Friday, May 25, 2007

Day of judgement

Like most junior doctors I’ve been busy following the judicial review into the MTAS fiasco over the past week and waiting eagerly for the result. It may be a loss but the judge’s comments are very interesting; although he didn’t rule that the MTAS review group’s actions were unlawful, he did suggest that many junior doctors would have good cases to take before an employment tribunal. Many recent posts from Dr Grumble and Dr Rant tell the story in more detail.

What is maybe more important than the result is the fact that the judicial review happened at all, and that it was initiated by a small group of doctors and allies who decided they couldn’t just do nothing.

This week I am proud to be a doctor and proud to know that the Remedy UK team and all the junior and senior doctors involved in standing up to MTAS/MMC are my colleagues. The sad downside is that I’m ashamed to be associated with the BMA and horrified by what the policies of Blair et al are doing to medical training and patient care. The fight cannot stop here.

Sunday, May 06, 2007

Go be a pathologist then!

Yesterday I was surfing around the latest Britmeds and discovered an interesting but typical example of ‘pathological ignorance’ (there’s also a link to a good article just below here!). When I say ‘pathological ignorance’ I mean the failure to understand what pathologists actually do, which tends to lead to statements like this one (on the subject of doctors refusing to do abortions):

If those doctors don’t want to do so, they should consider going to work in pathology, where most of the human beings they come across will already be past giving a damn about a doctor’s precious prejudices or their religious hang-ups.

Contrary to what Ben Fenton, the author of this article thinks, we do have religious issues with abortions in pathology. Some pathologists do not report specimens of ‘products of conception’ derived from abortions; the issue does not go away outside the gynaecology department.

The author of this piece also makes the mistake of assuming that in pathology the vast majority of our patients are dead. Not true. In most departments I’ve worked in there are around 10 times the number of living patients (their specimens, at any rate) than dead ones examined by us pathologists. He also assumes that the dead will not care about our prejudices or religious hang-ups; maybe the dead don’t but their relatives certainly might. In pathology it is more often the religion of the family that impacts on us as certain faiths need to bury the body as soon as possible after death so an autopsy needs to be done more quickly.

A second issue with autopsies is that in some cases the relatives, via the coroner, will allow only a limited autopsy which may not answer the questions posed by the death. As pathologists we want to do a high quality autopsy that is thorough, answers the questions and doesn’t miss anything. In cases where the pathologist thinks the autopsy will be too limited to be of use, he or she can refuse to do the autopsy (RCPath Guiodelines on Autopsy Practice 2002 section 4.6.2). Does this count as ‘prejudice’ or professionalism in Ben Fenton's book?