Patsy wishes you a merry Christmas

I have no idea who to credit for creating this, but thanks to Dr Evans on DNUK for posting a link for me.

http://www.elfyourself.com/?userid=ef6da7db05b5fd4e056385aG06122200

Wonderful!

Coincidence

Ok, I said I'd take a break, but nothing's happened yet, so here's another one for you.

NHS deficit: Approx £500 million

Amount spent on management consultants in the NHS last year: Approx £500 million

For fuck's sake Patsy, do the bloody sums.

In the Guardian...

Last post for a bit

Lord Warner is going. Will he be missed?

Lets hope he gets a good pension for his stirling work totally bollixing up the NHS finances.

The BMA is seeking a Judicial Review regarding the legality of the governments retrospective slash-and-burn of our pensions. How the hell they think they can get away with a gross breach of contract I don't know. Idiots...

As to why this is the last post for a bit:

Mrs B will imminently be having the baby, any time in the next 1-3 weeks. So I might be a bit busy...

(I will however post an announcement when I get chance!)

So, dear readers, take care and have a good Christmas or holiday-season-of-your-choice.

Pension Cap

I don't have full details yet, but it appears that bastard Lord Warner has written to the GPC to say that he will cap GP pensions.

Here is the text from a BMA press release:

Immediate release : Thursday, 7 December 2006

BMA to challenge the imposed cap on GPs’ pensions

Dr Hamish Meldrum, chairman of the BMA’s GPs Committee, denounced Lord
Warner’s decision to cap GP pensions as reneging on a contract agreement and
denying doctors the pensions they have already paid for.

“Most GPs are self-employed. They pay both the employers’ and the employees’
contributions into the NHS Pension Scheme. The pensions they have accrued
are in fact delayed pay resulting from a contract agreed by the government
with the profession. For Lord Warner to say they cannot have the pension
they have earned and paid for is a denial of their contractual rights. We
will be challenging his decision” said Dr Meldrum.

While family doctors have seen a substantial rise in income under the new
contract, the BMA believes the earning figures announced last week by the
government are wrong. Dr Meldrum said: “Because of a significant error, the
quoted figures are pitched at too high a level. We understand the 14%
employers’ pension contribution has been mistakenly included in the income
figures. The error means the average GP pay for 2004-05 is well below
£100,000, not the six figure income as reported. It also means the
percentage rise in pay is substantially below the 32% claimed by the
government.” Clarification of the error is being sought by the BMA.

Dr Meldrum said: “Lord Warner’s offer of a 48% rise in the pension
dynamising factor* over five years may seem superficially generous but it is
not the deal we negotiated and will seriously disadvantage GPs nearing
retirement and those who have recently retired. Those doctors retired
believing in good faith that they would receive the pensions they had earned
and paid for. Moreover, we believe the timing of the announcement is
premature, is based on estimated figures of doubtful accuracy and,
therefore, we do not accept the assertions that honouring this deal would
take money away from patient services.

“The government’s decision is a betrayal of good faith and is depriving
doctors of a pension we believe they have a legal right to receive.”

The BMA’s GPs Committee will now seek further legal advice on mounting a
challenge to Lord Warner’s announcements on capping of pensions.

Ends

This has got to be a breach of contract, never mind comp[l;etely removing any chance of healing the rift between the politicos and medics.

I will await developments with interest...

Follow up to "Spinal Privacy"

There have been further developments in the matter of Spine vs Everyone else.

Clarification has been issued to those who sent in coupons expressing a desire not to be included, here. Apparently the Department of Health "does not believe that processing their information in this way is a genuine reason linked to substantial and unwarranted distress." But I thought that distress was in the eye of the sufferer? Obviously only if the DoH thinks so to.

As a GP I'm now damned if I do, and damned if I don't.

If I do "allow" (and it doesn't look like I'll have any choice in the matter) the uploading of people's information, I could be held accountable for the breach in the confidentiality. In other words, I (as data controller for my practice) will be in Breach of the Data Protection Act and I suppose could be legitimately complained about to the GMC.

If I don't, I'll have everyone from the Health Minister (so-called) down trying to bend me over my desk...

This is also picked up today in the Torygraph.

I suspect that Tony and cronies will continue to ride roughshod over everyone, until either someone hacks the system or the opposition get of their arse and cause a fuss.

Watch this space...

The BritMeds 2006 (1)

John Crippen has started up a weekly collection of the best of British medical blogs.

Yours truly is mentioned!

Check it out...

Over-performance

Oh dear, oh dear, oh dear...

Hospitals in the South East are being told to delay routine patient appointments for eight weeks, otherwise they will not be paid for them.

Here's the link.

So, fail to achieve government targets and be damned.

Exceed them and be financially crippled (albeit temporarily).

On the other hand, I can see the Strategic Health Authority's point of view: the PCTs have to contract for an amount of "activity" and then pay for anything which exceeds that anyway (under Payment By Results, the national tariff). There's a big deficit heading Patsy's way, and of course she said that she'd take personal responsibility for achieving financial balance. Lets hope she isn't allowed to dodge it.

Although I personally thought that a bit of an oxymoron, a cabinet minister taking personal responsibility for their area of responsibility...

What about the patients? The only people who are talking about them are the consultants. But what do doctors know about health care, hmmm?

And there was me thinking the political silly season had passed already.

