Not a doctor

There's some uneasiness in the UK over the role of physician associates (there are some 80 in Northern Ireland). Patients who have never come across them before may think they're doctors or even surgeons. And some physician associates have made fatal mistakes because of inadequate training or supervision.

They have much less training than doctors (a two year course) and can only carry out a limited range of procedures, like physical examinations and taking medical histories from patients.

Patients who don't know they're physician associates may assume they have a level of knowledge and competence they don't actually have.

The husband of Susan Pollitt, who died in Oldham after a drain was wrongly left for too long in her body, said earlier this month that he didn't know the person treating her in hospital wasn't a doctor.

Emily Chesterton died after a physician associate at a GP surgery in north London - who she thought was a doctor - twice wrongly diagnosed the pain in her calf as due to a strain rather than a blood clot.

The Health Minister has now announced a review of physician associates and their role amid growing alarm in the medical profession over patient safety.

I must say I would be a bit wary of a physician associate attending to me (if I even knew that's what they were). They should at least have badges stating their role.

And surely they're not qualified to make diagnoses, which is a very advanced skill that even doctors can easily get wrong.

Yes, time for taking stock, I think.

Pic: So who do we have here? Physician associates? Doctors? Surgeons?

Footie

Supposedly men are all obsessed with football, cheering on their favourite team and trashing whoever their team is playing against. They'll sit in the pub for hours discussing the finer points of X's missed goal or Y's penalty kick.

It all leaves me cold. I was required to play football at my prep school but I hated every minute of it. I couldn't see what was so compelling about men getting balls into nets. Wouldn't they prefer to settle down on the sofa with a good book? Apparently not.

The young lad next door goes in for long sessions of ball-bouncing. That's okay for about ten minutes, but then I start to wonder if he could find some slightly quieter pastime. Like weightlifting.

My thoughts turned to football after repeated pitch invasions this week by football fans, with one fan head-butting a player, other fans throwing smoke bombs, and a club manager being taunted. Football clubs are urgently discussing how to prevent the disorder escalating.

All I can say is, why oh why? What's the point of running onto the pitch and causing mayhem? It just makes football fans look like uncontrollable lunatics.

As for the obscene amounts of money footballers command just to turn up and play a few games (Christian Ronaldo, Manchester City, £29 million a year; Kevin De Bruyne, Manchester City, £23 million a year), how can they possibly be worth such inflated sums? Is a footballer really worth 300 times the salary of the average hospital surgeon?

It's a nice little earner though, if you're a dab hand at getting balls into nets.

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Comments from five of my blogmates - Mary, Joanne, Ramana, Beatrice and Wisewebwoman - haven't appeared on my blog. Presumably a technical glitch at Blogger. I hope they sort it out soon, it's a bloody nuisance.

A prank too far

How would you react to finding out that your surgeon had carved their initials on your liver while they were operating? Would you be horrified or would you just shrug it off as a childish prank?

I pondered my own possible reaction when I read about Simon Bramhall, who autographed the livers of two liver transplant patients. Nobody reported it at the time, and he might have got away with it, except that another surgeon doing a follow-up procedure noticed the initials and duly reported it.

He has just been found guilty of "assault by beating" and will shortly be sentenced.

My first reaction was to dismiss it as a rather trivial incident that did no harm to the patients. In fact one former patient, Tracy Scriven, said "Is it really that bad? I wouldn't have cared if he did it to me. The man saved my life."

But then I thought, no, if my surgeon had done that to my liver, I wouldn't have the same trust and confidence in them. I would feel they hadn't taken my operation seriously but were fooling around. And it wouldn't just damage their reputation but the reputation of other surgeons.

And yes, he saved a patient's life, and of course the patient is grateful, but that still doesn't justify what he did.

It's one thing to carve your initials and a romantic message on a tree trunk. It's quite another to carve your initials on someone else's liver while they're under general anaesthetic and oblivious to whatever you're doing inside their body. It's not just taking advantage of an unconscious person, it's a total lack of respect for them.

Hopefully there aren't any initials on what's left of my prostate....

NB: Assault by beating doesn't literally mean beating. It refers to the use of unlawful force on another person

Pricey advice

If you had any sneaking suspicion that private health care might be better than the state-run system, the way a worried Times journalist was fleeced should be a wake-up call.

Richard Kerbaj phoned a private doctor because he thought he might have swine flu. The doctor asked if he had any symptoms, pronounced him fit and well, gave him the number for the NHS helpline - and charged him £99.

But suppose he did actually catch swine flu, he asked? Stay in bed, said the doctor, ring the NHS helpline and if necessary they'll provide some medicine.

And the cost if he had got exactly the same advice from his NHS doctor - or from an online source? Precisely nothing.

Despite all the evidence, there's still a general assumption that private care is always superior to public provision, that paying huge sums of your own money guarantees something extra.

But apart from merely being told something you could have been told by the NHS, you're just as likely to experience medical errors. It's simply that they're easier to conceal in private clinics.

If a routine operation leads to a serious complication like cardiac arrest, a private clinic may not have the specialist equipment or staff to deal with it. If they can't get you to an NHS hospital fast, you could die.

