Bob Bury

Bob Bury is a consultant radiologist at Leeds Teaching Hospitals NHS Trust

I want to look like a South American dictator

By Bob Bury - 8th March 2010 1:22 pm

We’ve had quite a few retirements at work recently, and several colleagues have slipped away quietly into the darkness, saying that they “didn’t want any fuss”.

Well, blow that! It’s my turn soon and I want it clearly understood that I shall expect a great deal of fuss when I go.

I want to see strong men in tears, and women wailing, gnashing their teeth and (hopefully) rending their garments in good Biblical fashion. I want the biggest display of public grief since Princess Di bought it (but without the flowers - I don’t want all those flowers). A present would be nice, too. I shall place a list with Harvey Nicks.

It’s surprising how much more bearable work is, once you can see an end in sight, largely because you can ignore any ‘initiative’ (don’t you just hate initiatives?) with a timescale longer than six months, and smile serenely as threats are made to cap pensions, abolish merit awards (sorry, CEAs) or introduce uniforms for consultants.

OK, I made the last one up, but I’ve never had a problem with uniforms, largely due to the 16 years I spent in the RAF Medical Branch, and I’ve always thought it would be a good idea for doctors to wear them. At least patients would know who we were, and we could make sure that all those over-promoted ‘nurse consultants’ with stethoscopes ostentatiously draped around their necks could be clearly differentiated from proper consultants by the colour of their uniforms (they’d have muddy brown, we would have nice red ones, with gold piping and those big gold epaulettes like South American dictators, or commissionaires at the Odeon).

Still, it’s too late for me now. I’ll have to serve out my time tieless and ‘bare below the elbow’ (which, if you think about it, means that you should also be bare below the waist, unless you have unduly long arms; not something I’d like to inflict on patients or colleagues, come to that).

Incidentally, in an earlier blog I talked about Henrik Thomsen, the Danish radiologist who was being sued for libel by GE Healthcare. That case has been settled out of court, and I assume it will have been a condition that Henrik says nothing more about it in public. And that, of course, is the problem with the libel law as it currently stands - victims, or should I say defendants, can’t afford to take their case to the judges if their accuser offers an out of court settlement which is anything less than ruinous. I just hope that GE realised that they had slipped up by pressing the case, and accepted nominal damages.

Simon Singh, on the other hand, did have his day in court recently, and it seems to have gone well. However, it is not unknown for judges to sound sympathetic, and then deliver a contrary verdict, so we have to wait, hopefully not too long, for the outcome. 

Tags:
Posted in Bob Bury | 4 Comments »

Pros and cons of self-referral CT screening

By Bob Bury - 19th February 2010 11:10 am

So, the Advertising Standards Authority (ASA) have upheld complaints by two doctors against TV adverts promoting the services of Lifescan, one of an increasing number of companies offering self-referral CT screening. As a radiologist with a particular interest in radiation protection, I ought to welcome that ruling, and I do, but with just a slight feeling of unease.

What the ASA didn’t like was the use of phrases like ‘an MOT for the body’ which would give clients ‘peace of mind’, the implication being that the all-clear from Lifescan meant that you were free of disease. They also objected to viewers being given the impression that screening for lung and colon cancer and osteoporosis was appropriate for all asymptomatic individuals over the age of 40, which is at variance with the evidence base as summarised in the recent COMARE report. 

They were less impressed by the argument that these screening examinations uncover a large number of incidental findings which trigger expensive further investigation, at NHS expense, with no benefit to the patient. That will be a disappointment for our colleagues in general practice, who get fed up with patients who arrive waving their ‘MOT report’ and demand specialist referral.

So yes, I’m pleased with the ruling, because there’s no doubt that unnecessary radiation exposure resulting from the unregulated growth of these companies could have a significant detrimental health effect for clients, not to mention the economic knock-on effect for the NHS. But we have a baby and bathwater situation here. Although indiscriminate whole-body scanning is undoubtedly a bad thing, we know that the targeted use of screening can be a force for good, and as the evidence base is built up, it may make sense to extend screening services within the NHS.

Note I said ‘within the NHS’. That’s not because I object to radiology colleagues making a few quid in the private sector - indeed, you could argue that the evidence for and against screening for particular conditions may come partly from early adopters outside the NHS. The problem is, of course, that relatively expensive private screening only benefits the worried middle classes, and fails to reach those sections of society most likely to benefit from it. It would therefore be a pity if the ASA ruling adversely affected the public’s already fragile understanding of the role of screening.

