what a blog was until I found yours last year through the Remedy forum Dr G .. so you see, you taught me a lot .. .. and I learn all the time from reading yours and Witch doctor’s blog and other stuff of course. See, the blogsphere needs YOU, in so many ways Dr G .. I also hear that your children are medics too, so for you, it’s about you, your family, your NHS, your patients .. everything. Take sometime off, then open up shop again because, you can’t affect change without participating … Come back after a while, maybe in a new life if you must or if you want to remain anonymous …
I sincerely hope you are addicted to blogging and that you will not be cured … don’t give him any of your potions or concoctions now Witchdoctor .. please ..
… ‘I put a spell on you’ .. I like this song …
By: Sam on January 6, 2008
at 4:46 am
I don’t know, Sam, whether the Grumble blog influenced anything but I am glad if it helped you understand how things are. Recently I found it frustrating to criticise CMO about his probably daft idea to fine hospitals for infections and then see David Cameron pick up CMO’s idea (as if it was his own). It was some time before either were challenged. The blog has really opened my eyes to how easy it is to spoon-feed lazy gullible journalists who don’t even pick up the phone to get a critique from anybody. And for that matter my eyes were opened to how lazy the politicians of all hues are in failing to think anything through beyond the initial soundbite. The trouble is that both major parties seem to have the same silly ideas. Now why is this? That is the key question that is connected with the one put to the Black Cat. Why does the government (as well as the opposition) talk down the NHS? As the Witch Doctor’s cat said it can only be to prepare the ground for the secret plan. How do I know there is a secret plan? I know only from the language they use. Words like plurality and contestability must be words intended to obfuscate. They surely have to mean privatisation or at least something similar.
Back to the question. Why is the government talking down the NHS? Why does it want to change an NHS that the public are happy with even if the government keep saying that they are not? And why do the Conservatives seem to have the same misguided ideas? Where could these ideas be coming from? I am not sure that the Black Cat has quite got there. You need to think who could possibly want to privatise the NHS. It isn’t the public. It isn’t the doctors or other NHS staff. So why can it be that politicians want it?
One of the cleverest things is to sell people things they don’t need and don’t even want. You can do this with the most amazing things. For example in this country we have wholesome running water everywhere. Years ago if you felt thirsty you got a drink from a tap. Now everywhere you look you see people swigging water from plastic bottles. They have even put a little teat on them so that Dr Grumble’s students take little sips in the middle of tutorials like babies with a bottle. This water costs more than petrol. People have the impression that they need to drink set amounts of this stuff (which is no cleaner than the liquid that comes out of a tap and in tests can be indistinguishable) to stay healthy. Dr Grumble has always known this to be essentially nonsense but the concept has only recently officially been debunked in the BMJ this Christmas. Where did our young people get this idea? Why do Dr Grumble’s children waste the money he gives them on extortionately expensive bottles of water, water that comes out of the Grumble tap for free? The answer is related to very clever manipulation of people’s thinking. Some years back there were several articles (not adverts) in the newspapers about how everybody needed to drink lots of water to keep healthy. Dr Grumble realised at the time that they were largely nonsense. Now how did those articles get there? He knows now because he has helped companies get articles on other topics into the papers. I did a post once predicting a spate of newspaper articles on a particular topic. That was because I knew that there was a company working on this. There’s a big industry out there doing this sort of thing.
So having told you that you can persuade people to think (as most people now seem to) that you need to sip water all day and pay for it more than you pay for petrol even though you can get it free from a tap, why do you think those in charge want to alter the NHS when patients are essentially rather happy with it and there are lobby groups in the US that seem to think it is the sort of system they should be aiming for? What one group can possibly benefit from privatisation? It isn’t easy to find the answer to this. Mrs Grumble is insistent that I do not tell you who is behind all of this because I have no evidence. The other problem you will find is that if you look for private companies behind this you may not find them. You may find a non-profit organisation and that will put you off your guard. It’s designed to. Some articles selling these new ideas have the word non-profit in the first sentence. It’s disingenuous. You need to stand back and think about where the profit is being made.
Take a look at this:
http://ducknetweb.blogspot.com/2007/09/allyson-pollock-on-what-michael-moore.html
and keep an eye on the NHS Beacon sites.
