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

Thursday, 29 January 2009

Wink, wink ... wink ... ;-)

The only honest art form is laughter, comedy. You can't fake it... try to fake three laughs in an hour -- ha ha ha ha ha -- they'll take you away, man. You can't.

I have just read the post on Dr Crippen's blog. It's about a GP whose husband is a hospital specialist . Apparently their daughter was not well and it seems they were unable to get an appointment with another GP at a 'health center' and were offered an appointment with a nurse practitioner instead.

The first thing that came to my mind was, didn't that woman GP betray the 'GP cause' by registering with a 'health centre' for her 'own' family?! Doesn't she know about 'la resistance'?! If I were Dr Crippen and I recieve this e-mail, I would have replied, straight away, and, of course, wished the child was better first then went absolutely berserk with those two doctors! Totally out of my mind! I mean, first, we have the head of the BMA signing a contract for one of those centres! Then you have GPs registering as patients! What atrocity and what utter betrayal of 'the' cause! ..... Grrrrrrrrrrrrr :-(

What message are those 'militant' GPs sending ordinary patients then? They must be stopped AT ALL COST, eh?! ;-(

Then again, I don't think a seasoned woman GP and her consultant husband can be that daft, can they?! It doesn't make much sense, does it?! No! So .. could it be that someone was playing a 'prank' on Dr Crippen? Of course this is possible in our twisted, conspiracy ridden day and age, isn't it? But then, how can such a stupid prank get past someone so intellectual like Dr Crippen?! .. who also happens to be an Oxbridge graduate?! .. I suppose the best of us do get fooled sometimes ... never mind dr C ;-)

Dr Crippen does not say whether the e-mail mentioned if the two docs were able to get an appointment for this ill daughter with a GP at the end or not? Or, what they did next if they were not able to do so? It is just that I am wondering whether the little girl was put at risk by the action of that centre ... stupid receptionist, isn't she?! Hasn't she heard about 'patient safety' and the consequences, for herself as well as that centre, for jeopardising that these days?! ... That 'incident' could have escalated really bad, especially because her parents are doctors themselves and did say that her condition had deteriorated to the point where even them needed help! .. I sincerely hope this little girl is fine now ... and ...

I'd love to know what happened next .. is the little girl ok Dr Crippen? ;-)

And, if this story is true, isn't that the best proof the GPs should not be afraid of their patients leaving them for those 'extra provision' centers? Who wants to leave 'a good' GP for a nurse practioner?! I wouldn't!

And BTW, I am still of the opinion that the GP representation let it's members badly down. It is the 'first' rule of diplomacy that if you are in a 'needy' position, it is the best approach to start matters by 'negotiating' calmly and with reason to get the best deal possible. If you disagree, show me 'one' diplomatic effort that had a successful outcome while following the opposite route to this rule, like you lot did? Just the ONE .. please!

Your representatives decided to take an opposite route .. with belittling and sarcasm too! Where did this get you?! I truly do wonder now how much you lot lost out because of this?!

Time to open up these talks again and try and salvage whatever can be salvaged, don't you think? ... 'he' did say he'd be waiting ... ;-)

Let's hope the little girl is ok now ...

If you haven't got it. Fake it! Too short? Wear big high heels, but do practice walking!

Tuesday, 27 January 2009

Learning ... :-)

What moves those of willingness to learn, what inspires their work is not new ideas, but their obsession with the idea that what has already been said is still not enough.

I am reading quite a bit these days because I have decided to learn more about the NHS. It is amazing the amount of information one can get on the net ... lots and lots but I prefer hard copies and so I visited many websites and got ordering. It really is very easy to get hard copies by just simply phoning relevant organisations like the National Patient Safety Agency, any trust's annual and strategy reports, complaints procedures, patient support bodies, the current reforms .. etc .. etc .. etc ... and all those organisations! And their abbreviations .. zillions of them! How do you guys get to remember them all!

I got a few bits and pieces last week but, I've just had about 10KG worth of stuff delivered today .. all for free!

Amazing! ... and .... overwhelming :-)

The kids know that I'll read anything ... but seeing all these packets delivered today, they now think I am becoming a bit obsessed with the NHS ... see, before MTAS, I had no idea ... and looking at all the reading material I recieved during the past week and today .. and I am still expecting more to arrive, it seems that I still have no idea ...

Well, I have always wanted to become a doctor ... this is the next best thing I suppose ... and I want to protect my investment in the NHS, my four children .. and our health so .. what better way than to learn .... Time to make a cup of cocoa, sit in bed with my pile of paper .... and get reading ... and reading ... and reading ...

And ... I have ordered lots more stuff too .... ooooh! :-O

Your ability to use the principle of autosuggestion will depend, very largely, upon your capacity to concentrate upon a given desire until that desire becomes a burning obsession.

Sunday, 25 January 2009

Free .. :-)

A dreamer is one who can only find his way by moonlight, and his punishment is that he sees the dawn before the rest of the world.

I believe the simple dictionary is the biggest and most comprehensive book of wisdom ever written. I like looking up the definitions of words I think I know the meaning of .. for every time I look up a definition, I always find a new meaning .... here is one I looked up today ... Of course the longer and more complex the definition, the more time it took wise men to find .. the bigger the wisdom ...


