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A faulty production line

Andrew Bamji

Retired consultant rheumatologist

  • Practice forced to declare ‘serious incident’ following IT failure

    Andrew Bamji's comment 07 Jan 2020 11:13am

    I was spared a large damages bill when sued by a patient, largely thanks to paper notes with an entry that would never have been put on an electronic record. These days some sort of back up is essential; having a cloud backup alone is not enough - practices need a local system as well. IT is wonderful until it fails, as any bank knows...

  • I was left unsupported for 80 minutes in a life-threatening situation

    Andrew Bamji's comment 31 Dec 2019 10:25am

    This is not a new problem. The year before I retired from the NHS my hospital was downgraded, lost its A&E and had all its acute physicians relocated to other places. So when a patient collapsed in my clinic there was no-one to decide whether he had had an MI or not. There wasn't even an ECG machine in outpatients. So I dialled 999. The ambulance took over an hour to arrive and ship him off to a "real" hospital. The reason for the delay? He was already in a hospital!

    This was in 2010. A decade has passed and plus ca change, plus c'est la meme chose...

  • Statin the bleeding obvious

    Andrew Bamji's comment 17 Dec 2019 2:49pm

    Missed this post. Enlightenment herewith. If a protocol comes up with a stupid answer something is wrong with its basis. Mankind has existed without statins for millennia. Most of the risk studies cannot disentangle other factors such as smoking and obesity but the bottom lines are (1) the quoted risk reduction from statins is relative; the absolute reduction is not statistically significant and (2) blood cholesterol is not a consequence of too much dietary fat because it's synthesised from carbohydrate in the liver and (3) cholesterol in plaques does not seep through from the bloodstream but is deposited as part of an incomplete repair process following inflammation, which is quite independent of the level of blood lipid. It follows therefore that the whole basis of the algorithm is based on a false premise, and I am only sad that the influencers, many of whom are paid handsomely by the statin industry, See unable to understand basic science. Self-justification papers continue to mislead. For the latest Lancet example it's worth reading the elegant dissection by Zoe Harcombe in her blog.

  • High-profile GPs lose seats in Conservative landslide

    Andrew Bamji's comment 13 Dec 2019 11:43am

    I have long bemoaned the general lack of institutional memory both within and without the NHS, but it must be remembered that the reason for austerity over the last 9 years was that the Labour Party had bankrupted the country. The Chief Secretary to the Treasury, Liam Byrne, even left a note for his successor to that effect. If any individual had splurged on their credit card to that extent they would have been seen as irresponsible. You cannot spend what you do not have. But now the dust has settled let's hope that sensible spending decisions can be made in the NHS. I believe that these must include serious discussions on what we don't do, as well as what we do do. Just because we can does not mean we should.

  • GP patient data 'sold to US pharma firms' by Government service

    Andrew Bamji's comment 09 Dec 2019 11:30am

    At least it's being paid for...

  • GP-based pharmacists can have 'significant' impact on cutting patients' CVD risk, finds study

    Andrew Bamji's comment 04 Dec 2019 10:46am

    I don't suppose that the risk was de-aggregated into the three mentioned components, was it? BP and diabetes are definite risk factors; LDL is probably not!

  • BMA: Government pensions plans are 'worthless' and won't stop GP retirements

    Andrew Bamji's comment 24 Oct 2019 11:21am

    As always people make decisions without thoroughly examining the consequences. One of my rules for assessing anything new is to ask "What could possibly go wrong?" Financially, pensions are the last of a long list; failed and expensive reorganisations, PFI... see my book "Mad Medicine" (https://www.amazon.co.uk/Mad-Medicine-maxims-National-Service/dp/1688011897/ref=sr_1_2?qid=1571912397&refinements=p_27%3AAndrew+Bamji&s=books&sr=1-2) out of which I suspect many GPs and others will say "Been there, done that."

  • Just who is the NHS working for?

    Andrew Bamji's comment 03 Oct 2019 11:14am

    Philosophical question: is the NHS working at all, let alone for whom? I don't think so. Doctors are trying to do too much (because orders are orders) with too little, and it has been ever thus. Otherwise how come NHS reorganisations never fix the system and never have?

    Let's knock all the bricks out of the wall, and start again, not least by considering what doctors will not do. See my book "Mad Medicine" (www.amazon.com/author/andrewbamji) to understand my concept of futility medicine...

  • Sorry, I won’t go south at this time of day

    Andrew Bamji's comment 28 May 2019 10:18am

    I have had a different lightbulb moment. Why offer appointment times at all? All it does is tie you to inflexibility. If you let them all sit and wait, first come, first served, any doctor will do, then the heartsinks will be balanced by the quickies. That's how it was back in the 1950s and 60s when my mother was a GP. Those who didn't really need to be there soon realised that turning up too often was simply wasting their time.

    Only joking. Or am I?

  • Why I'll leave RCGP if Julia Hartley-Brewer speaks at conference

    Andrew Bamji's comment 22 May 2019 9:21pm

    I remember my father at the time of Powell's speech saying he thought the language was rather inflammatory but he had much sympathy with the sentiment. As an immigrant from India (and and ex-communist to boot) he was no fascist, indeed the last person one might expect to hold such views; they were perhaps coloured by the fact that he was stabbed during a race riot in Mumbai - by a Muslim as it happened, and this was in the 1930s. His view (and mine) is that the way to undermine prejudice, racism and all the other evils of the world is to engage in debate.

