The GMC, the social media and our lives

It seems that the social media is an area of great fear and concern for many of us in the medical blogosphere these days.  With Dr Rant being take offline and in a state of deep paranoia, I decided to look through the BMA's guidance on the social media.

There are many obvious pieces of advice.  'Patient confidentiality' is key, personally I have never spoken of anything patient-related that has happened at my place of work on this blog and this is a wise thing to do.  'Facebook friends' - it is clearly unwise to befriend patients on the social media, still, this is a very grey area.

 'Defamation' this is a very important thing to bear in mind when on the social media.  Defamation relates to 'an unjustified statement about a person or organisation that is considered to harm their reputation ' and is a very subjective thing.  Obviously we all have a right to free speech and for something to be deemed 'defamatory' it has to be fairly extreme.  A good rule to go by is to pretend that what one writes is being published in a newspaper and if it seems acceptable in this context then it is highly unlikely to be defamatory.

I have looked back through all the ferretfancier's old posts and have found nothing that strays across these lines.  I have called Patricia Hewitt an idiot which is perfectly justifiable, I have labelled Liam Donaldon incompetent which is also very justifiable, I have not referred to any specific patient events, I have not been defamatory in my criticism, I have used evidence to prove my points and have not crossed the line into 'unprofessional' behaviour in my opinion.

'Professionalism' is where this all becomes very very tricky indeed.  In fact the human rights act makes it very clear that we all have a right to respect for private and family life, and if any public body starts trying to interfere with this then they will be on very very sticky ground indeed: 

"Article 8 

Right to respect for private and family life

1 Everyone has the right to respect for his private and family life, his home and his correspondence.

2 There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others."

It appears to me that unless a doctor's behaviour outside of the workplace breaks the law then the GMC or any other public body will be on extremely dicey ground in trying to punish this inidividual.  Article 10 on the 'Freedom of Expression' also makes it very clear that we all have a right to say what we want as long as it stays within the law and no public authority has a right to interfere with this.

It is perverse that the people who are endlessly calling for better patient care and 'patient safety' are the very same people who love to right roughshod over the rights of others to express themselves.  The more free speech and openess is stifled, the worse the implications for health care and patient safety, as we have seen time and time again that we need an open honest culture to drive progress.  A Stasi like system that runs on fear and that kills criticism unfairly with threats works in the very opposite direction to progress.

The GMC: a totalitarian regime?

Much bad in medicine in recent years has been allowed to happen because those in the positions of medical power have been looking out for themselves rather than the interests of doctors, the NHS and patients in general.  It is also true that much progress is stifled because certain vested interests at the top of politics, medicine and medical politics just wanted to serve themselves and will do anything to keep hold of the power they currently have.

"It is like a totalitarian regime: anybody who criticises it is said to be mentally ill - what used to happen in Russia."

These are the words of a high court judge and he was describing the GMC.  Classic signs of a totalitarian regime is its complete inability to react sensibly to criticism, rather than listening and acting to improve things, a totalitarian regime will silence any criticism at any cost, it will brutally throw around its power and ignore due process in trying to bully its own way.

Another thing that is true of totalitarian regimes is there complete inability to take a joke, they will react violently and aggressively to satire or humour when it is directed at them.  Anyone who is a regular in the medical blogosphere will have read the amusing, intelligent and sometimes overly offensive Dr Rant.  There are rumours concerning Dr Rant and the subject of this piece.  Certain fights are rather unwise as they will attract one hell of a lot of unwanted attention and I suspect this may be one of them.

Corrupt Bill edges through Lords

So as expected the Health Bill has won two crucial votes in the House of Lords today.  One would think that large numbers of those voting in the Lords would be objective and making a decision based on the evidence.  Unfortunately this is not the case, this Mirror piece today makes it rather clear that large numbers of Lords have rather significant conflicts of interest in this regard.

The BBC has reported things in their typically pro-government manner, interesting to see their question at the end of the article 'should doctors be given more financial power?', insinuating that the Bill puts power in the hands of doctors which is a great piece of spin.  Certainly some doctors will have some power in commissioning in the brave new NHS, however to pretend that the government won't be overseeing the new corrupt tendering process by favouring its friends in the corporate health care world is extremely naive.