1. (adj) free , at large, at liberty, escaped, loose, on the loose, at liberty, unconstrained, autonomous, independent, self-governing, sovereign, available, uncommitted, aweigh, atrip, clear, discharged, released, disentangled, extricated, freed, emancipated, liberated, loose, out-of-school, unconfined, unimprisoned, unhampered, free of, unrestricted, footloose, independent, unbound, unconfined, unrestrained, unrestricted
2. (adj) free , liberated, unbound
3. (adj) complimentary, costless, gratis, gratuitous, unpaid
4. (adj) unoccupied
5. (adj) detached, unfixed
6. (adj) free , emancipated, freed, liberated, freeborn, free-soil, slaveless
7. (adj) spare, unoccupied
8. (adj) loose, liberal, inexact
9. (noun) free people, people
10. (verb) liberate, release, unloose, unloosen, loose
11. (verb) rid, disembarrass
12. (verb) dislodge, remove, take, take away, withdraw
13. (verb) exempt, relieve
14. (verb) release, issue, supply
15. (verb) discharge
16. (verb) disengage
17. (verb) absolve, justify, forgive
18. (verb) release, relinquish, resign, give up, pass, hand, reach, pass on, turn over, give
19. (verb) unblock, unfreeze, release, issue, supply
20. (adv) loose

Then I looked it up in the thesaurus ... overwhelming, isn't it .. free

Isn't it amazing how some people interpret the meaning of 'free'? They think it is all about saying and doing what you want whenever you want .. or getting something for nothing! .. I think it is one of the most restricting definitions ever ... and the duties and responsibilities attached .. but then the liberation ... phew!

Let's all 'strive' to be Free ... for there is no absolute freedom ... and so the endeavour never ends ... till the end of time ....

Look up the meaning of a word you think you know today ... and ..

Enjoy the song ... and have a peaceful day ... :-)

Slow buds the pink dawn like a rose From out night's gray and cloudy sheath; Softly and still it grows and grows, Petal by petal, leaf by leaf.

Monday, 19 January 2009

Educate the patients ... :-)

"The public and the patients have a greater respect and believe in what the clinicians say than what politicians and managers do"

Last year when Professor Lord Darzi published his interim report it was followed by what I now understand to be an unjustified GP scare! A campaign that stressed that polyclinics must be avoided at all cost because they are as bad as can be for everybody! I had no idea what that meant or why reform was happening but if the doctors on the net say so, then they must be right! They are doctors after all, one must 'always' believe a doctor, otherwise, if you doubt those, who else can you believe?! And so, I displayed a yellow 'save your surgery' logo on this blog and ran to my GP to signed to 'save the surgery' for myself and on behalf my whole family, without their consent. I have a good GP and to me, what I heard the doctors on the net were saying made it seem that the government, through Lord Darzi, was hell bent on closing my practice as well as every practice in the country and herding all GPs into huge under staffed new buildings really far away from where anything is .. Then, a little later, the intention was to sack all the GPs and replace the lot with nurses to cut down costs! Below standard everything!

Oh, NOOOO! What a predicament .. Has our government gone mad! .. maybe :-)

Then you think, what a deceitful and kniving government! But then, how did they brain wash Professor Darzi of Imperial College, a world renown doctor, surgeon, academic , teacher, scientist, innovator and now decision, policy and law maker and expert of the highest possible caliber into doing all this to all of us helpless patients as well as his fellow hard working doctors?! Then you say, well .. it's government, isn't it? They are capable of doing anything, aren't they?! And so .. it was WAR! .. and I felt I had a duty to show solidarity with my comrades, the doctors ..

As I am a fighter by nature .. :-) I too felt I must take up arms and fight ... Ara, Alan .. and Gordon ... here we come! .. WAR! :-()

And so, as well as fighting on this blog, I too ran to a doctor rating site that gave really negative rating to Lord D in everything .. but then I had prior knowledge about the professor through my eldest son who considers him a role model and knew of this professor's achievements and contributions to British and world medicine soooo .. those 100% negative ratings seemed weird to say the least so I hesitated .. because it made no logic, no common sense and so, I decided to go 50/50 and gave him a neutral rating instead despite feeling somewhat uneasy still. It was the only neutral one amidst all the 100% negative ratings with sad green faces .. then I felt I had to write a 'reason' for why I rated him a s such but since I couldn't say I was part of la resistance, I wrote "Your life is safe in his hands but not your GP surgery" which I thought it made more sense and justified my action ... given the war situation, you know. But ... I was still wondering, what did they up there do to him to change a man like this from being a doctor and a scientist of the highest possible honour and integrity and with a totally unblemished career to match, to suddenly make a U turn to a completely unreasonable and unpredictable man who became totally bent on the unrelenting and systematic total destruction of the whole of the NHS! Then you think, how did 'they' convince 'him' to 'co-ooperaaate'?! Well, Lord D did describe how he was 'recruited' in this lecture. Apparantly the PM sat at the back of a room full of members of public for 3 hours! Quietly watching Lord D mingling while he wrote lots of notes .. @@ .. Then .. from KBE to KGB overnight! ... Frightening stuff, eh?! :-D

That's when I started reading more .. Because things did not add up!

