Bob Bury

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

Playing ‘pooh sticks’ will never be the same again

By Bob Bury - 31st August 2010 9:10 am

Being of a ‘certain age’, I have just received my faecal occult blood testing kit as part of the colorectal cancer screening programme. I must say, it’s all very well put together, with little spatulas and a set of intructions so simple and clear that a gynaecologist could follow them. It does feel odd, though, to find yourself examining your own motions for the first time in 62 years. It all seems a bit, I don’t know…French. And the next time my little granddaughter asks if we can play ‘pooh sticks’, I’ll get a mental image of those spatulas.

Actually, I’m almost hoping that the test produces a (false) positive result, so that I need a colonoscopy. I had to have one a few years ago (false alarm - diverticular disease), and I really enjoyed it. No, don’t get me wrong. It wasn’t the ‘oscopy itself, it was the drugs - pethidine and medazolam…mmmmmmm. Although I was at medical school in London during the swinging sixties, the free love/drugs thing passed me by completely, and the only drug-induced highs I have ever experienced have involved being pissed, and even then, I just tend to get maudlin and start showing people pictures of my kids. The old i/v sedation though, that was something else. I didn’t notice the procedure itself, and if the gastroenterologist had seen something interesting down the scope and had decided to crawl in himself to get a better look, I don’t think I’d have noticed that either. My wife, who drove me home, tells me the stupid grin (mine, that is) lasted for several hours. I can quite understand how that sort of thing could get addictive, he said, stating the bleeding obvious.

Still, it’s good to have a national screening programme that involves men as well as women, I’d begun to think we didn’t count. Is there a ribbon for colon cancer, and if so, what colour is it? Still mustn’t get on to the subject of ribbons just now - that’s a whole rant in itself, and could be a useful filler for one of these blogs if I find myself without a topic.

And this inconsequential contribution has taken so long to complete, that the result of my screening test has, improbably, been posted back to me in less than a week. And it’s negative, which means I’ll have to look elsewhere for mood-altering substances. And of course, now I’m thinking to myself ‘it’s only a screening test though - with a 75% sensitivity, you could still have cancer’. Lucky old patients - they are happy when they get the ‘all clear’. Too much knowledge, and all that.

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Was Thatcher the Milk Snatcher right?

By Bob Bury - 10th August 2010 4:23 pm

So, they’re not going to snatch the milk from the hands of our under fives? Well, that’s nice. But why the U-turn? Well, it’s because Dave ‘doesn’t like’ the idea, and also because the free provision ‘dates back to the war’. Jeez - I guess that means we can anticipate the return of powdered egg and Woolton pie to our national diet.

We’re told that nothing is sacred in the search for financial savings. Except that it now seems that some things are actually sacred - namely, any savings schemes that Dave ‘doesn’t like’ or decisions to cut anything that has ‘been around for a long time’. In the case of homeopathy, the saving grace seems to have been the fact that lots of people ‘find it helpful’ (and of course, the nutjob P of Wales likes the odd slug of arnica when he isn’t talking to flowers, so that presumably won’t have done the homeopaths any harm).

Does anyone else see the link between this craven publicity-seeking, and last week’s intemperate rant against homeopathy? Yes, that’s right, it’s the evidence-based thing again. Is there any actual evidence that giving young children a bottle of milk every day improves their nutrition of general health in any way? No - that’s a genuine question. My instinct is that there isn’t, but no doubt one of you will tell me if I’m wrong.

It might have been different 50 years ago, but these days kids should be getting everything they need from their diet without supplementary milk. And yes, of course I know that some parents feed the fruit of their feckless loins on crap, but I don’t see how giving them a third of a pint of fat-laden calcium solution every day until they are five will mitigate significantly against the effects of the rest of a childhood spent consuming turkey twizzlers and Vimto, graduating to deep-fried pizza and Tennents Super when adolescence kicks in.

So, milk, homeopathy, it’s all the same. If someone, somewhere, whose opinion the politicians regard as important (like a voter, or an heir to the throne, for example) thinks that something is a good thing, it won’t be cut, no matter how little evidence there is for its worth or how much money we waste on it. Actually, I hope one of you does write in saying that there’s good evidence for the positive effects of free milk - it would stop me feeling so angry about this twattery. My therapist says that anger is bad for me, as well as for the dickheads I take it out on. Whoops - terminal preposition. One for the pedants.