Lansley is a lying corrupt toad and this government stinks for the way in which it is forcing through this dishonest disgrace of a piece of destructive policy.  The Bill does nothing other than privatise the NHS, it will introduce a new pseudo-market that will allow the government's friends in big business to profit from the easy health care work, while local NHS services and emergency care will be undermined and shafted.  Bevan is remembered as a great, Lansley will be remembered as the very opposite of great.

#Blockthebill and corrupt media

A mass protest is currently taking place on Westminster Bridge in London.  UKUncut has organised this protest against the corrupt and dishonest health Bill that is currently being railroaded through by the coalition government. 

The reasons for this protest are the same old reasons that we all have in opposing this dreadful destructive piece of legislation.  The public and the NHS staff are united against this Bill.  The worst thing about it is that the government have no mandate for the Bill, they promised they would protect the NHS, much like New Labour did before them, they have since gone back on their word and have set about dismantling and privatising our national health service.

The worst thing about all this is the way in which the mainstream media are yet again showing us their true colours.  Generally very few in the media have actually explained what the Bill means, maybe some of them don't understand it, it is also clear that some do not want to cover this issue objectively.

Today the media's lack of objectivity has yet again been demonstrated.  The BBC and SkyNews seem to be trying to ignore the blockade of the bridge, they prefer to concentrate on Paul McCartney's latest wedding, how very very tedious and what a sad indictment of their priorities.  At least the Guardian is making a proper effort to cover things.  I suspect the Channel 4 news will yet again show the BBC up with some far superior coverage of events tonight.

Thousands protesting about corrupt dishonest government health reform should be making the top headlines, it's a great shame that the media seem to be helping the government out with their policy of brushing the public's protests under the carpet.  It is sad that our so called democracy has been reduced to this.  If this Bill manages to get through the Lords it will truly be a very sad day indeed for this country.

Letter to the Lords

I have taken the liberty of repeating this letter than Dr Grumble has recently reproduced on his blog.  I would strongly urge anyone to sign up, time is fast running out:

"As doctors in England, we are writing to you to express our conviction that the Health and Social Care Bill will irreparably undermine the most important and admirable principles of the National Health Service, and to appeal for its rejection by the House of Lords.

Because it is universal and comprehensive, and publicly accountable, and because clinical decisions are made without regard for financial gain, the NHS is rightly regarded all over the world as the benchmark for fairness and equity in healthcare provision.

The transfer of services to private, profit-making companies will result in loss of public accountability and a damaging focus instead on low-risk areas that are financially profitable. A confused patchwork of competing providers will deliver a fragmented and inequitable service and any reliance on personal health budgets or insurance policies will further increase inequality. Because there will be a financial incentive for providing treatment patients will be over-treated, the potential costs of which are limitless. And the possibility of the commissioning role being outsourced to the private sector is also deeply concerning.

In forcing through this ill-conceived Bill, without an electoral mandate and against the strident objections of healthcare professionals, the Government is also ignoring overwhelming evidence that healthcare markets are inefficient and expensive to administer.

The public has been misled throughout, first by claims that no major reorganisation of the NHS would be undertaken, later by repeated denials that what is happening represents privatisation, and furthermore by suggestions that the Bill enjoys the support of the medical profession. We do not accept the argument that "things have already gone too far" - the enactment of some of the Bill's proposals has been premature and illegal, however some of its most damaging aspects may still be mitigated.

We believe that on moral, clinical and economic grounds, the Health and Social Care Bill must be rejected."

Email Jonathan.folb@nhs.net to add your name on.  Do not hesitate, every little bit of resistance helps.

The Bill of disgrace

I must apologise for my absence from the blogosphere over recent months, it has certainly been a strange old time in the NHS. The health news has been dominated by the Health Bill but the word 'dominated' doesn't really express the fact that the media have not covered this issue well or objectively in my opinion.

The bias and lack of objectivity in the media as regards health as been demonstrated perfectly by the way in which this destructive and dishonest government policy has been ushered through thus far. The media just haven't got to grips with the issues and it was almost swept under the carpet as the Bill narrowly passed through the House of Commons.

