Bob Bury

Bob Bury recently retired as a consultant radiologist in Leeds

Forget the Bill, death is this week’s big subject

By Bob Bury - 3rd February 2012 1:21 pm

I bet you thought I wouldn’t be able to resist my pledge not to write about THE BILL any more, given the fact that Lansley is on the run, and that our College has ignored the craven capitulation of the Academy of Medical Royal Colleges, and stuck to the original stongly-worded statement of opposition that the AMRC retracted after late night phone calls from the increasingly desperate politicos. You did, didn’t you - especially after today’s call by the RCGP for withdrawal of the Bill?

Well, you’d be wrong - I’m not going to mention any of that. I’m not even going to lambast the surgeons for their self-serving toadying up to HMG - Jerry Nelson says all that needs to be said about their motivation. No, I thought I’d talk about death.

I’ve been thinking about it quite a lot recently. Not just because I’m getting older, and have recently acquired a proper illness for the first time in my life (yes, much better now - thanks for asking), but because during the past year I trained with the British humanist Association (BHA) to become a humanist celebrant, officiating at non-religious funerals. It may seem like an odd thing to take up in retirement, but it actually turns out to be very challenging and rewarding job.

And when you think about it, it’s a natural extension of a medical career. We deal with patients and their relatives at a very fraught time in their lives, and some of the patients die (although not all, hopefully, even in my hands). This means that we are used to talking to relatives and helping them to cope with worry and distress. When I did the training course, I realised that this gave me quite an advantage over some of the other trainees, who were coming from backgrounds that didn’t bring them into contact with people in the same way (one exception, I suppose, being the young metropolitan policeman on the course).

That’s not to say that the training was easy. I had naively assumed that the public speaking aspects of the job would be a bit of a doddle. After all, I had spoken at numerous medical meetings and conferences, and had also done quite a bit of after-dinner speaking. When, early on in the training, it became clear that the trainers were assuming that we would all prepare written scripts for our ceremonies, I was quietly contemptuous.

What did I need with a script? I had never read from a script in my life - I’d just wing it, like I always did. But of course, they were right. You can’t afford to make mistakes; you only have a short time to meet the family, get all the information about the deceased and produce a eulogy. I suddenly realised that this was much more important than any other speaking engagement I had undertaken. If I made a mess of a presentation at UKRC, it didn’t really matter - no one died, as they say. Well, here someone had died; this was the only funeral the family would have, and I had to get it right.

I actually almost gave up the training at that point. I’m glad I didn’t, but it’s a fact that I get much more nervous before a funeral than I ever did before the biggest conference presentation. It has been a privilege, though, to go into people’s homes and hopefully to be able to help them through a very difficult few days. I’ve been impressed by the dignity and courage of the bereaved relatives and friends, not least in a recent case of the sudden death of a 56-year-old man from a sub-arachnoid heamorrhage.

In an odd way, it makes me more sanguine about the possibility (or I suppose that should be certainty) of my own demise - I think I can see my own kids behaving like that relatively young man’s sons - not being afraid to shed tears on the day, but still producing an affectionate yet witty eulogy, and then getting on with their lives.

As for why I became a humanist after forty plus years as a card-carrying member of the C of E, well I didn’t. Like most humanists, I just suddenly discovered that I already was one.  And yes - I am planning my own funeral. It’s going to be a cracker, but I hope to keep you all waiting for a while yet.

Posted in Bob Bury | No Comments »

Why the ridiculous deadline on additional funding?

By Bob Bury - 12th January 2012 10:53 am

OK, now listen to this because you couldn’t, as they say, make it up.

You know how much pressure we are under to cut costs and rationalise services in light of the current austerity programme, don’t you? And you will have noticed that your pension contributions are increasing at an eye-watering rate, and that your money is being poured into the black hole of NHS finances rather than salted away to fund future pensions, as has been the (mal)practice of successive governments?

Knowing all that, you will be as delighted as I was to learn that Andrew Lansley is indulging in one of those old end-of-year mindless spending binges that we hoped had become a thing of the past.

