Healthcare has corrupted its mission

Victor Montori’s second edition of his book Why we revolt: A patient revolution for careful and kind care talks about how healthcare has stopped caring. Our current industrial healthcare needs to be replaced by a scientific, unhurried and person-centred care. Patient care needs to be reclaimed as the priority of healthcare organisations.

Medicine has tried to correct this imbalance over recent years in its training and practice (see eg. post on my Relational Psychiatry blog). As expressed by George Engel (1977) when proposing his biopsychosocial model, the fundamental problem is the overemphasis on biomedical aspects of illness at the expense of psychosocial factors. Reform may well not be enough, which is why I like the website of The Patient Revolution, a nonprofit organisation. Managers and funders need to be held accountable for creating and fostering systems that allow patient care to happen. As I said in a previous post, medicine needs to be rethought.

The indictment of medicine

David Sellu recently gave an interview to the Royal Society of Medicine. It was based on his book Did he save lives? A surgeon’s story. I have mentioned him in a previous post. 

His story is an indictment of the state that clinical governance in medicine has created. As I said in my BMJ letter, the increasing regulation of doctors has created a climate of fear and a culture of defensive practice. Over-reaction in investigation reports may lead to naming, blaming and shaming for what is presumed to be incompetence, carelessness or recklessness. But reports are not immune from mistakes and do not always deserve the authority given to them. Clinical errors occur and actually do not always detract from safety (see previous post). Clinicians live with uncertainty and have to act in the real world. 

Judgement about clinical behaviour needs to be fair and open. Even the legal system did not protect David Sellu, although it did eventually exonerate him on appeal. Medicine and surgery are in a precarious state when a decent and competent surgeon can wrongly be found guilty of manslaughter. Medicine needs to stop pretending that clinical practice is always objective and build on its professionalism and experience.

Now again retired

I've enjoyed returning to work (from home) for 3 months because of coronavirus (see last post). But now I need to find something else to do with the rest of my life apart from clinical work.

Now only semi-retired

Because of the COVID-19 crisis, I started back yesterday as temporary part-time consultant psychiatrist (from home) for the NHS Trust I thought I'd retired from!

Proximity in the time of coronavirus

Two small blocks on the front should nearly meet, without touching, but were actually welded together because they are in the same family group.

Physically and conceptually close to Lasdun’s Ziggurats.

Solving of difficult maths problem like being intellectually rigorous.

Couple on their daily walk in coronavirus crisis

When will I be able to go on a plane again?

I can now work again as a doctor if asked and willing to do so.

The art of slogans

Not sure that Dominic Cummings got this one quite right

British racism exposed by Windrush scandal

Although my last post was a joke, and even though coronavirus is very serious and game-changing, our obsession with coronavirus should not divert our attention from other important matters. The independent review of the Windrush scandal was published yesterday. Let's not forget that people were wrongly detained, deported and lost access to benefits because they could not prove they had a right (which they did have, to spell it out) to live here. For some reason the review seems to stop short of saying the Home Office was racist, instead saying it demonstrated "ignorance and thoughtlessness" over race and that the failings were "consistent with some elements of the definition of institutional racism". The government is still racist, as despite Priti Patel's apology, some ministers and officials still fail to accept the extent of the injustice to people who were made to feel like criminals. Britain must stop being a hostile environment to immigrants.

Coronavirus buries bad news

Inspiring maiden test century from Ollie Pope

The only other time I mentioned a maiden test hundred in this blog was for Joe Root (see post).

Rethinking medicine

Positive start from Martin Marshall as the new Chair of the Royal College of General Practitioners (RCGP). In an interview in the Guardian he says GPs need to do less to achieve more. The article cites the BMJ’s ‘Too much medicine’ campaign (see previous post). Medicine has become too fragmented and dysfunctional (see another previous post). Marshall is also on the Rethinking Medicine working group.

England won at least one match in the Ashes

Practising as a doctor

Following my retirement from clinical work (see previous post), today I am relinquishing my licence to practice as a doctor. I can restore my licence on application and for the moment stay on the GMC register, whilst I decide whether I need to be on it.

When I first became a doctor, revalidation was unnecessary. Qualification was enough to make me fit to practice (although of course fitness-to-practice proceedings could always be instigated against me - and have been (see previous post)). Following the Shipman inquiry, revalidation was eventually introduced, and I have had to undertake annual appraisals. Giving up my licence means I am no longer subject to revalidation as I am not practising as a doctor.

I guess I have always primarily been a clinician rather than an academic. It's taken me a while to give up this privilege but I'm now looking forward to my retirement (including from my Cambridge PhD (see previous post), currently in intermission).

Notice to retire

Gave my notice yesterday to retire at end July. Now what do I do?

Twitter followers increased by 2½ in just less than 3 years (see previous post) and number of tweets by 7.88 times in less than 4 years (see another previous post).

Didn’t Lansley reforms put an end to naive political interference?

Despite his enthusiasm, I’m not convinced Matt Hancock, Secretary for Health and Social Care, (see BMJ news analysis), fully understands the history of digitalisation of the NHS (see previous post). He needs to put computerisation in perspective and recognise there are genuine problems. I summarised these in a previous post, 

The essence of the problems is poor usability; taking too much time; interference with face-to-face patient contact; and degradation of clinical documentation.

I’m not disputing the need to give an impetus to IT in the NHS, but this does need to be focused on improving clinician satisfaction rather than making work in the NHS more difficult. Otherwise we’re just going to go through another wasteful phase of computer consultants ripping off the NHS.

How will the film Cold War go down in Poland?

