Wednesday, November 25, 2020

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.

Tuesday, August 25, 2020

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.

Thursday, August 06, 2020

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.

Tuesday, May 12, 2020

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!

Sunday, April 12, 2020

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.

Wednesday, March 25, 2020

Friday, March 20, 2020

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.

Friday, January 17, 2020

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).