As I discovered when I dropped in to work today for one of my twice-weekly locum sessions, and as reported in the Health Service Journal a few days ago, trusts (well, a few of them) have been told that there is a capital sum of £300m available - that’s 6.7% of the total available for the year - and that the DoH is inviting bids against it. The closing date for those bids - which must be for at least £5m? The 12th of January. That’s right - today. Although NHS London sent a letter announcing the bonanza on 23 December, many others have still not been informed about the end of year (?closing down) sale.

A colleague in Leeds first heard about it from a representative of one of the leading manufacturers of radiology equipment, who was asking if we would be directing any of the largesse their way. Well, we could easily spend four or five million on a PET/MR scanner, or a cyclotron for our existing PET/CT scanners, and even justify it to ourselves, but is this any way to allocate scarce resources in the middle of a funding drought?

This is just another example of crass incompetence at the highest level in Whitehall. How can they seriously expect trusts to produce fully-costed business cases for expenditure of this magnitude in a few days? Also, of course, many PCTs and trusts seem to know nothing about it even now, and so any distribution which does occur will be seriously skewed. It’s a recipe for waste on a grand scale in a department of state that has already set records for profligacy with its failed connecting for health programme.

As one of the PCT directors interviewed by the HSJ put it: “Get your bids in by 6 January for schemes that must be over £5m, preferably spent by end of March?…We haven’t seen this kind of thing in about 10 years. The ‘use it or lose it’ at short notice mentality went away for a long time. Seems it’s back.” Back indeed, and with a vengeance.

If you wonder how Lansley will explain this lunatic behaviour, wonder no longer. A DoH spokesperson said: “Thanks to good management of central capital budgets, we have identified capital funding which could be made available to the NHS. We are now in discussions with the NHS to see how it could best be spent“. So there you have it - contrary to what you had been thinking, this is an example of good management. As, presumably, was Liverpool’s purchase of Andy Carroll for £35m and £80K a week (and at least he has put the ball in the back of the opponent’s net on four occasions, whereas Lansley only seems capable of scoring own goals).

It’s difficult to know if the delayed and ‘hole-in-the-corner’ way in which the information concerning this fund was released is a deliberate attempt to keep bids against it to a minimum, or just another example of administrative incompetence. However, the fact that one half of the DoH apparently didn’t know what the other half was doing would tend to favour cock-up over conspiracy - in the early afternoon of 5 January the DoH spokesman denied that any such fund existed; later that same day they confirmed that Lansley had indeed authorised the release of the cash. Presumably at some point he will blame Nick Clegg.

What a bunch of wasters (no - literally).

Tags: ,
Posted in Bob Bury | No Comments »

Don’t mention the Bill, I think I mentioned it once…

By Bob Bury - 22nd December 2011 4:13 pm

I have to start by apologising to any of you who haven’t received the goods you ordered from Amazon (or FedEx or any of the other delivery services). That will be because all of their operatives have been diverted to Leeds to deliver the Christmas gifts ordered by my wife. This is the first Christmas where pretty much all of our (her) gift shopping has been done online, and it’s also the first one since my retirement, so I’ve been around to witness the steady stream of parcels arriving at my front door (or dumped near the back door or in the grandchildren’s Wendy house when we are out).

I realise that all the women reading this will be nodding to themselves and saying, “at last he appreciates all the work his wife puts into making Christmas happen”, and they’d be right. I mean, I knew all about the food preparation and cooking that goes on in the lead-up to the 25th, and on the day itself, but the presents for the kids and grandchildren gradually accumulated in the spare bedroom almost without me noticing.

It’s not that I don’t appreciate it, and I do my bit to contribute, as a New Man, by getting the wine up from the cellar and opening it as required. I even help out with drinking it if my sons look like flagging (not that they ever do). I have found myself getting a bit Grinch-like though, as the doorbell rings yet again, and I ask myself just how many toys a five year old can be expected to play with at any one time. I’m also concerned that on Christmas Day even our large family house will struggle to accommodate two tricycles, one child-sized police car, a little girl’s pink car of similar size (she wanted pink - we’re not imposing a gender stereotype), all the other presents, me and the wife, one mother-in-law, four children, four grandchildren and two dogs.

