The only way to get through life is to laugh your way through it. You either have to laugh or cry. I prefer to laugh. Crying gives me a headache

Tuesday, 8 April 2008

Dr nurse!

“No man, not even a doctor, ever gives any other definition of what a nurse should be than this - 'devoted and obedient'.”

'Dr nurse' is one of Dr Grumble's 'shared items list

'A fresh supply of well-trained primary care practitioners could help counter a physician shortage.'

'since these nurses with a doctorate can use “Dr.” some physicians worry that patients could become confused. “Nurses with an advanced degree are not the same as doctors who have been to medical school,”

Of course! and how misleading and dangerous is that?

Why are they not considering training more doctors to be GPs instead then? And the 70 extra medics recruited by medical schools, what will become of them?! It seems that, in the UK, everybody is having a go at medicine apart from doctors! With not enough training posts and according to MMC, many FY2 doctors who do not secure a post in 2008 will be given councelling to leave medicine!

Madman's logic! train doctors at great expense then ask them to leave medicine 2 years after graduation and 'upskill' nurses to do their work instead and pay for the upskilling too! ...PhD are now a penny a dozen! Any Tom, dick and Ali can get a PhD nowadays! I bet hospital porters will soon be doing PhDs on bed maneuver in hospital corridors! PhDs are a plenty these days, some not worth the paper they are written on while some others in diciplines than can't possibly satisfy the rigour of a 'true' doctorate degree!

With this Dr nurse in mind, is there any hope of Professor Tooke's recommendation regarding redefining the role of a doctor being implemented? If there is, how?

Some of the junior doctors I know tell me that some nurse practitioners have their own rooms or offices in the hospital where no one is allowed in, even the doctors, while those same nurses are allowed to walk in anywhere they like including the doctor's space. A doctor posted on the Remedy forum that his hospital wants to close the rooms used by doctors while on call! He said that the hospital intends to also make any on call rooms left 'mixed sex!' How will female doctors rest under these conditions? Of course, many will not, so, how safe for patients to be treated by an extremely tired doctor is this? ... I wonder if this does not go against a person's human rights? Is this legal? ... I wouldn't be surprised if this doctor posted again on Remedy that ttheir on call rooms were converted into offices for the Dr nurse brigade! Post MTAS, nothing surprises me now ... It disgusts me ...

... I am really beginning to dislike the term 'junior' and think it is acting against those highly trained and very well qualified fully registered professional doctors whose only fault is that they are young!

All this above is a disgrace! ... insanity!

Reading this Florence Nightingale quote at the bottom, this is one nurse, who should be listened to by those who decide on these crazy ideas, even that she is long been dead ....

“Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion”

Florence Nightingale


Dr Grumble said...

Dr Grumble's shared items can be found here. The link above doesn't seem to work.

The term junior doctor has always been an unfortunate one but demeaning titles have got worse rather than better. The old terms such as House Physician, House Surgeon, Senior House Officer, Registrar and, years ago, Senior Registrar had an element of status attached to them. In the case of the SR this was real: many would say that the Senior Registrars of old were more experienced that the junior Consultants of today - actually there's not much argument about that. All status has now been lost by calling many young doctors trainees. That's not good for them, it's not good for their consultants and it is not good for patients who need confidence in the doctor who is looking after them. If I have to refer a patient to another doctor I always try and build them up in the eyes of the patient. That makes everybody feel better. We should have chosen titles for our younger colleagues which give them a bit of status. This was an obvious thing to do that would have cost nothing and made everybody feel better. But this was never discussed. Not at my level anyway. But the nobody wants to 'build doctors up'. Quite the opposite.

Sam :-) said...

I agree with you Dr Grumble; nobody wants doctors to have status anymore! As the Witch Doctor has been saying for so long, it's all about 'forcing' heads to level but I no longer believe money and a cheaper workforce is the reason, it's about breaking the browess (sp) of the whole profession as Professor Brown said. It seems that this does not only apply to medicine though, but to law as well!

