Old Philosopher

I was reading another blog this afternoon and came across a quote from Karl Popper - considered to be one of the most important philosophers of the last century.
Karl Popper "philosophed" about scientific reasoning and also about the nature of politics. Considering we have so much in common (I am joking of course) it is surprising then, that when I briefly looked after a close relative as a medical registrar we did not hit it off. Professor Popper died in 1994 and it saddens me that, now I am more mature and deep thinking, I will never get the chance to chew the cud with him.
He did teach me one thing I have not forgotten and that is not to treat myself or my family. Professor Popper's relative had cancer and had developed abnormal liver tests. When I went through the treatments she had been receiving it turned out that the good Professor, at the pinnacle of human intellect and reasoning, had dragged this poor lady all over the world and procured for her whatever treatment was the fashion in each place he visited on his lecture tours. So the lady had the odd dose of this and that chemotherapy, a bit of alternative therapy, the occasional blast of radiation and various other pills and potions. He was obviously trying to do the best for her but even this man could not see the folly in this. What hope for lesser mortals?
Anyway, a good friend of Karl Popper was my old boss Professor Neil McIntyre so I ended up Googleing him to see where he was now and to my dismay I found out he had just given a lecture for the BBC in Brecon - just a few miles from me and I had missed it. He has retired now and I suspect he lives nearby because he was always going on about his Welsh background so I shall try and trace him. If anyone can help I would appreciate it. He was Prof of Medicine at the Royal Free in the late 80s.

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On a lighter note I was pleased with the number of hits on the www.uk-radiology.co.uk website this month. I started the website last December with no prior experience, a very basic hosting package and a couple of quid for the domain name. I built the site myself and then set about learning how to optimize it for the search engines. This was all new to me and I needed to do it on a shoestring because I didn't know if it was going to work and I was spending other peoples money. I certainly wasn't going to pay several hundred pounds for a site.
I am not particularly pleased with my first attempt but it does the job and cost me almost nothing. I have also resisted paying for advertising or pay-per-click like my competitors. This is only partly because I am so tightfisted. Pay-per-click gives you hits while you continue to pay but does nothing for long-term ranking. I also did not want inquiries from all over which would have overwhelmed me so I took the long term route of getting a high Google rating. The most successful way has been to mention the site on other peoples web or forum. This blog was started for the same reason but has taken on a life of its own.
Hits on the site (and inquiries) have gone up month on month just at the rate I could cope with and yesterday broke through the 1000 hit/month barrier:



This may not sound like much compared to say eBay or Amazon but how many people need an MRI scan? If 1000 a month are reaching my site that must be a big proportion of them. However a few days ago it didn't look like I was going to beat last months figure but a quick look at Martin Lewis'moneysavingexpert revealed a new tread on medical tourism so I mentioned on it that uk-radiology was cheaper than going abroad. This brought in about 60 extra hits within 12 hours and comfortably beat my previous record. Who needs Pay-per-Click? Would it be too cheeky to mention this as a tip on moneysavingexpert?

Road to Damascus experience

While listening to "Today" on the road to work I had my own Damascus experience this morning.
A judge was being interviewed about the imposition of the Ministry of Justice on the unsuspecting legal profession - that other dark force of conservatism. Apparently, true to form for Nulabour, the judges only found out about it from the Sunday papers.
The judge was worried that the Ministry of Justice would seek to influence judges’ actions. The good judge stated " We are not Civil Servants. We are not here to carry out Government Policy".
That was it. In a sudden flash of light I saw why we, as doctors, are having such difficulties with this Government. Are we civil servants? Are we employed to carry out government policies? Well, the government does pay our wages but it pays the judges too so that is not the criteria. I think most doctors of my generation thought we were autonomous and our responsibility was to our patients, our profession and, if we are self employed, to our business and staff. At some stage in the last 25 years or so this belief has been eroded and many modern doctors (including almost all those in influential positions, in the Colleges, Deaneries, BMA and Hospital Trust Management) are happy to carry out government policy and, indeed, enable the government to pursue its policies regardless of how mistaken -civil servants in fact. Doctors like me were never asked if they were happy with this and, belatedly, we are now saying that we are not.
Unfortunately, I don't think the general public understand our relationship with government. Although doctors are still, on the whole, trusted over clinical matters they cannot understand why, as employees paid for out of their taxes, we are so political and cynical of government diktats.
In short, politicians and the general public think we are civil servants but doctors think they should be like judges and be free to act without government interference. What do you think Dr Crippen and Sam Everington? - unlike myself you both have the advantage of a legal training.

