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A fresh start
Another new year. Time flies; perhaps that's because
it's faster downhill. Discovered that I haven't
been kicked off the 20six website even though my last entry was a year
ago. Decided that it was time to try harder and keep up with this. Use
it or lose it; useful practice thinking, writing, typing, computing.
More is less
From today patients are to be able to choose from four hospitals for
their treatment. Is this really as good as the government claims? Will
GPs know enough about four hospitals to offer patients choice? Will
they have the time to find out? I doubt people check four supermarkets
before deciding at which to shop; they probably choose the nearest to
them.
Food for thought
There have been calls for Jamie Oliver to campaign for better food for
patients in hospitals; his one to improve food in schools was
considered successful. However, is he, or any other well-known chef for
that matter, the right person for this? He caters for people with
hearty appetites. Poorly patients in hospitals are unlikely to have
hearty appetites, and if they aren't poorly and are in for
more than a few days then why are they there? I don't doubt
there is a problem getting patients to eat but I suspect it's
due more to lack of staff to coax and help them to eat rather than lack
of appetising food. The hungrier you are the more you'll eat
anything.
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1.1.06 19:00
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Who is fooling whom?
The Health Sec, Patricia Hewitt, described 'The Patient Choice
Initiative' which came into force yesterday as a milestone in the
improvement of the NHS. No it's not, it's a con.
She said 'And in the pilots, very expensive pilots' that the government
carried out, people wanted choice. I wonder what questions they were
asked. Should there be choice to improve services? As part of the
modernisation of the NHS, should patients be allowed choice? The
answers have to be Yes. However, the important question 'Will giving
patients the choice of where to be treated improve the NHS?' goes
unanswered.
The NHS is a national service so services provided should be good
throughout the country. The government should concentrate on this and
not play hospitals against each other. I expect all people would like
the area in which they live to have a hospital with a good reputation.
Will those who move from one end of the country to the other be able to
be referred to a hospital in their previous area or will they be
restricted to one of the four nearest to them?
Staff in hospitals who work hard to reduce their waiting lists will be
rewarded with more work which will serve to increase the waiting lists.
They'll end up back where they started from, and risk being penalised.
Is greater choice better? The longer the menu in a restaurant, the more
difficult the choice; often it's made on the price, depending on who's
paying. Increased choice in the NHS will come at a cost.
This web log is like sudoku; it sure wastes a lot of time.
Thought for today
Man is born immortal but everywhere he dies ... The belief is now
general that Man has achieved such mastery over Nature that, if life
turns out to be unfair, human malevolence must be to blame. Death these
days is definitely somebody's fault.
Theodore Dalrymple, Mass Listeria: The Meaning of Health Scares
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2.1.06 19:09
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You are what you eat
There was a programme on telly last night about three fat people
(Americans) who were described as eating themselves to death. Two were
so fat they couldn't get out of bed; the third could walk only a few
steps. As they were so incapacitated someone must have brought them
food. The presenter said that after the programme was made 'sadly one
of them had died'. Why was that sad?
The one who could walk, a man early 50s I think, had a wife and son.
Why had they let him get so fat? He seemed to imply it was just one of
those things. It's time TV producers made a programme about thin people
to point out that they are thin by design not chance. They follow a
lifestyle to keep thin; they work at it. We should see the amount of
food they eat in a week and the amount of exercise they take; i.e.
calories in/out. It ain't astro-physics.
Thought for the day
Patients do not have a choice about choice. Current political dogma
assumes that choice is inherently good, but patients may soon begin to
disagree vociferously if this ideology forces their local hospital to
close or disrupts established NHS services. BMJ 2005;331:1489
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3.1.06 19:03
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Reform, but not as we know it
The Conservative Party leader, David Cameron, is to change the party's
policy on health care; he wants to keep it free at the point of use.
This move 'thus effectively ruling out radical reform of the NHS' said
a presenter on Radio 4 this morning.
Why is radical reform of the NHS even considered? If there's any reform
it should be of the nation not of the National Health Service. The NHS
should be treated as an insurance policy, something people hope never
to have to use. They should live in a way that not only reduces their
chance of having to make a claim but, should they need treatment, one
that also allows the staff to deal with them easily and quickly. In
other words people should keep their bodies in good shape. An insurance
policy is not a maintenance contract.
