Archive for February, 2008

Damned if you do, damned if you don’t.

Posted on February 28, 2008. Filed under: Uncategorized |

This week more examples demonstrating that you’ll be lucky to get through life alive if you pay too much attention to the latest research…

The good news is…that power naps may boost your memory

Man dozing off on sofa6 minutes sleep can apparently get those old memory cells boosted. Great I could do with a better memory.  I’ll just read the newspaper to relax and then settle down for a quick 6 minute power nap.

I pick up the newspaper and read:

For those who had a habit of nodding off, the risk of stroke was two to four times higher than for those who never fell asleep in the day“.

So, I could have a power nap, remember things I would have otherwise forgotten, but be unable to tell anyone about it due to my slurred speach!  Great!

Apparently the team behind the research advised that we should be checking out older people who have a tendency to fall asleep in front of the TV during the day…. Oh my god!  If the government catches wind of this, I’ll have to go tapping on windows and checking vital signs of anyone dozing off during the afternoon edition of Doctors“, I can see the QOF form now:

Pt unresponsive as had stroke: Yes……..    No………

Pt unresponsive as crap programme bored them to sleep: Yes……  No……..

Pt dead as gave up the will to live due to poor quality day time TV:  Yes……. No……..

Doctor give government cash as Nurse Practitioner ticked the right boxes: Yes………. Yes………..

Pay rise given to Nurse Practitioner for doing the work: No……….. No……………

After doing those I’d need a glass of wine… after all we all know it’s good for you (Experts at five universities found that people who drank more than two glasses of red wine a day had 44% fewer colds than teetotallers)  or is it….

After one drink, blood vessels are more “relaxed” or dilated, which reduces the amount of work the heart has to do. (Great….) But,  (oh there had to be a “but” didn’t there) after two drinks, the heart rate, amount of blood pumped out of the heart, and action of the sympathetic nervous system all increase. Thanks Dr. John Floras, Director of Cardiology Research at the Peter Munk Cardiac Centre, and at Mount Sinai Hospital,

Sod the wine – it’s too confusing, get me a whisky….The British Medical Association apparently states that 30 grams of alcohol a day can protect against heart disease – That’s four shots of Scotch!  That’ll be fine.

Hic! Scotch can’t be bad for you……..

Meanwhile in my office:

Phone call of the week:  A patient rang up with a 24 hour ECG in situ wanting to know if he could use his mobile phone! 

“I don’t know, do you know where the “on” button is?”

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Q is for Quality…

Posted on February 21, 2008. Filed under: Journal from behind the desk... |

Max is a little peeved.

For those of you who are not familiar with QOF, it is essentially Quality and Outcome Framework, well that’s what it stands for.   Pretty gargony admittedly. I could describe it as a set of targets that the government has put in place for GP surgeries to meet and get rewarded for.

Cynically I could tell you it is basically a juicy carrot, for cheap statistics to make the government look as if they have improved primary care. 

Even more cynically I could tell you it is a bunch of tick box targets with no real meat to it.

I think somewhere in the archives you’ll have found me going on about it before.   On occasions when targets are looking like they won’t be met my employers, they put me off regular appointments and let me bash out a few tick boxes, so they get the juicy carrot.  Last time this happened it was to get “x” number of patients with dementia reviewed. The first year they sent me to nursing homes, bit of a joke really.

The patient who need reviews and assessments are sitting at home, can’t remember who their elderly spouse is, and the elderly spouse is acting as a full time nurse despite being 82 and riddled with arthritis.  But they take too long to get to and the target needed meeting in 3 weeks, so the people who get the reviews are in purpose built care home with qualified carers.

The second year they tried to pull this stunt off…

I put my foot down metaphorically (I said no) and literally (I ended up driving house to house visiting those who really needed seeing). It was a hell of a task, nightmare to organise and very time consuming.  But I did it and I felt I had done something worthy.

This year we are running short of asthma reviews, normally these are covered by someone else, but she just can’t catch up, so Max has been asked to mop up the overspill.

OK so I am not an asthma specialist, but all I have to do is check their serial peak flows – (tick the box), inhaler technique (tick the box) and have a quick chat. The nurse that does most of them has 15 minute appointments, and if things aren’t good enough in the patients asthma management she immediately knows what needs changing. 

I have 10 minute appointments normally, so have doubled these when doing asthma reviews.  It gives me time to look at the asthma management step up table and make sure I am giving the patient the right change in management.

I have just be asked to put my appointment times back to 10 minutes as I am “doing too much” in my reviews.

Times like this I remember I am now an employee in a private business contracted by the NHS and not working directly for the NHS.  I don’t like it.  I’ve always had managers, but I used to feel I was working for the patient, but on occasions like this I feel like I’m working for a tosser with an expensive sports car.

I’ve been encouraged in the past to become self employed.  Sounds too much like stress to me but perhaps I should, or would I then just become a tosser trying to get an expensive sports car.

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A random week….

Posted on February 14, 2008. Filed under: Uncategorized |

If I was Doctor Anonymous I would be posting you a video this week, as I really have had very lttle time to myself. (Incidentally how can an anonymous person post a film featuring his face?)

It really has been a tough week, for one reason or another I have scaresly had time to check my emails, lets alone write much in the way of a constructive post, (they are normally sort of constructive – honest).

