I can't promise anything...

But you're in good hands!

For those of you who have been surgical patients being taken into theatre at some point in your life, or for those of you who have watched the typical medical drama fare on tv, how many times have you heard some version of:

“Don’t worry Mrs Smith. We do this operation all the time and while I can’t promise anything, I can tell you that with Dr Jones you’re in the best of hands.”

Even as a child who had multiple surgeries on one of my eyes, I always had a negative, almost violent, reaction to anyone who managed to spit them out with a straight face. It felt like someone trying to convince me the sky was yellow with pink polkadots or that camel flatulence was a sweet, pleasant and aromatic pot pourri. As a result, I never once uttered these words myself when I was doing my training because I figured that if they sounded like unbelievable horse-hockey to me, they probably sounded like the disingnuous and unsubstantiated lie that they truly were to the patient I was talking to.

For those of you who are nurses, midwives or other hospital staff: how many times have you uttered some version of these very words to a patient yourself? Do you realise, even if you do actually think it, how disingenuous and not reassuring they sound to most patients given the number of NHS scandals we see in the media on an almost daily basis now?

That said, the blissfully ignorant or, more likely, financially motivated propagandist tv writers who want you to think doctors and pharmaceutical companies are our medical gods gave us not only this deceptively nonsense sentence but also two other forms of fallacious medical propaganda in the most recent episode 13 of Noah Wyle’s medical drama, The Pitt. All uttered by Noah himself.

But I will come back to Noah’s ‘Pitt’ later…

Or not. Enjoy ladies, this one’s for you.

NHS Scandals

Ever since I started delving into the individual neonate’s cases from the Letby trial I began receiving emails with often distressing and disturbing stories that had several common factors. Most told of failures to achieve true informed consent; vulnerable patients whose demise was either hastened by or entirely the result of iatrogenic harm; nurses and midwives who tried to raise the alarm but were shut down by management; doctors, NHS managers and even police who boldfaced lied in efforts that appeared entirely intended to cover up for (in)competent or (un)competent doctors; and corrupt and malfeasant NHS managers who acted more to protect ‘the brand’ than to protect the patients.

I have previously mentioned that there is, or is going to be in the near future, a case that will run through the High Court concerning a doctor who, after receiving his NHS-employer mandated DEI/EDI woke training, used race above all other (established and permitted) triage metrics to decide which patient to treat first. This doctor decided to treat a pregnant Black woman whose condition was established on arrival to the hospital to be unrecoverable, over another pregnant White woman who, but for ten-to-fifteen minutes of urgent critical care, would have had an entirely favourable outcome. Other staff were telling him the BAME patient’s baby was long deceased and the patient herself had almost entirely bled out and was brain dead and unlikely to recover even if her heart was rescuscitated, and that the White woman’s baby was dying and that she needed to be seen immediately. Yet, this doctor chose to expend more than an hour of unrealistic and unnecessary ‘heroic efforts’ on the BAME patient. It seemed, at least to the clinical witness I spoke to who was present at the time, that the obstetric doctor wholly believed the DEI manager’s unsubstantiated and unprovable propagandised claim that BAME patients at the hospital receive less or less effective care and this was his time to demonstrate that he was an ally for these BAME patients. It is, to management at least, simply an inconvenient shame that the outcome he was never going to prevent for the BAME patient would also be the outcome his blind faith and adherence to their DEI cause visited on the White patient.

While I am reticent to delve too deeply into individual cases here, I can tell you they include: parents of an infant whose demise appears to have been hastened and, whether intentionally for this purpose, whose internal organs were harvested and sold without parental knowledge or consent onto a university research laboratory; a mother who was accused of Munchausen's whose child was legitimately unwell but was abducted at the behest of Dewi Evans and so poorly treated whilst a ward of the state that she remains poorly educated and mentally affected even in adulthood; and the mothers of several babies who were otherwise gestating normally until some event brought them in contact with an obstetrician whose modus operandi was to invent conditions or hyperbolise in order to ensure he could surgically intervene into the pregnancy and immediate delivery occurred, often leading to trauma for the mother, harm for the child or, in some cases, even death to one or both. Several large-scale collections of cases are under investigation for doctors formerly or currently working at different nhs hospitals across the country, including a former obstetrics and gynaecology doctor from University Hospitals of Derby and Burton (UHDB) and at least two doctors from the Countess of Chester Hospital.

As it stands, I have received emails recently from anonymous staff or former patients that describe instances where NHS care regularly and repeatedly deviated from anything remotely alike competent, consented, effective and expertly administered evidence based medicine. These disclose events that occured at NHS hospitals including: University Sussex Hospitals Sussex NHS Foudation Trust (UHS) and Royal Sussex County Hospital (RSCH), Nottingham University Hospitals NHS Trust (NUH), University Hospitals of Derby and Burton (UHDB), Countess of Chester NHS Trust (CoCH), Great Ormond Street Hospital (GOSH) and the Gosport War Memorial Hospital (GWMH). In each case there is now an ongoing police investigation involving sometimes tens or hundreds of patients, hundreds to several thousand patient care incidents, and sometimes one single surgeon but in other cases as many as twenty-four collaborating clinicians.