Dr Grumble’s children are oblivious to what lies ahead. Medical students generally are. They worry only about their next set of exams. They naively think that all they have to do is qualify and then everything will be OK. The world we live in is tough. It always has been. It always will be. Some of the aims of MMC were a pipe dream. Expectations were raised that could never have been met and that has added to the problems. Dr Grumble’s father was a gynaecologist. It was not his first choice career. He had medical friends around the globe who left the UK because they could not get work. Yet at the same time our hospitals were full of foreign graduates. Little has changed. There have been good times but I myself struck a bad one.
By the way, Sam, I hardly knew what a blog was either. One day I just pressed the button to see how easy it was to create a blog and that is how Dr Grumble started. It’s not the right way to do it but I did not know then how it would get a life of its own – at least in my mind. As you have found it is not so difficult to blog. There are many out there with the same views as Dr Grumble. They too should tell the world where our health service is heading. I am not sure that British medical blogging is as vibrant as it should be given the crossroads that our health service is at. Part of the problem is that every senior doctor I speak to seems to think similarly but thinks that at the crossroads there is a no left turn sign and the road ahead is closed. In other words whatever we say will make no difference at all and we are going to have to turn right. Doctors have been neutered; nobody listens to them. Fortunately the public do not yet seem to have been taken in by the various blandishments.
By: Dr Grumble on January 6, 2008
at 11:53 am
Thank you both for commenting.
Sam, I don’t think the medical profession had the remotest idea what was going on at the turn of the century re the NHS plan. All of this was compartmentalized, and those medics involved in change only were aware of their own small area. Some stumbled across a trunk, a leg, a tail and so on but that was all. If they had been told at that time there was a huge elephant beside them they simply would not have believed it. It was too bizarre, and it would have pointed to a conspiracy rather than incompetence. Medics in general see incompetence. They are uncomfortable with the possibility of a conspiracy and tend to sweep this idea under the carpet.
MTAS did not ring any bells. Even now most medics see MTAS/MMC as isolated from the rest of the NHS plan and I suspect most junior doctors do too. Their main concern, understandably, is where and when their next job will materialize.
I see MTAS in the same way as Dr Grumble sees bottled water. Even if doctors were too busy with their day to day commitments to grasp the whole concept, there were doctors sitting on training committees with protected time for this not grasping the nettle. They could have said “No. We are not going along with this.” They didn’t. Perhaps they were trying to be seen to be “reasonable.” Committees like agreeable, reasonable people and doctors try to see a problem from all sides. Other “less important” members of the medical profession were being wheeled into roadshows to be “upskilled” in selection processes. A process, that a visiting alien with a fresh mind would have immediately recognized would not have worked. All it needed was for some of these people being trained to be “upskilled selectors” to say, loudly “No. I’m off. This is crap. This is why it’s crap. I’m not doing it.” Eventually the Birmingham surgeons did this at the 11th hour. Others could have done it earlier.
Dr Grumble’s reference to bottled water is very symbolic. The power of marketing. The Witch Doctor uses the word “creep” a lot to describe the phenomenon where sensible people can be made to do crazy things. “Creep” has enormous capabilities for good, bad and downright evil. The darker side of “Creep” terrifies The Witch Doctor, because every one of us is capable of creeping in the wrong direction. Indeed this could be considered the reason for this blog. It is not an intellectual blog. It is a “drip, drip, drip” kind of blog to try to make individuals recognize for themselves the creep going on round about them and hopefully even address their own creep.
Yes. Kaiser Permenante markets itself well as a “non-profit” organization but the “Permenante” component is “for-profit.” Already there are similarities in the UK. We can see the “non-profit” NHS engaging with its “for-profit partners.” Some of these are not even involved directly in health care at all but are siphoning off NHS money in order to do dubious things like organize 360 degree appraisal for NHS staff or train them to become “upskilled selectors” etc etc. Goodness knows how many companies will eventually profit from “The Skills Escalator” once it kicks in.
Unfortunately, The Witch Doctor is not a Witch Economist and so finds it quite difficult to grasp the whole picture, but I agree with Dr Grumble that Allyson Pollock should be listened to very carefully because she is trained to understand the full economic agenda.
As for Liam Donaldson, The Witch Doctor is not so hard on him as are other bloggers. This is because he seems to be bit of an enigma and I wonder about him quite a lot………….
