Tag Archives: NHS

‘The medical untouchables’

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The following is a recent opinion piece by Dr Des Spence published in the British Journal of General Practice.

I had been lined up to do the media interviews on BBC Scotland in relation to petition PE1651. However, on the day, due to changed travel arrangements, I was not available. Dr Des Spence was interviewed instead and did a better job than I could have done.

As an NHS doctor and specialist, I fully support this petition (PE1651) which calls on the Scottish parliament “to urge the Scottish Government to take action to appropriately recognise and effectively support individuals affected and harmed by prescribed drug dependence and withdrawal.”

I have submitted my response.

I feel it would be helpful to hear the views of the Chief Medical Officer for Scotland and in particular, how this matter might be considered as part of Realistic Medicine.

Three recent posts by me demonstrate the scale of competing financial interests in medical education in the UK. If you have a moment, you should have a look. Perhaps you might then share the worry that I have about this matter:

I have previously raised my own petition, PE1493, which the Scottish Public has supported. This was a petition for a Sunshine Act for Scotland, to make it mandatory for all financial conflicts of interest to be declared by healthcare professionals and academics.

My petition, supported by the public, had no support from “Realistic Medicine”. The public has had no update from the Scottish Government on my petition in 18 months. My view is that this is a shocking failure of governance and would seem to demonstrate a lack of respect for democracy.

Unrealistic Medicine

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This BMJ Editorial of the 30th June 2017 has had a number of responses:

The Editorial was a consideration of Academy of Medical Sciences report ‘Enhancing the use of scientific evidence to judge the potential harms and benefits of medicines’.

The President of the Academy of Medical Sciences and the Chair of the Report, Professor Sir John Tooke, has submitted this reply:

It is most welcome for Professor Sir John Tooke to set out his further thoughts but I found that what he said did not reassure me about the future of science and so submitted this response:

Unrealistic Medicine
Written by Peter, 15 July 2017
Submitted as BMJ Rapid Response.

The further thoughts of Professor Sir John Tooke, Chair of the Academy of Medical Sciences report ‘Enhancing the use of scientific evidence to judge the potential harms and benefits of medicines’ are most welcome.

Professor Sir John Tooke does not reassure me that an era of unrealistic medicine and the business of science will change anytime soon. Meantime the NHS is struggling across the United Kingdom and this may be in part due to the promotion of medical interventions whose evidence base lacks the objectivity that we all surely seek.

I would suggest that most of us fully understand the “reminder” from the Academy of Medical Sciences that potential conflicts of interest can come in all forms and not just financial. But like the public I share the view that we should start with potential financial conflicts of interest as evidence has determined that exposure to industry promotional activity can lead to doctors recommending worse treatments for patients  Godlee and Freer remind us that we expect this from our elected politicians and in other areas of public life.

The voluntary ABPI Register is not working. Its database is only a little more than half complete. This really does challenge the “E” in EBM.

The pharmaceutical Industry has, over the preceding year, increased payments to healthcare workers for “promotional activities” from £109 million to £116.5 million.  This is a major part of Industry budget. Furthermore, we do not know how much may be being paid by device makers and other forms of industry for promotion of their products.

It is welcome, but somewhat “after the bell has rung”, that Professor Sir John Tooke confirms that the Academy of Medical Sciences intends to “review” its approach to public transparency. But one wonders how many “houses” do we need to “get in order” to address this issue effectively? I find myself worrying that it could be like a game of Monopoly that never seems to end.

The most effective and cheapest way to address this matter would be Sunshine legislation. This would avoid multiple, overlapping and generally unsearchable databases of interests.

I would suggest that the reputation of science is at stake as is the balance between benefits and harms for us all

Roy Porter, who sadly died prematurely was considered as one of the United Kingdom’s finest historians of science and health. He ends “Madness: A Brief History “ with a teasing question: ‘Is folly jingling its bells again?’

 

freedom to speak

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The Director General for NHS Scotland:

  Peter's experience of the Director General for NHS Scotland

 

The Clinical Director of Healthcare Improvement Scotland:

     Peter's experience of the Clinical Director of HIS

 

The Director of Health and Social Care Integration:

Peter's experience of Director of Health & Social Care Integration

 

In my determination to put patients first I have been treated poorly.

These highly paid officials seem to be beyond accountability:

[I have always openly acknowledged that my view is no more important than any other. I am always careful to be clear in what cannot be said with any certainty. I am fully aware of my weaknesses.  I absolutely refute any charge that I am “vexatious”. I do not hold grievances. What matters to me is truth and fairness. I have found that the same cannot always be said of those in genuine positions of power]:

 

It can take courage to care. To resist the threats to your career and the misnaming:

 

Such abuse of power is not new:

 

You are invited to join me for this protest:

 

Lifeboat NHS

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A film about freedom to speak up in NHS Scotland based on an edit of the evidence session of the Health and Sport Committee, Scottish Parliament, held on 13th June 2017.