If I had the information that I have now, that reform is aimed at improving quality for all, through existing service provision and/or getting rid of failing GP practices, what we all know do exist. That those centers are extra capacity because the NHS can no longer cope with the spiralling out of hand increase of patients use of A&E departments and for equally huge unsustainable cost as well as treating ailments that do not warrant the specialised care that such departments provide. If I knew that these centres will provide extra services such as X-ray, physio .. etc and that it is proposed that federated GP practices will be allowed to use those extra facilities those centers as a substitute, where possible, for the now struggling A&E departments as well as provide walk in and out of hours care for patients who need it .. and the trend of more care in the community and the demands for extra capacity to cope with same, otherwise current GPs will be overwhelmed and will not be able to cope .. as well as employing the currently jobless doctors, nurses, physios .. etc, etc, etc ..

I would not have taken part in that 'save your surgery campaign!' .. Because as well as all the reasons above because it is a good idea to have extra facilities that are designed to properly meet local needs. And, I KNOW my GP surgery will be safe! .. My current doctor is that good .. not the one before though

I would also not have taken part, not because I now think the doctors were out to deceive the patients on purpose but because I feel now that the docs themselves were decieved! They were made victims of the 'scare campaign'! A campaign intended to cause a stampede amongst doctors as well as patients! .. This campaign was started by the GP VIPs at the RCGP as well as the BMA! .. I find this A M A Z I N G now! ... Because I know better. And now that I do, I wonder 'why?' again, only this time, I wonder why did those two prestigious representative of GPs institutions act the way they did? Only for the head of one to go on to sign the contract for one of those new health centres himself!?! And to the other VIP I ask, why did he, as well as join to devise and support the scare campaign, did those 'leaders' join efforts to launch an equally viscous campaign to belittle the only fellow doctor in a ministerial leadership position through the 'he knows nothing about GP' campaign ... as well as all the sarcasm .. etc, etc ... to me, they don't look very credible now that his report is law!

'A Pantomime villain! .. How dare you?! And what are you if you allow yourself to brand anyone, let alone one of our best , a villain?! .. I ask that to 'whoever' initiated then allowed this sad 'article' to run of course ...

Funny that because I always was under the impression that negotiations were the best route to agreement and I still think so .. I am also under the impression that 'leaders' have a duty to recognise excellence when they see it. That before they make any move to attack, they have a responsibility and a duty to justify why attack? .. giving valid 'reasons!' for their decision... so maybe those VIPs now need to explain; why they took the stand they did? Why didn't they properly evaluate the Next Stage Review report before they went blind folded for that hunt?! Did they read that report at all?! ..

Because I now feel they let their members, as well us patients down, wasted valuable time and an opportunity to cooperate with the 'doctor' in office for the benefit of their members as well as us patients! .. and this time I also want to ask .. how much did their ill sought actions cost their members?! If those institutions are so rich money has no value to them, maybe it is time they improved their performance somehow and/or gave much reduced joining rates to the financially limited juniors instead of that waste, spending on useless campaigns then shelve them at the end and apply for the 'fruits' themselves?! And for those who pay memberships to those 'prestigious' institutions, isn't it time you asked how 'your' hard earned money is being spent? As well as what are the 'worthy' achievements of your VIP leaders since they took office?

And, to oneVIP: Leadership is about protecting those you govern; as in not supporting an unvalidated recruitment system that proved to be the biggest black hole in medical history or running a 'scare' campaign for 'unknown' reasons! And, it would be nice to know; on what basis did you judge those two 'causes' to be worthy of your approval?! Of course leadership is also is about raising standards for patients and staff, including fighting for the right of young GPs to proper jobs and a right to a bright future. It is 'definately' not about how many media appearances one makes since coming to power! ...

As a mother of young doctors who may decide to become GPs in the future, I still wonder who is fighting for the young fully qualified but jobless GPs currently despairing because of lack of opportunity? and why aren't you doing so Prof Field and Dr Meldrum?! And .. what was the aim of the opposition to the health centers campaign? Why? What was gained by following it? Were they value for money? What other solutions did you put forward to solve ALL the problems that warranted the creation of those centres in the first place?

What happened recently and is still happening makes me feel that there is an essential need to educate the public on health as well as health policy. Patients need to know about policy before things happen. Otherwise, like me, they will end up without having the ability to make a decision based on real choice. Of course, I am still a beginner and may have mistakes in judgement above so, please correct me anybody where I went wrong for now I can and will change my mind if I feel there is a 'valid' reason to do so. But next time, I will need to be convinced based on knowledge and proper debate first.

I honestly feel that in this day and age of the information revolution, we need transparency and education. Because it is 'dangerous' to leave people out when decisions that affect their lives are being made. It makes no sense to anybody when they read in the papers that doctors are on the golf course or the not so nice exchanges with the government that followed without explanation of why all this was happening. This make people make uninformed decisions just like I did before. People now want to know where and why as well as 'how will policy affect me?' .. youtube is not enough ... and you need to aim to reach everybody and not just a certain class or a selected few.

Educate 'the patients' .. help them make real choice, the 'right' choice :-)

That said, I like to stress that I will still always believe in what a doctor says more than any other professional. Because I do firmly believe that most doctors have higher integrity and moral standards than most others .. but perhaps if I had better knowledge about the 'health centres' issue a few months ago, I may have been able to help my doctor, where his representatives have failed miserably, to see the reality of the situation so that s/he can get over the unfounded fears they now suffer due to that scare'em campaign ..

