Wasting time

There has been a discussion in the pathology forum on DoctorsNet recently about rapid tissue processors and how useful they are. It reminded me of an occasion when I walked into the histopathology department at one of the hospitals in our region and found the corridor filled with empty wooden crates. It was a similar sort of time-saving machine. The senior biomedical scientist told me it had been bought to speed things up in the lab. This seemed a bit strange since the things that slowed down the turnaround time in this department were the volume of work compared to pathologists, the antiquated computer system and the long process of report typing, correction, retyping and authorising. Making the slides come out of the lab faster wouldn’t really help. The senior BMS thought so too. I don’t know who decided this machine would be a good idea but I bet it was expensive, and even if it was cheaper than a new lab software package, an extra consultant, an extra secretary or a good think about how to improve efficiency, it won’t improve turnaround times as much as any of these options.

Who thinks of these ideas?

Shocking email

I got an email from the BMA this week. Periodically I have been getting emails from them in the last few months telling me what they’re doing for junior doctors. Before that I got the occasional email trying to sell me their financial services.

But this week, for the first time, I got an email from the BMA asking me to fill in a survey about what I thought of MMC.

Wow.

A survey, something the BMA has never, to my knowledge, bothered to do before in the whole MMC/MTAS fiasco. All this time they’ve been ‘representing’ junior doctors and sending me emails telling me what they were doing and now, finally and too late, they’re actually asking what the people they allegedly represent think. Not there’s any guarantee they’ll listen anyway.

Why the hell haven’t they done this earlier?

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.

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?

Bad medicine

One of my moments of fun at the end of the week is getting my ‘Friday dose of woo’ over at Respectful Insolence. It never ceases to amaze me that people can invent and promote the kind of stuff reported there, and that some people seem to believe it. The most recent entry contains something that is implausible whatever your branch of science and reading about it is an almost psychedelic experience. It’s called the SCIO.

Another place to sample some of the dubious medicine to be had via the net is over at The Little Black Duck’s blog. He discusses the subject of hair mineral analysis, something that sounds rather conventional and much more believable than the SCIO.

Shinga has been talking about food allergy and intolerance tests, another very plausible and conventional sounding set of tests.

While it might be easy to spot the rather dodgy nature of the SCIO, allergy testing and hair analysis sound much more plausible; and all these things have ‘scientific evidence’ presented to add weight to their claims. Shinga and the Little Black Duck show that it’s necessary to go back to the scientific and medical research literature and have a careful look at it to really evaluate whether these tests are actually of benefit to real individual patients. Allergy tests can be very useful – providing you’re doing the right test in conjunction with a good history of the patient’s symptoms.

I’ve talked before about what the RCPath have to say about diagnostic tests. Neither the allergy tests nor the hair mineral analysis would fulfil their criteria. They may sound more plausible than the SCIO but in the end they are no better.

Anonymity

Dr Michelle Tempest has written an interesting post on bloggers and anonymity, or lack of. When I set up my blog I didn’t even consider the possibility of not being anonymous, maybe because one of the great attractions of the internet is the ability to hide who you are.

So why am I anonymous on here? I don’t need to hide because I express controversial opinions as I don’t think I do and the things I say on here are the same things I say in the real world. A good reason for anonymity is to preserve the anonymity of my colleagues and hospitals. Sometimes I talk about them and they might not want to be exposed on the internet; maybe worse, they might think I’m talking about them when I’m actually talking about somebody different. Anonymity for me and my colleagues is a solution to this. Either that or naming all names so there can be no misunderstanding but that’s hardly acceptable.

Another reason for being anonymous is that it’s a bit of fun. Sometimes I wonder if anybody I know in real life reads this blog (actually they probably don’t!) and has realised who I am, or if somewhere, somebody is erroneously suspecting one of their colleagues of being me. It ‘s also a play on the slight stigma attached to being a pathologist. Sometimes it’s easier not to be specific about what you do because of the comments you might get. It reminded me of the stereotype of the Alcoholics Anonymous meeting where new members stand up and say: ‘I’m K and I’m an alcoholic’ – being honest about what they were. That’s where the name of the blog came from, and it kind of follows on from the name to be anonymous as well.

RCPath talk tough

I have obviously happened on this issue rather late, but I noticed this document on the RCPath website the other day. It’s a response to another document I hadn’t heard of before, a discussion paper called ‘The future of the medical workforce’, published by NHS Employers.

I read the RCPath’s response first and it’s quite a strong-worded response considering pathologists often hedge their bets with phrases like ‘suspicious but not diagnostic of’ in histology reports. I wondered what had provoked this and read the offending document. This is a piece of writing supposedly about the recent ‘reconfigurations’ in the NHS, the European working time directive (EWTD) etc and the effects these things have had, and will have, on how doctors work, how they are trained and how many are needed. To me it looks like a load of vague waffle written by somebody who uses the buzzwords but doesn’t really understand the issues. It talks about ‘mergers and closures of some smaller units’, the reduced training time for doctors due to MMC and EWTD without any hint that the authors have considered the effect of these things on patients and doctors and whether these are a good thing or not. The document is full of ‘key questions’ and I’m glad to see the RCPath have answered many of these in their response. Here are a couple of examples:

‘Is there a need for a new specialist grade below consultant?’ ask NHS Employers.
RCPath response: ‘No’

‘What will the doctor of the future look like?’
RCPath response: ‘Here is a likely distinction between expectation and reality. The doctor of the future should be fully competent in the clinical management of patients through a deep understanding of the scientific and pathological basis of disease. The reality is that he/she will be a politically-correct apparatchik who responds to clinical situations in a protocol-driven and codified manner. If such an event occurs, it will be highly detrimental for the medical profession and patients alike as well as being severely damaging for society as a whole.’

The RCPath’s conclusion says: ‘Overall, this is a naive document that exposes many errors and misconceptions currently held by employers and managers within the NHS. There continues an inherent advocacy of a ‘top-down’ directive approach without an acceptance that medically trained doctors are probably best suited to develop the environment necessary for good clinical care within society. Obvious lack of appreciation of fundamental constraints such as time and money do not engender confidence in the proposed discussion or consultation process as advocated at the beginning of this document.’

Neither of these documents is very long and they make interesting reading, particularly if you’re careful to read between the lines. I think the RCPath is pretty spot on in the majority of what is said, I just wish they’d shout about it more.