Wednesday, 29 February 2012

Care of The Elderly – again

So the Commission reported today. Yet another damning assessment of the treatment of elderly people in hospital, this time focusing on “dignity”. Or the denial of it.
It is all very sad. But it just tells us what we already surely know.
But will it make one jot of difference? You know, I really doubt it. They talk about the lead nurse in a ward having complete control on what goes on in her/his patch. And that nurses falling below the acceptable level on the compassion scale with be dismissed.
But how on earth do you get to dismiss staff on such grounds with present employment law as it is?
I can predict pretty confidently what will happen: the alleged miscreant will go weeping straight to their GP claiming stress due to victimisation and discrimination, demanding to be signed off sick. And believe me, GPs do not refuse them lightly. It is simply too much trouble, especially when the waiting room is packed.
And armed with the requisite piece of paper, the next stop off points will be the union representative and the lawyer.

Sadly, the patient, as happens so often, will come second. Unlike the employee whose livelihood is threatened, if you are old, frail or dementing you are hardly in a situation to stand up for yourself.

On Idiotic Driving

This morning I left Wiltshire at about 8.00 a.m. to drive with my wife to London on the M4.

The light was actually quite good, and the roads dry. But there was a slight mist. As always, when there are the least visibility problems I switched on dipped headlights.

For a few miles between junctions 15 (Swindon West) and 14 (Hungerford) the mist became rather more dense, as the downs are fairly high up there.

I noticed that at least a third of the drivers coming up behind me had no lights on at all. I was driving at just under 70, and plenty of these lightless drivers overtook me.

I just wonder what is with these people. Do they think their batteries will go flat or something? It worries me, though, how such thoughtless driving habits might equate with others – if they are not worried about being seen in poor visibility, do they also not worry about bald or under-inflated tyres, defective brakes or non-functioning windscreen wipers?

Then I remember the wise words spoken to me many years ago “never fall into the trap of thinking you’re a better driver than the one in front of you. And always assume that the one behind you is a dangerous fool”.

Thursday, 9 February 2012

The Clock that Forgot How to Chime

There’s a clock on our mantelpiece which has been around for pretty much as long as I can remember. It belonged to my father and two things I know for certain about it is that it is over 100 years old – probably well over – and that it is American.

I remember it ticking on a wall mounted corner cabinet, oh, it must be 60 years ago, in the little holiday bungalow he and my mother had bought in Suffolk and where they thought one day they might retire. In those days he and I would travel up there at weekends – a three hour haul then. He would read of an evening in front of the fire, and I would sit at his feet gazing onto the flames, his old dog wheezing away in his sleep at my feet.

It is an “eight day” clock, and so when he wound it up when we arrived on Friday evening, it would still be ticking the seconds when we returned the following Friday. And chiming the hours.

My mother died in 1953, when I was six. The old dog died in 1962, and my father in 1971. And then I got the clock. It ticked and struck the hours faithfully, decade after decade, until about 10 years ago when it just stopped chiming. I opened the back, tinkered with the mechanism and put a few drops of oil when it seemed they might be needed, but to no avail. I took it to a seller and repairer of antique clocks, but he looked down his nose at the clock, and, I have to admit, at me. “Nothing very special about this” he said and then quoted a price I thought ridiculous. Perhaps he just wasn’t interested in my custom. So I took the clock home and set it ticking again, consigning the sound of its chime to memory.

Last spring the old Bath stone chimney stack at our house in Wiltshire dropped some masonry, and the possibility of a total collapse looked frighteningly real. A good stone mason was engaged, and an application to the council made to allow us to commence with the work (the house is a listed building, and English Heritage is most particular that that any repairs be in keeping). And we thought that while we were at it we might as well have the chimney flue lined and a nice wood burning stove installed in our living room. By the end of the summer all the work was complete, and come the cooler months we basked contentedly in front of our new acquisition. In drowsy moments I fancied once or twice that I could hear the wheezing our old dog there in front of it …

Then two weeks ago I made a mistake, fortunately without the dire consequences that could have been: I left the bottom vent of the stove wide open, loaded it with fuel and set it going. It overheated. Some paintwork on the mantelpiece was scorched, and my wife had to go round the house opening windows to let out the smell, and I closed all the vents, wearing an oven glove. Gradually all began to settle, and it seemed that no harm had been done.