But it will all be lovely, and I’m looking forward to it as much as ever. The commercialisation thing is actually less of a problem for me, as a Humanist, than it is for the believers - I’m just celebrating the passing of the shortest day and the approach of Spring - although I’m now at an age where I get justifiably nervous about seeming to wish my dwindling amount of time away. You do have to wonder just how much the move to online buying will change the face of our towns and cities though.

Despite that first paragraph, I did get dragged in to the present buying from time to time in the old days, and there’s no doubt that browsing online then having purchases delivered to the door is vastly preferable (at least for me) to trailing around cold, damp streets and failing to find what you were looking for. It’s alright Mary Portas going on about re-designing our High Streets, but you almost begin to wonder if shops as we know them will survive at all - and that includes the out-of-town malls that she sees as the destroyers of our town centres.

I could go on to draw an analogy with changes in healthcare, quoting increased patient choice, plurality of provision and the increasing role of the internet, but frankly, it would all be a bit laboured, and I can’t be bothered to make the effort when there is still a turkey to be stuffed (that’s my other contribution to the Christmas effort - using my surgical skills to define a plane of cleavage between skin and muscle, and fill the space with sausage meat…mmmmmm).

Anyway, I think I’ll save my “stocking and one main present” suggestion for another time, and just enjoy watching the little ones having more fun with the wrapping paper than they do with the mountain of discarded toys. In fact, I suspect that raising this issue with the family might produce much the same response as if I took this advice from the National Obesity Forum and cautioned austerity during Christmas lunch. So here’s wishing you all a Happy Christmas (or Winterval or Hanukkah or whatever). And although none of this is humorous, I have at least kept my promise of last time not to mention Andrew Lansley and his bloody Bill…whoops.

And batteries. Must remember to buy lots of batteries.

Posted in Bob Bury | 1 Comment »

The last word on the Health and Social Care Bill

By Bob Bury - 5th December 2011 12:06 pm

Remember the Darzi centres (or khazi centres, as they rapidly became known to the Unbelievers)? These were the walk-in surgeries championed by Lord Darzi in his much-trumpeted review of the NHS. They were designed to give patients, particularly commuters, easier access to GP services - patient choice being, of course, the paramount concern.

Now, you may recall that a lot of people, well, pretty much everyone really, pointed out that duplicating provision in this way by insisting on setting up these centres even in areas which were already well-provided for by GPs, ‘nice’ though it might be, wasn’t perhaps the most sensible way to use resources which were already overstretched. But New Labour had the bit between their teeth, and clinics mushroomed across the country, including my home patch of Leeds.

Now they are closing them down.

I would pose the rhetorical question ‘why’, but it hardly needs asking. When walk-in clinics in the South were being closed earlier this year, the associate director of communications and engagement (sic!) at the relevant PCT explained the issue very simply: “The majority of patients who have been using the centres could quite easily have used another service…they created a demand which wasn’t there before.” In other words, exactly the problem which was predicted when the centres were first mooted.

The story was the same in Leeds - only 20% of the people passing through the doors of the new centres were the commuters for whom the service was designed, and most patients were already registered with GPs in the area.

You could, of course, make exactly the same point about NHS Direct. This too was the result of focus group politics and blind acceptance of patient choice as the appropriate parameter for determining resource allocation (and if you ask people whether they would ‘like’ to be able to ring someone up to ask if they needed to see the doctor or not, they’ll naturally say “yes”). No matter that anyone with significant symptoms will be told to go to the GP or nearest emergency department anyway, and that providing the service will take hundreds of highly-trained nurses away from the front line of healthcare provision, where they are sorely needed.

The patients have what they want, and their votes are assured. That’s the important thing.

And of course, we now have the Health and Social Care Bill, which will open up healthcare provision to ‘any qualified provider’, and ensure a free-for-all which will fragment the service and result in yet more wasteful duplication, making the essential coordination between services much more difficult or non-existent. Just as the last government were warned what would happen if they set up their new clinics, Andrew Lansley has been told what will happen if his Bill comes into effect. They didn’t listen, and nor will he.

Still, never mind. The patients will have chosen, and Mr Darzi has his peerage, and has retired (I assume) back into the relative obscurity of his surgical career. So all’s well with the world.

