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Gold, incentives and meh

Peter J Gordon

  • My first blog is NOT about Professor Steve Field

    Peter J Gordon's comment 06 Jan 2016 10:55am

    It is wondeful to have Pete Deveson write a blog for Pulse.

    Well said that man!

    Dr Peter J Gordon

  • RCGP leaders receive New Year honours

    Peter J Gordon's comment 05 Jan 2016 10:06am

    My personal view is one that has always disliked this "honour" system.

    In NHS Scotland we have Healthcare Improvement Scotland who has a significant number of award recipients. Healthcare Improvement Scotland work hand-in-glove with the Scottish Government. In my opinion, and experience, this adds to a culture of "top-down" control in NHS Scotland.

    Even the Scottish Health Council - who promote "stronger voice" for the Scottish public - are part of Healthcare Improvement Scotland (Scottish Government).

    Critical thinkers and counter voices are not welecome and science that learns from such loses out. Care suffers.

    Dr Peter J Gordon
    [writing in a personal capacity]

  • GPs urged to use screening tools to diagnose sepsis

    Peter J Gordon's comment 30 Dec 2015 10:33am

    I share the views of those who have posted so far.

    I am concerned about the proliferation of "tools" in healthcare.

    A National Lead for Healthcare Improvement Scotland recently suggested, in a public forum, that a tool should be "designed" for "person-centredness". Concerned about this, I wrote the following post:

    https://holeousia.wordpress.com/2015/04/18/a-person-centred-tool/


    I have also made a short film on this subject called "Tools of the trade":


    https://vimeo.com/139916890


    Dr Peter J Gordon

  • Hunt praises 'courageous' Professor Field after GPC calls for resignation

    Peter J Gordon's comment 18 Dec 2015 12:56pm

    I am not a GP. This denigration of generalism, from the top, is not just distressing to me but concerns me for the patient harm that it will cause.

    What a mad world is the theatre of politics. Vested interests rule. I could almost cry for our public.

    Dr Peter J Gordon
    Consultant NHS Psychiatrist for Older Adults

  • Niall Dickson: ‘We want doctors to feel protected’

    Peter J Gordon's comment 16 Dec 2015 2:59pm

    As an "Expert in this area" I am concerned about this emphatic statement by the CEO of the MWC:

    "If you’re asking me whether these deaths could all be avoided by the GMC doing something, that would be ludicrous, and nobody who’s an expert in this area would even begin to suggest that."

    Do others share my view that this interview demonstrates a defensive and legalistic approach to humanity?

  • Niall Dickson: ‘We want doctors to feel protected’

    Peter J Gordon's comment 16 Dec 2015 1:25pm

    I have never been referred to the GMC, but this is my story:

    My former employers, NHS Forth Valley, in what they termed "informal" letters "invited" me to meetings where I was reminded of my responsibilities to the GMC. In my experience this was used as a threat.

    I had a 13 year unblemished Consultant career with NHS Forth Valley.

    Worryingly it was my interest in ethics that led to the threat of the GMC. I was advocating for a timely approach to the diagnosis of dementia. NHS Forth Valley did not support my position. I was isolated, mischaracterised and then regarded as "mentally unwell" by senior managers and certain senior doctors.

    Timely diagnosis of dementia has since been embraced across Europe.

    It seems to me that we have too many "tools" used in today's healthcare. But it seemed to me that mention of the "GMC" was used as a tool by my former employers. This "tool" felt like an axe to me, cutting down the tree of ethics.

    Moral of the story:
    It is worth noting that a significant number of those referred to the GMC, who subsequently took their life, had been referred to the GMC by their employers.

    Dr Peter J Gordon

  • Professor Steve Field says GPs have 'failed as a profession'

    Peter J Gordon's comment 15 Dec 2015 11:36am

    I am most saddened by these remarks made by Professor Steve Field and understand that the CQC have confirmed that they are accurate.

    Our oath is based on primum non nocere. Undermining General practice, in such a sweeping way, is not just disproportionate but also harmful to providing care.

    My wife is a GP. I have learned more from my primary care colleagues than all the specialists put together.

    Generalism is absolutely the most important part of our approach to care. It distresses me to see it disparaged by so-called leaders like Professor Steve Field.

    I think that he should carefully consider making an apology.

  • The treatment - depression in adults

    Peter J Gordon's comment 15 Dec 2015 11:20am

    I note that Dr R. Hamish McAllister-Williams has been specifically cited as a key opinion leader from whom educational material has been taken.

    It was, I understand, Dr R. Hamish McAllister-Williams, who invited, and co-chaired an all-day "educational" CME event with Dr Stephen Stahla at this summer's British Association of Psychophramacology Conference.


    I say this as Dr Stahl has been paid over $3MILLION for his work with Big Pharma in the last few years.

    Dr R. Hamish McAllister-Williams has declared his financial conflicts of interest with a number of Pharmaceutical Companies. However, unlike the USA, we have no idea, how much he has been paid.