The ruling has been discussed in the forums on DNUK. One contribution, from a radiologist, raised the issue of regulation of CT screening companies under the ionising radiation regulations, bemoaning the fact that the Royal College of Radiologists (RCR) was a weak organisation that failed to police private imaging companies. He or she had of course got completely the wrong end of the stick, as people so often do when slagging off their own royal college. The RCR, like all the other colleges, is an educational charity, not a trades union or a regulator. However, they do provide advice to the inspectorate which enforces the legislation, and I would be very surprised if they (the inspectors) don’t have private CT screening companies well and truly in their sights.

Tags:
Posted in Bob Bury | 4 Comments »

Weighing up the pros and cons of aping the BBC

By Bob Bury - 9th February 2010 9:57 pm

It has often been said that the NHS would benefit from being run by an independent corporation, rather like the BBC, at arm’s length from government. Well, the Tories say that’s exactly what they’ll do, a fact that I’ve referred to elsewhere, having previously been in favour of it myself.

OK, the BBC might not be the most inspiring example, given that it’s currently under fire from every quarter, not least from those same Tories, but the principle should be a good one, given that we spend most of our time complaining about the political micromanagement of healthcare.

And yet, and yet. The more I think about it, the less sure I am that it’s a good idea - it will all depend what sort of outfit this ‘NHS Board’ turns out to be, and the trouble is, I suspect we all know the answer to that question, don’t we? We’d like it to be composed of respected medical professionals (not necessarily medical politicians - in fact, specifically not medical politicians) plus the cream of the sensible NHS managers (yes, there are some - you know there are).

However, we’ll probably get saddled with a bunch of professional quango members - those benighted souls who move from one highly-paid  sinecure to another, having never experienced a proper job in their lives; a couple of politicans with a health connection (Frank Dobson, bless him, will be a shoo-in); a clutch of businessmen with good Tory cost-cutting (sorry, modernising) credentials and, if we’re lucky, a couple of doctors prepared to take the DoH shilling in return for a gong. And, oh yes, almost forgot, a few over-promoted nursing Dames who haven’t been near the dirty end of a patient in 20 years, but who have acquired certificates and diplomas in facilitation, process engineering and service improvement.

The worst case scenario would be if the Board is brought into existence simply to oversee the piecemeal selling-off of the NHS to the private bidder offering the cheapest deal. This is a process already well advanced under Nulabour, and anyone who thinks the Tories won’t continue, or even accelerate, the privatisation of health care learned nothing from the Ken Clarke years (and it is truly remarkable that those of us who were around then find ourselves looking forward to the return of a Conservative government - a testimony, if one were needed, to the sheer awfulness of Labour rule).

Just as I was putting the finishing touches to that last paragraph, David Cameron announced that one of his first acts on taking power will be to abolish the post of chairman of the BBC, so I think we all know who’ll be our new boss.

Cynical, moi?

Tags:
Posted in Bob Bury | 3 Comments »

Let’s have a bit more reality in advertising

By Bob Bury - 1st February 2010 9:48 am

They often say that the adverts on TV are better than most of the programmes and anyone who’s been watching the new series of Survivors would probably find themselves agreeing with that sentiment.

The adverts are changing though, aren’t they? Not so much the style, but the selection of things it’s deemed suitable to advertise. We’re all grown-ups, and have come to terms with having condoms pushed down our throats (sorry) at peak viewing time, but when exactly did it become OK to advertise female incontinence aids before the watershed? (It was only after I typed it that I realised how appropriate that last word was).

I know we don’t expect the commercials to portray life as it is actually lived, but those Tena Lady adverts take the biscuit. Some of you will be gynaecologists, so tell me: how many of your female patients with stress incontinence look anything like the slim, active, pretty, forty-something models who skip about in the adverts wearing light coloured tight-fitting trousers, coughing and laughing and demonstrating their liberation from the fear of embarrassing damp patches? I thought so.

They could try harder to be realistic. I think a good advert for these products would show the front row of the audience at a Ken Dodd concert. Not so many skipping, lithe models there. As they were reduced to helpless laughter by his merciless barrage of jokes, one by one their expressions would change from glee to mild concern to acute anxiety. One by one, they would stand and shuffle awkwardly towards the exit, occasionally shaking a leg.

The camera would then zoom in on the only one left, the lady in the middle seat, who was still able to chuckle, secure in the knowledge that although she might be starting to smell a bit uriniferous, any external leakage had been forestalled by the stout bundle of wadding firmly strapped into place before she left home. The voice-over could say: ‘Laugh like a drain without filling one’, or something similar. I’m wasted in medicine, me.

And note that I specified ‘female incontinence aids’ - when was the last time you saw an ad for a male incontinence aid? I suppose it’s just another example of the reverse gender discrimination that us chaps have to put up with. Mind you, it begs the question of what name you would choose for the male version - it would need to make it clear what the function was while still being sufficiently macho for men to want to go into a shop and buy it. Stallion Stay-Dri perhaps?

