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!

Returning to Lancaster University

Returned to Lancaster University today for neuropsychology course. I was here over 40 years ago having enrolled on MA in Religious Studies, which I did not complete, in the department set up by Ninian Smart. He defended religious studies as a secular discipline and distanced it from tradional theology. I had been introduced to this approach in Cambridge by John Bowker, who was also at Lancaster for a while.

Blogademia

The term 'blogademia' was coined by Craig Saper (2006), before I fully understood what blogging was. I started blogging myself at the end of 2008, particularly my Critical psychiatry blog. Jolly et al (2016) reflect on 'blogademia' in a recent article in The Psychologist.

I've commented before on why I blog (Writing down thoughts on your mind for everyone to see and Blog resistance). Blogs are publicly available. There's no reliance on finding a publisher. Social media in general is user-generated, deinstitutionalised, interactive communication, which makes some academics wary of these publications as they are outside peer-reviewed journals.

Blogs do need to be of sufficient quality to merit publication. They can help maintain academic freedom in a university system motivated by commercial interests.

How computers are changing the world of healthcare

I have been reading The digital doctor: Hope, hype, and harm at the dawn of medicine's computer age. As I have done previously (eg. see my critical psychiatry blog post), I have tweeted quotes or modified quotes as I have read the book:-

DBDouble Rather than delight users, as Apple and Google do regularly, the electronic health record is a towering source of physician dissatisfaction 08/03/2016 08:16

DBDouble Though child can operate iPhone, physicians with 7-10 years postcollegiate education are brought to their knees by electronic health records 08/03/2016 08:17

Actually it's not the doctors' fault. They do have genuine concerns (see Health Affairs blog):-

DBDouble Physicians are not Luddites, technophobes, or dinosaurs about electronic health records 08/03/2016 08:31

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

DBDouble Only one in three physicians say electronic health records have improved job satisfaction 08/03/2016 17:37

Remarkably, electronic health records have not been developed to improve clinician satisfaction:-

DBDouble Medicine is an unusually expert-centric and somewhat arrogant field, so IT companies were slow to embrace user-centered design 08/03/2016 17:42

Doctors will need to adapt to electronic health records. There may be a role for the use of scribes, which a training doctor or medical student could fulfil in the interests of their learning (see NYTimes article).

Alan Partridge 100/1 to be first Mayor of East Anglia

East Anglia was one of the earliest settlements of the Anglo-Saxons. North Folk and South Folk may well have existed before any East Anglian King. East Anglia, with much of its earnings based on wool and textiles, was a rich area of England until the effects of the Industrial Revolution moved manufacturing to the Midlands and the North.

Duncan Smith has failed on welfare reform

Despite all his passion for welfare reform, the real reason Iain Duncan Smith has resigned as work and pensions secretary is that his reforms have failed (see resignation letter). The immediate focus is on PIP (personal independence payments). The introduction of this benefit has not generated the savings that the government expected. In fact, more people have been given it than expected and the average payout is higher than expected (see BBC report). The introduction of PIP was slowed to try and implement it properly and avoid the number of successful appeals, as was the case with Employment Support Allowance (ESA). There are still many people waiting to be reassessed. It's not going to be easy for the new work and pensions secretary to get this budget under control. I suspect Stephen Crabb has a recognition from George Osbourne that he can't.

Of the great climacterical year, that is, sixty three

Now I know what the problem is! I am now in my grand climacteric year. I am in the "mysterious period of life when the the numbers of seven and nine multiplied into each other" (see quote). According to Sir Thomas Browne, this is a vulgar error. Hopefully I will escape this dangerous year.

I now have to wait to see what happens when I'm 81.

Not yet a twitaholic

Doctors' unhappiness

As I tweeted, 'Junior doctors are not happy'. David Hunter usefully sets the dispute over the junior doctor contract and the likely strike action in the wider political context (see BMJ editorial). When doctors were happy, they:-

sacrificed early evenings, studied hard, saw patients, and provided “good” care. In return for these sacrifices doctors got reasonable remuneration; reasonable work-life balance later; autonomy; job security; deference; and respect. 

The drive for greater accountability over recent years has not always been well implemented (eg. see previous post). Care did need to change to be more patient-centred rather than doctor-centred (eg. see previous post). But practice has become too fragmented and dysfunctional. As Hunter concludes:-

resolving the concerns [of unhappy doctors] remains as big a challenge now as [15 years ago], regardless of the immediate outcome of the present dispute.

A sunny ferry trip

Now waiting to sail from Hook of Holland because of fog disruption yesterday to flight to Norwich (see EDP article). At least The Scotsman reports a problem (see article). Could be why I was redirected via Edinburgh tomorrow. I couldn't spend another night on a make-up bed in Schiphol in M terminal, but it's actually very warm and sunny on the ferry! Sailing now.

The case for the Physician Associate

The NHS is promoting the development of the new profession of Physican Associate (PA) (see NHS careers webpage). The role has been seen as "doctors on the cheap", but in fact, although Physician Associates are trained in the medical model, they are not doctors. The competition is more with other allied health professionals.

There are advantages in having allied health professionals trained in the patient-centred medical model. A PA is always responsible to a doctor. The Royal College of Physicians has set up a Faculty of Physician Associates (see webpage).

After training, it is important that Trusts support newly qualified PAs in a professional academy, as my own Trust has done for nurses and plans to extend to other disciplines (see webpage).