Posted by: Witch Doctor | September 21, 2011

BLACK HUMOUR : Old Crumbles and Ethnic Cleansing


If you have read the last three posts on this blog, you may have gathered that:

1. “Assura Medical” is the name used by virgin for their UK Healthcare, and the Witch Doctor is rather amused by this because it might be because the terms “Virgin Medical” or“Virgin Clinic” could be construed by some as a kind of “Black Humour.”

2. The Witch Doctor thinks that in the near future it might put a doctor’s career in jeopardy if he/she were identified in blogs or social media sites as using Black Humour.

3. Black Humour neither “shocks” nor “angers” The Witch Doctor.

4. The Witch Doctor thinks some types of Black Humour are witty and funny banter in the medical context may bear no relationship at all to a doctor’s compassion for patients or his or her professionalism.

As The Witch Doctor writes, she is exploring her own thoughts on the matter and “talking aloud” to you as she does so, because she is fed up talking to My Black Cat since she is deep into conspiracy mode at the moment as she contemplates the reported links between the CIA and Facebook.

In addition, Dr Phil has recently put up a thoughtful post, and The Witch Doctor can’t quite make up her mind how much she agrees with what he says.

It is unlike a witch to be indecisive, but then we do carry the human gene as well as the witching one.

The Witch Doctor has previously blogged about two terms that she hates. She is not shocked or angered by them- she just is disgusted by the terms.

The first term she mentioned in this blog was “Ethnic Cleansing” The second was “Old Crumbles”

The Witch Doctor is going to consider what she wrote then, whether she still feels the same way about the terminology, and whether they give her any insight into what she thinks about Black Humour in medicine.

Here is some of the things she said about this term “Ethnic Cleansing” and another term she loathes “The Good Death” on 6 November 2009



A “healthy” husband and wife recently committed suicide together because they wanted a “good death.”

We are disgusted by the words “Good Death”

All witches loathe this term.

It is like a sick joke.

No. It’s worse than a sick joke. It is sinister. It is intrusive.


Believe this witch, who is well qualified to talk about death – there is no such thing as a “Good Death.” It is just that some deaths are less bad, less painful and less sad than others.

“Good Death” is a hygienic term for the unthinkable. It is a play upon words. Worse still, it is play upon ideas. It is a formula for the future. It is a seed that is being sown that will de-stablise the thought processes of many troubled, elderly and dependent people. Particularly the naval-gazers, the ones who think too much about themselves, those who focus on their fears rather than enjoying what they have and getting on with life.

It is a term that will add confusion to muddled minds.

It is a term that will encourage the selfish folk.

It is a term used that will encourage the organised, tidy folk of the world who plan every life event.

Even death.

You should also believe this witch when she talks about planning your life, and death. The witch doctor has lived by the philosophy of only doing a minimal amount of planning, but a maximum amount of adapting to circumstance.

“The best laid schemes o’ mice an’ men gang aft agley……”

For The Witch doctor, like Rabbie Burns, knows that there is always a wicked uncle chuckling in the background when you make your plans.

She has a lot of experience of foiled plans, death and “Chuckling Wicked Uncles.”

Incidentally, we witches also loathe the other sanitizing words “Ethnic Cleansing” We consider it to be one of the most offensive terms in the English language. It is, however, used by television commentators and newsreaders without them batting an eyelid.

Perhaps they will stop using it now.

“Good Death”

“Ethnic Cleansing”

They are both subliminal intrusions of the mind.

These terms and the “hygienic” ideas behind them disgust us.

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The second term was “Old Crumbles”

This is what she said about this term on 5 September 2010:


A long time ago, when The Witch Doctor was a medical student, there was someone in her year that she didn’t like very much. Once she qualified, she found that she was working in the same hospital as this person although not in the same unit.