As Mr Jerry Nelson would say - arse! And I promise you, that’s (probably) my last word on the subject of The Bill, and it’s the appropriate word.

Tags:
Posted in Bob Bury | No Comments »

Reveal the risks of implementing the Health Bill

By Bob Bury - 17th November 2011 11:18 am

Well, here we go again. As Circle come riding to the rescue of the struggling Hinchingbrooke Hospital, we learn that their risk exposure is to be limited to £7m, which equates to approximately 0.7% of the NHS funds it will be responsible for over the term of the contract. Any surpluses they make will be split between Circle and the NHS.

Sound familiar? It should, because it was the estimate of ‘risk’ that was used to make the now discredited PFI initiative of the previous government look so attractive. By artificially inflating the level of risk to which the companies tendering for contracts would be exposed, the politicians made the business cases for PFI stack up. Of course, it turned out that these contracts were not actually very risky at all, which is why companies were able to make profits from building the new hospitals and then make another load of dosh by milking the NHS for the next 30 years as they maintain the buildings.

In fact, the risk was actually so low that a secondary market in PFI contracts sprang up, with quite a few firms taking the profit from putting the buildings up, then selling the contracts on for another fat profit to other providers who still felt able to get a good return on their investment from managing the PFI estate.

I suppose we should be grateful that this time the politicians are at least being up front about the way they are skewing the rules to the advantage of the private sector, but it does indicate that in their rush to involve new providers, the playing field will be far from level.

Still, no-one could accuse Andrew Lansley of being ‘up front’ in his attempts to get his pernicious Health and Social Care Bill through the Lords. Despite being ordered by the Information Commissioner to reveal the contents of the strategic risk register relating to the Bill, he is still stonewalling, on the grounds that publication of the report would ‘jeopardise the success of the policy’.

Well, quite. In other words, Lansley knows that the report, which details the risks for the NHS of implementing his changes, will confirm that the fears many of us have are well-founded, and might just lead the Peers to vote it down, or insist on root and branch amendments. Actually, now I think about it I’m wrong. He is not just being up front, he is being frankly shameless by effectively admitting that he can only get the Bill through if he stifles any debate on its likely adverse effects.

I hope readers will join me and many others in emailing their MP and asking them to tell Lansley to comply with the commissioners demands to release the report. It’s easy - just click here.

And to think it was only 18 months ago that we were hugging ourselves in relief that we’d got shot of New Labour. They really are all the same, aren’t they?

Tags: , ,
Posted in Bob Bury | 4 Comments »

Stop giving educational funds to private firms

By Bob Bury - 1st November 2011 12:16 pm

As the Editor points out, revalidation isn’t going to go away, and it’s difficult to argue against the need for some demonstration of continuing fitness to practise in a job like ours. But our masters do seem to be going out of their way to screw up the implementation of the scheme.

For a start, if revalidation is genuinely about avoiding problems before they occur, and ensuring that we all keep up-to-date with developments in practice, then postgraduate education (PGE) and continuing professional development (CPD) is clearly the key to success. So you would think that the Department of Health would ensure that the systems for delivering PGE were in robust good health, wouldn’t you? You would, of course, be wrong. The deaneries are doing a headless chicken act to rival that of the SHAs and PCTs - all thrown into disarray by the disaster in waiting that is the Health and Social Care Bill.

You might also think that PGE funding would need a bit of a boost, if we are to start taking CPD seriously? Not a bit of it. The government are, instead, throwing the current education budget down the commercial drain in order to make their ill-conceived changes to commissioning a reality. The Hansard report of the Lords’ debate on the Health and Social Care Bill is illuminating. In his contribution on 11 October, Lord Rea, in pointing out that the Bill was likely to increase rather than reduce costs,  stated:

“Clinicians in the proposed clinical commissioning groups will find that commissioning is a highly complex task. They will need the assistance of experienced administrators, statisticians and public health specialists, as well as competent clerical support… A freedom of information request revealed a list of 40 organisations, most of them private, which have been invited to bid for contracts to train GP consortia, now clinical commissioning groups. For this role, in London alone, £7 million has been allocated for the initial phase, taken from funds originally allocated for postgraduate education.”

