BMJ – Pensions – all the rage

There is good reason to think that the Colleges are now in discussion as to what to do. There is also good reason to think that this can be influenced.

The BMA, the Royal College of Nursing and the Royal College of Midwives have opposed the Bill. The Royal College of General Practitioners has failed to find support for it amongst it’s members.

But what about the other Royal Colleges?

The Royal College of Physicians have said that there are several major issues with the Bill but seem to be suggesting collaboration ”We look forward to constructive dialogue with government, the Department of Health and partners to address these issues as the Bill progresses“. (enquiries@rcplondon.ac.uk)

The Royal College of Surgeons seem to be rather over-optimistic and not nearly critical enough. (president@rcseng.ac.uk)

The Royal College of Radiologists say there is “progress” with the Bill and want more amendments. ( president@rcr.ac.uk)

There isn’t a clear rejection of the Bill from the Royal College of Anaesthetists either. (president@rcoa.ac.uk)

The Royal College of Obstetrics and Gynaecologists sound distinctly unconvinced about the Bill but don’t reject it outright. (President’s Office - amartin@rcog.org.uk)

The Royal College of Psychiatrists uses the word ‘welcomes’, but sound unhappy about many aspects of the Bill but again, don’t reject it. (reception@rcpsych.ac.uk)

I can’t find any response this year from the Royal College of Paediatrics. Same for the Royal College of Pathologists.

(Added: The Faculty of Public Health are having a Extraordinary General Meeting to discuss the Bill on the 25th January. This sounds as though the Faculty are unhappy about the Bill. (Faculty contact: paulscourfield@fph.org.uk) )

I have yet to meet a disinterested party who does not have major concerns for the adverse effects the Bill will have on patient care. It is disappointing that more Royal Colleges have not made more definitive statements on rejecting the bill, although it is clear there is unhappiness.

My question is: do the members of these Colleges not need to tell their Presidents how to respond? I don’t want to work in an NHS that fragments patient care into private providers, that makes it harder for patients with complex illnesses to get continuous care, or prioritises the least sick in a competitive market. I don’t think that the Bill is anything other than a reckless assault on the most sick in our society.

But this isn’t over. Please consider emailing the Colleges and telling them what response of theirs would make you feel proud.

(Update – please see http://callonyourcollege.blogspot.com/)

Show us the evidence for telehealth

Posted on January 18, 2012 by margaretmccartney

Free link to BMJ article here

Inside Health and Do Not Resuscitate

Posted on January 17, 2012 by margaretmccartney

Radio 4 Inside Health today - these are the references I used for the column.CPR on television - miracles and misinformation NEJM 1996

http://www.nejm.org/doi/full/10.1056/NEJM199606133342406

Survival in cancer patients undergoing in-hospital cardiopulmonary
resuscitation: A meta-analysis, Resuscitation, 2006 <http://www.sciencedirect.com/science/article/pii/S0300957206001328#foot1>

The Influence of the Probability of Survival on Patients' Preferences
Regarding Cardiopulmonary Resuscitation - New England
Journal of Medicine,
1994

http://www.sciencedirect.com/science/article/pii/S0300957206001328

 Early Palliative Care for Patients with Metastatic
Non-Small-Cell Lung Cancer
New England Journal of Medicine 2011

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1000678

Listen again here

http://www.bbc.co.uk/programmes/b019fxb5

The Alliance for Natural Health – my response

Posted on January 17, 2012 by margaretmccartney

The Which? investigation into nutritional therapists is ably reported here, on DC’s webpage. The Alliance for Natural Therapies responds by saying that “ Although Dr McCartney’s presence on the panel was presumably to advise on the medical diagnoses involved in the investigation, medical doctors in the UK receive minimal training in nutrition as part of their medical studies – a mere 1 day in the entire medical curriculum. Their competence to assess nutritional therapy must, therefore, be seriously questioned. ”

Unfortunately, I think this neglects the issues at hand. For a start, doctors in training and at a post graduate level receive plenty of information and training about food, inborn errors of metabolism, endocrinology and gastroenterology. However it is based in physiology and science. I certainly didn’t learn about ‘leathery bowels’ or iridology; in the end, it isn’t possible to criticise a doctors’ training for leaving out stuff that isn’t based in evidence. In any case, my concerns centred around the medical safety of the advice that was given. There are going to be failings in any profession, and no person is going to get it right all the time. But this is less about the minutiae of what happened in any particular consultation, and more about the overall issues concerned with high street nutritionists.People were usually using the nutritionists in a role as ‘primary care’ – first point of contact with a problem. If a person has symptoms and sees a nutritionist rather than a doctor, is this safe? The investigation found that people with potentially serious symptoms were not being given the appropriate care. The other issue is the cost of supplements, which were substantial, and not evidence based. This is the issue.