Redundant advertising

I read this story a couple of weeks ago. It was also posted in various other places, including the BBC, most of the national press and other media. I didn't comment on it at the time because I thought it pathognomic of the difficulties the NHS is facing, and that further comment was not necessary.

But now we have this.

So lets compare these two stories, shall we?

On the one hand, the NHS workforce has reduced in the last year by about 20,000. There are an indeterminant number of compulsory redundancies, which the Government says are just under a thousand. Yeah, right...

On the other hand, hospitals will now be able to advertise their services. who to? Not to patients, oh no. To doctors. Yes to GPs like me.

But hold on a moment. Don't I already refer to hospitals? Am I not already obliged to refer to someone I at least know of and trust to do the right thing by my patients? To quote paragraph 55 of Good Medical Practice:

Referral involves transferring some or all of the responsibility for the patient's care, usually temporarily and for a particular purpose, such as additional investigation, care or treatment that is outside your competence. You must be satisfied that any healthcare professional to whom you refer a patient is accountable to a statutory regulatory body or employed within a managed environment. If they are not, the transfer of care will be regarded as delegation, not referral. This means you remain responsible for the overall management of the patient, and accountable for your decision to delegate.

My highlighting, by the way.

But the Government is already trying to force me to abrogate my responsibility for ensuring that I know what service my patients can expect with Choose and Book: I can't refer to a named consultant, if I can refer at all!

But back to the point at hand...

So, lots of people out of work (however you want to define it), so cutting costs.

The money saved can now be invested in advertising a hospital's services to the GPs who are already referring to it, likely involving the recruitment of advertising and marketing managers. Of course that means less money for patient care. I suppose the idea is that advertising will increase the number of "service users", thus increasing income under the "Payment by Results" tariff.

What kind of buggered up system is this? That money should go towards patient care.


I'm 36. I can't wait to retire.

Five weeks to go...

There will soon be the patter of tiny feet in Chez Brown.

Mrs B is expanding on a daily basis, I'm sure she will explode soon. The baby likes Strictly Come Dancing, we can tell because she has a dance when its on. My other 2 kids are excited, we have arranged for them to be the first to meet their sibling (after us of course).

I can't wait...

Mind you, we're only just getting organised with baby-grows, nappies, clothes, etc. We were much better organised with our wedding last year at Newick Park.

And I've still got loads of painting to do :-(

I still can't wait to meet the thing that's been booting me in the ear while I'm reading or singing to it.

Of course, we still have to decide on a name...

Spinal Privacy

There is an interesting article in the Guardian today. I suggest you read it. It refers to the security (or otherwise) of the NHS spine, the computer system which is being built to house the medical records of all UK residents.
And therein lies the problem.

Given the Governments track-record on IT projects, given the fact that you can either have a functional or secure system (but for a project this size probably not both) the question you have to ask is:

"Do I really want my personal and confidential details available to any of the 250,000 staff in the NHS who have currently been given smart cards? Oh, and the police, security services, and anyone else who might have the technical skills to hack in or money to buy information from the spine?"

Speaking as a medical professional, I don't.

The Governments constant mantra of reassurance and complacent murmurings that security will be adequate completely fail to make me feel better about the scheme.

For a start, you won't have a choice about whether to be involved or not unless you opt out right at the beginning. Once your info is on the spine, its there in perpetuity (and lets not even start talking about civil liberties and the Data Protection Act).

Sadly, this scheme is just another manifestation of the current Government's inclinations to control us all. There is no safeguard with this. If it is "in the public interest" your records will be viewable by whomsoever the authorities deem. Right now, if the police want me to show them your records, they need to either provide me with your consent (in writing, and even then I usually check with people to make sure they understand what it is they've consented to) or ask a Judge to issue a Court Order (and although it has never happened, I would probably then wish to speak to the Judge myself anyway to clarify what exactly they want to see: it would be most unusual for someone's appendectomy in 1954 to be of any relevance to anything at all, really).

The Guardian also provide a page (here) with a draft letter to the Secretary of State for Health instructing that you don't want your data added to the spine. I will be writing.

The decision whether you should as well is not one I can make for you. But consider carefully before imagining that New Labour will treat your most intimate personal details with the dignity they deserve.

Disclosure statement

After the nonsense about PayPerPost, which although I am not signed up to is still in my view a bloody good idea, I thought a disclosure might be a reasonable idea. This is available for viewing here.

It is also replicated below.

This policy is valid from 02 November 2006


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This blog does contain content which might present a conflict of interest. This content will always be identified.


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Trust me, I'm a Doctor

Well, it seems people do.

In that case, why don't the politicians listen to us?

Because they want their reforms to go down as an historical achievement.

Great. Dismantling the NHS will be such an achievement, won't it?

I'm a bit busy today, but for invective about politicians generally and the health service in particular, try clicking on some of the links listed over there ->

Enjoy!

The cost of litigiation in the NHS

Whilst indulging in some forum posting on DNUK (no you can't have a link, unless you're a registered doctor in the UK) I came across a link to a question posed in the Lords yesterday (Hansard).

NHS: Compensation and Legal Costs

Lord Steinberg asked Her Majesty's Government:

Whether the cost to the National Health Service of £175 million for compensation and legal costs as stated by the National Health Service Litigation Authority includes all outstanding cases to the end of the past financial year. [HL7454]

The Minister of State, Department of Health (Lord Warner): The NHS Litigation Authority 2005-06 accounts report expenditure of £591,586,000 on clinical and non-clinical negligence claims in the past financial year. The accounts include a provision, as at 31 March 2006, of £8,344,980,000 for all outstanding cases including an estimate for incidents that have occurred but not been reported.