By: witchdoctor on January 6, 2008
at 3:06 pm
Of course your blog made a difference Dr G. I for one know it made a difference to me and I know that other bloggers/lay persons thought so too. Being a consultant like you are and with lots of experience abroad and in the civil service makes your opinion very valid; you know more about the ins and outs of things other people, even other consultants, know about. I, like which doctor, just wish that more consultants will have a voice too because you are multi-tasking geniuses and others will also have other areas of interest that they too can write about and affect change. This is why I always say ‘Dr G reaches information others can not reach’ because you, usually in very short posts, present topics that made people think and question how come and why? I know there isn’t enough consultants on the blogsphere or even generally voicing there concern about what is going on out of fear for their own positions as it seems they all feel vulnerable. The majority want to lie low and leave things to distiny but they are wrong because things will escalate and make you all more vulnerable. You all have a responsibility for yourselves, your patients and for handing over the profession, in good condition, as it was handed down to you.
Why are things happening the way they are? Taking your example of ‘bottled water’ I agree with the Witch doctor, it is all about maketing. I have a little idea about this, marketing depends on changing perception, otherwise it never succeeds as people form habits, they will always be comfortable using what they have tried and tested and go for nothing else unless you change their perception. Latest colour and shape car ..etc
Then again, why attempt to change people’s perception re something that is doing relatively well, like the NHS? Of course, in marketing you do this if you have a commercial opportunity to make more money from a new idea. Can this be applied to the NHS? Is the government now after making money rather than spending money on the NHS? and rid itself of the headache of running it too? Have a little supervisiory role and make money at the same time is of course the ‘dream’ of top marketing, right?
As you know, if you keep on repeating something long enough, people start to believe you! In a democracy, this is how you change perception, then impose what you like. A bit orwallian but it always works. To counter this, you must all make noise, lots of it and as loud as possible because this ruins the plot of ‘changing perception.’ Hence your presence, and others like you, on the net , as well as everywhere else, is vital if you want to influence policy.
If you remember Witch doctor, I once commented on one of your posts a few months ago and said that I think the CMO was set up, I really believe he was. He keeps on saying that ‘others’ were accountable too and I believe him. I believe he was made ‘busy’ with campaigns on things like obesity, drinking, etc, while his ‘unfinished business’ was being manipulated to open the door to reform of the whole profession, not the SHO grade alone. The problem with top medics is this ‘multi tasking’; juggling too many balls at the same time; very good in times of peace but opens the doors wide to attack in not so peaceful times, because your attacker knows you won’t be able to juggle anymore ball/s so, they throw hundreds at you and you get overwhelmed and they win! the ‘confusion’ method. Again, to counter this, make loud noise, as loud and as frequent as possible. It always works because you throw back the ‘confusion’ at your attacker and ‘they’ get overwhelmed.
Remember the 2007 MTAS Telegraph petition with the 1840 postings or so. I think I was suffering from ’severe’ ‘multiple personality disorder’ then and many other people were very angry, they paticipated with passion and it worked, as the government was forced to create more training posts and some form of ’safety net’ posts albeit temporary. Of course this only moved the problem to 2008 but if everybody makes noise this year, hopefully, careers will be saved ..
So, the moral of the story is … make as loud a noise as you can … it’s the most effective defence mechanism against tyranny ..
By: Sam on January 6, 2008
at 6:24 pm
As for why things are happening the way they are? IMVHO, We are ‘probing up’ the American economy, sort of ‘let’s all join together’ in an effort to face the threat of the rise of China, india .. as Witch doctor explained before. This is why our PM predicts a ‘dangerous’ year ahead and worldwide economic turbulance.
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/01/06/nbrown106.xml
It just makes me wonder, if this is the prediction for 2008, why not divert the money from projects like the Spine, to actual health provision and ensuring that our doctors are well trained to face the threat? Then again, what do you do with all the trained doctors if the NHS is going to be ‘nurse led’ to freighten people off and push anyone who can to buy health insurance …
By: sam on January 6, 2008
at 8:06 pm
If Dr Grumble is reading this, I am very sad to hear the blog is going off-air, Dr G. I was a regular reader and commenter, although for complex technical reasons I was using the nom-de-blog “PhD Scientist” (it’s a WordPress vs. Blogger thing).