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Come with me on a homeopathic journey

By Bob Bury - 2nd August 2010 11:48 am

So, the government are going to carry on funding homeopathy on the NHS? I wonder which of the coalition partners thought of that? Was it a Tory grandee with shares in a private purveyor of fairy dust to the worried well, or was it a Lib Dem, concerned that there hadn’t been anything like enough woolly-minded tree hugging holistic nonsense peddled by the Dave ‘n’ Nick rainbow alliance since the election?

Either way, it’s crap, isn’t it? I mean, if it’s OK to spend public money on bottled water for the fibromyalgic masses, why not radionics, or traditional Chinese medicine? In fact, I’d rather see it spent on Chinese herbal remedies. It may be bad news for endangered species everywhere, but at least there’d be a few active ingredients in the bottles. Plus, some of it’s pretty toxic, and I don’t imagine many GPs would regret the poisoning of the occasional heartsink patient.

Still, I suppose I shouldn’t get too sniffy about the homeopaths. One of the good things about being a radiologist is that, if you choose the appropriate sub-specialty (and I can recommend nuclear medicine) and then train the radiographers and imaging technicians to do all the stuff like injections, you hardly ever have to come into direct contact with patients. I’ve always thought that they were the biggest obstacle to the enjoyment of medical practice, so it’s nice to be able to keep them at arm’s length.

GPs and homeopaths have to spend hours every day talking to them - must be dreadful. I suppose it’s even worse for the homeopaths, because at least some of the GPs’ patients actually have something wrong with them (there again - so do some of the homeopaths’ patients, it’s just that the ‘holistic’ practitioners haven’t been trained to notice that sort of thing). Actually, I think I may just have talked myself out of my antipathy to homeopathy* on the NHS. If 70% of GP patients just need someone to talk to, it might as well be a homeopath. Better than wasting a doctor’s time.

Well, that was nice. We’ve been on a journey here, readers, and that’s a good thing, because these days, everything seems to be a journey, doesn’t it? There’s the Patient Journey, of course, without repeated mention of which no nursing document is complete, and most ‘celebrities’ seem to be ‘on a journey’, usually to or from The Priory. And you have all just been privileged to witness my journey from doubter to believer concerning homeopathy. A good day’s work all round.

*When I corrected the first draft of this blog, I found I had typed ‘hopeopathy’ instead of ‘homeopathy’ at this point. A term I think I might use more deliberately in future.

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Why give the scourge of paediatricians credibility?

By Bob Bury - 26th July 2010 1:36 pm

Only a week ago I was slagging off the GMC, saying that just when I thought they couldn’t do anything that would make me think even less of them than I already did, they had done just that (in their sentencing of Dr Jerome Ikwueke, one of the doctors in the Baby P case).

Foolishly, I thought that must be it. I didn’t feel it was possible for any organisation composed of supposedly sentient beings to sink lower in my estimation. But I underestimated them. They have trumped even that profoundly stupid decision by appointing Mrs Penny Mellor to their Expert Group on Child Protection.

In case you don’t know this lady, let me quote from an open letter to the president of the GMC from four paediatricians, who are chair and members of the organisation Professionals Against Child Abuse, which appeared in this week’s BMJ. They point out that Mellor:

• made false allegations against numerous paediatricians, other doctors, and nurses about their involvement in child protection cases, even to the extent of accusing doctors of sexual abuse of children, paedophilia and comparing one paediatrician to Josef Mengele.

• reported such professionals to their employers, regulatory bodies, and politicians, and harassed them through the media, in some cases wrecking their professional lives.

• contributed to a misguided and hostile media campaign against internationally acclaimed paediatricians who were central to the recognition and diagnosis of fabricated and induced illness (FII, previously known as Munchausen’s syndrome by proxy), which contributed to the fitness to practise panels’ decisions to order the names of Professor Sir Roy Meadow and Professor David Southall OBE to be erased from the medical register in 2004 and 2007 respectively. After much damage to child protection work, these decisions were found to be erroneous: Sir Roy was reinstated to the medical register by the High Court and Southall by the Court of Appeal.

• created an environment in which doctors are now turning their back on child protection work for fear of being targeted in the above way.

• has been convicted herself of “conspiring to abduct a child,” with Judge Whitburn concluding: “…you have been a self-appointed advocate for those, amongst others, whose children are taken into care on the basis of what was known as Munchausens Syndrome By Proxy, now known as Fictitious Illness Syndrome. Your view was that this was a misdiagnosis, designed to cover up medical negligence. Impervious to debate, convinced you are right, you have traduced, complained about and harried dedicated professional people working in this difficult area.”