Yes, you read that right.

The government have put aside £8.344 billion pounds to cover negligence claims against the NHS, both clinical and non-clinical. Doesn't say how much is put aside for non-clinical negligence though. Nor does it define what non-clinical negligence is. (Anyone fancy a Freedom of Information request there?)

Eight. Billion. Quid.

One thing that does surprise me is that no further questions were asked. Even in the current climate of rather defensive medicine (though not as bad as the USA) this figure is staggering. To put it in perspective, that would be a year's income for over 330,000 new police officers.

Yet so far, the Government (Lawd bless 'em!) have spent over £20 billion on a computer system which isn't fit for purpose and probably won't be.

God help us all...

Listening habits: the drive to work

Decisions, decisions...

Options:

1. CD. Good music (IMHO), I can sing along without discomforting anyone else (believe me, with my voice that's important) BUT I tend to play it too loud and end up with tinnitus byt the time I get to work, I don't hear the news before work.
2. Radio 1. I'm sorry, but Chris Moyles is just a big fat git who lots of teenagers finds funny. The music is at best variable, and most of what I get is actually inane drivle interspersed with occasional jingles, with the odd track of music thrown in.
3. Radio 2. Wogan. Music from elevators, humour from the 1970's but without the slapstick.
4. Radio 4. The Today show. I get the news and weather. The 0810 interview is sometimes ok, but generally just gets me angry with the vagaries and downright bastard lies from politicians (of all colours).
5. Southern FM. Really irritating adverts, not much music (and the same stuff over and over and over...), chirpy presenters (far too bright, eff off you bastards, its first thing in the morning), traffic reports every 20 minutes (but they make you listen to the bloody adverts first).
6. Southern Counties Radio. Decent traffic reports which have the advantage of being RDS, but OH MY GOD the shows are soooooooo boring I'm in danger of falling asleep at the wheel...

What to do, what to do...

Forms of nursing

It seems a week can't go by without yet another form appearing that I am supposed to use to refer patients to a particular service. I totted up how many different referal forms I have in my box file the other day: 22 . Yes, twenty-two different forms to refer patients to different NHS departments. Alot of these forms have similar information requirements: they all need demographical details of course, as well as a few details of the presenting complaint leading to the referal. Some of these forms we have managed to get in electronic form from the originator, which we can then adapt so our clinical software can automatically fill out at least some of it. Of course, we need to ensure that the forms' authors are happy with it before we can start using them. Others, we can't, for one reason or another.

A particular bug-bear I have is the fact that we now have to communicate with the District Nursing team by writing them a note on a specific form and faxing it to their offices. They have been expecting this for the last 2 years or so, ever since they were reorganised so that they were no longer attached to a specific surgery, but in a "locality". Before this, if Mabel developed a leg ulcer, we would speak to the District Nursing Sister when she came to the surgery (usually a daily occurence to collect supplies). She would check to make sure there were no matters to be discussed before she left. In addition we had a weekly Primary Health Care Team meeting in the surgery.

Not any more. Oh no.

Now face-to-face communication is non-existant. I don't know most of the nurses who visit our surgery to run clinics. You can phone, but its just an answer phone. And if you do leave a message, you get a message back saying that they need a referal form. So you send the form, they see the patient (one assumes).

Of course, we don't get one back when they discharge patients from their case load. Neither do they keep their records anywhere near ours: they have their own folders, kept at the patient's house, which are later archived somewhere mysterious, never to be seen again.

And I haven't even mentioned the referal/discharge criteria which are being introduced by the management teams.

I'll give you 3 guesses how much consultation there has been with other professionals stakeholders as to whether this is necessary, never mind a good idea. And the first 2 guesses don't count...

Where the driving force behind these changes comes from is a matter of further irritation. Yep, the good old Department of Health. Bless 'em. Except of course that the decisions where made locally, not centrally. Except of course that the decisions were basically forced upon the local health economy by financial decisions further up the food chain. Decisions made in London. See how that links up? Clever, innit?

I could go into why these changes are apparently "good for patients". All I know is that the patients complain to me that they don't see the same nurse more than two or three times. The nurses are getting more and more officious (a sure sign to my mind of the stresses they are under and their levels of dissatisfaction with the way they are working). Inevitably, there are the usual recruitment freezes periodically (though, to be fair, recently there seems to have been an influx of community nurses, less well qualified than District Nurses, though forced to do the same job).

Gets right on my wick.

Bring on Practice Based Commissioning. Care to hazard a guess at one thing we're contemplating taking over from the PCT?

Dr Rant

Oh my goodness.

Please please read this blog. (Click on thread title, it links to the Dr Rant blog.)

It is so right.

If I had more time, I would tell you more, but I haven't.

Go read it.

And then laugh.

And then wonder if you should actually be crying instead...

Entrepreneurs

My mate Pete has himself a new job as Director of Software Development for PayPerPost.com.

I worry about Pete: he's living several thousand miles away and can't buy me beer anymore.

So I checked out the PayPerPost website at http://payperpost.com/ and they seem to be a very interesting company, just the sort of thing that will help Pete keep his mojo going.

It seems a very sensible way for people to do business, you sign up and get paid by companies who want to advertise on blogs by writing posts about the subject they ask of you.

