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Gold, incentives and meh

Andrew Bamji

Retired consultant rheumatologist

  • 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.

  • Bawa-Garba: this case is far from closed

    Andrew Bamji's comment 01 Feb 2018 12:20pm

    I used to teach trainees that they would be likely to make at least one, if not two serious mistakes every year. I did. There are multiple explanations; fatigue, inadequate information, test results not back or misinterpreted, ignorance (particularly for rare-as-hen's-teeth conditions), failure to seek advice because you didn't realise you were out of your depth, delay are but some. I would challenge any doctor in practice to deny that they ever made, or make mistakes. Unfortunately the law is now clear that there is no mitigation.

    I was personally sued once in my career (by a private patient whose claim was spurious, but nonetheless dragged on for over a year) and another patient brought an action for serious harm due to a series of mistakes, some mine and some not. Had that patient died I suspect I could have been prosecuted for manslaughter by a vindictive relative; as it happened, the patient and I had a full discussion about what had happened and I suggested she brought a compensation case, which she won, but she continued to see me as a patient. This points up the inconsistency which may result from patients being greedy and vindictive on the one had, and fair and forgiving on the other. But who is to know which is which? It's a no-win situation for which the only defence is not to work.

  • 'Having an e-portfolio used against you in court would be exceptional'

    Andrew Bamji's comment 01 Feb 2018 12:06pm

    The crucial part of Dr Bradshaw's apparently reassuring article relates to reflective statements: "...but a doctor can choose to provide them if they demonstrate that they have shown insight."

    What purpose could that possibly serve? Let us suppose that a doctor has made a mistake which results in serious harm or death. In their reflection they acknowledge the mistake and show that there was not only a reason why it was made, but insight into how it was made. That does not alter liability, so it is pointless to consider allowing the reflection to be considered by a court but even if it is not', as another respondent has pointed out, if the reflection has been shared then the person with whom it was shared may, in court, be forced to reveal it under oath without the permission of the person who told it to them. In the eyes of the law there is no mitigation; someone who makes a mistake which results in death remains culpable. I was involved in a court case where this principle held; fairness is trumped by justice as, sometimes, is the truth.

  • Health secretary 'deeply concerned' about implications of GMC court ruling

    Andrew Bamji's comment 30 Jan 2018 9:34am

    No one submitting an appraisal containing any analysis of errors will be safe. There will be no defence against honest mistakes and no mitigating circumstances will help. While the court verdict is unequivocal and probably unappealable the GMC's attitude has in my view been heavy handed and vindictive. Yet when I raised serious concerns on an issue it not only did nothing but did not even bother to tell me why. It has lost its way and if it continues on its present path the medical profession should be very afraid. Perhaps if every doctor refused to be revalidation it might come to its senses; it couldn't suspend everyone.

  • Foundation trusts in GP practice takeovers as partners resign contracts

    Andrew Bamji's comment 15 Dec 2017 2:26pm

    This is not the future - this is the past! We are back to 1984.

  • NHS drops plans for peer review of all GP referrals, says BMA

    Andrew Bamji's comment 05 Oct 2017 2:29pm

    Someone has seen common sense over peer review of referrals! There are too may more important (and properly researched) things that need doing.