What I can not understand is why level top heads with those below? Surely, this would bring standards down everywhere ... What is the benefit to turning a country from a top position to third world standards, if even that?!

BTW, I used to like the term 'junior' because it sounded affable, a special relation between the more xperienced older doctors and their appentices but I now feel that the word is now being delibrately used, by others, to undermine the status of young doctors as you say. Where is your union in all this? Whether for the seniors, the GPs or the juniors?! The BBC calls them 'formidable' .. funny that, reminds me of 'something' else .. It must be some new craze to descibe those you want to kill as such ...
... and, thank you for the proper link to your list, only it does not have a copy/paste facility and ... that's all I know :-)

Of course if I link to your main page the topic would soon be replaced by new items so, visitors, please link to Dr Grumble's link in the comment above To the Dr nurse article/s ..

I notice you read more on this,so, off I go understand a little more.

Dr Grumble said...

Sometimes I wonder where the people are in the world (many of these things are global) who are planning the rapid changes that are taking place in our society. Is there a secret group in, say, the DoH carefully plotting to destroy the medical profession and are they in cahoots with those intent on destroying the lawyers? Of course there is no such secret group but there is a tidal wave of change taking place that is driven by changed management thinking. It's happening everywhere. The thinking may be appropriate if you are running Tescos but whether it's appropriate if you are running a hospital is quite another matter though it seems this has never been properly thought through. If the new ways were to be challenged it would be by the professional groups such as doctors. Unfortunately we would be seen to have an outmoded approach based on vested interests rather than genuine concern. That is perhaps the reason why we have just let it happen. And perhaps also there has been the feeling that we will always be needed and nurses cannot do our jobs and never will be able to. Many of the disasters we see unfolding seem to have their basis in the changed management attitude to professional staff (or human resources as people are now referred to – sometimes just resources even). Professional education has been replaced by listed competencies assessed by box ticking. Experiential learning is seen of little value and can be replaced by the odd course or practice on a stuffed dummy. And so on. The battles have all been lost. In reality we never went to war. There will be a lot of damage but it won’t be very visible.

Dr Grumble said...

You are quite right that Dr Grumble's shared items will soon change so for convenience here are some links to the Dr Nurse issue:

Wall Street Journal
Health Care Renewal
Kevin MD

And the Witch Doctor's Black Cat recommends this video.

jason said...
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jason said...
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jason said...
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Sam said...

Thank you for providing the links Dr G

"Sometimes I wonder where the people are in the world (many of these things are global) who are planning the rapid changes that are taking place in our society. Is there a secret group in, say, the DoH carefully plotting to destroy the medical profession and are they in cahoots with those intent on destroying the lawyers?"

Not in the DoH alone but, you are right, there is a global element in all this and what chance has the medical profession got, if the legals with all their might couldn't stand up to themselves? And, there is no secret about this new world order. It's to do with a side of gobalisation, the aims of which are still not very clear. However, I believe it's much bigger than, but also includes Wall Street. It seems the whole idea was designed to make those who attempt to discuss it sound as if they are crazy themselves. It's war of global control IMO. This is why I include the picture at the bottom of the post .. is it for the architects of this new order or for myself? .. Think of George Orwell and Napoleon's 'global deceit.'

"Professional education has been replaced by listed competencies assessed by box ticking. Experiential learning is seen of little value and can be replaced by the odd course or practice on a stuffed dummy."

This is the really baffling part Dr G! The true reason for this dumping down of an otherwise, set of 'excellent' standards, delibrately discarding excellence can't be for the sake of control alone ..

Dr Grumble said...