As Pete says in his blog:
"...despite what some would have you think, blogs are not journalism. Blogs are personal, and PayPerPost's model is a very real financial enabler for a huge portion of the Blogosphere; the single-mom trying to raise a small family, the student trying to make ends meet, the video game junkie looking for a means to fund his ever growing game collection. In fact, if you're human and have a blog, PayPerPost probably has something you can write about for cold, hard cash."

So good luck Pete, and good luck PayPerPost. More power to you...

Waste in the NHS

I've come across two posts on blogs which I enjoy. I commend both to you if you are curious as to why people like me think New Labour are full of shit when it comes to public services, being more concerned with their historical legacy than actually providing good services.

The first is an example of how pointless some of the exercises which take place in the NHS really are, from the estimable Dr John Crippen at NHS Blog Doctor, and is basically "How to have a crap, a user manual".

I kid you not.

The second is from Shiny Happy Person at Trick-cycling for Beginners. SHP describes the waste that is rampant in the NHS using a specific example.

Well, I say specific. This sort of thing goes on all the time.

I shall refrain from mentioning what others think of the way the Government spends billions on while hospitals and PCTs struggle to make ends meet.

Up the Revolution (and here's looking forward to the next election)!

Its all back to front...

A busy Monday morning today, as you might expect.

One of my nurses gave a print out of an email a friend sent her which she thought might tickle me. I assume its one of those things that goes round the internet every so often like a cold, which everyone in the wolrd gets, only to see it again a few years later. This one was new to me.

She was right about it tickling me (actually I snorted a half-chewed plum all over my keyboard), so here it is for your delight and delectation:

_______________________________________________________________

"You should start out dead and get it out of the way.

That way, you wake up in a retirement home feeling gradually better every day.

You get kicked out eventually for being too healthy. You go and collect your pension, then when you start work after a decade or two you get given a gold watch on your first day.

You work for 40 years until you're young enough to enjoy your retirement.

You drink alcohol, smoke, party and are generally promiscuous and you get ready for school.

You eventually become a kid, you play, you have no responsibilities, you become a baby and then...

You spend the last 9 months of your life floating peacefully in luxurious, spa-like conditions: central heating, room service, larger living space every day.

And then, you finish off as an orgasm."

_______________________________________________________________

Wonderful!

I like my job

Well, I've had a week off but today I'm back at work and running late already...

It seems the more things change the more things stay the same: same old faces, same old problems. A bit like a favorite old jumper.

My most recent patient (whom I shall call Daphne, as that is of course not her name) has been suffering from anxiety. Doesn't sound too major, does it?

Except that Daphne has had symptoms for years. It stops her going out, predominantly because she gets diarrhoea whenever she gets anxious. It makes her go home early for the same reason. She avoids doing things she used to enjoy just in case she gets diarrhoea while she's out. She suffers palpitations on a regular basis, which make her feel even more anxious in case there is something wrong with her heart. Her appetite could best be described as "variable", which becomes a problem when you realise that she hovers at a BMI of 19-20 (so any weight loss makes her underweight, although there are of course arguments about the validity of Body Mass Index as an appropriate measure of health in isolation). She smoked to help herself cope. She used to argue frequently with her husband and felt abandoned by her friends. She couldn't sleep because she kept mulling things over in her mind.

Three months ago, Daphne came to see me about her tummy problems. It had taken her a long time to summon up the courage to do that. After all, she said, I'm a very busy man. I don't need frauds like her taking up my time when there are people who are actually poorly who need me, rather than just people like her, "being stupid". She was sure that it was "just nerves". She asked why she couldn't just pull herself together. She asked me if there was anything I could give her and then followed that question immediately with a statement that there was nothing that could be done for her as she was just a pathetic waste of space. She didn't want a sedative or an antidepressant or anything like that, apparently.

I felt very sorry for her. Given she had said she didn't want anything which would actually help, I explained that she might like to reconsider, but that in the mean time we could try an antispasmodic.

She came back to see me about a month ago. The antispasmodic hadn't worked. She was now prepared to try something else.

Anxious people often have poor self-esteem. They sometimes don't come to see me when they should because of this. Which is a shame. Sometimes (as with Daphne) they come with something else, an excuse if you like.

Anxiety is usually very treatable. There are a variety of non-pharmacological therapies available, some with an evidence base, some without. However, in todays NHS, certainly where I work (at the moment, but there may be a post on this at a later date), the only readily available therapy involves pills on prescription from me.

Mind you, that isn't necessarily a bad thing.

Daphne, for example, left me after about 25 minutes with a prescription for a few diazepam and a month's supply of citalopram. I asked her to come back after a fortnight to see how she was getting on. When she came back, things weren't quite so bad, but she still couldn't go out for fear of an episode of diarrhoea. She was sleeping better though. Oh, and she'd stopped smoking.

She came back to see me this morning, after a further two weeks.

She tells me she hasn't felt so good in years. The diarrhoea has gone. She went into the local shopping centre early in the morning with her husband over the weekend for the first time in several years and apparently burst into tears because she was so relaxed. She feels normal again. Her husband says she is the calmest he's seen her in years, much more like the woman he married 40-odd years ago. She had a new hair-do. She is also wearing a new smile.

She's not there yet. But she is getting there.

I like my job.

The Now Show

A topical news show, broadcast on Friday evenings at 1830 UK time.

Worth it for Mitch Benn alone.

And now a podcast!

Give it a rest Tony

For goodness sake.

Its dead.

Leave it alone man.

You won't even be in the country then, you'll be on some lecture tour in the US.

Link to story.

Nursery rhymes

Let me ask you a question: Do you prefer "Baa Baa Black Sheep" or "The Ugly Duckling"?

Those of you who know me will remember (I'm sure) that I am noted for my melodious tones, although generally not the ones emanating from my larynx. I have a repetoire of nursery rhymes inherited from my family which I have sung to my other children to soothe them (with varying success).

Mrs B is 20 weeks now. Bumpy Brown is kicking for England. So I've started talking and singing to it. Rather bizarely, it seems to ignore Baa Baa Black Sheep, Jack and Jill or Half a Pound of Tuppeny Rice, whilst consistently becoming still if I sing The Ugly Duckling or Twinkle Twinkle Little Star, only to get going again once I've stopped (after a suitable pause for reflection and appreciation of its father's performances).

Hopefully, the little mite will recognise my voice after its been born. At 20 weeks gestation, it can already hear things in the womb. My singing will be audible to it, and although the hard consonant noises won't get through the softer vowel sounds and general tone will. Given it already seems to settle with certain songs, I suppose its possible we already have a baby with favorite nursery rhymes.

The alternative is that Bumpy is quivering in the corner or the uterus with it's fingers in it's ears, hoping the caterwauling will stop soon...

Orwell (can hopefully now) RIP

I've spoken about ID cards before.

There were various news articles yesterday (here and here).

The Register's John Lettice reports further today: John Reid, who I have always considered to be a ignorant prat of the highest order (and you know what they say: "Jack of all trades, master of none"), may actually be doing something sensible and kicking this riduclous Big Brother idea into touch (in effect if not officially).

This is most out of character for him. I can only assume he is trying to keep damage to a minimum...

Anyway, labour goons notwithstanding, thank goodness this form of identity management seems to be going away...

Your right foot

This is so funny that it will boggle your mind. And you will keep trying at least 50 more times to see if you can outsmart your foot, but you can't.

1. While sitting at your desk, lift your right foot off the floor
and make clockwise circles.

2. Now, while doing this, draw the number "6" in the air with your right hand.

Your foot will change direction.

And there's nothing you can do about it!

Lack of space

Had a bit of a blog break recently, what with Mrs B being ill and (ahem) other things going on at home, as well as having to go through the trauma of recruiting a replacement for my senior partner at work.

Could do with a holiday to be honest. I hear New Zealand is nice this time of year....

Anyway, to the purpose of this post.

It has become clear to SWMBO* and me that we really can't continue to live in our current domicile once Bump Brown arrives: it is a small Victorian terraced house. Fitting in 3-5 humans (depending on the time of the week) and 2 felines is going to be impossible in the medium term, though we might be just about able to manage for a few months. But where do we put the buggy, or hang the washing?

We've had a traumatic 18 months, what with one thing or another. Our lovely little house has been outgrown. And so we are examining our options: move or stay?

If we stay, we'll have to seriously consider a loft conversion. We are fairly sure that this is unlikely to be possible: the house is just too small. We're also unlikely to get our money back from the investment needed to get the work done.

If we move, we'll have to do it soon. Mrs B is 16 weeks in, so we'll need to be in a new house by the end of October at the latest, or she won't have time to plan the decorating before nappies intervene. But that has its own problems: the windows need refurbishment or replacing, our soffits need repairing, the place could do with a repaint. There are lots of other little and not so little jobs that need doing. Finances will need to be considered carefully as well. We'll probably need a second car (and even if we decide to stick with one, we'll need to replace mine which is too small for a baby carrier/car seat and two booster seats). And of course, where do we move to? Closer to my place of work and family, or stay near where we are, where we've been very happy?

So lots of thinking needed.

Watch this space, it might turn into a moving-house-blog.




*"She Who Must Be Obeyed"

Morning sickness

I've had reason to review my knowledge of morning sickness recently. Most women get this to one degree or other in pregnancy in the early stages of pregnancy. Most don't require treatment and it usually settles around the three month mark.

Some don't settle however. I suspect those women probably don't enjoy being pregnant as much as they were hoping to.

A few unfortunate souls suffer hyperemesis gravidarum. That is more serious and sometimes requires hospital admission, especially if the mother becomes dehydrated. But there are degrees of hyperemesis. Someone close to me has it at the moment (in my completely unbiased and objective opinion). I thought she would require admission last week, but luckily we've avoided that.

The constant nausea and repeated vomiting brought on dehydration and an extreme malaise and lethargy. She is currently not working, which is just as well because I don't think she would be able to anyway. This week, she is coping a bit better. In part this is due to the phenergan she has been using on and off. The only trouble with that is it causes sedation and gives her a headache, which in turn makes her feel nauseated.

See the problem there?

There are other drugs which help some people: prochlorperazine, metoclopramise, cyclizine. None of these drugs are licensed for use in pregnancy related sickness. But numerous studies have been performed which have not shown any adverse effects on the baby. The Prodigy website was one which I have found helpful as a revision, though it hasn't helped Mrs Brown very much. She is trying accupuncture, having already (unsuccessfully) tried the accupressure bands you can buy in any pharmacy. Accupuncture has not been shown to be helpful in 2 randomised controlled trials. But if it helps her, I'm certainly not going to argue.