I hear on the grapevine that at least one paediatrician has resigned from the Royal College of Paediatrics and Child Health in protest at the continuing presence of members of that college on the Expert Group despite Mellor’s appointment. No-one objects to the inclusion of parent representatives on the group, indeed, it’s essential that they should be there. But there must be some sensible people out there who are not “impervious to debate” and who are capable of arguing rationally on this fraught topic.

Not only would Mellor appear to be supremely unqualified to sit on a group considering child protection issues, but the GMC is currently (wait for it - you won’t believe this) dealing with a fitness to practise case against Prof Southall (yes - again), the man whose career Mellor has made it her business to destroy.

And yet the idiots have appointed her to their advisory group dealing with the very issue in which she has been a major protagonist. I am not, as they say, a lawyer, but it occurs to me that, should the case go against Southall, he would have an excellent prima facie case for arguing that he cannot have had a fair hearing from an institution displaying such bizarre behaviour.

This appointment shows contempt for dedicated paediatricians who continue, despite the continual barrage of ill-informed abuse from la Mellor and her posse of single-issue zealots, to practise in this difficult and essential area. But then contempt for doctors is fast becoming the hallmark of the GMC. Given the inability of the medical profession to speak with a single voice on anything, it is presumably unlikely that we could ever arrange a mass refusal to pay the GMC annual fee. But a man can dream.

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Looking forward to not having to pay the hangman

By Bob Bury - 19th July 2010 6:24 pm

A couple of weeks ago I was reporting my incredulity at the fact that the GMC had apparently got something right. Twice. But now normal service has been resumed, and just when I thought that nothing they could do could make me more dissatisfied with them than I already am, along comes their judgement in the case of Dr Jerome Ikwueke, the GP involved in the Baby P case.

They found that there were ‘serious failings‘ in his handling of the case, but then, he wasn’t alone in that. However, the fitness to practise panel chairman Dr Judith Worthington, said: “You don’t pose a risk of repeating this behaviour and there’s no evidence of deep-seated attitudinal or personality problems.” She also admitted that the GP had taken the appropriate remedial measures personally, and had changed procedures at his practice to minimise the risk of any similar failing in the future. She said, and who could disagree with her, that striking him off the register would not be “proportionate or in the public interest”. So what did they do? They suspended him (i.e. struck him off) for a year.

Which will achieve exactly what? It will deprive his patients of a GP they clearly have a lot of respect for (the panel received numerous testimonials to the quality of his care for them), and he will have a year away from his profession, with no income and no opportunity to put into practice the retraining he has already undertaken. I think we all know why the GMC took this craven action, but unusually, they actually came out and admitted it for once. They suspended the GP, said Dr Worthington, “in order to maintain public confidence in the profession and to declare and uphold proper standards of conduct and behaviour”.

In other words, they did it to appease the Daily Mail readers, whose spittle-flecked twin sets and florid, broken-veined complexions bear testimony to their incoherent and all-consuming need for a culprit. Any culprit. The GMC clearly accept that nothing beneficial will be achieved by Dr Ikwueke’s suspension, but it would rather pander to the general public’s lust for vengeance than make a reasoned case for allowing him to continue practising.

I have to laugh when people say it’s time that the medical profession lost the right to self-regulation. If this is self-regulation, I’d far rather take my chances with a lay judicial body, funded from public money, in the event that I was accused of malpractice. At least then I wouldn’t, in effect, be paying the hangman myself. The GMC should stick to their job of maintaining the register, and I reckon 20 quid a year should be plenty for that.

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Do GPs know how much radiology to purchase?

By Bob Bury - 12th July 2010 12:06 pm

Was it only on the 13 May that I was expressing the hope that Andrew Lansley et al would bring a breath of fresh air to health care politics? (yes, it was - Ed). Did I really believe that a move away from NuLabour’s micromanagement of (interfering with) the NHS would represent a great step forward for those of us beavering away at the coalface? (yes, that was certainly the impression you gave - Ed). What a naive prat I was. Today we will see the white paper setting out the coalition’s vision for the future, and what are they going to do? They are going to give all the money to the GPs and tell them to get on with it and commission the services they think their patients need.

In my last blog, I had cause to use the expression ‘arse’, and as any good medical writer should, I was careful to reference my source - in this case, Jerry Nelson. I now feel that I may need recourse to Jerry’s meta-anal expression of ‘arsington arse’, or maybe even the ultimate ‘arsington arsey McArse’. Because there really is no other way to express an opinion on this new Big Idea. I mean, what do GPs want for their patients? They want more of everything, and they want it now. And that’s exactly what I want my GP to want for me. More. Now. But that doesn’t really equip them to take a lead in the commissioning of global services across the board, now does it?

