Norman, I don't agree with everything you say but some of the bits about poor medical care ring true with me. In my surgical career, I saw some pretty shocking stuff, mainly as a junior when witnessing some of my bosses actions and behaviours.
On the subject of Lucy Letby, I am surprised that there has not been more comment about obstetrics at the COCH. eg. I note that the pregnancy of baby A was acknowledged to be high risk (anti P, severe hypertension etc) but delivery still took place at the COCH. The delivery of the triplets O and P was dramatic and probably precipitous, according to the mother's evidence in Thirlwall) but I am still in the dark about who actually did the CS and delivered the babies, as the consultant in charge was away at the time...was it a junior? The stage seemed to have been set for hepatic subcapsular haematomas, a known risk of birth trauma (though perhaps not known by Evans, Bohin and Marnerides, the "experts"). Allan Corder FRCS (retired general surgeon).
ps I don't claim to have never made a mistake but I always tried to be honest with my patients and treat them as well as I could, whether with or without operation (a good surgeon knows when and where to cut...an old surgical saying!).
When it comes to Lucy Letby, many have stated from the beginning that the way the mothers were treated during their pregnancy and before/during the delivery, was of great importance for the condition of the - mostly prematurely born - babies. However Dr. Evans apparently convinced the judge that this was not relevant at all and thus it was not brought up during the trial. It was one of the issues neonatologist dr. Michael Hall mentioned when he criticized the verdict.
Do not forget that this was not a looking-into "what happened?" It was a trial in which the accused was seen as guilty from day one.
Speaking of eye operations, I just had private cataract surgery in Genoa. (I went there on holiday.) I selected the opthalmic surgeon online based on the fact that he said surgeon skill is a function of how many times he has performed the operation.-- which he had performed thousands of times. When I saw him at his walk-in clinic, the idea of an American, from London having cataract surgery in Genoa seemed so preposterous to him that he asked "Why are you here?" I replied: "Is there a problem? I heard you're very good." And he was. Operation was extremely successful. This is how truly skilled medical practitioners should behave. No "bedside" manner. The ruder, the better.
I can relate to your story. I myself shopped for a good ophthalmology surgeon to have my eyes lasered. He did not advertise with 2 for the price of 1, like many do, plus from checking a lot of reviews he had the least number of people complaining about the result. And his name came up as the doctor who solved other surgeons’ problems. Honest and straightforward. He is in belgium whereas i live in holland. But i find distance the least of my worries where it concerns my health and wellbeing. I dont necessarily want them to be rude, but honest and no bones is what i like.
By "rude" I meant "brusque". But you're right. When it comes to having surgery on your eyes, it is crazy to shop around based on cost. Think of the risk/reward tradeoff!
It’s almost like we could do with a ‘We need to talk about the NHS’ campaign. I find it impossible to comprehend just how healthcare has been allowed to go so ‘off piste’. We hear stories about newly qualified nurses who don’t have jobs at the same time we know too well there’s a staffing crisis in healthcare. DEI seems a well intentioned idea that has turned into something with disastrous practical application. Just digging through all info to be found about one doctor’s education and career history, left me wondering just where are the checks and balances? What has happened to clinical supervision in practice? Are people actually being trained on the job, assessed and deemed competent before being let loose on patients? It’s reminiscent of the odd cosmetic surgery providers of many years ago, who employed visiting surgeons from overseas who were never seen again after their spell of duty. Sometimes leaving very unhappy patients behind who would seek remedies from genuine consultant plastic surgeons. The worst I saw was silicone injected into folds and wrinkles on a patient’s face that migrated leaving her disfigured with no ability for it to be corrected. We used to call them The Cowboy Clinics. Is this where we are now with the NHS? Will there be accountability? That good old word we had drummed into our heads! Being responsible for anything you did or didn’t do, that caused harm, regardless of if you knew about it or not, when working within the scope of your own, personal, professional practice!
When the big day of reckoning comes, will there be accountability? Will there be trust and transparency? Will the professional bodies that have their own accountability and responsibilities, hide under a rock, and WTF are the insurers buried under a mountain of medical negligence claims going to do?
