Friday, 22 June 2007

hasta la vista baby

I mentioned Vistadiagnostics previously on this blog. They are a bit of a mysterious company. They don't mention who owns the company or who the reporting radiologists are, except to say they are super special specialist radiologists or some such rubbish to impress the gullible. I adopted the attitude that all is fair in love, war and business and I was prepared to accept it as a compliment that their web designer (who I think is called Joe Lawrence) has copied the tag line (Affordable Accurate Accessible) off my uk-radiology website. He did make one change: he replaced "accurate" with "assured". I suppose he can't really vouch for the accuracy of the radiologists' reports, even if they are super special, so this is a wise move, although it betrays a lack of confidence. Anyway, "assured" sounds good even though it's meaningless.
What is getting me irritated is that he continues to shadow me. It's like being adopted by a mangy stray dog or having a stalker. What he must do is google uk-radiology and find out if the website is mentioned on a forum or chat room and then spams the forum with adverts for his company. This is really below contempt so I have done something similar to him.
I find he is getting links to his site by posting thinly veiled adverts on various article sites like amazines so I did one of my own. I don't know whether it will be accepted - it should be looking at all the rubbish on this site but I reproduce it below. I think I might have gone a bit far with this. I don't think Vistadiagnostics will be offering me any work.

When New Labour, the ruling political party in the UK, pledged to save the N.H.S. - the state-funded national health service, it invested a huge amount of taxpayers' money with little visible gain.

In an effort to reduce staff costs, which accounts for 70% of N.H.S. spending, untried systems were introduced into the area of diagnostics with some interesting unintended consequences.

A vast amount of extra imaging capacity has been purchased from privately owned providers who have been guaranteed profits and set-up costs but forbidden from employing N.H.S. staff. Dumbing down in radiology has resulted in many tasks previously undertaken by radiologists in the UK, such as ultrasound and film reporting, being done by radiographers and, at the same time, much larger numbers of radiologists are coming off the expanded training schemes and are unable to find work because hospital departments have frozen recruitment, partially to balance the books as required by the Secretary of State for Health (Patricia Hewitt at time of writing), and partially to see what effect the new providers would have on hospital radiology departments.

As costs of medical equipment have decreased and radiology reporting costs have plummeted, entrepreneurs have entered the private health-care market and set up patients-for-profit orientated companies. They have particularly promoted private MRI scanning, which is often advertised as a method of screening for cancer by the less scrupulous private companies. Since the method uses no radiation, regulation is lax and scans are widely advertised for dubious medical indications particularly to the wealthy worried well.

An example of this new breed of "health care-for-profit" providers is Vista Diagnostics who have installed a scanner in a London railway station and carry out scans seven days a week for the price of a meal for two in a fashionable restaurant.

A group of Consultant Radiologists working for the N.H.S. in Hereford, a small city on the England-Wales border, have shown that it is possible provide an ethical, high quality, low cost private service while benefiting the local N.H.S. patients. The partners have set up the Hereford Radiology Group and take private referrals from throughout the UK. They have a full range of diagnostic equipment available so are able to carry out CT scanning, ultrasound, isotope scans, plain X-ray and MRI - unlike most other private providers who can only offer a single modality. The consultants are also happy to discuss the most appropriate investigations for a particular problem and, because they are able put ethics before profit, may advise that imaging is not appropriate. In return for use of N.H.S. equipment the consultants share income with the N.H.S. hospital. This income is being used to provide extra N.H.S. scanning on Saturdays and they are now advertising for staff to provide a new N.H.S. scanning service in the evenings.

This is a win-win response to the changes in UK radiology. Private patients benefit from ethical and unbiased expert advice and the lowest scan prices in the UK. N.H.S. patients benefit from increased scan provision and the local X-ray department benefits from a secure future. There are losers of course. The entrepreneurs who see an opportunity for profits out of patients' health worries and illnesses will have to look elsewhere. I, for one, could live with that.