In other words, public funds earmarked for medical postgraduate education are being diverted into the pockets of an array of private companies in order to train the new commissioning groups, despite the the fact that the people who have actually been doing the commissioning via the PCTs and SHAs are currently in limbo, wondering how much longer they will have a job.

All the necessary expertise is there, but the government are insisting on giving the money that should be funding our PGE to their mates in the private sector.

This, in microcosm, tells us what to expect across the health service if the Bill passes, as services are fragmented and unnecessarily duplicated. The only winners will be the entrepreneurs, further evidence, were any needed, that a free-for-all in healthcare provision leads to inefficiency and waste. The royal colleges tell us that they are fighting to maintain their leading role in medical education. I would be more convinced if I heard them making a fuss about this misappropriation of the education budget.

I’m going to try to avoid mentioning the GMC this time, I don’t want to get boring on the subject.

Except to say (sorry), that Hospital Dr’s Editor sees “scant evidence that the GMC is winning the profession’s hearts and minds”. That’s an understatement on a par with Socrates’ dying comment that the wine tasted “a bit off”. And since I’ve started, I’ll just mention the fact that, having asked the public whether they thought the private lives of doctors were any concern of patients or the GMC, and been told by 94% of respondents that the answer was “no” (see previous blogs), our regulator has decided to ignore the result. This was apparently an ‘informal’ consultation (utilizing Facebook, if I remember correctly), and they now tell us: “given the very large response to this question, the GMC have decided to ask a specific question about doctors’ lives outside medicine in its formal consultation”.

In other words, they’ll just keep asking the question until they get the answer they want. And the really depressing thing in all of this? I can’t remember the last time I wrote a humorous contribution to these columns.

Bugger.

Tags: ,
Posted in Bob Bury | No Comments »

How would Fox be judged by a medical regulator?

By Bob Bury - 12th October 2011 12:40 pm

I expect you’ve all been following the Liam Fox affair. I can’t help wondering how differently things would have been handled if he had still been working as a GP, rather than secretary of state for defence.

Let’s see now. He appears to have involved an old chum in numerous high-level meetings and trips abroad, a number of them involving defence procurement, an area in which said chum is alleged to have a conflict of interest. Mr Werritty seems to have given everyone the impression that he was acting in an official capacity as an adviser, and it’s not clear if Dr Fox did anything to dispel that impression. The waters have been further muddied by the revelation that he only appears to have earned £20K over the past four years from the consultancies that are his only declared means of support - not that we should draw any conclusions from that, of course.

What this all seems to amount to is a staggering lack of judgement - political judgement - and in someone with a reputation as an astute political operator, that’s surprising. Not only that: his actions were also, according to the commentators and senior civil servants involved, ‘wrong’, and in breach of ministerial guidelines.

I’ve been trying to think of the equivalent offences in GP land, and it’s the ‘C’ word that keeps coming to mind - confidentiality. Dr Fox’s behaviour seems to have ridden roughshod over any consideration for security and proper accountability, and when we’re talking about national defence, defence procurement and meetings with heads of state under suspicion of crimes against humanity, this would seem to matter.

What’s the equivalent of the ministerial guidelines? I suppose that would be the GMC’s Good Medical Practice. So what I’m wondering is: would the president of the GMC still be expressing complete confidence in me if I had systematically breached confidentiality and flouted his guidance on being a good doctor? There again, perhaps we should be grateful that more is demanded of us than of politicians; I’m just not sure why that should be the case, though.

Now of course, we don’t know everything yet, but from the facts we have so far, those which are undisputed by Dr Fox and for which he has apologised, it’s difficult to see how he can carry on in his ministerial role. Which may be a pity - doctors who know him say he’s a thoroughly good chap, and the MoD certainly needs a strong hand on the tiller (although I’m not sure it’s a good idea to dismantle our armed forces to quite the extent demanded by the recent strategy reviews). But in this context, being a good bloke may not be enough - time will tell.

There’s another parallel with medicine. In all of the coverage, a recurring theme in defence of Dr Fox is that he has certainly been guilty of poor judgement, but hasn’t actually done anything corrupt or improper. Which got me wondering again. If I was forced to choose between a doctor with impeccable morals but poor judgement, and one whose personal behavior was a bit iffy but whose judgement was spot on, I suspect that where my own health was concerned, I’d choose the one whose judgement I trusted.