Scott, anyone who has escaped childhood and teen years, and further still is aware - through personal experience or anecdote - of these things. I commend you for your battle to impose integrity wherever it is absent. But let's have some good news stories, something positive.
I have just finished a book everyone should read who has misplaced trust in the medical establishment: MEDICAL NIHILISM. It's from Oxford University Press, and the Author is Jacob Stegennga, Ph.D.
Abstract
This book defends medical nihilism, which is the view that we should have little confidence in the effectiveness of medical interventions. If we consider the frequency of failed medical interventions, the extent of misleading evidence in medical research, the thin theoretical basis of many interventions, and the malleability of empirical methods in medicine, and if we employ our best inductive framework, then our confidence in the effectiveness of medical interventions ought to be low. Part I articulates theoretical and conceptual groundwork, which offers a defense of a hybrid theory of disease, which forms the basis of a novel account of effectiveness, and this is applied to pharmacological science and to issues such as medicalization. Part II critically examines details of medical research. Even the very best methods in medical research, such as randomized trials and meta-analyses, are malleable and suffer from various biases. Methods of measuring the effectiveness of medical interventions systematically overestimate benefits and underestimate harms. Part III summarizes the arguments for medical nihilism and what this position entails for medical research and practice. To evaluate medical nihilism with care, the argument is stated in formal terms. Medical nihilism suggests that medical research must be modified, that clinical practice should be less aggressive in its therapeutic approaches, and that regulatory standards should be enhanced.
The deeper epistemological problem is, how can we know these reports are true and not the next Letby? When the general public start to doubt reports of any scandal as possibly just the next limited hangout or cover-up, a point of no return of public trust may be reached. Britain for all of its modern history has been governed in a climate of public trust in government verging on deference. We are sailing into uncharted waters.
The biggest lie ever "safe and effective" how many have died, how many have been injured. I for instance have never been inso much pain since the COVID vaccine ruined my life! Doctor's now say we haven't got an answer because it was experimental. Well thanks very much. NOT😡
The media through this drama seems to be mirroring the actual abuse of trust that can exist in the health system. The medical drama with Noah Wyle sounds terrible, since 2020 I have been completely cured of watching any medical show fictional or not. The horrors that can happen in the health combat system known as the NHS fills me with dread as the chances are high I may have to use it at some future point in my life.
I think when more than 80 % of the population is finally killed from taking so called safe and effective vaccines and the survivors health is in tatters, a public inquiry will show the the NHS staff was merely following orders.
If an outsider attempts to raise awareness of how unsafe and ineffective those vaccines are, they will be quickly put down and booted out.
The NHS nurses who administered the majority of the vaccines in particular during the past 5 years are the worst, they don't want to think for themselves and when informed that vaccines contain high toxic ingredients they get furious and will have you escorted out of the building or a complaint made to HR and have you fired on the spot in your role and thrown out of the building.
The entire NHS got turned into a Trojan horse for the purpose to maim kill and injured via needle injection as many as possible .
Any patient who complains gets gaslighted. The NHS is using precious resources to cover its arse. They don't care what physical injuries they cause.
"...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."
This is a bit of cheap dog-whistle politics. You could at least make some sort of statistical analysis of the interactions of race, crime. poverty, culture etc.
Having been a UK hospital medical consultant anaesthetist for entire working life. the issue of what constitutes informed consent is not an easy issue. I used to routinely mention death as a possible outcome of anaesthesia, (ie separate from surgery), and I can say most patients were astounded and this was not something they wanted to hear. When I worked in the USA, the patients wearily expected a long list of possible problems, knowing full well this was not for their benefit, but to 'cover the doctors' arses'.
I do not believe it to be 'cheap dog-whistle politics' when it is what we are seing here on a daily basis. If it only happened once or twice or was trotted out as a quasi-argument for some other purpose then maybe, but in this case there is enough new evidence hitting the internet on a daily basis to support the assertion I make. Besides, I decided long a go that politics and politicians were nothing more than vacuous golems controlled by anyone other than the electorate that they are ostensibly meant to serve.