Hereford Radiology Group can be contacted on their website at:

UK lowest cost private scans

I'm particularly proud of "patients-for-profit .... companies" and "health care-for-profit providers". It has a good ring to it and fits in with the not-for-profit description of some companies wishing to make virtue out of incompetence like the nationalized railways.

Thursday, 21 June 2007

God hates bloggers

Just when it was getting interesting on my favorite blog reads at Devils Kitchen, Dr Rant and Dr Crippen a combination of NHS censorship and divine intervention put me out of action over the last week.
I have commented before that Dr Rant cannot be accessed from many work computers because it is "Tasteless". This is something of an own goal for a medical blog as many people who are interested would want to access it at work. Our NHS Trust in England blocks this site and more recently the private Nuffield Hospital has also started to block it. I could access it in a Welsh NHS hospital. Either they haven't got round to banning it yet or the Welsh are less easily offended!
Last week I found Devils Kitchen blocked because of the use of a certain 4-letter word which, interestingly, was displayed prominently on the screen explaining why the site was blocked.
When I tried to access the sites from home I found that a lighning strike had disabled my computer. I managed to fix this myself but there have been lightning storms every evening this week so I have had to leave my computer unplugged.
One of the blogs I wanted to leave a comment on was the Dr Rant assertion that radiographers and nurses don't do routine work outside the hours of 9-5. The team have seriously misjudged this and show themselves up as being out of touch.
The arguement that patients receiving nursing care in hospital after 5 must be emergencies just makes no sense and our radiographers provide a routine service on Saturdays and would do more if the funding was available. We bend over backwards to provide a service to suit patient demands, whatever our personal views on the sense in this, because the GPs can send patients to whoever provides the most accessible service. It is odd therefore that providing an accessible service shouldn't apply to GPs.

Friday, 8 June 2007

Private MRI scanning. Best year ever.

Now that we are coming to the end of Patsy Hewitt's "best year ever" for the NHS it is interesting to ask why, in my region of the W.Midlands and Wales, record numbers of patients are paying for their own CT and MRI scans and other radiology at UK-radiology and at our local Nuffield private hospital.

Many private patients are covered by medical insurance provided by their employers and I am sure in areas such as London, where the economy is booming, many people will "go private" because of this but in my area, which has missed out on the economic boom, patients are mostly paying out of their own pockets and doing so in increasing numbers.

We are also seeing a number of private companies risking their own money setting up private scanning services, even though Nulabour has already negotiated and paid for a vast increase in scanning provision from their friends in the independent sector.

To me, this doesn't indicate improving satisfaction with the NHS. Why is this?

I haven't done a scientific survey or brought in management consultants to look into this but I can think of a number of reasons.

The "improvements" in the NHS have been targeted at the sexier aspects of healthcare and for someone with, say, M.S., sciatica or dementia, access to scanning has not really improved. In fact, because of the pressure to do cancer patients urgently, these patients often wait longer now. Waiting times figures for facet injections, which I do for back pain, are not even collected by the DOH and these patients can still wait indefinitely without breaching any target.

I don't think the process of "NHS dumbing down" is driving radiology patients to the private sector yet. Most patients don't even realise that a Radiologist is a medical consultant and have been blissfully unaware that their ultrasound scans or barium enemas have been done by advanced practitioners for the last few years (if a nurse practitioner is called a "Numpy" should I call a radiology practitioner a "Rumpy"?). Now scans are being reported abroad and the UK medical establishment has lost control over standards but the general public is still unaware of this.

I think the real reason is unmet rising public expectations. When my medical colleagues or their families suffer say, back or neck pain, we tend to give them priority and scan them within a few days. However, like other departments, we also issue "evidence based" recommendations to our GPs regarding who should and shouldn't be scanned and therefore ration access to scanning for the general public. Wanting the reassurance of a normal scan is not considered adequate reason for a scan but it is the reason my doctor friends and, indeed myself, would want a scan. I suppose the distinction is between need and want and, as Dr Crippen points out on his blog, the government has quietly been changing the provision of NHS care from "free and the point of use" to "free at the point of need". So far they haven't specified who will define "need" but I predict this will be a moveable hurdle imposed by a system of incentives like the GP QoF points system.