Thought for the day
The government says introducing competition through choice will reduce
waiting times and increase the quality of care. ...The overwhelming
priority for most people remains access to good local services that
eliminate the need for choice. Which, January 2006
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4.1.06 16:34
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Informed consent; not
Betty Tucker, a middle-aged woman on the Radio 4 programme The Archers,
was given a heart attack just before Christmas because the person
playing her is emigrating to New Zealand so Betty needed to be written
out of the script. I happened to hear the episode and it's bothered me
ever since.
Her husband, returning home to find her unwell and gasping that she had
chest pain, called for an ambulance. One of the paramedics who arrived
asked Betty a few questions about her medication, allergies and
bleeding tendencies. His diagnosis of a heart attack was confirmed by
staff at the hospital to which he relayed her ECG. He gave her an
aspirin to chew and then said that he wanted to give her a clot-busting
drug intravenously. This would ease her pain and reduce the severity of
the heart attack but it did have a low risk of causing internal
bleeding. To be effective it had to be given as soon as possible;
however, he needed her permission to give it. Did she want him to give
it? It had to be her choice.
By this time Betty was more distressed, saying she was frightened and
thought she was going to die. She was in no state to make any decision,
let alone one about which she had almost no information.
I was left wondering if paramedics really say what the chap in the programme said.
Thought for the day
Politicians are often transient: yesterday's Transport Secretary is
today's Health Minister and tomorrow's Secretary of State for Defence
or, if things go badly, embittered back-bencher. The workforce the
Secretary of State faces is more or less permanent. Not unexpectedly
they will have a deeper knowledge and understanding of the real
business of medicine than a Minister appointed at a few days' notice.
Raymond Tallis, Hippocratic Oaths
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5.1.06 19:51
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The higher you fly ...
Big fuss about Charles Kennedy's 'drink problem'. Spices up politics.
His admission yesterday shows that he was deceitful and lacked
discipline; hardly suitable attributes for a parliamentary party
leader. Why did he drink heavily in the first place? I doubt anyone
forced him to do so. Some have tried to excuse it. 'What does one do in
Westminster with all those long hours but drink?' 'It is a stressful
job with few opportunities for more healthy ways to relax.' Read a
book, magazine, newspaper; drink tea, coffee, orange juice, water; go
for a walk. Haven't politicians brains enough to think of something?
If I heard correctly today, alcohol in the Houses of P is subsidised.
Well, I hope it isn't. The government criticises publicans for holding
happy hours during which they sell alcohol cheaply.
Chas Kennedy said in the past when asked about his health that he was
trying to follow his doctor's advice to stop smoking. Why did he need
advice from his doctor? Wasn't he old enough and sensible enough to
decide for himself? The hazards of smoking have been known since the
fifties.
Alcohol is a very necessary article ... It enables Parliament to do
things at eleven at night that no sane person would do at eleven in the
morning.
George Bernard Shaw, Major Barbara 1907
Drunkeness is nothing but voluntary madness
Seneca (c. 5 - 65)
Thought for the day
There has to be a lesson here for all leaders. Secure your exit
strategy and do it in good time. There is no need to let it all end
shabbily. Yet remarkably few know when to go. There is always the
delusion of personal indispensability, always the belief that there is
more to be done before it's time to go.
Polly Toynbee The Guardian 6 January 2006
You are what you eat (again)
There was yet another programme on telly about fat people. Plenty of
them about. The Diet Doctors. Two thin women, one of whom wore a
stethoscope round her neck all the time - to give an air of
authenticity no doubt. The fat woman featured (aged 37) ate little but
ready-meals heated in a microwave. What expense. A fit woman who ate
healthily acted as a guinea pig and ate what the other normally ate for
two weeks. She suffered; she gained weight, became lethargic and
struggled to last the course.
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6.1.06 19:12
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So that's that
Exit Chas K. People described him as courageous as he'd confessed to
having a drink problem; called it an illness. Maybe, but one of his
making. He smokes; why did he start? Was it from ignorance of the
health risks (known before he was born) or from inability to resist
peer pressure? It must have been his choice.
A writer in today's Times advises how to stay sober at a drinks party.
'If it's possible, drink only tonic water, but tell your hosts that
it's G & T. If it's champagne, drink orange juice and tell everyone
that it's Bucks Fizz.' Why the need for pretence; why the need to lie?
Democracy does not favour continuity. Winston S Churchill
Thoughts for the day
Actions may not always bring happiness, but there is no happiness without action. Benjamin Disraeli
There is no failure except in no longer trying. There is no defeat
except from within, no really insurmountable barrier save our own
inherent weakness of purpose. Kim Hubbard
Success in going from failure to failure without losing enthusiasm. Winston S Churchill
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7.1.06 20:11
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