Isn't that what people are for? .. take good care of each other while striving for better standards for all?

Our knowledge can only be finite, while our ignorance must necessarily be infinite.

Sunday, 18 January 2009

Cracking the 'NUT!'

A few clowns short of a circus

How do you crack the specialty training 'nut?!' Well, it seems that part of specialty training 2009 is to put young doctors on an endurance course with crazed 'machines' then wait and see what happens! .. Are 'they' having a laugh .. two years on from the MTAS catastrophe!?! .. You betya! There are still hitches with the potential to ruin many an excellent young doctor's career yet again! Haven't those systems been tested and validated before they were unleashed on the young doctors?! It seems I was too optimistic here ... for ..
Two years on from the MTAS circus and still, the 'machines' can not get it right!

"This year three medical royal colleges have been running their own online national application system where junior doctors can apply to train in their speciality.
A glitch in the computer system meant trainees filing in the forms at the same time could see each other's answers and at least one candidate had his qualifications and experience swapped for someone else’s.
The problem was spotted 'within minutes' and the system was taken offline. Deadlines for applications have been extended. Around 3,500 doctors had registered with the system.
The Royal College of Psychiatry system is now back up and running, but the Royal College of Paediatrics and Child Health system has still not been reinstated.
The Royal College of Obstetricians and Gynaecology was also affected for a short time but has now solved the issue."Amazing stuff! .. then ...
"Experts said it is on nowhere near the scale of the failure of the Medical Training Application Service (MTAS) two years ago"

E X P E R T S !!! .. Oh PLEEEASE! Are they the same 'experts' of MTAS 2007?! .. or is it that everybody is now an 'Expert?!' .. A new lot of 'EXPERTS' perhaps?! Where do 'they' find all those EXPERTS with the same 'high' performance calibre from?! ... Ah well, at least 'it' is not on the same scale as hurricane MTAS 2007 .. that's alright then, isn't it! The 'EXPERTS' said so, didn't they?! .. The 'Experts' said ..

Tell that to the doctors who may lose out because of this .. the application to speciality training of 2009 blunder ...

AND .. while we're at it .. talking about 'blunders' .. please tell the 'Experts' there is something wrong with the Royal College of Physicians 'core training' application 'machine' too! REALLY!

Albeit small-ish in comparison to the above but 'valid' nonetheless! You see, there are questions requiring answers that allows a maximum number of words to be used. Those are on experience in audit, research, commitment to specialty .. etc. Of course this takes time and lots of effort for a young doctor to get what they want to say within the permitted allowance for each question .. Then you press the submit button .. but the system won't accept your application if you have used all your allowance! It will tell you that your word count is over the limit when you know that it isn't because you counted AND counted! ..

But then, you do go back and count and recount and count and recount .. to find out where you went wrong but you didn't .. It seems that the 'machine' may be configured somewhat different to whatever word package you may be using and hence, the word count may differ by just a few words .. and you can't submit! Meaning, you have to go back to one question, try to omit a few words from your 'perfect' answer , then try to re-submit again but .. again, the 'machine' won't accept! Then you go to another question and remove a few words from your 'perfect' answer .. then another .. and then the machine will finally accept your application .. but, were your submitted answers as perfect as you wanted them to be?!

Of course, the deadline for applications to core training have now passed. But, for the sake of those young doctors, why didn't those who devised the system allow say 10 or so words extra per application to allow for the variation of word packages used by the applicants .. if indeed this was the cause of this 'glitch'? .. because this reasoning is only my guess ... Of course the 'Experts' know better ... yeah .. maybe! ;-(

And now that most applications to specialty training have been submitted. How do we know that the 'machines' will be fair in marking same? Will they be using an MTAS style 'buzz word' system to mark?! .. how else can 'machines' mark applications?! How do we know those 'machines' won't 'spit out' a few applications here and there while they are in the midst of their marking convulsion .. munching and crunching?!

We await the 'EXPERTS' reply to this question .. soon please!

AND ...

God help all young doctors applying this year to 'Cracking the NUT!'

If we are all bouncers, who is going to get beaten?! .. Only the children left ...

Wednesday, 14 January 2009

Time for beating the Congas ... ;-)

But hark! My pulse like a soft drum. Beats my approach, tells thee I come.

Where did Glen Burley, the Chief exec of one after another lucrative NHS exec post, get the money to keep Dr Mattu at home for 5 years from?!

According to the Mail online, Mr Mattu, the suspended Cardiologist was paid around £75,000 a year to stay at home, the total for 5 years is £375k! What a waste! But then the paper says that the total cost to the NHS for those 5 years he stayed at home was £5000,000,00! Nearly a staggering 14 times the amount of money paid to Dr Mattu over the same period! The rest are for legal and other fees to do with keeping the Cardiologist at home, then for the same Cardiologist to win his case and be re-instated! Forget how much will it also cost to train him on what advances he missed in his field for that's 'nothing' .. in comparison!

How many patients could have been treated with this money? How many lives could have been saved? How many, say, MRI scanners could have been bought and placed in where needed?!

The 5,000,000.00 used by Mr Burley to pursue the hunt for that Cardiologist could have built THREE new health centers and employed so many people including young, fully qualified but despairing jobless GPs! How many needy people would have benefited from the better use of this money?!