Ps. Look what I’ve just found - male ones do exist? So ,why do they only advertise the women’s version?

Posted in Bob Bury | 1 Comment »

“I’ll miss my collection of e-learning certificates”

By Bob Bury - 19th January 2010 5:15 pm

I’m beginning to lose count of the number of e-learning packages I have to complete every year in order for my trust to allow me to continue irradiating its patients.

There are the fire training and resuscitation ones of course, not to mention infection control and hand-washing instructions. I suppose the latter might be the first in a series of courses dealing with basic personal hygiene tasks, but there, I’m already one step ahead of them: I still have the training manual from my RAF days which offers an illustrated guide to going for a poo.

Admittedly, it was instructing us how to do it in a contaminated environment whilst wearing the all-encompassing NBC (nuclear, biological and chemical) protection kit - a nerve gas attack being a situation which might reasonably give rise to the urge to defaecate. I especially relished the illustration of the squatting squaddie captioned ‘remember to reach behind and pull your braces to one side’. I liked to think it had been written by someone who had once forgotten to do this, and had spent the rest of the day banished to the corner of an airless bomb shelter, shunned by his colleagues.

Anyway, where was I? Yes, e-learning. The latest one is on ‘safeguarding’ (quite a sensible word for the process of protecting children, so I’m not sure why the term irritates me so much). Because I seldom have direct dealings with children, and always in the company of other members of the team, I only have to do the basic package. This consists of looking at five Powerpoint slides which tell me that there are bad people who do things to children, and I’m to keep my eyes open for evidence of this. So I will. Lucky they told me.

Evidence of all this online instruction ends up in my appraisal folder, an invaluable document which is designed to stop me becoming ‘another Shipman’ (and Harold trained in Leeds, so you can’t be too careful - it could be something in the water).

I do like the way you can print off your own e-learning certificates. They’re already quite impressive, but I like to embellish mine with a bit of desktop publishing - a few wreaths of vine leaves, the occasional Latin inscription, a little star at the bottom with ‘distinction’ written under it.

My folder gets bigger by the year, and I’m growing increasingly proud of it. It certainly ranks up there with the best of my creative writing and I’m almost sorry that I’ll soon be retiring. Although, I suppose that when I’m at home with my lovely wife all day, performance appraisal, if not the need for documentation, will continue (there’ll certainly be a robust feedback process, albeit less than 360 degree).

And I suppose there’s also the possibility that the NHS scheme will be extended beyond an assessment of how clean and nice we are, to include tests of medical knowledge. Yes, perhaps it is almost time to go.

Tags:
Posted in Bob Bury | 2 Comments »

First they came for the outspoken doctors…

By Bob Bury - 11th January 2010 2:53 pm

You know that poem that starts ‘First they came for the communists, and I did not speak out because I was not a communist’ and ends with ‘Then they came for me and there was no one left to speak out’? Well, I’m feeling a bit like that.

I don’t know if you’ve been following the Simon Singh libel case, but this link to the excellent Sense About Science site will give the background to Simon’s problems with the chiropractors.

And having come for Simon, they came next for Dr Peter Wilmshurst. He was involved in a trial to test whether closing atrial septal defects using a device manufactured by the American company NMT Medical would reduce the incidence of migraine. The results of the trial were negative, and Dr Wilmshurst suggested several ideas to explain the findings, as a result of which he is now being sued by NMT.

Note that an American company are suing him in an English court, for a libel allegedly perpetrated in Washington. That’s because their chances of success in an American court would be significantly less, and because any settlement in an English court will be two orders of magnitude greater than in the States.

And then they came for me. Well, not me exactly, but as someone who edits a radiology journal, it’s getting uncomfortably close to home. They (General Electric Healthcare in this case) actually came for Dr Henrik Thomsen. He now faces financial ruin as a result of remarks made to a small number of radiologists at a meeting in an Oxford hotel, as outlined in this recent Sunday Times story.

In addition to selling MRI contrast media, GE are one of the big three or four manufacturers of imaging equipment, and decisions on which CT, MR or PET/CT scanner to purchase are frequently very finely balanced, being swayed by such apparently minor factors as a recent bad experience with the servicing of existing equipment by a particular company.

However, GE have clearly decided that pursuing a radiologist for an alleged libel only heard by a handful of his contemporaries makes commercial sense, so we must assume that they consider Dr Thomsen’s remarks to be far more damaging than is suggested by media reports and the recollection of radiologists who were present at the meeting.

Still, the Sunday Times editorial was supportive, and it now looks as if the campaign to reform libel law is getting somewhere, with Jack Straw professing to see the need for change.

Something is badly wrong when researchers and editors are afraid to publish and comment on the results of research, just because the libel laws in this country favour the interests of big business over those of individual scientists.