Mrs PhD Sci will miss Dr Grumble too, as I used to “relay” / paraphrase her views in my postings as well. She is a doctor (8 yrs in general medicine, 2 in anaesthetics / ITU, 6.5 yrs as SHO, two as registrar, MRCP and so on) who has basically given up on medicine because of MMC/MTAS. Like, I would guess, a fair lot of others in their 30s, she now feels she has next to no chance of ever getting a training job, given that she is not able to up sticks and move round the country and that experience does not count for much (anything?) in the assessment process compared to all sorts of other bullshit. Her friends at consultant / reg level in the system have told her bluntly “your options are to be a staff grade doctor, or to get out of medicine”. Given the way staff grade get treated, you will be unsurprised to heard that getting out of medicine is now uppermost in her mind. What a waste.
By: draust on January 6, 2008
at 10:01 pm
Yes Sam, I watched the Andrew Marr interview too and must admit, The PM talks very articulately on economic matters following his long spell as chancellor.
I think the NHS is caught up in the net of economic turbulence along with demographic change. Presumably the acquisition of new businesses will help the western economies during a turbulent period that may be long and painful. Health care as a commodity is a huge untapped market in Europe but is saturated in the US, and the NHS may be seen as the jewel in the crown, which if captured by the multinationals will open the door to the rest of Europe. This is probably why there has been so much rushed investment in The Spine – it will enable “clients” to move easily from provider to provider in a profitable cultivated demand led service.
Presumably even if the multinationals are based in the US there would be profits also for the UK.
A global economic health concept of this nature is far, far bigger than the UK medical establishment can challenge, however, there is a bottom line.
For The Witch Doctor, that bottom line is that the “patients” are identified from among the “clients” and they at least remain within the NHS unless they opt otherwise, and while there, they receive optimum care which is truly world class. ie the least we can do is retain a NIIS – A National Illness and Injury Service and make it the very best it can be ie “excellent.” I would also include pediatrics and maternity care.
My fear is twofold:
(1) Everything becomes muddled and those that are ill or injured may get caught up in the search for profit and not be properly diagnosed and treated.
(2) The private sector sequesters the best staff.
To prevent this happening, we need to make sure that the NHS is a truly GP/ consultant delivered service which is not weakened by the concept of The Skills Escalator and Agenda for Change and that it stays that way. This is why it is so important to define the role of these senior doctors first and decide how many are needed, how they are trained, and not to compromise this role by introducing a more malleable sub-consultant grade. And the consultant needs explicitly to retain overall responsibility for patients in his/her care. This is insidiously being eroded.
By: witchdoctor on January 6, 2008
at 10:04 pm
I am sorry PhD scientist to hear of your wife’s career problems. I have some idea of how she feels. As Sam recalls I was out of clinical work for a while which was something close to a bereavement for me. It’s also, as you say, a waste.
It’s going to be too late for anything much to be done about the problems that are going to face so many junior doctors including perhaps the Grumble children but this problem is at least now getting some publicity. I understand the Evening Standard want to run an article for tomorrow about how desperate the situation is and how junior doctors are being forced to consider making applications abroad. They are looking for affected doctors to interview so if anybody out there is interested in helping, get in touch with the Standard now.
Sam and PhD Scientist, thanks for your interest and contributions to Dr Grumble. I learnt a lot from the blog but it had to stop as I was just not careful enough about protecting my identity.
By: Dr Grumble on January 6, 2008
at 11:36 pm
I then wish you all the best whatever you do Dr G albeit, I remain hopeful to see you in another life soon …
And Whichdoctor: ” that bottom line is that the “patients” are identified from among the “clients” and they at least remain within the NHS unless they opt otherwise, and while there, they receive optimum care which is truly world class.”
I think you summed it up very well, however, during the ‘transition’, those real patients will suffer, as we see now; cuts in maternity care, nurses doing doctors work, chronic patients asked to care for themselves; propaganda about filthy, disease ridden hospitals .. etc. And there will be no guarantees whatsoever until you push all the ‘clients’ to sign for insurance, then, who knows what will become of health provision in the UK?! I can’t remember where it was, but there was a leaflet/questionaire asking doctors what they thought about the future of medical training in Britain and whether they thought that the ‘private sector’ will have a bigger role… They were also asking if hospital doctors may in the future become stand alone businessmen like GPs; consultants working ‘only’ in their own practices. I suppose this paints a picture of what will come eventually if the trend is left to continue. As you say, this is far bigger than the medical profession .. so, we have to wait and hope for the best.
