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Gold, incentives and meh

Rory

  • RCGP chair: 'I advise patients to take photos of their hospital notes'

    Rory's comment 08 Oct 2019 10:37am

    I advise my relatives to do the same from a Medico-Legal standpoint. Too often things have either disappeared or what was written did not reflect what was said.

    Over a decade ago I observed a consultant using dictation software to write her letters straight after the consultation for the majority of straightforward patients. Probably to be printed off and then sent via the post of course - emails would be impossible.

    I am not surprised that this simple, cheap approach to speed up the process has not been taken forward.

  • Bawa-Garba: a journey from hell to redemption

    Rory's comment 10 Apr 2019 10:53am

    All these systemic failings and oddly enough they are only called out after they contributed to the death of a patient after a coroner forced the matter to be looked at.
    How many levels are actively trying to hide issues that lead to deaths? I imagine that this is merely the tip of the iceberg.

    Oh, and I thought that speaking out against this behaviour is in both the best practice for the GMC and the NMC. Yet so far the silence is deafening.

  • GPs to receive training on tackling unprofessionalism from GMC

    Rory's comment 03 Apr 2019 10:19am

    A tacit admission that Revalidation fails so utterly that even behaving professionally with colleagues requires remedial action.
    What does it achieve beyond an additional source of revenue?

  • Your referral criteria rejection does not meet my referral rejection criteria

    Rory's comment 25 Jul 2018 11:05am

    My personal "favourite" from was the CMHT regarding a referral from the surgery after a patient's therapist had called in worried that the patient was at a high risk of suicide and required urgent intervention.
    The letter we were sent outlined the refusal to see him since the therapist had not contacted them directly and hence he couldn't have been at that high a risk.

  • The end game was always to dismantle general practice

    Rory's comment 11 Jun 2018 2:00pm

    I am less interested in how care is delivered but am very interested in the quality of the care.

    There are many organisations - from the DoH, the CQC to the GMC along with many others who seem to enjoy their time making statements rather than having a cohesive way of providing oversight on clinical care.
    Reviews are often late, have reached a point when hundreds if not thousands have suffered and the outcome tends towards "lessons learned".

  • GMC spares seven doctors from investigation while mentally unwell

    Rory's comment 16 May 2018 10:39am

    The article wasn't clear whether the doctors have been suspended in the meantime.

    Dr Laxman managed to remove the head of a baby during delivery, and has been suspended by the Trust. Could she work elsewhere? Should she pop to hear GP and get a certificate that she's suffering from depression to send to the GMC whilst she works abroad for a bit?

    I note that this case will be in the future part of the number which is used as evidence that the UK healthcare system is discriminating against minorities. This might be the case, but it does highlight how providing a narrative of the cases adds important information.

  • GP practices set up not-for-profit company with trusts in bid to attract staff

    Rory's comment 09 May 2018 11:02am

    There is no system of company organisation that of itself will ensure that it is virtuous. Some might be more easily manipulated than others, but I am sure accountants with the right mind set can work with any structure.

    Setting up as a Charity would probably have been far more difficult (and perhaps impossible) given that it would then have much stricter rules and oversight. But even they can and do have issues.

    I laud that they are at least trying something rather than just wringing their hands and moaning that it is so unfair that others won't just give them more money or provide a solution.

  • GMC review finds revalidation 'may not improve practice'

    Rory's comment 01 May 2018 2:51pm

    The only persons who benefit from this are those who collect the money for overseeing it.

  • I’ve learned the hard way to live without patient ‘satisfaction’

    Rory's comment 19 Apr 2018 11:26am

    The first step is to realise you are merely a tiny, almost insignificant cog in a massive edifice. Even if you worked 20-hour shifts you'd not make the slightest impact even if by some miracle you were on your "A" game for all 20 hours, 7 days a week.
    I want to see (for example) a lawyer, I pay per hour. They can allot a 6 hour slot since I paid in advance for this. If I need 6 hours and I can afford one I get one and a disclaimer that they did not have enough time.

    I work for my family and I provide a service to fulfil a contract to get paid. Those that don't like it can go elsewhere.

    Viewing myself as an average white collar worker might make it all mundane, but also means my limitations and those of the system I work for.

  • Dilemma: Patient with learning disability refuses care

    Rory's comment 13 Apr 2018 11:04am

    Reassuring to see the medicolegal view remains constant in each and every dilemma - make it someone else's risk as soon as possible.

  • No one likes us – and we don’t care

    Rory's comment 13 Apr 2018 10:38am

    The only thing being a clinician in the NHS is being a patient: fighting to get an appointment with a GP, working one's way through the treatment algorithm designed by the CCG to keep patients away from expensive options...
    It would be better the NHS accepted that it can do a limited number of things well and stop pretending it can offer all services only to restrict them to the point of a theoretical option. Treat all stakeholders as adults and ask if people are prepared to pay the money required for a great system or whether they'd like a simpler, but cheaper one.