HTAS

Margaret Hodge, MP (barking) and Industry Minister, has today proposed that native Britons should be given preference over Johnny Foreigner in the allocation of social housing. She proposed that applicants would be given points depending on how long they have contributed to the UK economy.
Now, I have been mulling over some thoughts for a blog for a few days and when I heard this I instantly recognized where this was heading.
We have a housing crisis in the UK. It's not only that there aren't enough houses but that they are in the wrong place. Demand pushes up prices in some areas while, in Northern towns, perfectly good homes are demolished or stay empty. What we have is failure to match sellers with buyers.
Computers are good at doing this sort of thing and it just happens there is a perfectly good £6.3m computer system sitting idle at the Department of Health.
What I, and the barking MP, are proposing is a Modernisation of the Moving House process (MMH). Instead of the current Old Boys Network, which favors people with money, jobs or rich parents, home providers will be required to submit a home information pack (HIP) to HTAS (Homes Transfer Allocation System). Prospective home seekers would apply online to the secure HTAS computer system and submit details of age, race, sexual preference, religion, social class, parents social class, schools attended, schools parents attended, previous home ownership and income. Points will be allocated on a series of short essays on a range of everyday topics, such as the care of garden water features and how to deal with the situation of a neighbour who wishes to replace his period sash windows with uPVC.
Applications will be graded by a panel of celebrity TV house makeover program presenters and applicants will be allocated properties in order of merit so that, for example, a high scoring home seeker will be allocated a house in leafy Surrey and a lower scoring applicant would be allocated a high-rise council flat in Grimethorpe or indeed become homeless. Anyone becoming homeless will be encouraged to use the services of Shelter, until the next round of applications. All home relocations would take place on a specified single day each year.
It is appreciated that many applicants may have a preference regarding the location of their homes but this is considered socially divisive and HTAS will work with stakeholders to encourage a culture change in location prejudice.
It is self evident that HTAS will be an improvement on the current flawed system and that it should be rolled out without delay. I expect it to be whole-heartedly supported by the Royal Institute of Chartered Surveyors and any failings in the system can therefore be blamed on them.

