I agree fully with all responses. The piece above is the hymn-sheet and the NHS is the space with appalling acoustics.
The advice is ostensibly sound but when "your unwell colleague" takes time off and the understaffed rota is stretched further, the likelihood of more "colleagues" needing drink/drugs to cope gets bigger.And the whistle-blowers own work schedule gets rougher. Worth it for the greater good?
Reminds me of the Cold War and The Domino Effect theory.
Nadine Dorries acts from a position of being heavily influenced by Christian theology (and the rights or wrongs of this are worth discussing in its own right) but is somewhat selective when invoking Gods Commandments (yep to restricting abortion and obstacles to gay marriage; nope when filing her expenses).
Christopher Ho, our esteemed Libertarian, does beautifully what libertarians do ie have a myopic view of the individuals responsibilities to society and far-ranging but intellectually less than rigorous notions of what freedom means, and a penchant for soundbites. He objects to subsidising abortions as he sees it but doesn't consider the longer-term costs to his pocket of having children born to women who may have been persuaded by a whole range of pressures to proceed with a pregnancy with a less than full recognition of the potential costs to her, the child and society in the longer term.
A contributor here mentions that babies born at 23 weeks can survive but if we look at the data, the incidence of longterm complications and problems (not cheap, Christopher!) is very high.
There are many aspects to consider, and a "meta-view" is useful. Certainly more so than the rigid adoption of an ideological dogmatic paradigm.
Copperfield, I dares you, for the sake of counterpoise par excellence, to reply "Dear X, Wot-evs. Yours sincerely, Dr Copperfield".
Relax- sincerely, no apologies necessary. I hope the other SA thickies are also this charitable(!!!). Smiley Face inserted here..
You have utterly missed the point.The issue is one of assessing clinical skills to some degree, which means for primary care hands-on detection of clinical signs.Your use of the term "vaunted medical consultant" is quite telling and misunderstands what MRCP is all about. Doing the basics well, fluidity of thinking, competent and purposeful examination (which largely comes from the experience one needs to pass the exam rather than the paper its written on) with a full recognition of how invaluable the examination is to work out whats going on, or where to go next. Experience of the other disciplines you mention are vital too and their clinical examinations techniques should also be assessed with hard signs present.
I love how you broad-brushed all those who entered the hallowed ground of General Practice via Summative Assessment as thickies. At the time I passed that oh so demanding examination I was told by my trainer that MRCGP denoted excellence whereas SA established competence. I entered GP training holding MRCP(UK) when the format still included the dreaded Short Cases section (which had an accepted failure rate of 70%) and quite frankly I saw absolutely no point in striving for an inferior qualification (namely MRCGP) when I had already been blessed with a diligent apprenticeship in clinical medicine with robust evaluation of my clinical skills. I accept that quite clearly I must be a thickie on some level as I had chosen GP as a career but your trite analysis needs calling out especially when the holders of MRCGP, at their very sharpest (eg GP registrars who have just passed) when asked to examine the respiratory system feel it is below them to actually percuss the chest and consequently get the findings backwards.Clinical excellence? Absolutely- depending on ones yardstick.
You Sir/Madam, are absolutely correct.MRCP is indeed a most respected qualification and not without very good reason. Primary Care needs more holders of this diploma, who have the skills to elicit the signs and the confidence to interpret them correctly which can only improve patient care.Both you and I know why this level of scrutiny will never be applied to GPs because the overwhelming majority will woefully fall short of the grade due to poor training, too much touchey-feeley cr#p and trainers who are also far far short of the quality this kind of exam demands.
The prism that MRCP bestows on the run-of-the-mill practise of most GPs also shows it to be pretty poor in doing the basics to a decent standard. Ultimately MRCP simply ensures that the basics are done very well, and imparts lasting good habits which endure.And sadly, in my opinion, many GPs at some level feel threatened when their work gets scrutinised closely- they forget that such scrutiny cannot help but fall upon their work when one is doing ones job properly ie considering past events, correspondence, clinical findings and test results to accurately evaluate what is before them in any particular clinical encounter.
For those readers not well-versed in dissecting politico-speak let me highlight a couple of features of the esteemed Mr Johnsons blatherings:
1.By ensuring the incompetent Hancocks retention of his job it will come to pass that the 3 week wait to see the GP will no longer exist, as the wait will be extended to five weeks.
2. When it is ones position that the elderly do not deserve much in the way of either dignity nor security one can readily deliver on the promise made by cutting their provision back even further.
All it needs is a "can do" attitude folks.
Whoaml @8.20m- almost none, because blood tests are ancillary to history/exam, and support the evaluation of the case.
Dylan @5.26pm-that really depends on the action you choose. And that means thinking around the whole case to get some context for the abnormal result before you to determine the correct course.
I'm not convinced getting Hancock to "look" at the paperwork is gonna achieve much. Maybe if one of his advisors reads it to him his dyslexia could be circumvented.I resent his comment re doing a full weeks work- this shows he has no grasp of what the job entails and the solid graft done by those who are regarded as part-time, where 6 sessions done properly is damn close to full-time in terms of hours spent being slowly destroyed by the job.
A government which doesn't care cannot help but push people into self-preservation mode, and rightly so. This job cannot seriously be regarded as a vocation any longer.
Why not take a good deal of the subjectivity out of the equation, and have real patients with clinical signs and examiners who can actually competently elicit them?
Some time ago I had a patient who, on taking some social history, proudly stated they were an "actorrrr for the GMC doing PLAB exams". I will leave how the consult went to the readers imagination, and if the description of the typical role player was 110% accurate, or not.....
Deviant GPs- what would the public think?
Case A- I would opt for option C-"Get some cannabis-next".
Case B-Again, option C-"f you have a smart TV, get Alexa to change your channel-next".
This article had me humming "Exodus" by Bob Marley but its all good because Dr Kasaraneni still has "hope"- and this is on top of the pompous title.
Just like Rory Stewart (AKA Pug from the Beano) said about quitting if the prison system is not fixed by x date. It means Jack-Sh#t when you are no longer in the same job.
Broadbrush "CSE" (not O level) medicine.It is well known that CRP elevation can be absent in a flare-up of SLE- or it should be. If the clinical picture is right than a raised CRP in a LE patient suggests an infection.
Nuances people, nuances. Its sad that such advice has to offered because GPs by and large are not attuned to such nuances.
"Your pain is the breaking of the shell that encloses your understanding".
I said that to a patient the other day and within a day I got a complaint.However, they did have multiple liver mets.
Serves you right for doing your job properly!
Perhaps you need to review the concept of patient expectations, and amend your practise accordingly.
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"Never a frown with Golden Brown" as The Stranglers knowingly said.
I wonder if aluminium foil could be a tax-detectable work-related expense?
Personally I have been traumatised by the word "Think-Tank" because this suggests something militaristic and aggressive.
I also find it amusing how those disingenuous contestants for leading the nation are now able to recognise how the underfunding of many areas of public services has caused problems. Their superficial bleating in order to gain the position which will massage their egos the most should hold no sway with anyone who has witnessed a prime ministerial succession take place.