It came as no surprise to her that this doctor she didn’t like very much, identified a vast group of patients called “Old Crumbles.” He did everything within his power to guard against “Old Crumbles” entering his ward on receiving days. He did this by being patronisingly rude to any GP who phoned him asking to admit a patient who might meet his definition of an “Old Crumble.” Since most of the GPs knew their patients pretty well and were much more experienced than this green behind the years Junior House Officer, they generally were able to deal with his rudeness and their patient was eventually admitted to the ward.

It is not clear exactly what kind of patient was classified as an “Old Crumble.” Since this JHO was in his early twenties, he may have considered that anyone over 50 came into this category. On the other hand, confusion, hemiplegia, incontinence, inability to feed oneself, and multiple pathologies may have been necessary to meet the “Old Crumble” criteria. Or an “Old Crumble” may have been any patient who was likely to block a bed because it was difficult to discharge them home again.

The Witch Doctor found the term “Old Crumble” offensive. It was probably because she would not have liked her grandparents or parents or herself for that matter, referred to as “Old Crumbles”

It would be very politically incorrect nowadays to refer to patients as “Old Crumbles”

However, there is still a problem if patients who “block beds” are admitted.

The Oldest Sage Witch’s Highland Granny has just been caught up in a new way of dealing with patients so there is no bed blocking.

She was made to walk along a “Patient Pathway.”

Sometimes it was called a “Patient Journey.”

These pathways and journeys tend, if possible, not to have a hospital ward as the destination. They are also involved in keeping clinic waiting times down.

This, of course, will lead to a good “Patient Experience”

And a very good thing too!

Now I have no idea what exactly is bugging the Oldest Sage Witch’s Highland Granny, because she writes a lot of her telegrams in “The Gaidhlig.”

Nor can I explain why terms like “Patient Experience” or “The Cancer Journey” or, at the end of the road, “The Liverpool Care Pathway” or if patients slip through the net into the wards “The Rapid Discharge Pathway” annoy me every bit as much as the term “Old Crumbles.”

But they do.

They do.

No reason.

They just do.

Some day, I’ll maybe work out why they do.

And if I do, I’ll tell you.

redapple.jpg a red apple ……………………

The Witch Doctor – Link to a random page





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  1. Assura health seem to have friends in the right places:

    Vigin varies tremendously in it’s customer service. The airline is very goo, the railways much less so. I think that this is explained by the airline industry being a fairly free market, the railway a franchised commisioning process. I think that the airline knows that it’s customers can go elsewhere, while the railway knows they have little choice, and can afford to not make the effort of being polite.

  2. We had a group at our hospital known as the ‘early discharge team’. That used to annoy the living daylights out of me . It made me imagine a cheery bunch in t-shirts and baseball caps going round hurling people out of their beds. There’s faint gang associations as well; up here a ‘team’ quite often is a street gang. Maybe that was the point..

  3. […] The Witch Doctor has been musing on it. […]

  4. Dr Phil,
    It all seems to be going on full steam ahead without the need for the HSCB becoming law. At face value, being handed out millions of taxpayers money to fund health care services must seem like a gift from Heaven to the private sector. It will be interesting to see whether these companies harness The Third Sector for themselves to keep costs down and profits up. It would be interesting also to know whether some of the taxpayers money they are given is set aside to cover legal costs if they are sued. I suppose abdication from ” the duty to provide” may be tied up in this aspect.

  5. Julie, in yesteryear I suppose the “early” discharge team would have involved the patient’s consultant, a social worker, OT, and physio. Blocked beds were usually because the patient could not be supported at home and no long term care facilities were available. It would be interesting to know who is involved now in some of these initiatives, what types of patients are being targeted, who makes the ultimate decision and who is responsible if a premature discharge goes wrong.

  6. Dear WD,

    That is what puzzles me about the HSCB, if these changes are going ahead anyway, why do we need the bill? It can’t just be to make the changes irreversible, as any new Parliament could pass it’s own bill revising the changes if it wanted.

    On the whole I like the Virgin Companies approach. The airline is excellent, but if SERCO were to get a contract…

    Dr Phil

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