Nulabour wanted to abolish private practice and private schools and, after 10 years, they are both flourishing. "Vote Nulabour - things can only get better"

Tuesday, 5 June 2007

Top Gun Quacktitioner

The ultimate in quacktitioners?

News from the Armenian Medical Network

Responding to actor Tom Cruise’s purchase of an ultrasound machine to monitor his fiance’e’s fetus, California lawmakers voted on Thursday to restrict sales of the machines.

The California Assembly voted 55-7 for a bill by Democratic Assemblyman Ted Lieu that would only allow sales of the machines to professionals and medical facilities licensed to use them.

In an interview with ABC’s Barbara Walters last year, Cruise said he bought a sonogram machine for then-pregnant fiance’e Katie Holmes. Concerned lawmakers feared other private citizens might do the same and possibly misuse the machines.

"Having an ultrasound once, twice during the course of a pregnancy, there is no danger,” Lieu spokesman David Ford said. “But too much or too often could cause the liquids in the womb to heat up, which could cause damage to the mother and fetus.”

Lieu’s bill now goes to the state Senate.

Friday, 1 June 2007

Bad start to June

Arrived at my Welsh moonlighting job this morning to find an envelope on my desk marked urgent. Inside was a complaint from a patient. Among the ways I had abused her she complained that I asked her to hold her breath and that I had pressed the probe against her abdomen while doing an ultrasound. She also claimed that her appointment was at 5.05 but that I had not scanned her until 5.55 even though she had turned up with an empty bladder and I had to waste almost an hour of my evening while she filled up. I just didn't know what to say and ended up replying that I didn't treat her any different to the previous 5000 patients so I suppost she will escalate it to a formal complaint now and I will never work in Wales again.
Still seething I went to start my morning list and the first patient was someone who shouldn't have been referred for a scan at all. After scanning the abdo. as asked and finding nothing I had a look at the pelvis. All the time the patient was asking what I had found and trying to get up to look at the screen (as if she would see anything on it). Finally she demanded to know why I was scanning her pelvis when her doctor had asked me to scan the kidneys. I told her it was because I was a holistic radiologist and she shut up for long enough for me to finish the scan, presumably not wanting to admit she had never heard of a holistic radiologist. But then it started again when I told her that there was nothing wrong as far as I can see. She asked why I couldn't be more definite and I told her ultrasound was an Art not a Science. Silly really and unnecessary. Patients behave strangely under stress and I should have kept my head. Now there will be two complaints on the same day. Using the legal principle of "there's no smoke without fire" I shall now be branded a callous patient abuser.

Talking of patient abuse I am getting progressively irritated by the sheer number of criminal record checks I am asked to do at around £35 a shot. Its not something people tend to complain about because "if you haven't done anything wrong you have nothing to fear". When they came in I thought it was a bit odd that a mass murderer could become NI education minister while someone with a collection of grimy photos, who perhaps worked in a non-clinical area, would be denied a job in the NHS for life but I accepted it as necessary to protect children in hospital from pedophiles.
Over the years the emphasis changed to asking for a CRB check to protect NHS property so this applied to everyone, even those with no contact with children. The result is that if you had done a bit of thieving in the past you would never work in the NHS. A bit harsh since many young men fall foul of the law in their youth but I suppose it leaves a few people free to follow a career in business or politics.
Now I am asked to get a CRB check for each locum agency I register with every 6 months. They are not allowed to just use the same one! My local private hospital also asks for a CRB check every 3 years even though they don't see kids. The last straw was trying to register to do teleradiology reporting from my own home. The companies are still obliged by HMG to get CRB checks. I suppose there might be someone who gets a thrill out of looking at a child's X-ray but I suspect it's a way of diverting huge amounts of money from the health sector to Nulabours political donors at Capita (Crapita according to Private Eye). Anyone for a peerage?