    As for Duloxetine - have you read Dr Ben Goldacre on the evidence behind this?

    As for adding-in antipsychotics. It is worth looking at financial conflicts of interst that significant UL "Key Opinion Leaders" may have. Start with looking up Professor Allan Young, who is Chair of the Psychopharmacology Committee for the Royal College of Psychiatrists.

    Dr Peter J. Gordon

  • GP trainee died by suicide after fearing GMC suspension

    Peter J Gordon's comment 01 Dec 2015 3:01pm

    This is so sad and so wrong.

    My story is that I mmake short artistic films in my spare time. I recieved a formal letter from my NHS employer stating they had "concerns about my films" and that I may be reportable to the GMC.

    The film in question was about the potential harms of early diagnosis of dementia. My employers did not support my concerns. I advoocated a tiemly approach. Several years on this approach has been embraced across Europe.

    After receiving this letter I was suicidal fearing GMC and also intrusion into my creative life, artistic restriction, and my right for 'freedom to speak up.'(Robert Francis QC)

    Two years on and my films have been highly praised by leading national figures in Scotland.

    The point of my story is that it seemed to me that my employers were using the GMC as a threat, a weapon. My fear is that I am far from alone to have suffered this experience.

    And would you believe, the Medical Director who wrote to me expressing "concerns about my films" had never watched a single film made by me!

    Dr Peter J Gordon
    Consultant Psychiatrist for Older Adults

  • ‘A mature conversation is needed over statins’

    Peter J Gordon's comment 30 Oct 2015 10:15am

    I dislike the expression "early adopters". The history of this expression is interesting and worth considering.

    I personally find this short piece telss me more about the writer's views than the evidence or ethics behind prescribing.

    I say this as a non-GP who has no fixed view.

  • GPs’ diagnostic skills could be obsolete within 20 years, says Hunt

    Peter J Gordon's comment 06 Oct 2015 3:22pm

    "Mr Hunt informed delegates that Silicon Valley tech ‘gurus’ were confident diagnosis by humans would be obsolete within two decades."

    Such futurism is scientifically and philosophically ridiculous.

    The caring profession replaced with TOOLS, TOOLKITS and ROBODOCS.

    Coming from our Health Secretary this is very concerning.

    Dr Peter J Gordon

  • Duty of candour will overburden GPs, says BMA

    Peter J Gordon's comment 15 Sep 2015 1:54pm

    I raised concerns about the potential misdiagnoses of dementia with my former employers, NHS Forth Valley. I did so by following the appropriate line management system.

    Initially I had some support. However this did not last.

    For raising concerns (duty of candour) I suffered hugely. So did my family. I was mischaracterised by senior colleagues, isolated and bullied. I eventually resigned.

    "Duty of candour" sounds the right thing. But we must be careful as it could end the career of well-respeceted, dedicated doctors who only wish to put patients first.

    Dr Peter J Gordon
    Consultant Psychiatrist for Older Adults

  • Don’t leave policy on drugs costs to me

    Peter J Gordon's comment 09 Sep 2015 10:49am

    Dear Martin,
    There are indeed questions to be anwered.

    Thank you for your activism on this matter where vested interests yet again have triumphed in the NHS and costing us dearly.

    I have found that it is not always easy to speak out about these matters. Your inegrity marks you out Martin. In my opinion (actually in my experience) we have too many senior leads who do not stand up for what matters.

    I do hope that we get some definitive responses on this matter soon and that these are shared in the public domain by the powers that be.

    aye

    Peter

  • Anyone we have missed? Let us know here

    Peter J Gordon's comment 04 Sep 2015 10:42am

    Dr Martin Brunet

  • 9. Dr Margaret McCartney

    Peter J Gordon's comment 04 Sep 2015 10:40am

    Should be number one.

    In case I did not say this clearly enough:

    Should be number 1.

    aye

    Dr Peter J Gordon

  • America has been drafted in to save the NHS

    Peter J Gordon's comment 02 Sep 2015 1:23pm

    In NHS Scotland, Healthcare Improving Scotland have an over-arching role.

    Their remit covers EVERYTHING: Improvement - Scrutiny - Evidence.

    "Improvement methodology", as best I understand it, has been introduced from America (Institute for Healthcare Improvement, Massachusetts)

    Dr Peter J Gordon

  • Is it time to slash psychoactive drug prescribing?

    Peter J Gordon's comment 26 Aug 2015 12:33pm

    I am an NHS psychiatrist who has worked In Scotland over the last 20 years.

    I fully agree with Dr Spence.

    "Education" of my specialty has been, and sadly continues to be provided most significantly by vested interests.

    If you are in doubt you can have a look at the evidence I have provided the Scottish Parliament: https://holeousia.wordpress.com/about-me/a-sunshine-act-for-scotland/

    In NHS SCotland antipsychotic prescribing, in all ages, is rising year on year.