When we look across these police investigations and the emails I have received we can see examples in which: (i) surgeons violated their duty to provide and collect informed consent because they failed to correctly advise patients of available less-drastic treatment options while often also not faithfully informing them of the potential complications and long term effects of their surgeon-selected and foisted solution; (ii) patients were administered life-ending doses of analgesic and barbiturate medications in order to hasten their death (the so-called Liverpool Care Pathway); (iii) patients were told they needed urgent surgical interventions that resulted in harm, sometimes death, where later review of the clinical evidence shows they almost certainly did not require that drastic intervention; (iv) iatrogenic (doctor-caused) surgical harms wrought on patients that the doctors who caused the harm or death either failed to record and honestly report, or deflected the blame onto nurses or other clinical staff; (v) (un)competent junior doctors being left without appropriate supervision to care for critical patients by consultant surgeons who preferred to both bask in their own self-importance and distance themselves from their supervisory and patient-facing clinical duties; and (vi) a myriad of medical negligence examples that question both the training and competence of the many all-too-often overseas-trained doctors the NHS are employing and giving significant, unmonitored seniority and clinical independence to in our healthcare system.

Even more disturbingly, in each case the NHS response seems less about undertaking a process to identify what went wrong and putting mitigants in place to ensure it never happens again, and more about seeking to identify which cases are so obvious they cannot be avoided or so egregious they cannot be swept under the rug, and otherwise giving the appearance to the rest that something has been done and there was nothing to see here. So sorry. Please move along. The gap between what should be done and what is done gets wider with each incident, health record and prosecution document I read.

And we wonder why people are getting more hesitant to place their trust in the medical professions now?

Does TV Medical Drama Propaganda Help?

If watching episide 13 of Noah Wyle’s The Pitt and hearing that disingenuous you’re in good hands line wasn’t enough to put me off my cup of Earl Grey, seeing Wyle to the detriment of an entire room full of saveable patients expend heroic efforts on a patient who, similar to the example about the pregnant women above, his colleagues all told him was beyond saving, certainly did. But, if I thought that was as bad as it could get I was suffering from nothing short of a serious absence of imagination. Minutes later Wyle’s character was seen to forcefully engage with parents and tell them not one, but two utter medical falsehoods. At this point I very nearly sprayed my hot tea and potentially more across the loungeroom floor.

It seems that the writers and directors of these hollywood ‘dramas’ can’t escape the need to incorporate any and all present day politics into their scripts - even when they themselves are clearly not experts in or are simply being led by the nose to create that propagandised content. We’ve all seen or heard the terrible examples of hollywood writers and directors incorporating present-day mainstream media-based politics on topics including race, religion, trans-treatments and vaccination into their stories to the absolute detriment of the resulting product. Consider… how well is Disney’s latest Snow White movie doing? or their Acolyte TV series? or the Adolescent tv series here in the UK that race-swaps the lead character in order to create the impression that timid little white christian boys you pretty much never see in the news, rather than the radicalised immigrants of another particular faith group we see in the news sometimes several times a day (e.g.: here, here, here, here, here and here just to show you but a few), are the ones raping eleven and twelve year old white girls, waving large knives in London streets, and stabbing girls listening to Taylor Swift in northern English beachside towns? And yet they keep doing it.

Noah Wyle’s character, Dr ‘Robbie’ Robinovich, is heard to castegate parents because even in the absence of a valid positive test for measles, he has decided the symptoms their child has that could fit the mould of several differential diagnoses are measles in an unvaccinated child. First, he yells at them that the MMR vaccine is completely safe and has never hurt any child. Then, as if that first statement isn’t enough propaganda for the audience, he follows it up with the fact that even before he has explained his reasoning and sought informed consent he is going to prove their son has measles by administering an invassive lumbar puncture cerebro-spinal fluid (CSF) draw that he says, after the mother questions whether it is safe or not, has exactly zero risk of causing paralysis.

Both of Wyle’s character’s ‘facts’ are questionable at best, and provable lies at worst - as I showed in my twitter post minutes after hearing them. I didn’t even have to look very hard. Case reports, case control studies and systematic reviews literally sprang forth from pubmed showing that there have been many, many incidents where doctors… yes, that’s right… DOCTORS have reported: (i) that the Measles vaccine (and MMR in particular) has caused everything from anaphylaxis to acute encepalopathy, permanent brain injury and even death; and (ii) that lumbar puntures have resulted in subdural haematomas and paraparesis (weakening in the lower limbs) that both deteriorated into complete paralysis for the patient. And, as I later added, the argument by some that these things may be rare (although the literature suggested otherwise) does not mean, as Wyle’s character agressively yelled at the parents in the episode, that they are zero risk procedures. There is no such thing as the zero risk procedure in healthcare and any doctor who tells you otherwise is a doctor best avoided.

So, does TV drama propaganda help? The writers, directors and producers might think so but I do not. All it does is promote medical falsehoods, further reduce the trust that people have in the medical professions, and creates the increased potential for worse, not better, health.

It seems at the moment that NHS Trusts and doctors in particular, and medicine in general, are at a crossroads. They can either continue down the path they are already following that permits, covers up and makes excuses for a myriad of harms wrought on trusting patients, or deviate onto something like the course that was intended after the ethical issues were exposed and mitigations were proposed arising out of the Nuremberg Trials.

But whichever course Doctors and NHS Managers choose - the continued deception, misdirection, disingenuity and gaslighting of patients and their families when you are caught out simply has to stop.