I suspect the same might be true for defence secretaries. Or not, but it does merit some thought.

Posted in Bob Bury | 6 Comments »

Apparently doctors might have a useful purpose…

By Bob Bury - 27th September 2011 12:21 pm

I don’t know if you’ve noticed, but the last few weeks have seen a number of reports in the medical and lay media that seem to be leading to a rather startling conclusion. Namely, that dumbing down in healthcare provision is widespread and may be a bad thing. It may even end up with the frankly bizarre suggestion that doctors have a useful purpose to serve.

But let’s not get ahead of ourselves. We’ll start with The Times’ report on the issue of the poor quality of nursing in our hospitals (I’ll link to some of those reports, but only those of you contributing to Mr Murdoch’s pension fund will be able to access them). It began with the now customary and justified complaint that nurses spend too much time in the classroom and not enough on the wards learning how to look after patients, with even Peter Carter, President of the RCN joining in the condemnation.

This then morphed into an argument that there weren’t enough qualified nurses on the wards because cash-strapped trusts have been replacing them with an army of health care assistants (HCAs) who now undertake most of the jobs traditionally performed by nurses, a move which today’s Times headline trumpeted as ‘a disaster in waiting’.

We’ll pause there for a moment to allow you to savour the image of nurses complaining about the usurping of their role by less highly-trained workers. There - you enjoyed that, didn’t you?

Incidentally, the first of those articles prompted a letter from someone asking why, if this decline in nursing standards had been going on for so long, the doctors hadn’t spoken out against it. I couldn’t be arsed to reply that we had, and that I, for one, had had a letter in The Times stating that we were raising a generation of nurses more at home with a clipboard than a bedpan. And of course the result of letters and articles in that vein, coming from doctors, is the accusation of arrogance and elitism - usually from nurses. As is so often the case, we’re damned if we do, and damned if we don’t.

Which would bring me on to skills mix, and the rise of the ‘practitioner’, but we’re all sick of reading diatribes about noctors, and the arguments for and against have been rehearsed at tedious length here and elsewhere. For what it’s worth, and at the risk of repeating myself, I believe that role extension, properly instituted and monitored, can rationalise the use of highly-trained staff and improve the service. I have even been actively involved in the training of radiographer practitioners who fulfill a very useful role in many of our imaging departments. There’s no doubt, though, that this whole process is now running out of control, driven by managers hell-bent on cutting costs, with no regard for quality of service or patient safety.

And then we have the recent report on the capital’s health services, telling us that more consultants are needed to cover junior staff, and that this could save 500 lives a year. In other words, from top to bottom, we are seeing a downshift in the grading structure of NHS staff, with an over-reliance on less highly-trained, and cheaper, staff. And this can only get worse as Lansley and Cameron drive through their ill-considered ‘reforms’, fragmenting the service further and exposing it to the wholly commercial motives of ‘any qualified provider’.

But as I say, if you follow the HCA/nurse argument up the food chain, it does at least look as if there may eventually be a grudging admission that doctors have some small contribution to make to the health of the nation. Which would be nice.

Tags: ,
Posted in Bob Bury | 2 Comments »

Just when I thought the GMC couldn’t sink lower…

By Bob Bury - 13th September 2011 2:34 pm

I seem to recall using the words “just when you thought the GMC couldn’t sink any lower” in one of these blogs some time ago. Well, here we go again…

Concerned that they don’t already have enough sticks to beat us with, they have now launched an exercise in which they seem to be trawling the public to come up with even more ways in which doctors can be held to account - this time for their private beliefs and behaviour.

Sol Mead, chair of the Academy of Medical Royal Colleges’ Patient Liaison Group tells us: “I would be unhappy with a doctor supporting a racist organisation, advocating religious fundamentalism, or being part of an organisation promoting conflict.”

Well thanks, Sol, but it’s actually none of your business what I do or don’t believe, nor is it my job to make you happy. For what it’s worth, I’m an atheist and yield to no-one in my disregard for religious fundamentalists of any stripe, but my GP’s beliefs are no concern of mine unless they have a negative impact on the quality of treatment I am offered, in which case sanctions already exist to deal with the problem.

