Posted by: Witch Doctor | February 7, 2011



The Spirit has moved The Witch Doctor to consider Oregon (well it was not really the spirit – it was Dr Philyerboots in his current post.)

“The demographic and health care challenges deserve a more open and above board debate on rationing, but our politicians are too cowardly to trust us to do so. If only our politicians would trust us, as they do in Oregon. This system is not without controversy, but in the private sector insurance companies also ration. An insurance company is an organisation that sells you an umbrella when it is sunny, then removes it when the rain starts.”


The Witch Doctor first encountered the Oregon health care system many years ago when she was spirited away to a posh hotel by the seaside in order to be reframed into looking at our NHS “differently.”

Bad idea.

Witches don’t take kindly to reframing attempts and, although usually quite placid souls, we can become quite belligerent if we think people are trying to surreptitiously change our view upon life.

We witches change our own view upon life if and when we want to. We don’t need the help of government lackeys. And we don’t respond to the smooth talk, good food and posh surroundings, free at the point of use for senior doctors, considered part of their compulsory Continuing Professional Development, and paid for by the taxpayer.

So there was a bit of a skirmish.



They introduced the term QALYs. We were told they were a product of the American state of OREGON. The Witch Doctor had never heard of “QALY’s” before and she listened carefully to what was being said. Remember, this was a very long time ago, and QALYs had not yet reached the UK as they have now.

Then there was a little game.

We were then all given a handout. We had to prioritise various conditions according to QALYs. (Quality adjusted life-years).

The Witch Doctor refused to fill in the damned form.

She said it was a load of piffle.

She said that no-one, absolutely no-one, was in a position, or should be arrogant enough, to attempt to measure another person’s quality of life to decide whether they were worth treating or not.

Basically, that was not what medicine was about. If a patient crossed your path and required treatment, and you had the means of treatment, then you treated them.

It was simple then.

And professional.

And moral.

That was the way it was in the UK way back then.

No longer.

Anyway, back then, The Witch Doctor was a very busy, harassed witch and could have done without wasting a few days at that seaside hotel. She vociferously said something about how would she be viewed by the populace if she was quadriplegic and needed care 24 hours a day? How, for example, would an athlete view her quality of life then? Or a pop star? Or a Secretary of State for Health? Would her life be considered worth living by the populace? She then said that at least, as a quadriplegic she might have uninterrupted, quality, precious time to listen to her children, guide them, teach them in a way that was never possible as a mother working an 80+  hour week plus 1 in 3  on call in the NHS, degenerating to 1 in 2 to cover annual leave, sick leave, maternity leave, study leave, and delaying tactics in advertising the post when a colleague leaves or retires (and then it was 1 in 1 on call if no locum was available) Yes. This was the reality of many a consultant’s life before the new contract. in these days consultants had to work hours just as rigorous as junior doctors but doing different, less visible but every bit as demanding work.

Yes, being quadriplegic would have given her a strange and morbid type of quality in one aspect of her life.

She gave a few more cogent examples to make the point.


So, as you can gather, QALY’s did not appeal to The Witch Doctor back then.

She also said:

“This will lead to death by neglect in Oregon and may lead to euthanasia becoming legal in that state.”

Do you suppose she was correct in this assessment?

Of course not!

She was way over the top!

Of course she was!

As witches often are……

Eh, My Black Cat?

In the meantime My Black Cat is reading this:




redapple.jpg a red apple ……………………

The Witch Doctor – Link to a random page





© Dlundin |


  1. This is not good. I fear with the changes in the NHS coming and the credit crunch that it’s going to be like a siege, where the poor and disabled are put outside the city walls. I think we’re becoming more venal as a society and the thing is; we constantly kid ourselves on that we’re not.

  2. I share a lot of doubts about Qalys, and remember a conversation with a public health registrar at medical school, in a tutorial. He explained the nature of Qalys.

    I asked “what is the health economic benefit of admitting an elderly patient with carcinomatosis, who was certain to die within weeks. Where is the Qaly in that?” I still have not had an adequate answer, but what is the alternative? discharge the patient to die in the gutter?

    Terminal care done properly is not cheap, and it is hard to justify on economic grounds. It is however one of the things like art, poetry and religion that makes us human.

  3. […] the last post, you will recollect that The Witch Doctor many years ago refused to fill in a stupid questionnaire […]

Leave a Reply

Please log in using one of these methods to post your comment: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s


%d bloggers like this: