Leading doctors ~ a doctor writes

Here’s one that arose on Twitter, taken from the Guardian letters page:

• Every NHS doctor, every day, sees a disproportionate number of patients with illness caused by poverty and the associates of poverty – smoking, obesity, alcohol, drug use, domestic violence. The NHS should be predominantly paid for by those whose privilege is to need it least. Then it will be there for all of us when we need it. This is how tax works. 
Dr H, consultant physician

I agree with Dr H that we see these problems, but I fail to see the causative link between true poverty and being fat, smoking, boozing and taking drugs. On the other hand, I can see how those bad habits can cause poverty. When I was a student, and genuinely poor by today’s elastic criteria, I couldn’t afford to get fat, or even booze a great deal.

The ‘solution’, to spend more of our money, is a non sequitur.  In fact, I’m not sure whether she wants to spend more of our money on the NHS, or on the individuals that she describes, to alleviate their alleged poverty.

Dr Holt is entitled to her view, but being an NHS consultant is something of a bully pulpit, especially in the Guardian. I must try it myself.

In fact, the bully pulpit is being used a lot this week.  Sir Richard Thompson for example. Sir Richard is the President of the Royal College of Physicians. A quick look at his bio (in Debretts) suggests a glittering career: Physician to the Queen, extensive private practice and…oh…retired in 2005.

So, the last time he could realistically have participated in the combat zone of an NHS acute medical take was 9 years ago. Given his status, it’s likely that it was a lot longer ago than that, particularly as he was a nutritional gastroenterologist  by special interest, but I couldn’t say.

This is not being bitchy, as Sir Richard has just sought attention in the popular press (if you can say that about the Guardian) to make the following claims:

Overworked doctors are looking after up to 70 elderly patients during a single shift making it ‘impossible’ to provide adequate care

patient safety is being put at risk because doctors are so stressed and over stretched.

some doctors can only spend five minutes investigating each patient’s symptoms – far below the recommended 15 minutes.

doctors ‘miss things’ as they are working under constant ‘strain and stress’.

‘In spite of what weasly words people at the top say, money’s been taken out of the NHS.’

doctors (are) running around ‘like a scalded cat’ during a typical seven-hour shift, with safety most concerning at weekends and on night shifts.

‘You try standing on your feet for seven hours trying to be on the ball, thinking of the various complications, being nice to patients, for seven hours. It’s absolutely destructive.

There is a grain of truth in some of this, and a bucket load of exaggeration. I have no idea about Sir Richard’s political views, but it does smack a little of the dreaded Professor John Ashton. The last quote in the above series is frankly embarrassing, coming from a so-called ‘leading doctor’.

Taking Sir Richard’s financial theme, his blog has previously noted a view held by many working hospital doctors, that in a way there is too much money in the NHS.  There is not too much in clinical care, but as everyone knows, much of the NHS is bound up by highly expensive layers of unnecessary management, ‘governance’, perks and titles, and an obsession with branching out into areas that could only tenuously be described as healthcare.

If Sir Richard had instead said that:

“The NHS is under-doctored, under-nursed, under-bedded and under-funded for important clinical areas” he would have had a point. The problem is that the NHS is lavishly funded in many areas where the money is not going on clinical care. That is the problem, and an internal reorganisation and rebudgetting would be the answer, not squeezing the taxpayer further.

The Knife’s point in all this is not so much the detail, but the enduring principle that so often, when there are big decisions and discussions about the NHS, the proceedings are dominated by people who no longer have enough knowledge or insight about what’s happening in the hospitals etc, at the point of delivery. As a hero of this blog, Thomas Sowell, once pointed out, in what has become almost a mission statement:

“There is usually only a limited amount of damage that can be done by dull or stupid people. For creating a truly monumental disaster, you need people with high IQs.”

MMC (Modernising Medical Careers) has turned out to have been largely an unhelpful debacle, instead of improving the lot of the junior doctor ascending the career ladder. It was designed by committees  with too many barely-there clinicians.

In the medical press the British Medical Journal is bad enough, but the Lancet can be even worse. More of those so-called ‘leading doctors’.  A while ago The Knife pointed out the hysterical claims of its editor Richard Horton, whose clinical career was predictably remarkably short. The smart Tim Worstall has just ably dissected more Lancet madness over at Forbes, this time relating to the overt politicisation of the once noble specialty of Public Health. Here is a choice snippet:

To take issue with certain parts of what is being demanded:

The discipline of public health is critical to this vision because of its values of social justice and fairness for all, and its focus on the collective actions of interdependent and empowered peoples and their communities.

That’s an interesting distortion of what public health is usually taken to mean. Which is more about the health of the public than any bleatings about social justice and fairness. For example, the victory over smallpox, the one we’ve nearly achieved over polio, these are very definitely public health measures to stamp out communicable disease through vaccination. They’re not though about social justice nor fairness, not unless we’re extending the meaning of those phrases to the absurd point of claiming that they mean we’d rather people didn’t die of something we can prevent.

Our patterns of overconsumption are unsustainable and will ultimately cause the collapse of our civilisation.

This simply isn’t true

etc etc

My objection to all this nonsense is that it ends up with a very narrow and usually left wing view being promulgated through the British media as the voice of ‘leading doctors’, even though it very rarely is. In fact the last true clinical giant that The Knife can recall being behind a big important structural NHS reform was Sir John Temple, a surgeon, who introduced the long overdue and largely successful Calman reforms in clinical training. That was in the 1990’s.

This begs the question: how does one become a ‘leading doctor’? The answer is reduce your clinical work as much as possible, avoid patient contact,  and hang around as many committees as possible, preferably in London.

And that’s the problem.


...real 'leading doctors'
…real ‘leading doctors’





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