Don't Chief Execs at the NHS get audited?! How did this Mr Burley get away with this?! How many others like him are getting away with 'it' too? And, How many more health centres could have been built?

What a cheek! .. What a waste!

I am an incurable eternal optimist! I firmly believe that the call for 'quality' is also a LOUD call for transparency and accountability too .. for everybody .. including those who fail to manage.

Let's wait and see ... for only time will prove me right!

This is the amaaazing Cesaria Evora singing Esperanca Irisada ... enjoy!

And ... I used to play the Congas ... They are the loudest of latin drums ... and the most hollow too ...

E s p e r r r a n c a amigos .. E s p e r a n c a! :-)

There's a moon in my body, but I can't see it!
A moon and a sun.
A drum not touched by hands, yet it beats, and I can hear it!

Sunday, 11 January 2009

A wise jungle is a happy jungle .... Always :-)

The well bred contradict other people. The wise contradict themselves.

From this ... to .. Happy and prospering .. soon :-)

As the wise saying goes:

A wise old owl sat on an oak;

The more he saw the less he spoke;

The less he spoke the more he heard;

Why aren't we like that wise old bird?

Have a happy and wise Sunday ... :-)

A wise man makes his own decisions, an ignorant man follows public opinion

Saturday, 10 January 2009

Fatal errors of judgement

The risk to be percieved defines the duty to be obeyed

It's a shame that Dr Sherene Boadrman has lost her appeal against her sacking from the Warwick Hospital. However, reading the appeal decision, it seems Dr Boardman was warned by the trust not to transfer patient records without their consent to the Apnee Sehat centre where she worked. This means that despite formally receiving such warning, she carried on transferring those records nonetheless. So, she can't claim that she did not know this was forbidden, although this does not excuse the offence either because all clinicians know, very well, those rules on confidentiality. The general opinion around the blogsphere is that the data system in that trust is inefficient anyway and the doctor was acting in her patients best interests especially that she has a track record for excellence and is in fact a good caring doctor.

However, from my point of view as someone who is not working in the NHS, as well as someone with a bit of management experience as well as an NHS patient, I view this matter somewhat differently. I am not disputing this doctor's integrity, compassion or that she was indeed trying to do the best for her patients but this is not relevant here and so, does not excuse her from being responsible for this offence. There are times when management has to take a tough stand because the offender gave them no other option but to do so. Sadly, this is one of those situations.

Patient confidentiality is at the core of the NHS and she jeopardised that by transferring unconsented patient data from one place to another. This put the trust in a really vulnerable legal position as the 70 or so patients involved could make valid legal claims against that trust for having their details moved about without consent. This of course could result in legal cases against the trust being won with unnecessary pay outs being made to the patients concerned. Assuming all 70 + patients made such legal claim, these payouts would amount to a huge sum plus of course the legal expenses and the time and effort to manage this headache but most important of all, this leakage of patient records could end up in the wrong hand with dire consequences to follow as well as the reputation of the trust would be tarnished because it's management were not able to see the risk and deal with it. Of course this is still valid because the offence did take place.

I assume the trust dealt with this case according to policy when they first found out about the problem then gave her a proper warning not to carry on with such practice but it seems that she carried on nonetheless under 'I'm doing what's best for my patients' banner. It does not work this way because, in effect, for the management, she made the situation untenable, ie, it was either her or the managers that had to account for this 'serious' breech. Since it was her who misjudged the situation, then she had to go .. there were no other options. That another professional appeal panel looked at the case and decided to uphold the sacking means that she had a fair go and was again was found to be wrong to the point of termination of services. Less than that and again, the legal doors would have been left wide open against the trust! .. This too may still be the case.

I do not know the full case of Dr Boardman but if I was a panelist on that appeal committee and found, after properly studying the case, that she jeopardised her trust's legal position by breaching a core element of trust and the national policy on patient confidentiality, I too would have had no other option but a duty to uphold the decision to sack. I would not have felt happy about making such decision but by the same token would have considered it a tough decision that had to be made by any professional manager.

I do not believe there was any 'witch hunt' involved in this case and it's is such a shame that this happened to a good doctor like her and what a loss to her patients but the law does not protect foolish errors of judgement and, sadly, this was one clear example of this. She made a fatal mistake by ignoring that warning and not responding positively to the management, by not realising her limitations as a trust employee and the grave error she was making and it's consequences. I do not know about NHS contracts of employment but I also think she must have breeched same if it contains a clause on patient confidentiality? I also do not know the trust's policy in such cases but such grave errors and/or breech of contract usually warrant dismisal without warning. That the managers did give her a warning first proves that they were not trying to 'witch hunt' her but on the contrary, they were somewhat lenient. Despite that, she presisted and if the managers had not taken such a tough stand, it would have been them on the line because of their inability to do their job to uphold and implement trust policy as well as identify and deal properly with risk.

Of course this case also highlights the trust's deffeciency in having an appropriate Data Transfer System suitable to the activities of the said trust so, .. I don't think this will go away either because this too is a risk to the trust itself ...

Please excuse me if I made any factual mistakes in this case as I am not really aware of the whole story, hence, my opinion is based on assuming the circumstances above were true.

I wish Dr Boardman peace and hope she finds another suitable post in the near future ..