Overpaid doctors

Dr Rant and Dr Grumble both pick up on an article in the Telegraph today quoting a GP comparing the annual cost of providing GP care and insuring a hamster (£50 vs £65).
Vets are skilled, dedicated professionals, who have been selected for university degrees from among the brightest of our school leavers and undergone rigorous and demanding training. In a free market, they deserve whatever they are paid. So would doctors in a free market. Looking at the USA, it would probably be more than they are currently paid. The truth is that having the same monopoly acting as employer, provider of facilities, regulator of trainee and job numbers and regulator of income has actually held back doctors wages. Perhaps the USA is not typical one might argue. After all UK doctors are the best paid in Europe. They may well be but there is also government interference in healthcare in Europe and perhaps a more valid comparison would be with those other bright and hardworking individuals working at the pinnacle of free markets - the City, where a fund manager with say 15-20 years experience, if he still needed to be at work, would consider a GPs or Consultants annual wage no more than lunch money.
I was made aware of how much we stood to benefit from free markets when I started contacting osteopaths about our MRI service. I really knew nothing about osteopaths until recently but the ones I have spoken to have been gracious, well mannered and personable. Then again they are all self employed and these same qualities are their stock in trade. And what a trade it seems to be. Having phoned up many dozens of practices it seems many work from about 8am until 8pm and some even do OOH home visits. They book patients back-to-back at 20 minute intervals and the going rate around here seems to be about £35. I have never managed to phone and find an osteopath free between patients. Some employ a receptionist but some just have an answering machine and a few even work out of their own homes so expenses are low. When I did call in to one practice to deliver leaflets I noticed a patient paying in cash so even paperwork is minimal.
Well, by my calculations that is around £100/hour, lets say 10 hours/day, 5days/week, for 40 weeks a year (they all seem to take a long holiday between Xmas and the skiing season). That makes £200,000 pa before expenses.
Recently I have had 6th form students, interested in a career in Medicine, spending part of the day with me at work and I have mentioned that they could be earning this sort of money after only a three year course and should reconsider their options.
My other conclusion from my observations is that patients are willing to pay hard-earned cash to someone who is nice to them and devotes 20 minutes personal attention. The same message in the magazine from the Medical Protection Society today - patients rarely sue doctors who are nice to them. Whether the treatment is correct, safe, evidence-based or effective doesn't even register on the scale. Doctors ought to remember this.

Hot Bath

Nice email from a radiologist working in Bath who has found out about uk-radiology. The radiologists there have set up a partnership just like uk-radiology. They are near enough to be competitors but the real competition are the parasitic independent 2nd wave providers whom the Government have brought in to smash DGH radiology departments. The Department of Health know that if routine work and funding is diverted to these people, the local district general hospital radiology departments would be starved of resources and in a few years would become obsolete and unable to attract staff. This would spell the end of the hospital itself, which is, after all, the point of the whole devious exercise. Remember, Nulabour set out to boldly "reconfigure" district general hospitals and got a good drubbing when retired surgeon Richard Taylor stood as a "Keep Kidderminster Hospital Open" candidate and overturned a safe Labour majority in 2001- they weren't going to try that again and Alan Milburn had to think up a more devious plan to offload the troublesome and inconvenient network of autonomous DGHs.
The evil plan was to lumber hospitals with debts (PFI), make them financially independent and then divert away their income stream and watch them go under. To avoid any public outcry the DOH feeds a steady supply of stories to the media about how common conditions like heart attacks and strokes can't be properly cared for in local hospitals, and that consultants in DGHs (where most are employed) don't work hard enough for the huge incomes they are paid.
So far its not quite working to plan. Nulabour thought GPs would do anything providing they were paid enough but they have, unexpectedly, decided to support their DGH and local consultants. The general public no longer believe Nulabour spin (for example, many preferred the Iranian version of events surrounding the capture of Royal Navy personnel, hence the extraordinary decision to let the sailors sell "their" version to the press) and now treat any government announcements on Health with healthy skepticism. Finally the independent sector providers have only been able to recruit piss-poor radiologists for what they want to pay and are facing competition from NHS departments who have upped their game to compete. Some, like BUPA, have already pulled out, others have delayed their launch and ATOS Origin had it's service suspended because of worries about its quality.

International joke (not the NHS)

This is a joke from Johan - a S.African Radiologist. I don't think they know much about PC there:

On a group of beautiful deserted islands in the middle of nowhere, the following people are suddenly stranded by, as you might expect, a shipwreck:

2 Italian men and 1 Italian woman
2 French men and 1 French woman
2 German men and 1 German woman
2 Greek men and 1 Greek woman
2 English men and 1 English woman
2 Bulgarian men and 1 Bulgarian woman
2 Japanese men and 1 Japanese woman
2 Chinese men and 1 Chinese woman
2 American men and 1 American woman
2 Irish men and 1 Irish woman


One month later on these same absolutely stunning deserted islands in the middle of nowhere, the following things have occurred:

One Italian man killed the other Italian man for the Italian woman.