    Furthermore if you look in the wider world you see reality; what about the plight of white farmers in Zimbabwe who have been threatened, dispossessed and even murdered? And while I cannot disagree that black rule is right (I was a fervent anti-apartheid supporter in my youth) one has to concede that there were rivers of blood there. Then there's Protestants against Catholics, Muslims against Christians, everyone against Jews, Muslims against Hindus... we'll end up with nothing to debate. As for Brexit...

  • GP petition threatens RCGP resignation due to 'controversial' conference speaker

    Andrew Bamji's comment 20 May 2019 10:51am

    Maybe global warming will reduce snowflake formation. Listen and rebut (or possibly change your views if you discover you are wrong. You need open ears and open minds. BTW in response to the suggestion, ironic I trust, that Clare Marx be de-platformed, she didn't join the GMC until after the Bawa-Garba case so cannot be blamed for the sins of her predecessors.

  • ​CCG's £32m Babylon deficit 'may lead to practice closures', Hancock told

    Andrew Bamji's comment 29 Apr 2019 4:07pm

    Utterly predictable.

    Many years ago I pointed out that the proposed development of an Independent Treatment Centre for musculoskeletal work in the north-west would threaten the existence not only of existing cold orthopaedics and rheumatology departments but also, as a consequence, emergency trauma care. The plan was dropped. If you have a finite budget, then to pay Peter you must rob Paul. You don't need to be a financial wizard to see this. I would seriously suggest that the CCG resigns en masse after declaring itself bankrupt. There is a good precedent; the Fracking Czar has fallen on her sword on the basis that government policy has made her job impossible.

  • Half of patients on statins have ‘sub-optimal’ response to treatment

    Andrew Bamji's comment 19 Apr 2019 5:00pm

    No correction was made for alcohol consumption or smoking so the study is worthless.

  • GPs 'should prescribe statins to younger patients' using 30-year risk score

    Andrew Bamji's comment 20 Nov 2018 4:30pm

    Next thing we know they will be trying to put it in the drinking water. Let's be clear; statins work, but not very well, and their cardiac effects are NOTHING to do with cholesterol, lowering of which is an epiphenomenon. And anyway - what actually is the absolute risk reduction they found? If it's

  • Appeals court tells GMC to show 'restraint' as it quashes bid to sanction doctor

    Andrew Bamji's comment 18 Sep 2018 2:45pm

    The most extraordinary paradox is that the GMC is contesting the rulings of its own tribunal service. This says two things: (1) it does not trust the MPTS and (2) as it only appears to contest MPTS rulings which it deems too lenient, it is biased. Given that it is also prepared to invoke the courts it would appear that doctors are at risk of triple jeopardy. This has to stop.

  • Bawa-Garba: What happens next

    Andrew Bamji's comment 16 Aug 2018 10:12am

    Anon2016 has a good point - but there may be two ways of proceeding. I still believe, despite the Court of Appeal's judgement on the criminal case, that she should not have been found guilty, and on that basis a further appeal to the Supreme Court might be justified. However if that is turned down then I agree there is a case for a corporate manslaughter charge. Other people have raised the issue of whether it was appropriate for there to be no consultant cover because the supposed on-call person was double-booked; also whether the pathology computer system failure was acceptable. I have always said that any doctor is likely to make one mistake every year that will seriously compromise a patient, or even end their life. If that is truly the case - and from my own experience such mistakes occur through ignorance, fatigue, lack of supervision or simply having tramlined thinking to the wrong diagnosis - then almost all of us should have been, or will be charged with gross negligence manslaughter. What a prospect!

  • Appeals court rules in favour of Bawa-Garba appeal

    Andrew Bamji's comment 13 Aug 2018 3:32pm

    The ruling appears to confirm that the High Court's judgement was based on incomplete evidence. The question now is whether sleeping dogs should be let lie or whether the criminal conviction should be appealed.

  • Superpractice to have 380,000 patients following eight-practice takeover

    Andrew Bamji's comment 31 Jul 2018 11:00am

    A population of 380,000 is bigger than most hospital trusts...

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

    Andrew Bamji's comment 20 Mar 2018 10:27am

    The GMC's questioning of the decisions of MPTS tribunals is nothing less than an admission that it doesn't trust its decisions or its panel members. Perhaps it should now identify which panel members have the worst records of "leniency" and sack them. It will soon find no-one is prepared to become a member.

    Meanwhile I still consider that a High Court appeal is required in Dr Bawa-Garba's case, on the basis that relevant evidence was not heard by the original jury (nor, for that matter, included in the Trust's whitewash report).

  • GMC criticised by its own regulator for handling of Bawa-Garba case

    Andrew Bamji's comment 20 Feb 2018 12:21pm

    This indictment of the GMC is appalling, but welcome. It has overstepped the mark and should be ashamed.

    However there are still concerns over the justice of Dr Baba-Garwa's conviction, and an appeal must be pursued on the grounds that important evidence was withheld from the trial.