Many private surgeons are the same surgeons who work for the NHS, and the chances of their making a mistake are much the same. They're equally likely to be overworked, stressed, tired or simply incompetent.

Yes, you can probably jump a queue for treatment and get an operation in a few days. But if the operation goes wrong, what have you gained?

If I ever have £99 burning a hole in my pocket, it won't be going to Dr Tell-You-The-Bleeding-Obvious, that's for sure.

A life cut short

What a nightmare it is when some innocent, everyday action turns into an endless disaster you can never be rid of. As happened to Denise Hendry when she tried to lose a bit of fat after giving birth.

In 2002 she booked a liposuction session, as thousands of women do every day, but in her case it all went horribly wrong. The surgeon damaged her bowel and colon, leading to multiple organ failure, her heart stopping for four minutes, and blood poisoning.

She had to have corrective surgery to repair the damage but that too was unsuccessful. A few months ago, she had further corrective surgery but contracted a meningitis-type infection, went into a coma and died 11 weeks later. She was just 42.

This dreadful saga of incompetence and misfortune certainly undermines belief in some benign creator watching over us and keeping us from harm. A novel this calamitous would be dismissed as incredible.

Not surprisingly Denise's experiences led her to campaign about the dangers of plastic surgery and the need to check out your surgeon's credentials thoroughly before they let rip on a vulnerable human body.

I've said before that I see no need for cosmetic surgery unless someone is seriously disfigured. Most of the imagined defects being remedied are invisible to everyone else and the real problem is the desire for a non-existent perfect body.

Unfortunately in Denise's case this desire meant not just a nice little earner for a greedy surgeon but a devastated and drastically shortened life.

People always play down the serious medical risks involved in a supposedly routine operation. But the fact is that any operation can go appallingly wrong, and when it does it's too late for second thoughts. Just say no!

Photo: Denise Hendry

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Katie the cat has mysteriously reappeared after two weeks' absence. We did ask her where she had been all this time but she refused to say. I suspect a failed romance she'd rather not discuss.

Dummy run

Airline pilots train on simulators, one reason why flying is so safe. Surgeons hardly ever train on simulators, one reason why a hospital patient has a 1 in 300 chance of dying or being seriously harmed.

No wonder I'd have to be dragged kicking and screaming into a hospital if the need arose. That statistic is seriously scary. I'd probably have a higher chance of survival in crocodile creek.

Britain's Chief Medical Officer says that if all surgeons trained on simulators, or plastic dummies, there would be a big drop in the number of mistakes and mishaps, and surgical expertise would be greatly improved.

It would avoid cases like Elaine Bromley, who suffered irreversible brain damage during a minor operation because doctors weren't sure how to do a tracheotomy (an incision in the windpipe).

Airline pilots do regular simulator training to help them deal with emergencies. That's why a plane can be successfully landed on New York's Hudson River by an ice-cool pilot who knows exactly what he's doing.

Apparently Israel leads the world in training surgeons and health workers on simulators. They use sophisticated dummies that can bleed, breathe, be anaesthetised, be resuscitated, and show tell-tale medical signs.

If they're so beneficial and they could reduce the shocking toll of medical cock-ups, why on earth aren't Britain's surgeons making more use of them? Perhaps when people go into hospital, they should ask if their surgeon's been trained on a simulator. If not - find one who has.
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The abysmal standard of patient care at Stafford Hospital in England, which has caused up to 1200 unnecessary deaths, is quite shocking. It seems the hospital management was more interested in meeting performance targets than in looking after its patients. Thirsty patients were drinking out of flower vases and others were screaming in agony for lack of pain relief. Unbelievable.

Operation blues

Countless cancelled operations in the UK's health service are prolonging misery and pain for thousands of people. The latest cause is cock-ups over surgical instruments.

Surgeons say they are more and more likely to be broken, missing or dirty. In which case an entire surgical team, ready to operate, has to down tools and tell the patient to go home again.

Yet again the government has handed over a job to private businesses which are failing to do the work properly. Ward cleaning was farmed out and still isn't up to standard. Many nursing posts were farmed out to agencies, again causing lots of complaints. Now it's providing and decontaminating surgical instruments that's being screwed up.

The politicians are still besotted with the idea that private firms can do the job better than their own NHS staff, even though they've been proved wrong repeatedly.

So people like Helen R. in Leeds, whose hip operation has been postponed twice because the surgeon didn't have the right instruments, is angry and upset at such elementary blunders.

"This is supposed to be the 21st century. We're supposed to have sorted these things out" she said.

There are already tens of thousands of cancelled operations because of sick staff, vacant posts, funding problems or emergencies taking priority. A lot of operating theatres aren't even used in the evenings or at weekends.

Now even more people are finding they have to put up with that excruciating pain or disabling condition for longer than they thought because of the results of political dogma.

Clearly the politicians could do with a bit of emergency brain surgery themselves.
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The BBC reports today (Sunday) that there are 10 times more deaths across the UK from the superbug clostridium difficile among over 65-year-olds than in any other country in the world. And one person dies every hour in our hospitals from this deadly infection.