The two French men and the French woman are living happily together in a menage-a-trois.

The two German men have a strict weekly schedule of alternating visits with the German woman.

The two Greek men are sleeping with each other and the Greek woman is cleaning and cooking for them.

The two English men are waiting for someone to introduce them to the English woman.

The two Bulgarian men took one long look at the endless ocean, and another long look at the Bulgarian woman, and started swimming.

The two Japanese men have faxed Tokyo and are awaiting instructions.

The two Chinese men have set up a pharmacy, a liquor store, a restaurant and a laundry, and have got the woman pregnant in order to supply employees for their stores.

The two American men are contemplating the virtues of suicide because the American woman keeps endlessly complaining about her body; the true nature of feminism; how she can do everything they can do; the necessity of fulfillment; the equal division of household chores; how sand and palm trees make her look fat; how her last boy-friend respected her opinion and treated her nicer than they do; how her relationship with her mother is improving and how at least the taxes are low and it isn't raining.

The two Irish men have divided the island into North and South and set up a distillery. They do not remember if sex is in the picture because it gets sort of foggy after the first few litres of coconut whisky. But they're satisfied because at least the English aren't having any fun.

Patricia Hewitts Boobs

Poor Patsy Hewitt just lurches from disaster to disaster.
She made her name in British politics as press secretary to Neil Kinnock, helping snatch defeat from the jaws of victory in the 1992 General Election. From 1994-1997 she was head of research at Andersen Consulting

Rebranded "Accenture", one of its subsidiaries - Accenture Technology Solutions is dedicated to providing technology solutions to the client. The solutions work is mainly outsourced to low-wage developing countries like India and The Philippines.

Her next career milestone was the destruction of the remnants of the British car industry as Secretary of State for Trade and Industry. She claimed that the receivers had been called in to the firm before the event had taken place and then, in order to avoid embarrassing redundancies during an election campaign, she gave a further £6m of taxpayers money to the company to keep it solvent for the few days prior to polling day. Almost all this money was paid by the Receivers to themselves for a few weeks work.

Flushed with this success she took over at the helm of the NHS and steered it "to its best year ever in 2006". Putting her faith in technology she ploughed ahead with MTAS - a computer based system of selecting trainees for jobs in the face of expert advice that it would be a disaster and then blamed the experts when it was.

Not content with one computer disaster she has continued to support the misguided and widely ridiculed Connecting for Health computer system at a cost estimated to eventually reach £12b. When asked to justify this expense she always quotes the success of PACS - the picture archiving and communication system now widely used by x-ray departments. While PACS has indeed been a success she has as much justification in seeking credit for this as for the replacement of film photography by digital cameras - the technology is analogous and the transition to PACS was occurring without Government involvement; the driving force actually being lower costs. PACS does bring together two things which are close to Patricia's heart (yes, we might be talking about boobs here): outsourcing work to low wage economies and the impossibility of ensuring computer security.

It would be interesting to see if Patricia has her mammograms stored digitally on an NHS hospital PACS. I doubt it because the security is so poor that it would only a matter of time before they appear on the internet. I did hear that politicians would be able to opt out of having their medical details on-line because of national security; celebs too, but I can't remember the reason they gave for opting out. In our Hospital Trust, until recently, the password for nurses (or indeed anyone) wishing to access patient data and images was "nurse". This was not considered much of a security risk because we don't have many Labour politicians or celebs where I work.

Time was when anyone with a vibrator up their rectum would have their x-rays shown around the doctors mess - with the marvels of PACS and the NHS IT system the images can be shared with the whole world. Let all hope it's not Patricia's biggest boob.