The first step in the risk management process is to acknowledge the reality of risk. Denial is a common tactic that substitutes deliberate ignorance for thoughtful planning.

Thursday, 8 January 2009

Will the government's obesity campaign work?

I'm fat, but I'm thin inside... there's a thin man inside every fat man.

When I had my first child, I had no idea how to raise or what to feed them so, when it was time for my first child to eat solids, I just fed him foods out of ready made jars or dried fruits and veg junk powders that I bought off the shelve from drug stores ... and that's all he ate for nearly one whole year. I also had no idea and nobody to turn to to find out what a portion was supposed to be like for a young baby and so, I fed him on demand .. and without demand .. I just fed him all the time ... and he ballooned .. but, he was so cute and really beautiful, people used to stop me in the street to admire and play with him, so I thought I must be doing it right and just continued .. :-)

I did the same with my daughter when she came along but by then I was a bit more experienced. I used to give her some of our everyday food pureed to suit as well as the jars and junk I bought from the drug store. Then, things got better and better by the arrival of my fourth child .. and he was the lucky one for he was never fed any jars or dried junk at all .. but only home made, healthy and well balanced tasty food.

However, the portion sizes remained a problem for me until one of the mother helps I got to help me with the children during the day while I was at work just reduced the children's portion sizes and that's how my children were saved from a future of obesity. None of my children now is obese or even slightly overweight. I should say that I am truly grateful to this young woman for her help.

The reason why I mention my own experience with feeding my own kids is because the government has launched the Change4life website to encourage healthy eating for children. While I think it is a really good idea, I haven't found any information or help about what a portion is for each stage in a child's development. It just simply says that a portion is about 60g for fruits and vegetables and that's it! Nothing about what a full meal should weigh or look like, for a baby, then a toddler the say a 5 year old, then a 10 year old .. etc. Why didn't the govenment use this opportunity to include this vital information and also give full practical examples of real dished up healthy meals with pictures as well as the weight per each item in that meal. One example or two for each stage in a child development.

I also really find that idea of 5 a day ridiculous and is very off putting to young parents because it makes feeding children fruits and vegetables look like a real chore. Children do not eat 5 meals a day and so, their intake from fruits and veg should be designed to fit in with the three meals they eat. You can then tell young parents that giving the child some juice and/or a fresh snack once or twice a day would be sufficient to balance their children's diets. I have no idea how many parents visit the Change 4 life site but, I imagine many people don't, especially those from lower social and financial backgrounds. Those, I think, depend on what they see and hear on TV while they are eating their dinner and they will be put off by that 5 a day TV campaign because of that number '5' , which is misleading IMO .. and .. because there is a lack of portion examples.

Unlike this writer here, who thinks the government's campaign to tackle obesity will be a failure, I think it is actually a very good opportunity to educate and teach ordinary people and change their attitudes towards food for themselves and their children. therefore the current campaign can and has the potential to succeed in reducing the obesity threat IMO. It was my 'home help' that taught me how and what portion sizes to feed my children not a specialised government campaign, a celebrity in a bath tub or a fancy chef on TV cooking meals you just watch then go to bed forgetting totally about them the following morning.

But since we're lucky to have a specialised campaign these days, why don't the government try talking to the masses through representatives of the masses? An ordinary mum or mum and dad 'look alike' chefs who also specialise in nutrition, on daytime TV, cooking 'ordinary' everyday food that the majority of Brits do really eat everyday. To include showing those ordinary people how to balance those meals, either for them and/or their children and what the portion sizes should be for each age and gender group, then actually dishing up those freshly made meals to show what the end result should look like.

Doing things that people can relate to by example is the best way to learn and the best way to influence people too. Seeing and understand will produce better results than fancy chefs talking about fancy food that ordinary people can not relate to. It is also the cheapest method to influence people and help them change their habits and attitudes IMO ... I also think that change4life site can be enhanced further to make a real difference

I would have benefitted greatly from such a programme myself had this campaign been around when I needed the advice :-)

.. and I once forgot my first child, when he was a week or so old, at a dept store! I actually went out of the shop with all the shopping, waited for the traffic light to turn green then walked about 200m before I realised I was missing something! You should see how the staff looked at me when I ran back with eyes as big as saucers .. and no shopping in my hands! .. It still gives me the shivers every time I remember :-)

Tuesday, 6 January 2009

Improved application process :-)

The best performance improvement is the transition from the non-working state to the working state.

The team at MMC seem to really want to improve the application process and treat the juniors with much more respect than the fiasco of 2007, so, good on you MMC team :-)

Gone is having to produce up to 9 copies of a 30 page application form and having to post them in padded envelopes because they were too heavy to put in normal brown envelopes. I remember that I had to drive myself carrying the load of applications and their copies to the post office because they were too heavy to carry and walk to post them. Our copier at home did not stop printing for ages, I am sure the next door neighbours must have thought we were printing money or something sinister of that nature. Well, it is now all done electronically AND the application forms come in two parts, the first of which is standard for all specialties, so, again, well done Prof Sowden :-)

There is also a comprehensive guide to applicants with a proper time line with all the information needed and what to expect once an application is submitted. All unsuccessful applicants will get feed back from the deaneries .. again, a great improvement on 2007. They are trying hard to fix and treat the juniors with the respect they deserve, good .. better late than never!