You are probably right that big business is driving some of these things. Some of what they do is not always apparent. The last time I was on live TV it was organised by a private company supported by a powerful publicity company. The last time I met with journalists it was also set up by a private company with professional support. These people are very clever at changing the ways we think. They have persuaded us to buy water in bottles for more than the price of petrol. Water dispensers have invaded our hospital – and the NHS pays. Articles in newspapers years ago about how we all need to drink more water were generated by the companies that are now profiting. I have discovered that articles on the need for a good night's sleep are also generated by private companies with pills to pedal. The more you look the more you find.

Now suppose a private company was given the task of trying to get a slice of the enormous budget that goes to the NHS, an NHS that people love, how would they set about that? Most people love their GP and are very happy with NHS primary care. But you wouldn’t think so if you listen to Lord Darzi. At great expense questionnaire after questionnaire has been sent to patients (I have had two) trying to get them to say negative things about opening hours and the like. But, curiously, the main users of primary care (who are not city slickers) are quite happy. But this hasn’t stopped all the headlines about overpaid GPs and poor opening hours and the need for polyclinics. You might think that our government would want to persuade us how good our primary care and NHS is not how bad it is. So what is this all about? There can be only one answer and the public will not like it.

Dr Grumble said...

Today's Guardian shows what's ahead.

Sam said...

'He' said before he left that he stayed until all the modernisations he inistiated were beyond the point of no return. Speaks volumes as It seems it is now financially imposible to revert back and halt the privatisations, either in health or elsewhere. Which is a real shame because, as you say, the NHS for one, is a much loved insitution that should not have been tampered with. Rather, they should have found ways to stop the worried well abusing the service as well as cut the waste hiring financial advisors and the like instead.

With regards to the Guardian's article, Witch doc was asking, and betting on, whether the GPs will work for Virgin? I personally think they will, enticed by the 10% share of the profits and for fear of unemployment. Unless, the profession either unites and fights back or the GPs are clever enough to understand that this high share of profits is only the bait and will not last very long and decide to fight back somehow. I can't see either senario happening though unless the BMA takes a proper stand to fight this.

I also think the multinationals waiting in the wing, including Branson, will in the future depend more on GPs currently in training or getting into GP training in the next few years for Virgin's future supply of salaried GPs, then, he won't need the seniors he intends to recruit now and they will be made o leave. Then, watch as this 10% profit award disappears overnight. Still, he will get his GPs, exactly how he wants them at the end. And those work ahappily alongside the Dr nurses and the NPs of his clinics! As you know, GP training was the most over subscribed specialty this year. Amazing turn of events since only a couple of years ago, there were not enough applicants to fill the places. Where are they all going to go once the finih their training? Of course some will go to Branson, because there will be no other option!

When you ask the young doctors why they want GP, it's not because they have developed a sudden passion for it, but because they now think the future is in Primary Care not hospital medicine, which will just lead to unemployment, if they will be even allowed to complete training. I think young doctors are in the dark re choosing a specialty nowadays because there isn't any real advice out there as no one knows, including their advisors, what will happen next year, let alone a few years from now. This confusion is very unfair on the younger generation and the results is this increased uncertainty and extremely low morale which affects all seniors as well as juniors nowadays.

Let's wait and see what Darzi comes up with in June, I hope he will have some solutions but I am not so optimestic.

BTW, do your children still buy the bottled water? Mine still do because it is convenient, or so they say! It's very hard to break a habit once formed as you know Dr G ...

Dr Grumble said...

I can't stop them buying that bottled water. And the hospital is full of young people swigging from what look like babies' bottles as they walk down the stairs. The students clutch these things and have little sips throughout tutorials. One of our ward sisters (my age but sadly now retired - the last of the tough sort) told the junior doctors off for sipping from these things while on the ward. They were greatly affronted and thought she was quite mad. That was the last really well run ward in the hospital.

There are more important things to get upset about but it is really my money that is being wasted. Put another way think what you could buy with the money saved in a year from never purchasing bottled water?

sam said...

A lot of Evian shares I suppose .. good investment too :-)

Anonymous said...

Good idea, eh?