By: Sam on January 7, 2008
at 12:20 am
Tell me what black cat thinks of this witchdoc:
http://news.bbc.co.uk/1/hi/health/6998195.stm
“Doctors would also not be allowed to wear long-sleeve shirts, jewellery, or watches as part of the measures.
The Department of Health says cuffs are likely to be “very contaminated”, and that other forms of protection such as “plastic aprons” would be introduced. ”
To me, this sounds like everybody will look like a nurse …
By: Sam on January 7, 2008
at 2:34 am
Well, Sam
In Germany where my other half trained, uniforms for medical staff are standard - put them on when you get to work, take them off when you leave, hospital washes them. It has certain advantages, and German doctors I know who work in the UK are always incredulous about the British contortions over dress codes.
It would be perfectly feasible to “colour code” uniforms to show who was what, methinks.
By: Dr Aust on January 7, 2008
at 11:25 am
This is a good idea Dr Aust, maybe it should be adapted here …..
By: Sam on January 7, 2008
at 3:20 pm
It would cost money, Sam, is the (or at least a major)drawback. Hospitals typically don’t have the laundries any more (dirty linen is commonly washed off-site by outsourced providers) and they don’t have the space for changing rooms either…
Getting back to the overall theme, it is going to be a poorer medical blogging world without Dr G, and with Dr Crippen still missing in action.
Finally, talking of medical training specifically, this got some media exposure on the BBC last week - still on Listen Again as I write, though may be disappearing soon. Seemed a pretty good programme to me, apart from the slightly silly name (”Where’s the Femur?”).
By: draust on January 7, 2008
at 9:07 pm
… and Hospital Phoenix is also MIA, one suspects for similar reasons to Dr Grumble.
The BBC programme is definitely worth a listen, very well-informed. Perhaps they had been talking to some of the medical bloggers past and present.
By: draust on January 7, 2008
at 9:14 pm
WITCH DOCTOR
Yes, Sam, I remember reading this. This is what me and My Black Cat said at the time.
http://witchdoctor.wordpress.com/2007/09/17/white-coats-forbidden/
And then with tongue in cheek, we had a bit more to say later:
http://witchdoctor.wordpress.com/2007/11/04/alan-johnsons-white-coat-ban/
http://witchdoctor.wordpress.com/2007/11/05/no-white-coats-like-it-or-not/
They say there’s no hard evidence that infection is spread by cuffs, ties watches etc although it seems reasonable that it may be on occasion. Hand hygiene and hand care, ongoing day to day environmental cleaning, adequate sinks, estate maintenance and repairs, bed occupancy rate, movement of staff and patients are all much higher up the list when it comes to minimizing the spread of hospital acquired infection. The government has opted for the one at the bottom of the list. It may be a coincidence that it is particularly relevant to conventional UK doctor’s dress.
Interestingly, however, there was a recent report, initiated by the DOH that shows that high bed occupancy and movement was no longer associated with the spread of MRSA. It used to be, but apparently is no longer. I wish My Black Cat would read this paper critically because The Witch Doctor will never get round to it. I think only bacteraemias were included and this could easily be accounted for by Trusts firming up on their care of IV lines rather than the effect being closely related to bed occupancy or movement. My Black Cat will need to find out if wound infections were studied too, but she probably won’t get round to it either.
It’s here if anyone wants to read it:
Anyway, it’s what HMG wants to hear. Bed closures and agency staffing can continue as long as watches are thrown away and sleeves and ties are chopped off!
Dr Aust.
As you say, laundering is a problem. Few doctors wear white coats nowadays partly because of this. The Witch Doctor watched laundering facilities being run down insidiously, and is interested in how hospitals will cope if a standard uniform to be washed by the employer and changed daily, is introduced. Most hospitals at present turn a blind eye to uniforms being washed at home.
I wonder if HMG have shot themselves in the foot over this. If they consider white coats and other uniforms are an infection risk, then it could be argued that any new uniform introduced should not be washed at home. Can’t have it both ways!
Hm - forgot. The proposed tunics are made of infection fighting material - so they must be sterile!
By: witchdoctor on January 7, 2008
at 10:02 pm
Mrs Dr Aust with her German training is appalled that the staff who do wear uniforms wander off to lunch wearing them, and then wander back to the wards, and then wear their uniforms home. She considers this an infection risk, but says she is putting her money on over-high bed occupancy as the number one cause of hospital acquired infections. Though lazy hygiene by all grades of staff was also apparent in the places she has worked, at least when she was last doing hospital stuff 3 or 4 yrs ago.