By the same token, it should be no concern of yours if I sympathised with the BNP*, and as for “organisations promoting conflict”, would that include membership of Unison? You see, it’s difficult to know where to draw the line, isn’t it, so it’s probably best to keep your unhappiness to yourself.

In fact, Sol, it wouldn’t even matter if I were a rural GP with ovinophilic tendencies, as long as I was careful about personal hygiene and didn’t bring my sheep du jour into the surgery with me.

Reaction on medical forums has been predictably hostile. Doctors are getting pretty fed up with the GMC acting as agents provocateurs, stirring up the public into a froth of indignation concerning the potential proclivities of their medical attendants. Fortunately, they are asking us to respond to the exercise, and many of us have taken the opportunity to do so. Some of those responses have been couched in terms which would doubtless result in more unhappiness for Sol, but that simply reflects the degree of discontent with the GMC expressed by most doctors that I speak to.

Of course, I acknowledge that doctors still (just) occupy a position of trust in society, and despite the attempts of politicians to turn us into wage slaves we are still a professional group with an obligation to act professionally. In our public behaviour, which these days includes anything we say on Twitter, Facebook or blogs like this one, we need to avoid comment that would, to use that slightly pompous phrase, bring the profession into disrepute. That’s very different from saying that my private behaviour and beliefs should be the concern of the GMC or anyone else.

* I don’t - my tattoo/teeth ratio is <1

Tags:
Posted in Bob Bury | 20 Comments »

Looking beyond the headlines on the box

By Bob Bury - 31st August 2011 9:51 am

Well, I thought someone else was sure to write about this, but they haven’t.

Were you as alarmed as me to see the headlines telling us that every hour spent watching TV reduces your life expectancy by 22 minutes? It wasn’t the content of the headline that alarmed me, it was the knowledge that if I read further, I would find yet another example of dodgy ‘research’ and shite journalism which would raise my blood pressure to a dangerous degree, but that I would have have to read it anyway. And so it proved.

The Australian researchers had analysed the results of a large population lifestyle study (the Australian Diabetes, Obesity and Lifestyle Study), looking at data collected between 1999-2008. They concluded that watching six hours of TV a day reduces life expectancy by 4.8 years, compared with freaks who don’t watch any TV (I wonder how many of those there were? I don’t know because I could only be arsed to read the abstract).

Now that’s bad enough, given that if you’re watching TV you clearly aren’t taking exercise at the same time, unless you’re tuned in to the porn channel. If you watch six hours a day, you probably aren’t taking any exercise at all, other than trips to the fridge for more beer during the adverts, and that can’t be good for you, can it, regardless of whether you’re looking at the TV or at the empty space in the corner where any right-thinking person would put a set ?

I can’t believe that they isolated TV-watching as an independent variable, unless they had a large control group who watched no TV, but also took no exercise and had a rubbish diet. And even if they did, there’s another aspect of the results that wasn’t reported in The Telegraph (shame on you) or Mail (to be expected). If you look at the confidence limits (or the uncertainty interval as they call it, in line with recent trends), you get some idea of their data quality. That 4.8 hour figure has a 95% uncertainty interval of 11 days to 10.4 years. In other words, the TV effect could be bugger all or a decrement of a decade.

If we read a paper on the effects of a new drug with that degree of uncertainty, NICE would want to wait for a bigger, better study before approving it. Still I suppose that trying to explain confidence limits to a Mail reader would be a pretty thankless exercise.

They then piled uncertainty on uncertainty by producing that meaningless 22 minute figure. They must have known that this would be the number that appeared in the headlines. Of course, what they are saying is that if six hours per day in front of the telly has the effect they claim, then each hour of viewing would be responsible for 22 minutes of life lost for that particular cohort of sad losers. What it doesn’t mean is that if a slim, normotensive paragon of lifestyle virtue like myself sits down for an hour to watch an improving documentary on BBC2, I’ll be scything 22 minutes off my natural span. But that will, of course, be how it is interpreted by most readers.

As Jerry would say, what a load of arse!

Tags:
Posted in Bob Bury | 2 Comments »