I spent a long time today trying to find the jobs themselves but the only ones I could find up to 5pm were those of the Northern Deanery so, again, well done Northern. Unknown to me, applications to certain specialties like Core and Obs &G are now done as just the one application to the relevant college .. wot? no heartache filling zillions of different format forms in a few minutes? And there is a sample application form too! Published around the end of November .. fantastic!

The only 'white boxes' in that sample application are about 'commitment to the specialty' which I can't understand why does say, an ST1 need to be committed to any specialty! Say, I am committed to Cardiology but don't get it, wot? Commit to Obs&G instead? and if not that, commit to GP .. and so on? Do I need to take three or 4 part one exams for the relevant colleges, Where is the time? .. and the money?! .. and all the effort?! I personally think that this particular question should only apply from ST3 onwards when a doctor has enough time and experience in a specialty to commit to it for real but the younger ones?! No, no, no .. it just doesn't make sense, unless there is enough posts to accommodate all those who want to commit to Cardiology for example .. and there isn't! So, please think about this bit again MMC .. No logic in it for the younger docs, more sense for the older ones.

Another abbreviation is on the table as well, the MMT, the 'machine' marked test ... :-), they don't say what 'machine' will that be though :-)) .. so I suppose they mean the computer because you do sit that test online, but ... they had to find something with an M in it to match the set ... MMC, MEE, MMT .. cos they look pretty together, don't they ... 'Team Work'

This 'mechanised' test comes in two parts, the first one is on clinical judgement while the second is on 'situations' .. and there you have it! .. The white boxed have been disguised in an exam! .. In an effort to stop cheating? It won't because some docs, out of fear of not getting in because the numbers are low, still atend those half day courses for £400 each and do have an advantage against others who don't. Then again, didn't a panelist at the HSC enquiry into MMC say that the NHS trains other Health workers on using them? I then wondered why were doctors not treated similarly then but .. I don't know what is this fondness with those useless white boxes?! IMO, they can probably select engineers, finance managers, anything else, but not the docs IMO, because of the human element involved with a doc's work! In any case, the score for the second part counts towards GP score but not towards Core training score, providing you get a 'valid' score in it .. they do not say what is a 'valid' score! It is a pilot anyway so ... who knows, it maybe ditched if it doesn't work ;-)

That said, the application form as a whole gives more emphasis to a docs' achievements and qualifications rather than in 2007 when those did not make any difference .. And, Professor Sir Tooke was/is involved in reforming MMC and the difference between applications under the control of the '*whatever*' of 2007 and that influenced by the top academics is evident of course .. Now I can also safely say that I have added Prof Sowden to my list of good leaders that I respect and admire because he is trying hard .. And so, we now have three BRILLIANT leaders .. I hope this excellence is contagious because this is what British medicine was, is and deserves to be;

World Class Golden Standards ------- ALWAYS

The numbers are quite low though so, let's wait and see what happens .. and hope for the best .. :-)

... to be continued ...

To enter Europe, you must have a 'valid' passport with a photograph of yourself in which you look like you are being booked on charges of soliciting sheep.

Monday, 5 January 2009

Time for the 'Dance Of The Sugar Plum Fairy'

Good luck :-)

Today is the 5th January 2009. Applications to specialty training starts today and soooo for us, here we go again, wish us all luck.

Good luck my girl .. and everybody else applying in 2009 :-)

"Put all your eggs in one basket then watch that basket"

Sunday, 4 January 2009

My sister is a BEAUTIFUL... witch! :-)

Gravity is only the bark of wisdom's tree but it preserves it

Awesome Beauty

When the golden sunset

Sets over the amber hills

And when the moon shines bright

And all the world stands still

There is beauty, awesome beauty

God took the dust and formed a man

He paints each sunrise with His hand

He took all the love within His heart

And gave us beauty from the start

There's beauty, awesome beauty

Through every age

There is a call

To admire the creation

He gave us all

It is beauty, awesome beauty

See the beauty, hear the call

Enjoy the life He gave us all

God took the love in His heart

And gave us beauty from the start

There's beauty, awesome beauty

In each and every loving heart

Danny Speicher

Sister, this amazing beauty can not go anywhere and will remain with you forever .. It is still there, inside and out ... but we have been working so hard, we forgot we have it ... and maybe also forgot we are alive! .. time to get back into that red dress and the ruby tiara and sister, the whole world is still out there and is waiting sooo, let's start everything ..

life is still looong and so, no battered football haircut or digging at the terra here! Instead, we're going to go live our lives AND .. we .. all .. 'insist' on 'quality' and lots of noise! .. That's what I call .. girl pa'a! ;-)

Happy day everybody ... :-)

It's beauty that captures your attention; personality which captures your heart .. and my sister has both

Friday, 2 January 2009

On aligning perspectives :-)

Krishna, the master of multi-tasking

Aligning perspective in management is about enabling good decision making in a multi tasking evironment then andaccordingly setting priorities to suit reaching the desired outcomes. Of course no one can do this better than Krishna the Hindu god and 'supreme being.' Krishna is portrayed in many forms and has many attributes and name derivatives but his most striking feature is his ability to do 'everything' at the same time and get it all right too. We are all familiar with the Hindu image of the god in the image of man with many arms. This actually is just one person but one who is so able to do everything with best results. He is like a line of people standing one behind the other with each doing something different to that of the one in front. In the picture above for example, although the arms are joined to the main character in the picture, the numerous faces that surround it, although look different to indicate ability to change mind set to suit task, are all actually images of that same person at the front .. This is about leadership at it's best :-)