And, anyway, I thought they were all busy? That’s what they keep telling us - they may not have to do any out-of-hours work any more, but some of the poor buggers only have one half day off a week (and when I say ‘week’, I do of course refer to the five days from Monday to Friday - sometimes even including Friday). So how are they going to find time to decide how much of my specialty (radiology) to purchase? And let’s face it, they won’t need any stereotactic brain surgery at all, will they, because they can’t recall anyone on their list actually needing that for absolutely ages, so why waste the money? Much better to use it to buy motability scooters for their patients who are Tired All the Time, or just too sodding fat to walk.

But perhaps I don’t understand. Perhaps it will all become clear when I see today’s white paper. And perhaps Wayne Rooney will win next year’s Man-Booker prize for his sensitive depiction of gay love in post-war Oxbridge.

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My PDP objective: continue plodding along

By Bob Bury - 30th June 2010 11:51 am

I’ve just been asked to write a report on the work of a committee I chair. They want me to provide three (not two, not four, but three) objectives for next year. Well I’m not going to, so there. In fact I’m getting a bit sick of this universal assumption that everyone needs to have objectives, over and above just continuing to do their job. Doesn’t matter what this particular committee does, just take my word for it that it has been fulfilling its purpose in a perfectly adequate fashion.

It’s the same with personal development plans (sorry, PD-bloody-Ps). Everyone has to have one of these, even the porters for all I know. It just makes no sense. Take me - I don’t need one. Not because, like Mary Poppins, I’m practically perfect in every way (although I’d be prepared to argue the case) but because I’m near the end of my career, and all the trust needs me to do is to carry on with my moderately lifelike impression of a competent radiologist, shifting the reporting without making too many actionable errors.

The same is true of many other members of staff, not just the old-timers like me. If it was really the case that everyone had an urgent and annually-recurring need to develop, it would mean that they had appointed a bunch of wasters who weren’t up to the job. If everyone has to have a PDP, it means that no-one is performing adequately. It’s just crap.

Of course, there are times in your career where you are actively learning and building up your practice, developing your service. But it’s not like that all the time, thank God, and for a large part of a career what you need to do is consolidate. There’s a lot to be said for plodding. And what’s the result of all this pressure to come up with ‘aims’ and ‘objectives’? I’ll tell you - the outcome is that everyone dreams up an aspirational and largely irrelevant wishlist, and then makes everyone else’s life a misery by trying to sign them up to providing ‘multi-source feedback’ to pad out their appraisal folders. Everyone is spending so much time examining their own and other people’s navels that nobody can find time to just do their bloody job.

So I’m going to give them just one objective for my committee - to carry on carrying on. And if they don’t like it, they can look for a more compliant chairman. They’ll have to soon, anyway, I’ll be in the garden, or fishing.

As Jerry Nelson would no doubt say (and probably has): continuous improvement, my arse!

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Bat’s head and cocaine risotto anyone?

By Bob Bury - 18th June 2010 3:49 pm

So, Dr Jerome Ikwueke is pilloried in the press for his perceived errors in the sad case of Peter Connelly (Baby P). Obviously, if there was any clinical negligence, it should be investigated, but this particular doctor’s career is pretty much screwed now, whatever the outcome of the case. And what’s the betting that he’ll be the only professional required to carry the can for poor Peter’s death?

Actually he won’t be the only one, of course. Kim Holt, the paediatrician who blew the whistle over the dangerous shortcomings at the clinic that was involved remains suspended from her post by Great Ormond Street Hospital, six months after the publication of a report which recommended that she should be allowed to return to work as soon as possible.

Obviously, I don’t know the full background to Dr Holt’s suspension, but given that the trust offered her money if she would withdraw the complaint about the clinic, it seems likely that if she had just kept quiet, she would still be gainfully employed. Which does rather suggest that those who claim that doctors are ‘damned if they do, and damned if they don’t’ when it comes to raising concerns about standards of care do have a point. So I’ll re-phrase the question posed above: what’s the betting that doctors will be the only professionals required to carry the can?

Mind you, we soon won’t need doctors at all, as long as we follow the lifestyle advice which is now so freely available in the media. Who would have thought that the latest celeb to join the dreadful Gillian McKeith in advising us on healthy living would be this chap?