Another life saved

One of the paradoxes of working in hospital medicine is that my actions becomes less relevant to patients the more experience I gain. More than 25 years ago, even as a medical student, I could make a difference to the outcome of a patients illness. Now I just seem to investigate patients where, either the diagnosis is already known or, if not known, the knowledge would not benefit the patient in any way.
A typical example today in a baby. Now I admit to not knowing much about babies. I really can't remember anything about my paediatric attachment as a student except that the childrens' hospital staff restaurant was rather good. I also seemed to have missed the nappy years of my own children-lost in a mist of sleep deprivation and long days at work but I was surprised at the referral I received today.
I suppose the referrer was following the recently rediscovered ancient Hippocratic principles of one investigation good; two investigations better and no one has ever been sued for asking for too many investigations but when a child came down for an ultrasound scan of its nappy rash I did wonder whether it needed a Consultant Radiologist to make this diagnosis. Of course the parents expectations had been raised by the prospect of the scan revealing all and, rather than ending up with disgruntled parents, it was easier to pretend to do the scan and announce that I did not think it was anything serious. At least it has saved the baby from an MRI scan (well I hope it has but I might be surprised tomorrow).
From my point of view it is easier to agree to do a scan, however pointless, than argue with the referrer or patient. In most cases even the unnecessary radiation is hardly a consideration as the life expectancy of most of the patients we investigate is weeks rather than years.
Contrary to popular belief there is no shortage of radiologists or scanners but the number of ridiculous requests just keeps increasing at a faster rate than we can clear them. And the more we try to improve access the more silly requests we get.

Tasteless Rant brings on backlash

From Doctors.net.uk:

Regulation of Medical Blogs ( paul.grech) 13/05/2007, 15:42
I know many medical bloggers lurk on DNUK looking for material so I was hoping to get some views on a letter I was planning to write to Patricia Hewitt pointing out the need for regulation of this burgeoning area of medical activity.


Dear Ms Hewitt,

I wish to bring to your attention the activities of certain medical practitioners, known as "Medical Bloggers" who, acting in a completely unregulated way, are undermining the morale of NHS staff, particularly managers and nurse practitioners, and damaging the confidence patients have in the government stewardship of medical services.

Some of the more notorious sites such as the tasteless Dr Rant (http://www.drrant.net) have, I regret to inform you, been less than generous in their assessment of yourself and your predecessors in the Department of Health. By pointing out deficiencies in the NHS I believe these sites are subversive and serve to increase patient anxiety. It may be that these sites seek to drive patients to the private sector by circulating tales of patients being treated by unqualified quacktitioners on MRSA infested NHS wards and in support of this I would point you to the large number of advertisements for private care on the disgraceful Dr Crippen Blogsite. (http://nhsblogdoc.blogspot.com)

I propose that the interests of patients and the overwhelming majority of hardworking nurses, managers and doctors be protected by a system of compulsory regulation of medical bloggers overseen by a new department within the Department of Health called Modernizing Medical Blogging(MMB). This department would be equipped with the most comprehensive and advanced computer systems sourced from the the market leading IT supplier, Joe's Komputer Korner@Kilburn and headed by a blogger Tzar at a rate of renumeration set to attract an international high-flier (such as, I hesitate to suggest, myself).

MMB would be revenue neutral by requiring all bloggers to pay a nominal annual fee of say £350 linked to x3 the annual increasea in doctors pay in return for a licence for medical blogging(LfMB). Compulsory indemnity cover will be provided by the reputable financial institution, Sue Uras & Runn, for a modest additional fee.

I further propose that standards of medical blogging be set and monitored by an independent committee of your choosing, later to acquire a Royal Charter and to be known as the Royal College of Medical Bloggers. Membership of the RCOMB will be voluntary and anyone wishing to blog without paying the modest membership fee will be permitted to do so provided they do not use the internet.

Overseeing conformity to standards will be the Medical Blogging Council (MBC) who will have powers to levy unlimited fines, instigate GMC and Inland Revenue investigations and suspend doctors on no other evidence than a malicious tip off.