  • Dilemma: A frail patient has no means to pick up an urgent script

    Rory's comment 20 Mar 2018 11:28am

    Such patients should ensure that they can either care for themselves, or move to where they can be cared for.

    There are probably many advantages to living in a small hamlet in the middle of nowhere. One of the disadvantages is that there is no support. Living in sheltered accommodation has many downsides. One advantage is support on hand.

    Adults can make their own decisions. If their choice is to remain in a large, isolated house then this is their right. But they also have to accept the potential consequences.

  • Protection for reflection: how to rebuild confidence in a learning culture

    Rory's comment 19 Mar 2018 12:02pm

    The reality of the data that is required to progress through milestones was highlighted as a FY1 - everything had to fit the view of one's assessor - even having too "positive" feedback too early on in the year was bad apparently.
    My practice has progressed considerably since those early days and I ensure that even my views do not deviate from those that my assessor would wish to read - and of course all events are minor and self limiting or without question outside of my ability to affect. To document anything else would of course require me to try to drive change - so better to engage in double-think that there is nothing wrong so therefore there is nothing to try to improve.

  • Set a fair exam and we won’t need to retrain ‘failed’ GPs

    Rory's comment 19 Mar 2018 11:54am

    So doctors can be callous, disinterested and fail to communicate to their patients as long as they can say that this is linked to the colour of their skin?
    The exam is not there to be "equal", it is there to ensure a certain level of ability.

    If there is a gender or race bias in how the exam is assessed, this should be addressed. If however for whatever reason a certain demographic of candidates fails more often to meet the standards then that is acceptable: I would want a good doctor, not one that happens to fit some sort of quota.

  • Caught in the middle (again)

    Rory's comment 19 Mar 2018 11:38am

    Very good point. Although I imagine that there is a lot of lobbying to ensure that this doesn't happen.

  • Spare us the heartsink celebrity endorsement

    Rory's comment 19 Mar 2018 11:36am

    Scientific method is almost always too dull for the Media - iterative advancements requiring rigorous testing can't compete next to tabloid hyperbole.

  • I am a BME doctor and I worry about my future in the NHS

    Rory's comment 19 Mar 2018 11:32am

    Is this causation or correlation? Certainly the doctors I have worked with who have had the poorest grasp of English have tended to be BME. The number has been extremely low whereas I have personally not worked with a non-BME doctor who had poor english, so the relative rates are very high if expressed as a ratio.

    Frankly I do not have enough information to make any sweeping statements. Clearly others feel less constrained.

  • Bawa-Garba 'tip of iceberg' as seven doctors struck off after GMC appeals

    Rory's comment 19 Mar 2018 11:26am

    Disgraceful! Doctors should be allowed to do their jobs and if people happen to die from negligence or poor infrastructure it should be dealt with internally by a round table over lunch.
    Surely non-clinicians understand that Physicians are above any and all laws when they are at work? Any attempts to enforce them are clearly a witch hunt!
    Can't they just be happy that we now do reflective continuing professional development which is little more than a chat and a GMC medical standards that are clearly ignored most of the time.

  • GP leaders instruct GPs to stop written reflections in light of Bawa-Garba case

    Rory's comment 12 Mar 2018 11:26am

    The paper trail that Doctors have been obligated to have for years has always had "right" things to record and "wrong" things to record - who would be foolish enough to not submit a carefully curated list of events with "significant events" being at the level of discussing how to deal with a patient who was five minutes late for clinic and the discussion that ensued?

    Mine will for the foreseeable future remain a Potemkin village for the same reason - it is what everyone wants there to be.

  • #IamHadiza: GPs share stories of when it could have been them

    Rory's comment 05 Mar 2018 12:38pm

    Consultants should be the ones leading reform by challenging the systems that currently exist. On occasion I have worked for ones who would refuse to discharge until the patient notes had been found for inpatients, and told all juniors to tell the discharge team to write in the notes themselves rather than bully juniors to do it. They invariably backed off taking responsibility themselves.
    But more often I have experienced Consultants more interested in hiding errors including negligence - especially if they might be exposed by an admission: overflow wards renowned for high mortality rates? Surely a matter for someone else.
    If consultants / GP Partners were to insist that all their teams were to work their hours, to protocol and in the best interest of patients there would very quickly be the need for reform.

    I am not surprised that the attitude appears to be that killing one or two should just be expected (after all, if everyone has done it, it isn't really a problem, is it?) and everyone in the general public should keep calm and carry on.