Incidentally, where I work we have a cafe neatly poised between the University and the teaching hospital. The entrances to outpatients and A&E are near by.
Univ research staff are expressly forbidden from wearing their lab coats into said cafe, and get told forcefully to leave if they arrive thus attired. However, I regularly see all sorts of hospital folk in there in their working kit. The uniformed nurses and auxiliaries are the most obvious, but I see plenty of junior doctors with stethoscopes draped round their necks in there too.
By: draust on January 7, 2008
at 11:43 pm
Dr Grumble,
I don’t know whether you will visit this post again but if you do, My Black Cat has requested that I ask you something.
It is this:
Your posting on January 6 at 11.53 says it all. In a way I suppose it articulates the reason why many UK medical bloggers are blogging. It is a seminal piece that needs to be scattered everywhere so that others can think about it too. It is situated too deep in the bowels of this blog for people to find it for more than a short time.
My Black Cat wonders if you would object to this as a separate “cut and paste” post going up in this blog called something like “Grumble’s Swan Song” or “Dr Grumble - The Last Post, or any heading you might choose. Thereafter she wants it put on a page permanently just under where she sits. I think My Black Cat became quite attached to you since she read your blog every day.
She has stopped purring!
And that is very sad!
She thinks your quiet measured approach will be very missed by many readers on the web and since your blog has disappeared completely, an entry such as this might keep others thinking,
The Witch Doctor agrees with her, but will not allow her to go ahead unless it is OK with you.
If you do agree, we will of course incorporate the photograph of you in meditation mode.
If you do not agree, then I’ll just go out in the dark and catch a rat to make her happy again.
And then we will give you peace!
By: witchdoctor on January 8, 2008
at 12:03 am
Witch doctor,
Did anybody do research to copare hospital axquired infections 2 decades ago, a decade ago against current levels?
Then again, if the levels/per head are higher (?) than before, then, does the government not know the great value of a good scrub with soap/water/detergent?!
And … if watches are such ‘lethal’ infection carriers, how come doctors have been wearing them for, at least, the past 60 years from the time the NHS was born?!
Why didn’t academics with qualifications up to their ears, like Dr Aust, not recognise the potential danger long time ago and warned the profession about it? Actually, why didn’t doctors themselves, who also have scientific and clinical qualifications up to their ears, notice that their patients were getting sicker and sicker then suddenly dying whenever the doctors approached them? Did anything like that happen? …
And Dr Aust, part of the reason why highly qualified academics are supposed not to be seen in the cafe next door with their white coats is precisely because they are highly qualified academics ….
By: Sam on January 8, 2008
at 12:31 am
By the way, we both think the same way Witch doctor! Deja Vue?! premonition?! Black cat .. most likely!
I was going to offer Dr G a share of my blog! But then I thought it is unlikely that I will blog again once the government does the right thing, the reason for my existance on the blogsphere in the first place. and I actually believe this will happen right now, during this round, then will be official for 2009 and beyond.. then .. there’ll be nothing left for me to talk about. We’ll find out as soon as the results of this recruitment round becomes known..
Dr Aust, I have commented on ‘where is the femur’ here
http://chezsams.blogspot.com/2008/01/current-true-shape-and-direction-of.html
By: Sam on January 8, 2008
at 12:51 am
WITCH DOCTOR
Dr Aust
The Witch Doctor has observed that it seems to be almost impossible to stop hospital staff wearing uniforms in dining rooms and the street. I think this is because the “Dictat” comes from too high a level ie Infection Control Committees rather than those leading very small groups.
The lack of laundering and changing facilities doesn’t help although this isn’t true of theatres.
Sam,
I don’t believe many places would have been collecting very accurate statistics of these organisms two decades ago although it was done on a much smaller scale. It is a time consuming task that needs computer expertise that was not as widespread as it is now. It is necessary also to compare like with like or the findings are meaningless. Some of these organisms have only appeared in significant numbers in recent years because of the “natural selection” effect of antibiotic pressure.