Presumably his healthy eating tips will include the recipe for bat’s head and cocaine risotto, which actually wouldn’t be as bad as some of McKeith’s nostrums. And I suppose there may be some logic in the suggestion that anyone who is still around after leading the life he has led must know something about survival, at least.

Although if we follow that logic, it will presumably mean that we’ll also be asked to take advice on leadership from John Terry, on financial prudence from Gordon Brown and on restructuring medical careers from Liam Donaldson. Oh, wait a minute…

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A new area of practice for the Loophole Department

By Bob Bury - 14th June 2010 9:03 am

Just when you thought it was safe to start reading the papers again, there’s a another outbreak of political twattery - this time from the new lot. Andrew Lansley wants to fine hospitals if they re-admit patients within 30 days of discharge. None of you need me to point out what a facile load of ordure this represents - others have done that already, and when even The Guardian’s health correspondent can foresee problems, it should be clear to anyone that the Secretary of State for Health has inherited his predecessors’ difficulty concerning orifice selection when making policy statements.

Still, it will open up a whole new area of practice for the Trust Loophole Department (you know, the people who dreamed up the ‘clinical decision unit’ concept to avoid breaching the A&E 4 hour wait target, and the re-badging of any nurse with more than three GCSEs as a ‘consultant’ to avoid the inconvenient tendency of real doctors to want to keep patients hanging around long enough to actually examine them). They will now be able to support the focus-group driven initiative to provide care closer to the patient’s home by establishing a complex bureaucracy to ensure that no patient gets re-admitted during the penalty period. This will give GPs a valuable opportunity to hone their skills and acquire new ones. COPD patients, discharged after their latest exacerbation, will have their day 14 left anterior descending occlusion managed for a couple of weeks by Dr Finlay and the home angioplasty team (one nurse practitioner who has ‘done the course’ assisted by a couple of slack-jawed teenagers undertaking their work-experience as Auxiliary Interventional Technicians), until they (well, the lucky few) can be admitted to the CCU for salvage on day 31. Brave new world indeed.

To think that we had high hopes of Andrew. Perhaps they really are all the same? That would be depressing.

Oh well, it won’t matter for most of us, if the Daily Mash is to be believed - we’ll all be on the beach.

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Too old to have my GMC prejudices challenged

By Bob Bury - 26th May 2010 4:55 pm

I’ve got to go to a bullying and harassment course. Two and a half bloody hours. I thought the consultants’ forum on the trust intranet would be buzzing with ripe comments from disgruntled refuseniks, but no. A number of colleagues felt it was a good and necessary thing. And some of them were - wait for it - surgeons!

For God’s sake - when I sat the FRCS nearly 35 years ago, we had to do a whole module in bullying - methods; choosing a victim; deflecting the blame, that sort of thing. How times must have changed*. And anyway, I do rather resent the implication that I might be bullying our SpRs. No, as long as my tea and toast is waiting for me when I arrive in the morning, my car gets valeted once a week and they hand over their dinner money every day, the lazy little gobshites have nothing to fear from me.

Incidentally, it looks like being an interesting week for anyone who questions the GMC’s competence (i.e. anyone on the Medical Register). I see they’ve just struck Andrew Wakefield off for paying children to give blood as part of a research project for which he didn’t have the appropriate ethical clearance, and in which he had an undeclared financial interest.

Then there was the shock/horror programme on the telly about their ‘victimisation’ of Dr Myhill who was only doing her best for her patients. For those of us with a natural and, I believe, justified antipathy to the Hallam Street mafia, these cases make interesting reading. The initial reaction is to hope they get a good media kicking over the Myhill case, then you read her website and begin to wonder if they don’t have a point. Which would mean they had got it right twice in one week. I’m at an age where it’s unsettling to have your prejudices challenged in this way.

But to get back to the bullying course: one reluctant potential participant asked if our masters couldn’t make it an e-learning course, like all the other (hand-washing and bottom-wiping nonsense) training we have to pretend to absorb in order to get appraised, or revalidated, or canonised, or whatever it is we have to be in order to continue doing our jobs. But the answer was “no” - you have to be there in person apparently. And you know what that means, don’t you? Sodding role-playing. Well, I don’t do role-playing, not since I grew up, anyway (although I don’t suppose it will be a problem for the surgeons). I’m going to have to do something I haven’t done for 50 years; forge a note from my mum excusing me on the grounds of my innate diffidence and good taste.

And anyway - bullying is good for them.

*On the other hand, perhaps they haven’t. See Jerry Nelson’s latest column.

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