In this case we are also intentionally prevented from making most statisical analyses by a government that seems more intent on obscuring who the perpetrator was if they are of an immigrant descent. Never forget, for example, that we were told that the Southport killer was not muslim but an innocent little Welsh chiorboy (intended to invoke images of cute little toothy white boys with a vaguely non-english accent singing Pie Jesu), and not any number of other things. People who correctly identified that he was from an immigrant muslim family with radicalised views and a decidedly questionable history in their homeland were prosecuted and jailed for misinformation spreading... eventually it had to come out that these things were true yet the people prosecuted for stating these truths remain incarcerated? Doesnt that seem more like dog-whistle politics... or, as some describe it, totalitarianism? Surely, any credible government and judiciary would review and release people who were, on the face of it, criminalised for stating something that was shortly thereafter found to be entirely true? Maybe not, it seems.
I agree wth you that the impression for some patients (especially those in litigious jurisdictions like much of the US) is that informed consent is 'cover my arse' stuff... but that doesn't negate the fact that we should do it and do it diligently and honestly. Telling a patient not to worry ("She'll be right mate" in aussie parlance) or yelling at them that they are arseholes for questioning whether something is safe because, you - the doctor - say it is zero risk whether or not that is true isn't the correct response. I agree that we need to develop a better approach that is more accountable than just quoting what is on a small piece of paper at the patient disinterestedly and hoping they dont ask any more stupid questions. That said, and looking sideways at a few of my friends who are also anaesthetists, anaesthetists are a special breed when it comes to these matters. Most come across as a little anal retentive and overly analytical - which, don't get me wrong, is actually what I want in my next anaesthetist. I want the guy who looks like he is running weight and distribution calculations on the inside of his eyelids and who is willing to tell the surgeon to take a powder for a minute because the numbers dont add up. I am always a little pleased when I encounter an anaesthetist who is slightly aloof and matter-of-fact. That said, each discipline needs to find a way to partner with the patient and meet the legal obligation. We should not want to slip back into pre-WW2 medical ethics (or lack thereof).
Norman, I don't agree with everything you say but some of the bits about poor medical care ring true with me. In my surgical career, I saw some pretty shocking stuff, mainly as a junior when witnessing some of my bosses actions and behaviours.
On the subject of Lucy Letby, I am surprised that there has not been more comment about obstetrics at the COCH. eg. I note that the pregnancy of baby A was acknowledged to be high risk (anti P, severe hypertension etc) but delivery still took place at the COCH. The delivery of the triplets O and P was dramatic and probably precipitous, according to the mother's evidence in Thirlwall) but I am still in the dark about who actually did the CS and delivered the babies, as the consultant in charge was away at the time...was it a junior? The stage seemed to have been set for hepatic subcapsular haematomas, a known risk of birth trauma (though perhaps not known by Evans, Bohin and Marnerides, the "experts"). Allan Corder FRCS (retired general surgeon).
ps I don't claim to have never made a mistake but I always tried to be honest with my patients and treat them as well as I could, whether with or without operation (a good surgeon knows when and where to cut...an old surgical saying!).
When it comes to Lucy Letby, many have stated from the beginning that the way the mothers were treated during their pregnancy and before/during the delivery, was of great importance for the condition of the - mostly prematurely born - babies. However Dr. Evans apparently convinced the judge that this was not relevant at all and thus it was not brought up during the trial. It was one of the issues neonatologist dr. Michael Hall mentioned when he criticized the verdict.
Do not forget that this was not a looking-into "what happened?" It was a trial in which the accused was seen as guilty from day one.
Speaking of eye operations, I just had private cataract surgery in Genoa. (I went there on holiday.) I selected the opthalmic surgeon online based on the fact that he said surgeon skill is a function of how many times he has performed the operation.-- which he had performed thousands of times. When I saw him at his walk-in clinic, the idea of an American, from London having cataract surgery in Genoa seemed so preposterous to him that he asked "Why are you here?" I replied: "Is there a problem? I heard you're very good." And he was. Operation was extremely successful. This is how truly skilled medical practitioners should behave. No "bedside" manner. The ruder, the better.
