Grand Rounds

Welcome to Grand Rounds, Volume 5, Number 38. The rounds have travelled over the Atlantic to reside briefly in the green fields of England, to give an English flavour to what is going on in the Medical Blogosphere.

The advent of blogging has internationalised many issues, and we see many health care issues are very much shared throughout the world. Some of these I will touch on this week, but the Jobbing Doctor is

pleased to be hosting the grand rounds.

Some issues will always straddle the world and Abortion is a subject that will always polarise views. However, the cold blooded killing of Dr George Tiller (pictured, right) in Wichita, Kansas, USA, for being willing to perform late terminations in women requesting them has shocked many people. The issue is covered by Toni Brayer in her blog. There is also a philosophical post from Katherine Howell on Blog this rock, which I found valuable to read. For Jobbing Doctors, the issue of abortion is always a very difficult issue, and this murder is a very tragic affair.

Many bloggers in the USA are increasingly concerned about the weak position of primary care in the USA. The progressive dumbing down of UK Primary Care (led by a Government that really doesn't understand the value of primary care) means that Bloggers are some of the few who can emphasise the importance of primary care. The new US administration recognises the fact that their health system is failing at least 50 million of their people, and tentative steps are being followed to moved to a more socialised system that is present in the UK, New Zealand and many other countries.

There are many veste

d interests that do not want this to happen, and wish to preserve the status quo. One of the best medical bloggers around, Dr Kevin Pho (who blogs as Kevin MD), puts this very well and simply in one of his posts about the patient being a commodity. There are other proponents of reform, particularly at the ACP internist blog. Massachusetts State has being trying to reform for quite some time now as has been pointed out by Henry Stern.

A country's healthcare system is only as good as its primary care system, and it seems disappointing that the UK Government is looking at the US system for inspiration when the USA is seeking to change its own system. It seems that in Canada there are problems as well, with the New Brunswick doctors being threatened with their jobs.

The Political system in the UK is rapidly deteriorating. Our current prime minister, Gordon Brown, succeeded Tony Blair without any election at all, and has presided over a continuing chaos of a Health Service that is being hugely, and badly, overmanaged. Combined with a sleaze crisis and an economic recession, he is in difficulty. I don't blame Gordon Brown particularly for all the mess, as he inherited this smelling heap of ordure from his predecessor. It might surprise our American readers to know that his charismatic predecessor (Tony Blair) is regarded over here by doctors as little more than a snake-oil salesman.

Gordon is feeling the strain, following catastrophic local and European election results, and there are now real concerns about his mental health, eloquently described by the best British GP blogger, John Crippen - the NHS Blog Doctor.

Meanwhile, the privatisation project continues by stealth. Big beasts are circling around the UK health sector hoping to asset strip the public sector of the profitable bits of health care. This has largely gone unnoticed in the UK thanks to the collusion of some senior figures in the Medical Profession, 'special advisors' to the Government and the politicians themselves. Money is being squandered in Industrial amounts on management consultants (£350,000,000 in the last year alone) where we really need more nurses, doctors, physiotherapists, radiographers and other front line staff that people will recognise).

Few Doctors are prepared to speak out, but those that do are worthwhile reading - including the Ferret Fancier, Northern Doc, the NHS Blog Doctor and (if you can tolerate fruity language) Dr Rant. The Jobbing Doctor (ahem) puts his two pennyworth in as well, as does a wonderfully sagacious Dr Grumble, who - in his understated way - points out the idiocies of current Government policies. Finally, the Doctors' trade union - the BMA have woken up (too late, guys!)

The crisis in management of the Health Service is partly due to monumental incompetence at a Government level, so that many UK graduates are leaving the UK medical service altogether (readRemedy UK to understand why) and some specialties - like psychiatry - are unable to recruit any locally trained UK graduates. Much of this must be laid at the doors of the Department of Health, advised (allegedly) by the Chief Medical Officer - described as the worst one in living memory. The Cockroach catcher describes it well.

One of the big issues in the UK is the blurring of roles, and the lack of distinction between various practitioners: it can either be referred to as empowering on the skills escalator, or dumbing down of contacts. ' You pays your money and makes your choice' as the old saying goes. Whatever the role in healthcare, the managerial types seem to very rarely appear on the wards. Kim has noted this in emergiblog when she comments on a purely fictitious role for a senior manager who seems to do everything and hands on working as well. Absolute fiction, of course, and (if you can cope with the language - here is an old post from the Militant Medical Nurse that talks about what she experiences of senior nursing officers). Another short and poignant post comes in from 'reality rounds' - anurse's eye view of what we do.

Jobbing Doctors have contact with virtually every specialty in the secondary sector. One group we don't have much to do with is anaesthetists (except in pain clinics, maybe), and so it is interesting to keep a note of what they do. The ones I come over on the internet seem very empathic and understanding: is this the rule or the exception? Michael (the junior doctor) and the anesthesoboist suggest the former.

Some people say that Doctors are doctor-centred. This is not so in my practice, I hope. One of the major roles I have is to be the Patient's advocate in the system. It seems to me that making sure that patients avoid unnecessary interventions is one of my core tasks. I was therefore amused to see this post from Dean in the Back Pain Blog. I agree with you!

We have just had 1 week of sunshine in England. Now it's raining again! But, as clinicians, we are all advising our patients about sunscreens. Two useful posts (thanks to Nancy and Paul) come from a naturally sunnier place, and contain good advice on the efficacy of sunscreens. Very helpful.

The libel laws in the UK are notorious for their favouring the person who feels that they are being libelled. This has enabled the rich and powerful to try and protect themselves. Recent causes celebres include to facing down of the powerful vitamin pill salesman, Mattias Rath, who tried to push useless medications as a cure for AIDs. He was undone by the British Newspaper 'The Guardian' and by Ben Goldacre - a doctor who writes the Bad Science Blog.

However, as soon as one set of pseudoscientific nonsense is faced down, then another one comes along. Currently, the British Chiropractic Association is suing the respected scientist and author, Simon Singh, who has the temerity to question the mostly risible pseudo-science underpinning what seems a simple form of spinal manipulation. They are using the libel laws in the UK. Most sensible people are aghast. David Colquhoun, a scientist himself,covers it very well.

I hope that I have started to give my readers a flavour of what is going on in Britain in the blogosphere. Next week (Vol 5, Number 39) will be at ACP internist - over to you, Ryan.