So in case you've come across my blog because you're suffering from pregnancy related sickness and you've googled it, here is my suggested managment plan:

1. Sip frequently, don't drink large volumes. The quicker you drink a large volume, the more likely you are to throw up. Try using a straw.
2. Drink and eat whatever you feel like. Don't worry about whether the baby is getting enough vitamins because your previosuly healthy diet has been reduced to mashed potato and baked beans. The improtant thing is that you avoid dehydration and manage to get food in to yourself. The baby will take what it needs from you, at your expense.
   
3. If you can't stop vomiting, seek help from the health professional of your choice. Midwives may have some sensible suggestions. GPs certainly will and can prescribe certain drugs (though be aware that many GPs will prefer to avoid them if they can).
4. Try having some sort of bland carbohydrate before you get up (crackers or toast).
5. Don't get hungry: nibble snacks throughout the day and see point 1.
6. Rest. You're not superwoman, and the world won't fall apart because you're knackered. If you have other things that need looking after (like other kids) enlist help from family and friends. Do not try and do it all yourself. You don't have to.
   
7. Despite the fact that most alternative therapies have not been shown to be of benefit, that doesn't mean they won't make you feel better. Any cynical GP (like me) who says anything other than "If you say it helps I won't argue" shouldn't be told (as long as it won't do any harm of course).
8. Ginger in various forms may help. Of course, it makes some people worse.
9. If you're prescribed medication, please use it. We don't prescribe for fun. You never know, it might help.
10. See points 1 and 6 again.
    

And here's Russell's management plan for husband's/boyfriends/whatever:

1. Be sympathetic. Its not nice. Jokes will not go down well and do not make your wife/partner/girlfriend/lover feel any better.
2. Cuddles are good, but don't squeeze. You will regret it.
3. Try and think ahead of yourself. Keep fresh water handy. Try flavoured electrolyte replacement or rehydration salts (such as dioralyte). Buy crackers.
4. If you're worried, seek help. That can be your Mum, her Mum, your doctor, her midwife, anyone you like. If you don't ask, you won't get.
5. Wash up before you go to bed. You won't have time in the morning.
6. Don't feel guilty. Its not (just) your fault. Two people had sex. At the same time however, accept any and all criticism with that stock phrase: "Yes, dear."
7. Don't forget to tell her you love her either. That will help, because the way she is feeling, she is unlikely to love herself at the moment.
8. Just because she isn't eating her broccoli doesn't mean you shouldn't.
9. Beer and whiskey smell. You should be aware that women with pregnancy relates sickness are often made worse by certain odours. Ask first.
   
10. Remember, things will get better. (Probably in about 18 years.)
    

Flea: When Daycare Calls - Part I

Flea: When Daycare Calls - Part I

Flea posted this recently. It seems they have GANFYD's in the States as well.

If you don't know what a GANFYD is, well, hopefully you'll never need one. All they do is create work for people like me.

The number of different notes people ask for never seeks to amaze me: examination board notes, holiday notes, simple "been to the doctor" notes and yes, "safe to return to nursery/school" notes.

Flea is absolutely right: no-one seems to use their common sense anymore. Perhaps more to the point, no-one is happy for anyone else to use their common sense anymore either!

Anyway, I'd better get back to work and stop reading blogs...

Dame Janet slams docs again

Ho hum.

Dame Janet Smith is perturbed by the lack of progress shown by the Government over her recommendations after Harold Shipman's crimes.

Talk about tarring everyone with the same brush...

She made this comment: "There are doctors who still think that everything is fine and that there is no need for change. There are still those who think Shipman was a one-off villain."

Well, wasn't he? Is there any evidence that there are more mega-serial killers in the current medical workforce? No?

Thought not.

I do think that some of the changes she has proposed in one of her many reports are sensible: the proposals about changing death certification and cremation administration; the need for a system to ensure doctors' skills remain up to date; her criticism of the GMC's procedures for monitoring doctors (although that led to the GMC embarking on disciplinary proceedings when perhaps it should not have).

But it seems to me and I suspect many of my colleagues that she would rather have us all shot. That would certainly prevent any more Shipman's.

But there are other things about her rampant anti-doctor attitude that concern me more. I can't help but wonder how many patients have been left in unnecessary pain because doctors have been concerned that adequate pain relief may result in an earlier demise than might otherwise have been the case and that that demise may then be subject to vexatious scrutiny. Certainly I've been aware of a lot more post-operative patients are being discharged by surgeons with simple, less powerful analgesics. Perhaps they don't need anything stronger. Palliative care also feels a lot more defensive in the last few years, or perhaps cautious would be a better word.

Perhaps this caution is for the best. Perhaps doctors do need more monitoring to ensure public safety. But I certainly came in to this career because I wanted to help people through their lives, from beginning to end. I suspect the same is true for most of my colleagues. Dame Janet's viciously negative attitude does nothing to help avoid another Shipman. It just makes doctors feel vulnerable and defensive and that cannot be good for patients.

If I was a rich man....

Apparently, as a GP, I'm very rich. The BBC investigative team have discovered the scandal that some GPs (less than 5%) are earning over £250,000 a year, after expenses.

Well, most aren't. I'm not. Wish I was...

Apparently "Experts have said the contract was ill devised and is partly responsible for current NHS deficits."