Tough week

However my editor is insistent that I publish once weekly, and although he is a bit of a git, I have to live with him, so it’s just a bit random this week…

Question of the week:  To Holiday or not to holiday??

Presently there is lots of talk about the change in GP hours/contracts, essentially this amounts to about an extra 3hrs work a week, to decrease the pressure on the failing out of hours service. The GP’s are stuck between a rock and a hard place on this.  NP’s could of course help to extend opening hours, (Although only if the GP’s see us as team members and not the Crippens ideal that we are evil).

This WILL hurt…say: Arrrrrggggghhh!!!

Meanwhile the parlimentary website has a petition….Any of you Brit’s fancy an extra bank holiday….sign the governments petition here…

So with one breath the government is saying – There is not enough GP’s working out of hours and in the next they are saying there isn’t enough “out of hours”.

Well, we have less bank holidays than the rest of Europe, so kick back, open a beer…  You can afford to having just increased your out of hours pay!  But have you got the time to do it??

Phone call of the week:

I had the pleasure of treating a patient with piles this week. The prescription was for Anusol Suppositories. (The guy from that marketing company was either a genius or a moron – what a name!! – Yeah, you shove up your anus ‘ole)

2 days later the patient requested that I phoned him.  Dutifully I rang up…

Female voice: “Hello”…Obviously not my patient.

Max: “Ah, Could I speak to Mr Sorranus please?”

FV: “Well he’s in the garden at the moment, he said you would ring and I was to tell you, he is much better, and should he stop using the suppositories now?”

Max: Laughs….”It’s a good job I am who you were expecting, and not just trying to sell you double glazing”.

And this prompts a joke in my mind….I don’t normally do jokes, but it is a random week after all….

Joke of the week…

A nun is naked in the shower, there is a knock at the door, and a man shouts: “Can I come in?”

The nun panics…. “Well who is it?”

“It’s the blind man” replies the manly voice.

“Well in that case, I suppose so” answers the nun.

So the guy comes in and says…

“Nice tits love, now where do you want these blinds?!!”

 Sorry, no more jokes I promise…

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Crippen you love us, part two.

Posted on February 7, 2008. Filed under: Elsewhere in the blogisphere | Tags: |

I was checking out my Bloglinesaccount today (something I tend to forget to do, what with facebook blog buddies etc..) and I spotted that Dr Crippens “NHS Blog Doctor” was up and running again (and has been since the start of Jan).  Quenching all rumours about alien abduction etcetera.

Crippens wasn’t cute – “they” bought him back.

…and what has that old Curmudgeon Crippens been writing about….yes, he has been Nurse Practitioner bashing again.  I would like to point the good reader in the direction of my last Crippens related post.  Which pretty much says it all.

Crippens is currently having a moan about a new, over marketed group practice, that is offering free gym membership when a patient registers with them…

 

…I agree this sounds a little bit dodgy, especially when considering the Code of Practice for Promotion of NHS servicesas flagged up by Crippens.  But it is his NP bashing which I don’t agree with….

The Melbourne Grove Medical Practice (MGMP), has a statement on its website that reads:

You don’t need to wait to see a doctor.
“Our prescribing Nurse Practitioners are highly trained and are able to deal with the vast majority of medical issues that you present us with. They are able to diagnose and prescribe medication and work closely with our GPs on any cases about which they want a second opinion. As we have a growing team of nurse practitioners, you could save you time if you want to get in and see us as quickly as possible. You don’t need to wait to see a doctor!”

And the old Curmudgeon goes off on one… 

“If your child or your grandmother is really ill, do you want them to be “assessed” by a nurse practitioner and only passed on to the doctor if the nurse practitioner deems it necessary? Is that safe? If you believe it is then I am nought but a luxury, an expensive luxury at that, and superfluous to requirements.”

Now I’m not defending the MGMP in any way, but Crippens is misquoting, and as I have said before, Nurse Practitioners are not simply triage nurses.  The MGMP statement said nothing about their NP’s simply “assessing” the patient.

An NP Assesses, Diagnosis, Plans, Implements and Evaluates the patient. (It is called the Nursing Processes and it has been about since the 1970’s).  And then his comment about “being passed on to the doctor if the Nurse Practitioner deems it necessary”.

It is called “getting advice”.  Crippens doesn’t get it. He wants to be treated as a Superior-being compared to the humble NP. He wets his bed at night worrying that NP’s are going to replace GP’s totally.  Nobody (with the exception perhaps of the cost-cutting bureaucrats), wants that.

The main thing Crippens doesn’t seem to get, is that it is called team work!!

I don’t mind being a link in the chain.  I see a patient and I either:

1: Sort them out & send them away (about 95% of the time)

- maybe even (shock horror) refer them onto secondary care.

2: Get the GP to see them.

Not that dis-similar to a GP managing their patient and either sorting them out and sending them home or referring them to a consultant. NP simply have the “luxury” of asking their GP colleagues for advice.   So in direct response to the “good” doctor: Yes, I think it is safe for NP to see the patients, Yes, you are a “luxury” (but not in the way you meant it), and No you grumpy old git, you are not superfluous to requirements!

And why would a Doctor not like working in a team? Something to hide?

  ‘arold, is that you!

 And on the subject of team work, lets all get together for a Change of Shift…

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