This is just an edit. A subjective view. Nothing more and nothing less.

The stories we hear and the stories we tell

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The stories we hear and the stories we tell from omphalos on Vimeo.

Forgive me for worrying about the lack of philosophy and ethics in science and healthcare today.

To learn from and cherish

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In the Scottish Herald on the 1st October 2016:

the-elderly-should-be-valued-and-respected-1-oct-2016-2

reminded us all that:

the-elderly-should-be-valued-and-respected-1-oct-2016-1

and suggested that we:

the-elderly-should-be-valued-and-respected-1-oct-2016-3

Rebecca McQuillan  worried, as I do, that:

the-elderly-should-be-valued-and-respected-1-oct-2016-4

Our treasured NHS and those who educate us might consider:

the-elderly-should-be-valued-and-respected-1-oct-2016-5

As an NHS doctor for those who I value and respect I worry about the promulgation of a reductive language of loss. I often hear our older generation described as a “challenge” and that complex, and unique situations have been reduced to a single word, such as “frailty”, “capacity” and “delirium”. Language evolved over tens of millennia to avoid such simplification.

Rebecca McQuillan closes beautifully:

the-elderly-should-be-valued-and-respected-1-oct-2016-6

I shared this post with the British Medical Journal. There was 
an interesting reaction on social media to my post and to those made 
by others by the original columnist:

"some truly bizarre responses to what was a mainstream common 
on acute frailty"

"I am thinking of changing my BMJ column from 'acute perspective' 
to 'everybody must get Stoned'"

Exactly what species of bear was Flaubert?

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I am certain that I have still something more to offer to medicine. But for some time now I have been contemplating becoming a full-time artist.

As a doctor I have been fortunate to be entrusted.

I have only ever been mysel.

I have tried “my wee best” to bring together humanity and science.

Perhaps ‘my wee best’ is realistically just wee.

I plan to continue to work as a doctor for a few years yet.

Let there be sunshine.

Only the grave from omphalos on Vimeo.

Inspirational: the Chief Medical Officers for Scotland

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The Chief Medical Officers for Scotland have been a huge inspiration to me.

I was delighted to hear, earlier this year, that Dr Catherine Calderwood had been appointed to this office to replace Harry Burns. My full support goes to Dr Calderwood in her appointment.

Last year I spoke at a Civic Trust event in Glasgow and was fortunate to follow Sir Harry Burns. His talk on “salutogenesis” accorded with all that Hole Ousia is about.

Salutogenesis from omphalos on Vimeo.

Kenneth Calman was the Chief Medical Officer before Harry Burns. No other Scottish doctor has inspired Hole Ousia writings more than Kenneth Calman.

001-Makars-&-Medicinersa 025 Makars & Mediciners

In my need to put patients first I have included the Director General for NHS Scotland in e-mails that I have considered important to patient safety and well-being. I admit to being persistent in this matter.

Communications sent but unanswered:
No response came from the office of the Director General for NHS Scotland. With this experience I eventually asked for a “read receipt”  (this is something I most rarely do) This appeared to establish that my communications were being received.  Following this, I reluctantly made a FOI request to the Scottish Government to ask why I had received no response to my communications. This was the reply:

Paul Gray 02

I cannot understand why the Director General did not re-direct my 
communications from outset.

My communications to the Director General were specifically about:

(1) Health and Social Care Integration

(2) Transparency in NHS Scotland

National conversation from omphalos on Vimeo.

the above film ends with the promise as made by 
the Director General for NHS Scotland

The consequence for me, as an NHS Consultant, for raising questions about patient safety:

Dr Catherine Calderwood, Chief Medical Officer

Footnote to the above e-mail:

I am not a "locum consultant". I am a substantive Consultant with 
NHS Lothian.

I agree with the Chief Medical Officer that my concerns relate to 
openness and accountability of the Scottish Government and 
especially its "advisors".

In my telephone conversation with the Chief Medical Officer, 
Dr Calderwood, I found that she never once asked about 
my wellbeing. Instead she seemed on guard, ill at ease:
almost as if she was hiding an ulterior motive 
for contacting my employers?

All I can say to anybody reading this: imagine the Chief Medical 
Officer for Scotland had expressed concerns about your 
mental "wellbeing"? 
How would you feel? 
How might your employers react? 
Might you feel that you had been re-defined? For better? Or for Worse?

My advice to the Scottish Government: do not be tempted, on the 
advice of your advisors, to so easily LABEL anybody for 
raising concerns. 

"See me".

First Minister Nov 2014