Not quite sure who these experts are, of course, that's not stated. And why are us GPs being pilloried for the NHS deficit when the Government negotiated our contract? It was NEGOTIATED!! We're now being paid for things we were already doing. Our pay had fallen behind comparable professions, and its almost caught up, thank you very much.

As far as the guys earning a quarter mill are concerned, good on them. They will be managing businesses (as do I) to the best of their ability, to get maximum bang for buck, and in the process taking a profit. I wonder if there would be so much fuss if it was some private company making a profit from the NHS, perhaps from following an American model of some sort (which Our Glorious Leader seems to want to emulate).

Well, wake up BBC: GPs are private companies. If you think you're not getting value for money, start comparing us to other countries, see how much we spend per head of population on GPs and the services they provide.

Idiots.

Orwell eat your heart out...

Well, when George Orwell wrote 1984, I'm sure he didn't think that we really would end up with a totalitarian regime. And so far, we haven't got one. But that could change.

Our Glorious Leader has done a fair amount to erode our freedoms in this country, usually under the guise of ensuring our safety, protecting us from terrorists and the like.

The main thing is of course Identity Cards. These will apparently "keep us safe". Yeah, right. They really would have stopped the Tube bombings by British subjects, wouldn't they? They'll really stop people getting into the country we don't want, won't they?

A google search of "Identity cards UK" immediately pulls up several websites who are basically against them. they summarise nicely what is wrong with the scheme as is suggested by Tone and cronies. NO2ID are a pressure group whose news letter provides updates on where the legislation is at. After the recent Lords climbdown and "compromise" over the compulsory nature of the scheme (and make no mistake, it is compulsory), we will all over the next 10 or 20 years have to have a card. Then, the police will be able to insist on seeing it on demand. In other words, in a fundamental shift, British citizens will have to answer to the State about their identity.

WHY SHOULD WE?

And now we have more concrete plans for SOCA. This Agency, going "live" very soon, will be a rough equivalent to a combination of the American FBI, DEA, Justice Department and Customs. This one I have less of a problem with.

BUT. What happens if in 20 years we end up with a government led by some sort of megalomaniac, possibly a right wing xenophobe? It could happen, all it would take is a few more terrorist attacks, a whipping up of the populace by the likes of the BNP, an exageration and a playing on of peoples' fears. All of a sudden, we could be in a position of having to carry the cards to prove we are who we say we are when the SOCA officers stop and search you. If we can't, we'd be dragged off to chokey until, well, until who knows when.

The Nazi's insisted on ID cards. Especially for Jews. I don't want to live in that sort of world. I don't want my children growing up in that sort of world. But currently we are being "managed" by a Government more concerned with leaving something for posterity than in the actual well-being of us, the Great British Public. Think about that at the next General Election.

Despair

The latest in demotivational accessories for your company. Just click on the Thread title to go to the web page.

Despair, Inc. are based in the US. They do, however, ship worldwide. With regard to international shipping, their website says the following:


"Despair ships to most international locations. Most orders to most international locations are delivered within 1 week, however- larger-sized orders often can take 4 to 6 weeks (and in a few cases, even longer) to deliver. For faster shipping, we recommend moving to the United States."

The rest of the website, and indeed the whole company ethos, is centred around the principle of demotivation, in juxtaposition to the huge market there is for motivational literature and products.

But I personally recommend the video podcasts, available through the website or iTunes Music Store.

Flame of the week

The Register has published a "how to" for flaming the ultimate flame.

Wonderfully apt, given some of the flamings I've read over the years, and I'm surprised I didn't come across this before.

Mind you, I only really started browsing the Register a few months back, and then fairly intermittently.

So a competition for anyone reading my blog: flame me.

Best flame wins a prize, though I haven't decided what yet.

What kind of coffee are you?

You Are a Frappacino

At your best, you are: fun loving, sweet, and modern At your worst, you are: childish and over indulgent You drink coffee when: you're craving something sweet Your caffeine addiction level: low

What Kind of Coffee Are You?

I am sooooo not a Frappacino...

Flickr sorted

Not sure what they did, but I can now access my account. Received an email telling me how to log in (which was what I was doing) and all seems fine.

Mind you, haven't added any more pictures to it as yet...

Problems with Flickr

Getting lots of problems when I try to log into my Flickr account from work. It keeps telling me that my Yahoo id is already associated with a Flickr account, and I need to merge the acounts.

Fine. So I follow the links and instructions, only to be told that the email address I supply is linked to a Yahoo account and I need to log in there.

Fine. So I log into my Yahoo account and then try to access my Flickr acount, only to be told that I need to merge the accounts.

Guess what happens next?

I've emailed Flickr support, but I guess they'll be on US time, so I will have a bit of a wait.

I've tried to resolve the issue using both Firefox and Internet Explorer, no joy and consequently not many pictures as yet. The funny thing is I can access the account without any problems from home using both safari and Firefox.

It's very fustrating.

Global Warming

Following on from my last post, and by a strange quirk of coincidence, the Sustainable Development Commision, chaired by Jonathon Porrit and reporting directly to Our Glorious Leader, have released a report into whether the UK should invest in nuclear energy.

And the answer is: No!

Surprise, surprise.

A press release is available here.

We all need to reduce, reuse and recycle much more than we are at the moment. That is well known. Developing countries carbon output will inevitably go up over time, so we need to lead by example. If you haven't got a compost bin or water butt, why not? Go and buy one next weekend, or start a wormery. If you need a new boiler (unlikely, granted) get a condensing boiler. Use the car less, walk or cycle more.