    Antipsychotic prescribing to our elders has doubled in a handful of years. This may be the result of delirium/dementia "awareness" campaigns and Improvement work nationally.

    1 in 9 of adult Scots are on antidepressants. Many of then stuck on them. Though some expertsd have advised such is "appropriate" treatment. Some have even described prescribing as "conservative"

    Dr Peter J Gordon

  • Why is it so expensive for GPs to get a little bit of training?

    Peter J Gordon's comment 09 Jun 2015 12:45pm

    Dr Brunet raises an important issue.

    In my research for a Sunshine Act for Scotland I have found that meaningful transparency lacks across the board interms of the financial support of conferences. Here I include conferences organised by various Royal Colleges, professional conference organisers, Charity conferences etc,

    https://holeousia.wordpress.com/about-me/a-sunshine-act-for-scotland/

    Asking for full transparency about financial transactions in medical education is neither anti-business nor anti-innovation.

    In my view medical education need not be so expensive.

    In my view Science is at its most objective when free of potential financial distortions.

    I would like to see the GMC act here to back up what they ask of us all in Good Medical Practice. Especially as doctors we all have to ensure our CME points are all acquired for Appraisal and Revalidation.

    My own College, the Royal College of Psychiatrists, have not governed or followed their own Guidance on this (CR148) which was introduced more than seven years ago. I have no wish to "pick on" any one Royal College.

    The recent PULSE Live Conference in Edinburgh was heavily sponsored with paid speakers:

    https://holeousia.wordpress.com/2015/04/23/pulse-live-is-heading-to-scotland-the-corn-exchange/

    The Alzheimer Scotland Conferences are always heavily sponsored.

    The forthcoming Scottish Government Conference on "integration" (NHS Scotland and social services) has widely promoted itself for expensive supporters.

    Thank you Dr Brunet for raising this issue.

    Dr Peter J. Gordon

  • Have we swapped Balint groups for Facebook rants?

    Peter J Gordon's comment 22 May 2015 2:31pm

    I think Dr Brunet writes with thought and care. I applaud that Dr Brunet is willing to explore some of the more difficult aspects of the doctor-patient relationship.

  • GPs should be sued for ‘late’ dementia diagnoses, says professor

    Peter J Gordon's comment 24 Apr 2015 12:21pm

    It is welcome that Professor June Andrews is engaging in discussion.

    I have met Professor Andrews several times and I know that she is a passionate advocate for those living with dementia. However I do not agree with her on early diagnosis of dementia, and never have. Professor Andrews is aware of our differing views on this. I have advocated for a timely approach to diagnosis and was delighted to see this enshrined in the “Glasgow Declaration” in October 2014. This declaration has now been signed by 50 dementia organisations across Europe.

    I am afraid that the suggestion by Professor Andrews of adding in a "stick" (threat of legal action) in addition to the £55 "carrot" seems hugely misguided to me and potentially most harmful.

    I have covered this here: "Can't - Won't - No point" https://holeousia.wordpress.com/2015/04/21/cant-wont-no-point/

    I work in NHS Scotland and was concerned about the target based approach Scotland took. This approach WAS incentivised (but not at GP level) as NHS Boards were paid for reaching the target. I must correct Professor Andrews on this. The target was specific and asked for "Early diagnosis". In my experience the target skewed behaviours in unethical ways and at all levels: from senior managers and right through the clinical “chain”: as a result, my experience was that the consultation no longer seemed to belong to the patient and doctor. Rather a political target loomed over both.

    Scotland was TRIUMPHANT (!) about reaching the target and in giving evidence to Westminster parliament chose to shame the rest of the UK. This was the beginnings of maps and targets rather than patients and patient-centredness.

    As Dr Brunet has pointed out target rates are very crude and the ‘dementia prevalence-calculator’ implies scientific and epidemiological accuracy though it has (to my knowledge) never been studied in any academic detail (at least independently) before being implemented as the guide to policy in NHS England. This is an experimental approach. Delayed diagnosis of dementia is a complicated issue. Surely the better approach is to support and encourage professionalism in our profession rather than target (and I use this word correctly in this case) our GP colleagues.

    The approach that Professor Andrews forthrightly advocates risks inappropriately medicalising swathes of our elderly. Age-related cognitive changes are real (distributed on a parabolic curve) and should not be treated as dementia. The risk is that care for those living with dementia worsens as services get stretched as a result. I am sure Professor Andrews does not wish this. In my opinion, inverse care is a very real risk.
    I worry that we are adding great fear about all this through simplified "awareness" campaigns (I am of the view that the Big Dementia Charities carry much responsibility here). I feel that Prof Andrews approach, as a high-profile and international expert, also risks this.

    Lastly, whilst I very strongly disagree with Prof Andrews on this matter, I respect her as a person and do understand that she has a good heart. I just think that Professor Andrews has not thought through the complexity and the ethics of the doctor-patient relationship which is far more important than any crude target.

    Dr Peter J Gordon
    NHS Scotland