Management were made very aware by their own local consultants at the very onset of the appearance of multi-resistant organisms, but unfortunately it happened at a time of harsh cut-backs, and funding was not made available for the search and destroy policy similar to the one that was being followed in the Netherlands at that time (and still is). The secret is to nip these new organisms in the bud before they become established. This is not easy to do because they have a will of their own.
The Witch Doctor’s opinion is that whatever is done it is now it far too late eliminate an organism like MRSA from the hospital environment because it is now firmly “bedded in” (and is much cleverer than the human race). Up to a point it can be controlled though, and that is what we will achieve. However, good will come out of the current exercise because not only has it raised the profile of infection, but it means there will be an early “listening” next time, to the local microbiology experts in every hospital when the next clever little chap comes along to set up home. Both the will and the funding for a “search and destroy” policy for the next organism will be in place.
By: witchdoctor on January 8, 2008
at 1:34 am
You are free, Witch Doctor, to do what you like with my posts. Choose whatever title takes your fancy. And thank you for your kind comments about Dr Grumble.
By: Dr Grumble on January 8, 2008
at 6:30 pm
Thank you for getting back, Dr Grumble. My Black Cat and I will make some plans over the weekend. I hope you will approve of them.
Enjoy your rest for a while.
By: witchdoctor on January 8, 2008
at 9:56 pm
Dr Grumble
Has the old stuff on your blog been taken down? Or is it just “locked”? I ask because if the latter, I would be interested in accessing some of my comments there to maybe re-work them for my own blog. [You can email me at DrAustBlog - at - gmail.com rather than us having a proxy conversation here and mucking up the Witch Doctor's thread.]
Back on the issue at hand, I would be sorry to see all the medblogs suffer the sort of fate of Grumble and Dr Crippen.
My time reading media reports of scientific and medical issues - particularly relating to “bad science” of various kinds - have convinced me that many print and broadcast journalists - who I always thought were supposed to dig out what was really going on and to relay it to the public - lack the knowledge and understanding to interpret the things they are officially paid to write about. Others don’t have the time, and still others just want “a story” and aren’t that fussed whether it is accurate. But basically for things I am familiar with, the way they are portrayed in the media is way off the reality.
And, as a corollary, the extent to which the media nowadays simply reprints press releases or recites leaked “messages” - whether from the Govt, the Univ press office, Big Pharma, or advocates of Alt Health - is deeply depressing.
Amid this gloom, I have found that the Blogosphere teaches me far more about what is really going on in the areas I am interested in than the media does - more accurate, more detailed, more informed, and much faster.
So here’s hoping other medical blogs keep up the trickle of inside info and comment. But I will still miss Messrs Grumble and Crippen.
By: draust on January 10, 2008
at 12:34 am
Dr Aust,
Good news!
Dr Crippen appeared back on the Blogosphere today. He seems fit and ready to go!
He too maybe thought the medical bloggers were getting a bit thin on the ground!
By: witchdoctor on January 10, 2008
at 1:02 am
I really, really miss Dr Grumble
By: Sam on January 10, 2008
at 7:23 pm
I agree very much with Dr Aust about the quality of the better blogs in comparison with the quality of the average journalist. Perhaps this accounts for some journalists being very rude about us.
By: Dr Grumble on January 10, 2008
at 9:37 pm
Ferret Fancier actually sent letters to most newspapers to enquire whether their reporters has any scientific qualifications and the vast majority didn’t. I think it is time doctors made health minsters, managers, journalists, politicians, mps .. etc, etc
As for the quality of the ‘better’ blogs …. lots of ‘visitors’ as quite sad at the moment ..
By: Sam on January 10, 2008
at 11:16 pm
[...] HAS GRUMBLE BEEN RUMBLED? [...]
By: Dr Grumble’s Swansong « The Witch Doctor on January 11, 2008
at 10:56 pm
Just heard a great name (in Private Eye, a trail for an upcoming book) for the all-too-common modern writer for the newspapers who simply re-cycles press releases / agency stuff / spin.
The word de jour is: “churnalist”
..as all they do is churn the material around whilst recycling it into a “story”.
By: Dr Aust on January 23, 2008
at 11:34 pm
Just read your last comment Dr Aust.
Yes “churnalist” is a good word. I like that!
(I must bear it in mind, when I’m cutting and pasting though).
By: witchdoctor on January 29, 2008
at 10:36 pm
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This old barber's shop will remain until The Witch Doctor decides that the medical profession have Achieved a Balance.