Mind you, renewable energy has a long way to go before it can hope to provide us with the energy we need. Wind farms are unpopular, solar water heating is one thing, but photovoltaic solar panels are not as cost effective as they need to be to generate a mass market. It can take many years to recoup your investment.

But, and its a big but, the current Government are only interested in votes, especially those from Middle England. If Colonel Bluster (rtd) from Greater Whinging in Surrey says "No!"*, the politico's wobble and rethink. Sound bites are all. They have to start paying attention to the long term needs of the country. Of course TB says he is. But if that is the case, why is the nuclear option being considered with such alacrity?

Personally, I think the Government should move away from a centralised energy grid towards a more flexible, locally delivered system concentrating both on big power stations and small microgenerating schemes (such as solar energy, small wind turbines on everybody's roof next to the TV aerial/satellite dish). Grants are already available in the UK to help get your roof insulated, even to get solar panels of one sort or another put up. But the Government needs to improve the structure of these mechanisms, making it easier for householders to have the work done, and easier for planning authorities to ensure that developers build in a more sustainable fashion. Why not insist that all the new houses that are being built in the south east of England have either solar water heating, or photovoltaics, or both? Build in water capturing technology to reduce the amount of rain water that goes into the drains, there to the sewers and so to waste. It can't be that hard.

So come on, people. Have a think. And this weekend, do something green.


*Col Bluster is fictional and any relationship to any figure in life or imagination is unintentional and your own problem.

Planet Earth

There's no getting away from it: Sir David Attenborough has done it again!

The first episode was aired last night and already you can see that the show will be a tour de force in the genre.

Stunning landscapes, beautiful animals and state-of-the-art videography and filming have become de rigeur in wildlife filming but, in my humble opinion, there is no organisation who bring it together as well as the BBC.

That it also makes people more aware of the damage we are doing to our home can only be to the good. This post is not the place, however, to go on about global warming. I'll do that at a later date...

Doomed!! We're all doomed!!

It never ceases to amaze me how the media affects people. Bird flu is a case in point.

This morning a patient contacted me to say she had seen a dead duck the day before yesterday. Now she is feeling unwell. She is worried she has contracted bird flu. I take a deep breath, explain that she hasn't got it, and give the usual advice on how to deal with the symptoms of the common cold. But I don't blame her for being worried. How was she to know?

Only recently have the press started being less sensationalist about bird flu and its possible effects on humans. However, somewhat over-egged stories can still be seen in numerous tabloids such as this story in my favorite paper. The BBC has generally been more circumspect, providing a more balanced view of things.

For myself, I am more sanguine: bird flu will inevitably reach the uk. This is not the disaster people think. It is part of the natural order of things. At some point, this virus or another will make the transition to human from whatever it's current host is and we will see another global pandemic.

But there is no need to panic. Admittedly they started slowly, but worldwide, governments are finally starting to take the threat seriously. There have been moves afoot to develop a vaccine for some time, but only recently have governments started to take an interest.

So what can you do to stop yourself getting bird flu? Not much to be honest. But don't worry. At the moment you are significantly more likely to die as a result of an asteroid strike on the Earth.

Normal flu on the other hand is doing the rounds. Advice on flu and managing the symptoms can be found here.

Next patient please...

NHS blog Doctor

I've just discovered this blog.

Very funny, and I commend it to you, one and all.

I only wish I'd got my act together sooner and thought of this first. I could have made a mint from the advertising...

I've just discovered that Safari (the web browser on my iMac) doesn't have as many options on the compose bar when composing posts for the blog.   :-(

This means I can't do some of the formatting automatically, which is another reason for me to get to grips with html tags sooner rather than later.

Oh well, what doesn't kill you makes you stronger.  And I can run Firefox (which does support the extra formatting options) along side anyway!

You should probably be prepared for odd posts occasionally, as I don't think its fair to keep all my elementary html errors from certain of my viewers. (Pete, you could probably do with a laugh, am I right?)

More posts at a later date...

Me!
Originally uploaded by Russ and Julie.

Well, here's my first attempt at a flickr-esque blog posting.

Direct from flickr, no expense spared! (Hope it doesn't make you gag)

Wedding DVD

Well, finally got round to sorting out Nick's video so we can create a DVD of our wedding.

If anyone wants a copy, mail me and I'll send one to you in the post.

We've even figured out how to print out the innards of the |DVD case (though we haven't managed to get hold of printable DVD labels yet through sheer can't-be-bothered-ness).

Its been great fun learning how to do it all, using our iMac to copy the film into iMovie, then creating a DVD movie, then finally ripping it.

In between times, I've started learning a bit about html tags, but unfortunately none of you will be able to see as you're not doctors as I've been practising on my profile entry for DNUK, which you can't access unless you're a GMC registered doctor!

Unless of course you've come here from my profile in DNUK, in which case you've already seen it!

Next blog posting will hopefully incorporate some images. Once I get some on flickr of course.

Welcome to The Brown Stuff!

Hello!

I thought I should finally get a blog going for all those little thoughts that I want to share with the world.

I've been reading my mate Pete's blog for ages (http://peterwright.blogspot.com/), and from his I've navigated to other blogs of people all over the world.

So if you've already found the blog, watch this space, you never know how many pearls of wisdom you might find here.

Or, of course, not!