Posted by: Witch Doctor | March 25, 2008

A patient like me, who knows more than you.



WEB 2 marches on relentlessly.

Think of Facebook, Bebo etc.

Think of where this may lead. Think of something new.

Something new, which some day soon will become very, very powerful.

The face of medicine is changing, changing, changing.

And as a consequence, the Competency Clutchers and the Tickers of Boxes, will, within less than a decade, be totally out of their depth with most patients.





As far as real patient care is concerned, The Skills Escalator will not work.

Are you listening, Lord Leitch?

Are you listening Sir Derek Wanless?

Are you listening, The Job Share Pied Piper?

Are you listening, Mr Brown?

The Skills Escalator will not work.

That is our prediction.

Isn’t it, My Black Cat?


This article was published in The New York Times magazine.

A first tenuous step – there will be ups and downs, arguments and counter-arguments. Ethical issues will be raised as will security issues. But now it has begun, it will go on. It cannot be ignored. The potential of what is happening here is enormous.

“But PatientsLikeMe seeks to go a mile deeper than health-information sites like WebMD or online support groups like Daily Strength. The members of PatientsLikeMe don’t just share their experiences anecdotally; they quantify them, breaking down their symptoms and treatments into hard data. They note what hurts, where and for how long. They list their drugs and dosages and score how well they alleviate their symptoms. All this gets compiled over time, aggregated and crunched into tidy bar graphs and progress curves by the software behind the site. And it’s all open for comparison and analysis. By telling so much, the members of PatientsLikeMe are creating a rich database of disease treatment and patient experience.”

The whole concept of the soft, touchy feely, “Patient Experience” as expressed in UK healthcare jargon, will take on an entirely different dimension when this new era of medicine comes into full swing.

Patronising little leaflets designed for those with a reading age of 9 will do for some, but not for many.

This is real patient experience. It is not the experience of the “precious ones” – the clients, the worried well, the ‘something will need to be done”

Doctors everywhere, as well as politicians and drug companies should read this article.

For it is a preview of how medicine will develop.


And they will need to be prepared.

And make sure the fallout is good for patients, rather than ugly.

We are seeing the beginning of real empowerment of patients, by patients. Patients who suffer, not clients who pontificate.

The Skills Escalator will not work at all in this environment.

The staff climbing the rungs will flounder much of the time. These patients will not present as competences.

Chronic conditions are testing. These patients will be testing. They will ask testing questions. And will know when they are being fobbed off.

We need more doctors.

Fully trained doctors who can help guide very knowlegable and empowered patients. Patients who want and need a partnership some of the time, most of the time, or all of the time.

As well as those who need a more paternalistic approach some of the time, most of the time, or all of the time.

And those who flit between the two.

Truly excellent doctors, with both width and depth of experience and judgement. And always up to date.

Doctors, so secure within their experience, that they can acknowledge to their patients that they do not know all the answers. Doctors who can say, “Our greatest teacher is you, our patient.” And tell them so.

Doctors practising medicine in a different, and perhaps more challenging way.

Perhaps in ways not yet conceived.

Yes, Sir Liam Donaldson was right. He said in the face of both Agenda for Change, and the MTAS Debacle, “We need more doctors”

He said this consistently.

Do you think he saw the concept of “A Patient Like Me” coming, and appreciated where it would go, when everyone else was twittering on about Skills Escalators, and Hospital at Night, and about over-producing doctors, My Black Cat?



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  1. Frankly No! I don’t see that the ginger limpet foresaw such!

    If he had he should have been both more visible and far louder in his assertations on the matter, for the drift is going to cost the country many more of its brightest to the Colonies again this year.

    My view is that he is a classic example of the Peter Principle in practice, clinging on for dear life despite the calamitous situation all about him, instead of accepting his responsibilities for the mess of MMC and its appalling consequences.

    If he had the vision you suggest, perhaps he would declare it loud and clear, before he resigns! But don’t have him wait – we’ve done that for far too long!

  2. I doubt if he did either, but he may have!

    He could be incompetent. He could be a government stooge. He could be both.The way the witch doctor sees it, he is a civil servant, an adviser to the government. Should a civil servant, who ultimately is bound to follow government policies also be a leader of the medical profession? I think not. If the same government is hell bent on destabilising the medical profession, he could have resigned much earlier over that issue if and when he saw the way things were going. However, even if he had been free to speak then, and he would not have been, no-one would have believed him. So why resign then?

    This is what Calman said:

    “I don’t know the answer to that, but I regularly point out to doctors that they have the power to solve these problems. It’s not for government or the CMO. Look at the problem of senior house officers – the lost tribe. It’s been exactly the same since I was an SHO 30 years ago. Little has changed. Who stopped that change? It certainly wasn’t the government. Look at preregistration house officers – in some places a disaster. That’s not the CMO’s fault.”

    No, in my opinion these junior doctors have been caught up in net as innocent bystanders and it is the colleges, deaneries, BMA who should have taken off the kid gloves a long time ago, but they probably didn’t grasp the whole picture.

    Also, medical committees tend to be too polite!

    Junior doctors will not be secure until it is acknowledged that we have a consultant delivered service and GP’s retain responsibility for their patients.

    Look at what is happening to GP’s now. If that’s not de-stabilisation, I don’t know what is. All this will have a knock on effect on the number of jobs for junior doctors.

  3. He cannot have it both ways!

    He is either a leader of the profession as the title implies or is a senior civil servant.

    If the former he should be loudly beating the drum for the consultant led service you describe, and offering, as has RemedyUK and the excellent Fidelio, practical suggestions to solve the immediate problems of the lost tribe of SHO’s – including, lest we forget, those lost overseas already! Certainly the government’s shillyshallying about acceptance of all the Tooke recommendations should have been mentioned by him in public by now, especially as he says he accepts the Tooke Report and its recommendations. Such action might help!

    If the latter, the cost of the losses, now well into the billions and climbing, should prompt him to point out that he is a civil servant, there to protect the public interest as well as advise the government, and in this case stop wasting my taxes and your’s!

    He should go!

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