Monday, 3 May 2010

A little knowledge is a dangerous thing

The health service has been dumbed down magnificently since Labour came to power in 1997. In order to try to save money a lot of work previously done by highly trained doctors has been handed to people with much less education and training. Some people think this makes sense, but the fallacy of their arguments is obvious, you simply cannot expect those with less education and training to do as good and as efficient a job as those with the higher skill levels. This tale demonstrates just what is going very nicely indeed:

"In my locality, Transforming Community Services has actually meant Terminating Community Services.
As a result one of my residents in a Nursing home has fallen into the clutches of an "Outreach Practitioner", who this morning gatecrashed my surgery to thrust a paper into my hand, with the request to "sign this".
Fortunately I read it, & it was a request for a liver scan.WTF? Why?
"She keeps going high in the morning & low at night. I think it's her liver. Liver disease can cause hypos & I noticed she's had an ocular melanoma. We need to find out if she has metastases."
It takes about 30 seconds to ascertain that the LFTs on her last diabetic clinic with us were perfectly normal & the melanoma was treated with laser at an early stage, not by enucleation, over 10 years ago.(a) I think we'd have known by now.(b) All she needs is her bolus insulin in divided doses (as her consultant has already instructed).(c) She's 90 years old & has end-stage cerebro-vascular disease. What the Hell use is a liver scan?A little knowledge is dangerous.
When medical students reach that stage we educate - even ridicule - them into thinking "common things first, rarities last", but noctors' university training gets them diplomas without benefit of the cultural memes handed down in medical apprenticeship since the days of John Hunter & William Osler. So they think exotics first & 'simples' (such as cocked-up insulin dosage) last.So if anyone thinks they might be cheaper than real doctors, think again."

Numerous pseudo-doctors have been deployed into roles that were only previously done by doctors. This has led to a lot of patients getting a rather raw deal. Whether this be diverting Orthopaedic referrals to physiotherapists and away from the consultants, or seeing the nurse practitioner at the WIC with your chest pain, the costs in terms of patient care are obvious. This dumbing down may save money in the short term, however in the long term in may well cost a lot more to pay for the consequences of the substandard care that a lot of patients are getting these days.

The government has decimated Out of Hours General Practice in this country in the last ten years. Now instead of properly trained doctors covering patients at night, we are seeing nurses replacing doctors because they are cheaper. If they had kept GPs in charge of Out of Hours care we would not be in this mess and patients would not be dying as a result of the shambles that has resulted. The government has taken over and wrecked a perfectly good doctor led system, it has now been replaced by a numpty led shambles.


GrumpyRN said...

Sorry, but it is piss poor practice to use the Daily Mail to back up any argument you have about the NHS. You're whole argument is now null and void!
If you must disparage nurse practitioners, fine, but use properly researched articles not propaganda and one anecdote.

Garth Marenghi said...

It has been happening for a while actually GrumpyRN.

Your argument is null and void if you just write mine off because I linked to a Daily Mail article! Tit tat.

The fact is that a lot of nurses are being empowered way beyond their means in jobs in which they are having to make complex clinical decisions for which they are not adequately educated or trained.

Whether the Daily Mail says it or not, this is a dumbing down and it is bad for patients.

To argue that less training and education makes no difference to the service, something that many pro-quackers try to do, is just plain stupid.

You can sometimes get away with it, however errors will be more frequent and patients will inevitably pay the price more frequently.

GrumpyRN said...

I am not necessarily disagreeing with your point, just the way you have stated it. To use the Daily Mail instead of researched articles is bad practice.

Not all nurse practitioners work outwith their competency, some of us are well aware of our limitations. Perhaps sometimes the nurses who make stupid requests are working within a system which demands that they can only work in a certain manner, yes I mean protocols. I know most doctors disparage working to protocols but the only way that nurse practitioners can work is with the cooperation of a consultant doctor somewhere, and they are the ones who insist on protocols for practitioners.

The European Working Time Directive means that there are now not enough doctors to carry out all the tasks that used be doctor only - so who takes up the slack?

In the case of out of hours, most of the stuff seen is very minor and the most effective use of staff is to be seen by a nurse practitioner or emergency care practitioner thus allowing the doctor to see the more urgent problems. Especially when there is only one or two doctors on duty.

Old Codger said...

But GPs could have remained in charge, admittedly their already significantly increased salary would have received only a slight further increase for the extra workload. Let's face it, the government bribed GPs to relinquish OOH duties.

GrumpyRN said...

Old Codger;
It took a heart attack for me to get off nights, if someone was offering me money to stop working nights and weekends I would have snapped their hand off grabbing it.

Anonymous said...

Nurse Practitioner is not a protected title. Often time served rather than educated and trained over and above registration.
Retired NP

GrumpyRN said...


Nurse is a protected title, Nurse Practitioner is a role just as theatre nurse, surgical nurse etc. but lets other people know that you have extra training and qualifications.
Yes, I know that some hospitals call some nurses 'practitioners' but only an idiot would do a job without the knowledge to do it. These are the ones that give the rest of us who are qualified a bad name.

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