Having read the background to this on the Sense About Science site, I hope as many of you as possible will follow the embedded link to sign the libel law reform petition.

Tags:
Posted in Bob Bury | 12 Comments »

Newbies won’t know their arses from their elbows

By Bob Bury - 7th January 2010 2:29 pm

I said in my blog last time that I’d probably be acting the old curmudgeon (love that word) so this week I’m on the government’s case about its half-baked scheme to make nursing training all degree level by 2013.

Before Christmas, Hospital Dr editor Mike Broad referred in a blog to a letter I wrote on the subject to The Times. There were other letters in The Times - several from nurses - making the same point and only one opposing voice, that of the President of the RCN (as you might expect, given that the driving force for the change is the hankering of RCN apparatchiks for more professional status).

While Mike described it as an “interesting” letter, he had the temerity to disagree with its main premise that mandatory degree entry was a bad thing.

However, the week after my letter this article appeared in the same paper, confirming the fact that degree training is not appropriate for many of those who currently enter nursing, and that making it mandatory will only exacerbate the shortage of nurses in the UK.

I also know that I’m right because I recently discussed the issue with the only two people who can hold a candle to me when it comes to curmudgeonliness - my wife and daughter. Lin is a retired midwife and school nurse, and my daughter Kate is a practising midwife (yes, I share my house with two ‘madwives’ - I’m not going for the sympathy vote or anything but…).

Anyway, Kate was bemoaning the fact that trainee midwives get so little practical experience on the wards now and I was saying that it’s getting that way with medical students.

This set Lin off reminiscing about the days when we met at the Central Middlesex in the early seventies, and how there were so many medical students and junior doctors on the wards that the student nurses would often latch on to the informal teaching that was going on, or even buttonhole an SHO and ask them for a quick tutorial on something they were finding difficult to understand. And, of course, both the nurses and medical students were doing stuff as well as listening; they were acquiring the practical skills that were essential to their respective roles. Not any more, it seems.

We’ve become familiar with the concept of qualified nurses who can’t wash a patient’s dentures because they haven’t done ‘the course’, and we seem to be going down the same path with medical training. For example, as far as I can tell, today’s medical students don’t learn any anatomy - I expect they’re all too busy with their empathy workshops - and we risk producing doctors who are lovely little communicators but who don’t have anything useful to say.

It really worries me that, just when I’m likely to start needing medical attention myself, the doctors providing it will, literally, not know their arse from their elbow.

Tags: ,
Posted in Bob Bury | 8 Comments »

Writing blogs when wearing rubber pants

By Bob Bury - 30th December 2009 2:17 pm

Hello, it’s good to be here. No, really, it is. I was sorry to see the print edition of Hospital Doctor fold in 2007. It was the only topical and occasionally light-hearted magazine for hospital doctors (unless you count the BMJ, but I’m never sure if they mean to be funny).

GPs still had Pulse and GP, but us toilers at the secondary care coalface had nowhere to go for a bit of news, comment and light relief, so I was glad to see we have an online successor to the old redtop.

I was even happier when asked if I’d like to contribute. I’m now approaching the bottom of the inexorable downward spiral that ends in retirement, rubber pants and driving very slowly in the middle of the road, and I’m going to need something to keep me occupied when I finally stop working. It’s either this or start talking to the wife, and I fear that a sudden burst of conversation might be a bit of a shock for her after 37 years.

So, anyway, I had a look at the other contributors to this section to see what sort of stuff I was going to be expected to produce and, frankly, to assess the competition. You’ll have noticed that I’m a radiologist and, being perceptive people, you’ll also have noticed that at least one of the other bloggers is similarly afflicted: the one I’m thinking of is Sarah Burnett-Moore.

Now this gives me a bit of a problem - not the fact that she’s a radiologist - but the fact that she’s Sarah Burnett-Moore. I was hoping to adopt the role of class clown, but Sarah’s funnier than me (I was going to say even funnier than me, but I don’t want you to think I’m full of myself, not on the first date).

I know she’s funnier than me because she occasionally contributed to the RCR newsletter when I was editing it and it really used to irritate me. And there’s a witty anaesthetist to contend with as well, not to mention all the other erudite contributors. So, I might be reduced to casting around for a serious topic occasionally, but luckily there’s no shortage of those at the moment.

I should probably warn you that contributions in subsequent weeks are likely to contain more than their fair share of variations on a ‘things are not what they used to be’ theme. That’s because they’re not, and I’m old. Deal with it, as our American cousins say.

Sorry, that sounded a bit abrupt. I’m not like that…really, I’m not. As I hope you’ll find out, if I can think of anything to write about.

Posted in Bob Bury | 1 Comment »