Divine Krishna adored for his leadership qualities and abilities ... hallelujah

Good leadership is not set in concrete rules while good management has little room for manouver because it is controlled by targets and cost amongst other things. So, while you can learn about management in books and seminars, you either have leadership qualities, including stamina and the backbone to affect proper management including change or you don't. Again, the Hindu tradition highlights this fact by lifting good leadership qualities and abilities to much higher realms than that of anything else, thus glorifying able leaders or putting them on a special pedestal. This divine godly status indicates the leader's status as higher than that of any mortal being because they are entrusted with the well being of the whole and so their abilities is much higher than the ordinary too. To achieve this, a leader must also consider anything and everything to achieve their goal, including dimplomacy, democracy as well as even dictatorship as and when needed and have the ability never to lose the momentum or show panic if the going gets tough. This then emphasises the Hindu wisdom of ' protecting the protector' for it is not easy to replace such high calibre leaders and so, those must to be held in much higher grounds :-)

In the normal world, good management is always symbolised by the 3 Cs; commitment, culture and cost, although these can also be sub-divided as one considers one or more other concepts, for example, adding innovation in management where the original 3 Cs then must also focus a futher 3Cs for innovation; collect 'information', compute or write down and 'communicate' either as team effort or one's own reflection so as to enhance one's natural abilities to create new ideas then formulate ways to put them into practice while keeping the overall concept of the 3 original Cs of policy, culture and cost or available budget in perspective. Layers upon layers form as one considers more factors of course.

Krishna, the wise thinker, leader and manager of everything

To be able to affect good management as well as include innovation too means taking those two sets of 3 Cs into account at the same time. Hence, you need to start by being totally committed to both your organisation, as well as the task or policy at hand; yet another layer or multi-tasking concept. If one is involved in top management then this means that you are not just working towards getting a particular task done then out of your system because you are the system itself. You set the rules and policies to follow, bearing in mind that even top management and policy setters are influenced by so many other factors such as the available budget, cost and the economic climate at the time, either local or global .. etc. Meaning yet more multi-tasking abilities needed to achieve good leadership as well as management outcomes. Of course, middle management then follows the much easier route of implementing whatever policies handed down to them from above to implement. However, unless those too follow the multi-tasking 3Cs routes as well as possess good leadership attributes, 'quality' will always suffer as a result. In all those stages, a good manager needs to, much like in medicine when attempting to make a diagnosis, follow a flow chart to set priorities to enable the achievement of targets or set goals or indeed, as in medicine, to get the diagnosis right. Add other concept/s to the above, like leadership in a specialised field such as in medicine and the sub focus on, say, safety and/or patient experience for example and you would really be multi-tasking, hence multi-tasking is always open-ended as one can always add more sub factors to the pyramid. Therefore setting priorities or the need to align perspectives become harder and harder, first laterly as in in bigger organisations and/or as well as vertically as you go up the ladder, in which case, the need for good leaders and managers to have the ability to organise, either mentally or practically, as in implementing and adminstration becomes a real neccessity .. as well as possessing good intellectual abilities to facilitate the delgatation of tasks as well as to teach, analyse, predict, present, negotiate, teamwork, communicate, motivate, work to dead lines and budgets .. etc .. etc .. Oh .. and not forgetting show authority when needed too ... you need a big brain and many, many hands :-)

Therefore, good management involving the alignment of perspectives is really all about the positive manipulation of resources, including human resources and helping the latest reach full potential in order to enhance quality as well as production, hence, profitability. Add good leadership and that means adding fairness, harmony, protection, motivation and reward. If one of those is lacking, it opens up big holes in good management, as in the case of Scot junior who was not protected for example. Or where there is no syncronisation of effort leading to loss of harmony leading to depreciation in quality and production. Or where staff, in any organisation are not properly remunerated and therefore do not develop loyalty to their fiem but end up being always on the look out for better opportunities elsewhere thus leaving the organisation with the inability to retain staff and the management of same. Where ability to retain staff is non existant or limited, as well as the extra cost involved in lost output, there is also the non ending headache and cost of advertising and training new staff therefore, retaining staff is of paramount importance to all good businesses because it affects profitability at the end. This concept is therefore always held ashigh priority by any good management, unless the organisation knows that some particular staff will be retained come rain or shine for one reason or another of course. Such as in recessions and the ensuing times of high unemployment that follows. The managers then have a free hand to do what they like including keeping wages down, but the danger here is that those staff will never produce the highest quality they are capable of because of their lack of 'real' loyalty, motivation and reward ;-)

In Indian tradition, leaders are 'devine' and even them are rewarded. Not just with lavish earthy luxuries but with the much higher spritual standing too because they are considered to be 'the truth' itself or 'goodness in action' .. of course, we all know what they are capable of doing if they are not properly rewarded ... :-)

Maybe we should all learn something from this great wisdom of the Indians,
as well as others ...

Lord Krishna deserves the rewards for his continuous strive for excellence as well as his hard labour :-)