I can relate to your story. I myself shopped for a good ophthalmology surgeon to have my eyes lasered. He did not advertise with 2 for the price of 1, like many do, plus from checking a lot of reviews he had the least number of people complaining about the result. And his name came up as the doctor who solved other surgeons’ problems. Honest and straightforward. He is in belgium whereas i live in holland. But i find distance the least of my worries where it concerns my health and wellbeing. I dont necessarily want them to be rude, but honest and no bones is what i like.
By "rude" I meant "brusque". But you're right. When it comes to having surgery on your eyes, it is crazy to shop around based on cost. Think of the risk/reward tradeoff!
Strangely enough, some people do! But since I only have one pair, i wanted the best as well! Brusque, I get it.
It’s almost like we could do with a ‘We need to talk about the NHS’ campaign. I find it impossible to comprehend just how healthcare has been allowed to go so ‘off piste’. We hear stories about newly qualified nurses who don’t have jobs at the same time we know too well there’s a staffing crisis in healthcare. DEI seems a well intentioned idea that has turned into something with disastrous practical application. Just digging through all info to be found about one doctor’s education and career history, left me wondering just where are the checks and balances? What has happened to clinical supervision in practice? Are people actually being trained on the job, assessed and deemed competent before being let loose on patients? It’s reminiscent of the odd cosmetic surgery providers of many years ago, who employed visiting surgeons from overseas who were never seen again after their spell of duty. Sometimes leaving very unhappy patients behind who would seek remedies from genuine consultant plastic surgeons. The worst I saw was silicone injected into folds and wrinkles on a patient’s face that migrated leaving her disfigured with no ability for it to be corrected. We used to call them The Cowboy Clinics. Is this where we are now with the NHS? Will there be accountability? That good old word we had drummed into our heads! Being responsible for anything you did or didn’t do, that caused harm, regardless of if you knew about it or not, when working within the scope of your own, personal, professional practice!
When the big day of reckoning comes, will there be accountability? Will there be trust and transparency? Will the professional bodies that have their own accountability and responsibilities, hide under a rock, and WTF are the insurers buried under a mountain of medical negligence claims going to do?
It’s a mess!
Scott, anyone who has escaped childhood and teen years, and further still is aware - through personal experience or anecdote - of these things. I commend you for your battle to impose integrity wherever it is absent. But let's have some good news stories, something positive.
I have just finished a book everyone should read who has misplaced trust in the medical establishment: MEDICAL NIHILISM. It's from Oxford University Press, and the Author is Jacob Stegennga, Ph.D.
Abstract
This book defends medical nihilism, which is the view that we should have little confidence in the effectiveness of medical interventions. If we consider the frequency of failed medical interventions, the extent of misleading evidence in medical research, the thin theoretical basis of many interventions, and the malleability of empirical methods in medicine, and if we employ our best inductive framework, then our confidence in the effectiveness of medical interventions ought to be low. Part I articulates theoretical and conceptual groundwork, which offers a defense of a hybrid theory of disease, which forms the basis of a novel account of effectiveness, and this is applied to pharmacological science and to issues such as medicalization. Part II critically examines details of medical research. Even the very best methods in medical research, such as randomized trials and meta-analyses, are malleable and suffer from various biases. Methods of measuring the effectiveness of medical interventions systematically overestimate benefits and underestimate harms. Part III summarizes the arguments for medical nihilism and what this position entails for medical research and practice. To evaluate medical nihilism with care, the argument is stated in formal terms. Medical nihilism suggests that medical research must be modified, that clinical practice should be less aggressive in its therapeutic approaches, and that regulatory standards should be enhanced.
https://academic.oup.com/book/6511
The deeper epistemological problem is, how can we know these reports are true and not the next Letby? When the general public start to doubt reports of any scandal as possibly just the next limited hangout or cover-up, a point of no return of public trust may be reached. Britain for all of its modern history has been governed in a climate of public trust in government verging on deference. We are sailing into uncharted waters.