Applications for Medical Blogging licences will be online using a secure computer network and require details of sexual orientation, religion, political affiliation, income, parents income, schools attended and types of property owned. This will ensure that licences are issued on an equitable
basis and keep out those Tory Voting GPs and Hospital Consultants and other dark forces of conservatism.

In order to redress the imbalance caused by the current wave of cynical unregulated medical bloggers, highly trained allied health professionals such as nurse practitioners should be sent on a course and empowered to spend more time blogging. Hospital Trusts and NHS GP Practices should be incentivised to employ such experts in newly created full-time paid Medical Blogging posts.

I remain Madam, your most faithful servant and hope that this letter finds you still in your present cabinet post.

New kid on the block

Noticed a new outfit offering private MRI scans in Waterloo station. Call themselves Vistadiagnostics and they have an interesting pricing structure varying the charge depending on how busy they are. They work 7 days a week and their charges start at £250 + 50% per additional area which will be a shock for the other providers in London used to much higher charges. The reason I was interested is that they have obviously copied much of what I am doing with uk-radiology and even used my tag line "Affordable Accurate Accessible" with minor variation. I am flattered as this was my first attempt at a commercial website. It will be interesting to see if they can turn a profit with London expenses. I would be worried if I ran a scanner in London but we are sufficiently far away and our prices at £200 + 50% per additional area are still lower. It might damage the Cobalt Appeal in Cheltenham though as there is nothing in it on price and no-one from London will bother traveling up. It would be interesting to know who is behind them-I don't think it is a radiologist because there are a couple of silly errors on their website which they will have to find themselves.

Tasteless Rant

Tried to get onto the Dr Rant website from work today but access was blocked by "websense" a web filter which our hospital has installed to prevent staff accessing porn and online casinos. You may be interested in the reason it gave: "Tasteless"
I thought it was a rather odd phrase.
I shall try accessing some other blogs over the next few days to see if the web filter's critical appraisals include "shite", "waste of bandwidth", "subversive" and "too Tory"

I have to say that the computer has a point. The Dr Rant blog is well informed, well presented and funny but when I pointed out that the use of foul language did his cause no good at all I was subjected to a torrent of abuse more typical of a group of drunken chavs at throwing out time rather than a group of GPs.

Cost of the middlemen

Our local commissioning group (aka GP fundholders) have agreed on an contract for our local NHS X-ray department to do MRI scans at £330 each. In fact its quite an achievement to get them to agree to anything but that's another matter. What is interesting is that uk-radiology do private MRI scans for £200 and both the radiologists and the Trust can turn a modest profit at this price using the very same machine, radiographers, clerical staff and radiologists. It is not however at all clear that the Trust will make a profit at £330. How can this be? The difference is that we have cut the middlemen out of the equation for private patients: that vast army of people who shuffle paper, collect statistics, analyze waiting times, go to meetings and attend courses on staff motivation and capacity and demand management. This is one of the clearest illustrations I have seen of the cost of all this dead wood; not just cost in terms of money, it is the reason front line staff posts are frozen and vital pieces of equipment are not purchased to the ultimate detriment of the service we can provide.

Another medical blogger

I have noticed more medical blogs recently and some, like Dr Rant and Dr Crippen, are now regularly featured in the print media. Might have something to do with the increased militancy of junior doctors in the UK (or maybe they just have more free time).
I don't know if there is another radiologist blog but as a group we sit next to a computer all day and are pretty verbose so blogging would seem to be an ideal time-waster for work, alongside contributing to medical forums (or is it fora) on doctors.net.uk and the specific illness websites such as the usually excellent kneegeeks.
The Dr Rant and Crippen type blogs serve a purpose and counter some of the Nulabour spin against doctors while protecting the bloggers from the attentions of the DOH Stasi. I have seen the same vindictive political interference with the medical profession as these other commentators but I am responding differently and hoping to show that we don't need to learn how to run an x-ray department from the independent sector. This blog is going to follow the progress of uk-radiology as I try to attract private income to support a vulnerable DGH radiology department.