The brilliance of Pawel Palinowski’s latest film, Cold War, as with his previous film Ida, is partly because of the way he blends political allegory about the state of Poland into a glorious film. As far as the film is concerned, Poland comes to an end in the Cold War and the only hope is a young child left behind. I look forward to seeing Palinowski take forward his themes about Poland into the more recent era.

Nothing left in the tank

Alaister Cook is leaving the England team to find others to depend on (see his resignation statement). He started test cricket at a young age (see Guardian report). But England came to depend on him too much (see previous post). At least Sam Curran and Moeen Ali prevented Joe Root suffering the same responsibilities as captain in the last test, although hopefully he will be able to bat at four, where he wants to bat. I'd put Bairstow at three, not Ali. Still, I look forward to last India test this summer at Oval, as I have tickets for third and fourth day. I hope Alaister Cook leaves on a high.

Scolt Head Island

A rarely visited hump of dune on the Norfolk coast, not far from me and visited yesterday.

Medical disciplinary procedures need improving

As I know to my cost (see eg. previous post), there are problems with at least the implementation of medical disciplinary procedures. My medical protection society has produced an excellent document  to take this issue forward. See the highlights on my twitter thread.

Ian Kennedy's back

I appreciated Ian Kennedy's Reith lectures in 1980 (see previous post). But I think he got caught up in a managerialism (see another previous post), which had disastrous consequences for the Healthcare Commission (see another previous post), of which he was the chair, and may have contributed to a phase of bullying in the NHS (see another previous post) and even the mid-Staffs inquiry (see yet another previous post), in which there was an element of scapegoating which has still not been adequately recognised and accepted (see even another previous post).

However, he seems to have now come back 'on song'. As reported in the BMJ, he is quoted as saying that the "role of criminal law and medical manslaughter in cases where doctors make mistakes must be rethought" (see news item). After all, David Sellu was jailed for gross negligence manslaughter and later had his conviction overturned (see another BMJ news item). This has relevance for the Hazida Bawa-Garba case (see timeline). It even has relevance for the Ian Paterson case which Kennedy himself reviewed (see yet another BMJ news item). Even the prosecutor at the trial admitted that Paterson's motives remained obscure (see BMJ news item). However unprofessional his conduct may have been he seems to have not been aware of it. Paterson maintained his innocence throughout the trial and sat with his eyes mostly closed, shaking his head throughout the statements (see another BMJ news item).

Maybe Kennedy is angling to do the report on this matter. He even did the MPs' expenses inquiry. I do wonder though whether he ought to hand over to someone else.

What do you do if a cricket ball won’t reverse?

Hey, guess who’s on Mad In America radio 

Special performance from Jos Buttler

Pleased to witness ODI series win by England (see tweet)

Medical staffing in the NHS

I've mentioned before that doctors are unhappy (see post). Rachel Clarke, in a BMJ article, describes situations in which NHS HR fails to provide junior doctors "with a contract, rota, or confirmation of their salary in advance of starting work". She also describes an anecdote of an unwell junior doctor being told by HR "that they expected him to find his own locum cover, that the rota gap was his fault, and that it was unprofessional and unacceptable that he had not filled it".

Actually the NHS has always been poor about providing written contracts. It maybe seemed to matter less in the past when there was a good personal relationship with someone in medical staffing. One had confidence at least that one would be paid correctly. Rotas were often worked out by the doctors themselves, which gave them flexibility.

This goodwill has gone in the era of acountable, so-called patient-centred care. It's reasonable for doctors to expect the NHS to be accountable in the same way as they are.

The Laker Balcony has one of best views in world cricket and is so close to Pavilion balcony that it is almost extension of those facilities 30 Jul 2017, 19:56

I was there on Friday! 30 Jul 2017, 19:57

For the May, not the few

Academic critical psychiatry

I've never really been an academic in my working life, apart from being lecturer for 2¹/2 years in Sheffield 1989-92. Now I'm semi-retired and just doing 2 days clinical work as a consultant psychiatrist, I'm looking forward to going back to Trinity College, Cambridge in October to do a part-time PhD in the Department of Psychology on "The foundations of critical psychiatry" (see my critical psychiatry blog). If anyone's interested in funding the Institute of Critical Psychiatry, do let me know. Cambridge University may even be interested to know if you are.

The club of consultant psychiatrists

I started as a consultant psychiatrist 25 years ago today. This was in Sheffield. I had been told at my interview that it was like I was joining a club. I guess it has been a privileged position.

At that time, my contract was with Sheffield Health Authority, although I was working for the mental health service unit. This was before the days of NHS Trusts and Foundation Trusts. Consultant contracts were subsequently transferred to these provider organisations, even if, as I mentioned in my previous post, mine has been suspended twice. Health Authorities were also replaced by purchaser GP organisations, now called Clinical Commissioning Groups.

Have I been right all along about critical psychiatry?

In an article I mentioned on my critical psychiatry blog (see post), Professor Sir Robin Murray says he wishes he had tried "harder not to follow of the fashion of the herd" (sic) in his research career in psychiatry. He thinks the mistakes he has made "have usually resulted from adhering excessively to the prevailing orthodoxy".

That's as may be. I'm glad he is now admitting his mistakes. As I implied in my post, I wish he would go further in realising the conceptual mistake he has and still continues to make about the nature of mental illness.

Actually, I think it's understandable the reason he has taken the position he has in his career. He has been a professor in psychiatry and knighted for his research efforts. I have tended to concentrate on my clinical work and been suspended twice for my efforts (eg. see previous post). So what if I've been right about critical psychiatry all these years!