And at midday the clock struck 12.

I suppose it must have had to do with the heat getting into the depths of the antique mechanism and freeing something within it. We were delighted, of course. But would it all seize up again when it had returned to its ambient temperature?

Well, it hasn’t so far. And every hour is a delight. And memory after memory flood back, some joyous, some bitter sweet and some sorrowful. Just as is life.

Friday, 3 February 2012

Flu Jab

I went to my GP surgery yesterday and had my flu jab. The first flu jab I have ever had in fact. What prompted me to go for it? I have to confess it was in part a guilt reaction to the publicity given to the fact that the uptake of flu jabs among NHS personnel is woeful, and suggests that health care professionals don’t practise what they preach.

But there was always that fear than one might react to the jab rather unpleasantly. Heaven knows, I saw enough patients in my time who insisted that the flu jab “gave them” the flu. But since I have retired from practice that doesn’t matter so much, although I did time it so that I would have a free day afterwards.

I got jabbed in the morning and felt generally OK for the rest of the day. But I was restless and mildly feverish during the night. At 6.00 a.m. today, wakeful, I was hugely relieved that I was not faced with a typical 10 hour stint in surgery seeing patient after patient expecting me to be in tip-top form. (Patients often say ‘And how are <I>you</I> today, doctor?’ And of course the question is asked in anticipation of only one reply: naturally, no patient wants to entrust herself to any doctor who is not 100% on the ball. If they only knew the truth!!).

But the malaise I experienced certainly wasn’t the flu – which is a vicious illness at best – or anything like it. I shall certainly book myself in for it next year

Wednesday, 1 February 2012

How Doctors Keep Up – or how they don’t

I did my last GP locum slot on the 30th December and followed it with a resolution – it really would be my last. So now I am lost to general practice for good.

What prompted me to do this? Well, I have to admit that HMRC telling me that I owed them quite a lot less than I feared had something to do with it. But also I have come to realise that working only 8 sessions a month really isn’t enough to keep one’s hand in as a GP – things are changing so quickly and you really don’t want to see a doctor in 2012 who is practising the same as he did in 2002 now do you?

And the reason I was only doing 8 sessions a month is that my defence organisation – the bods who come to doctors’ aid when they get sued – said that with my reduced sub (over £150 a month) that’s all I could do. I got miffed – I must have paid them pretty close to £100,000 in subscriptions in my 42+ doctoring used and got nothing back. That is, although I may have deserved it, I never got near being sued by a patient in my whole career.

But to get back to the point: to really keep up with trends and changes I guess that I would need to be working double that. But I couldn’t afford the defence subs and quite frankly I don’t have the energy and staying power I once had.

And there is another point: for me, the looming spectre of regular revalidation for GPs, necessary though it is in principle, is a real block to effective learning. Yes, really, even though it is about keeping doctors safe and up to date. But they have gone about it in a way that is crass, cumbersome and costly: requiring doctors to undertake audits of their work, engage is 360 degree appraisal by colleagues and staff, promising to improve themselves in line with comments made by patient questionnaires. And much other similar crap.

Look – I was a GP educationalist in my time, and a damned good one. I know as much as anyone about identifying learning needs and acting upon them. I did it conscientiously and with rigour. When I was allowed to. But now the meddling politicians have decided that they know best. Such a pity, as the resources available to practising doctors now for ongoing learning are phenomenal. And believe me, most of them engage with them with huge enthusiasm.

Funny – my own enquiring of the general public leads me to conclude that very few of them are aware that their doctors are going to have to devote a considerable amount of time – which they would prefer to spend with their patients – to a revalidation process that is unproven and is going to cost somebody a hell of a lot of money (don’t worry – it will probably be the doctor). And any process of assessment that is worth anything at all is going to have a failure rate which means that doctors will be removed promptly. So if you pitch up a the surgery with your chest, your feet or your piles and the doctor isn’t there, then you’ll know why.