Retired consultant rheumatologist
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...
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...
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.
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.
At least it's being paid for...
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!
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."
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...
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?
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...
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.
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.
No correction was made for alcohol consumption or smoking so the study is worthless.
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
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.
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!
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.
A population of 380,000 is bigger than most hospital trusts...
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).
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.