The biggest lie ever "safe and effective" how many have died, how many have been injured. I for instance have never been inso much pain since the COVID vaccine ruined my life! Doctor's now say we haven't got an answer because it was experimental. Well thanks very much. NOT😡
The media through this drama seems to be mirroring the actual abuse of trust that can exist in the health system. The medical drama with Noah Wyle sounds terrible, since 2020 I have been completely cured of watching any medical show fictional or not. The horrors that can happen in the health combat system known as the NHS fills me with dread as the chances are high I may have to use it at some future point in my life.
I think when more than 80 % of the population is finally killed from taking so called safe and effective vaccines and the survivors health is in tatters, a public inquiry will show the the NHS staff was merely following orders.
If an outsider attempts to raise awareness of how unsafe and ineffective those vaccines are, they will be quickly put down and booted out.
The NHS nurses who administered the majority of the vaccines in particular during the past 5 years are the worst, they don't want to think for themselves and when informed that vaccines contain high toxic ingredients they get furious and will have you escorted out of the building or a complaint made to HR and have you fired on the spot in your role and thrown out of the building.
The entire NHS got turned into a Trojan horse for the purpose to maim kill and injured via needle injection as many as possible .
Any patient who complains gets gaslighted. The NHS is using precious resources to cover its arse. They don't care what physical injuries they cause.
"...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."
This is a bit of cheap dog-whistle politics. You could at least make some sort of statistical analysis of the interactions of race, crime. poverty, culture etc.
Having been a UK hospital medical consultant anaesthetist for entire working life. the issue of what constitutes informed consent is not an easy issue. I used to routinely mention death as a possible outcome of anaesthesia, (ie separate from surgery), and I can say most patients were astounded and this was not something they wanted to hear. When I worked in the USA, the patients wearily expected a long list of possible problems, knowing full well this was not for their benefit, but to 'cover the doctors' arses'.
Hi Ian,
I do not believe it to be 'cheap dog-whistle politics' when it is what we are seing here on a daily basis. If it only happened once or twice or was trotted out as a quasi-argument for some other purpose then maybe, but in this case there is enough new evidence hitting the internet on a daily basis to support the assertion I make. Besides, I decided long a go that politics and politicians were nothing more than vacuous golems controlled by anyone other than the electorate that they are ostensibly meant to serve.
In this case we are also intentionally prevented from making most statisical analyses by a government that seems more intent on obscuring who the perpetrator was if they are of an immigrant descent. Never forget, for example, that we were told that the Southport killer was not muslim but an innocent little Welsh chiorboy (intended to invoke images of cute little toothy white boys with a vaguely non-english accent singing Pie Jesu), and not any number of other things. People who correctly identified that he was from an immigrant muslim family with radicalised views and a decidedly questionable history in their homeland were prosecuted and jailed for misinformation spreading... eventually it had to come out that these things were true yet the people prosecuted for stating these truths remain incarcerated? Doesnt that seem more like dog-whistle politics... or, as some describe it, totalitarianism? Surely, any credible government and judiciary would review and release people who were, on the face of it, criminalised for stating something that was shortly thereafter found to be entirely true? Maybe not, it seems.
I agree wth you that the impression for some patients (especially those in litigious jurisdictions like much of the US) is that informed consent is 'cover my arse' stuff... but that doesn't negate the fact that we should do it and do it diligently and honestly. Telling a patient not to worry ("She'll be right mate" in aussie parlance) or yelling at them that they are arseholes for questioning whether something is safe because, you - the doctor - say it is zero risk whether or not that is true isn't the correct response. I agree that we need to develop a better approach that is more accountable than just quoting what is on a small piece of paper at the patient disinterestedly and hoping they dont ask any more stupid questions. That said, and looking sideways at a few of my friends who are also anaesthetists, anaesthetists are a special breed when it comes to these matters. Most come across as a little anal retentive and overly analytical - which, don't get me wrong, is actually what I want in my next anaesthetist. I want the guy who looks like he is running weight and distribution calculations on the inside of his eyelids and who is willing to tell the surgeon to take a powder for a minute because the numbers dont add up. I am always a little pleased when I encounter an anaesthetist who is slightly aloof and matter-of-fact. That said, each discipline needs to find a way to partner with the patient and meet the legal obligation. We should not want to slip back into pre-WW2 medical ethics (or lack thereof).