Dr Grumble's recent post shows just how deep the feeling is against this Bill, this letter gets across just how dangerous the Bill is and how it spells the end of a national service as we know it. The Bill is not what the liars of politicians pretend it to be, it is the blueprint for the mass privatisation of the NHS, anyone denying this is simply lying. The fact that the media have not widely acknowledged this makes it clear they have not bothered to read the Bill or they are liars.

The NHS has many faults but these can be worked on in many effective ways without the mass privatisation of services, in fact the mass privatisation is likely to drive down standards and reduce the continuity of care further. Arguing that the Bill is a dangerous corrupt disaster does not mean that I do not want some effective future reform, the point is that this 'reform' is not progress, it is a regressive and dangerous step backwards for the nation's health.

I just hope and pray that the Lords can stand up for the best interests of the people of this country, the politicians have already let the people down and the Lords are our last hope.

Infection control madness

Dishonest manager-led patient torture

This current news story is old news, the sad thing is that this shocking treatment of patients has been going on for years now and it is completely evidence free and dishonest. Patients are being left in severe pain as their local managers are stopping their local surgeons carrying out joint replacement surgery which is the best evidence based treatment of their painful condition. Stupid managers in the Department of Health are trying to justify it by saying:

"When clinicians and patients are making decisions about joint replacement surgery, it is right that other procedures - which could provide better outcomes for patients and provide better value for taxpayers - are also considered."

What utter lies. I wonder if the above Department of Health manager knows which procedures are able to provide better pain relief than a joint replacement for patients with end stage osteoarthritis? I will not mince my words. Certain filthy individuals are trying to save money in the most disgraceful manner possible, by denying patients the best and most appropriate treatment for their medical conditions. It is quite simply beneath contempt. This non-clinician led cost cutting is based on zero scientific evidence, it is simply inhumane torture in my eyes. The worst thing about all this is that by trying to save money, the alternatives to surgery are more expensive than the surgery itself, it makes no sense on any level at all:

"The double jeopardy is that patients wait longer in pain, and when they have the operation, the result might not have been as good as it otherwise would have been had they had it early. "

Lansley and his lies: a tired corrupt joke

I recently took the time out to listen to a certain Andrew Lansley interviewed on Doctors.net.uk, unfortunately nothing surprised me. Lansley comes across as a slightly unpleasant and aggressive individual, he doesn't like having to answer questions, he seems to just assume that 'his change' is good change.

I was not impressed by several of Lansely's naive assumptions. He frequently talked of 'decreasing bureaucracy' but he was never adequately questioned on this. The reform is costing several billion in itself, while the reorganisation of PCTs into GP consortia hardly promised to do much to the size of the administrative layer. Lansley should have been asked why introducing a marketised system with a central regulator 'Monitor' will drive down the bureaucratic costs, all the evidence suggests that markets like this lead to more bureaucracy, not less.

One thing Lansley was also not adequately questioned on was emergency care at NHS hospitals. The current white paper is the thin end of the wedge, it's one thing for certain elective work to be farmed out to alternate providers, but the problem comes when hospitals start to lost bits of their services and are still expected to provide the unprofitable emergency services in areas such as surgery/medicine/obstetrics etc.

Lansley talks of commissioning leading to 'more integrated services'. Relating to emergency services as explained above, certain hospitals will start to lose various bits of their axial skeleton while still being expected to run at the same speed in providing decent emergency services. Lansley needed to be grilled and taken down on emergency services, 'the fragmentation' will destroy decent DGH emergency care, it is an inevitability. Emergency care is unprofitable and the private firms will not bid for this, the NHS will be left to pick up the pieces but they will have lost essential parts of themselves, it is a disaster waiting to happen.

'Not allowing cherry picking', ignoring the improving outcomes and patient satisfaction levels, there were just so many cases in the interview where Lansley ignored the point and just repeated the same old claptrap. Lansley got far too easy a ride, he was very rarely grilled, hardly ever picked up on his errors, barely interrupted. interesting how is links to Care UK were not questioned at all in this interview. Not impressive in my eyes.

For anyone else worried about the government's 'reform', have a look at this, the rewording of Clause 2 looks rather key:

"Clause (2) is the crucial one. Where the wording used to be ‘must’ (provide services etc…), with its attached duties, it is now ‘must act with a view’ (to provide services etc…).

Now, note the syntax. In the previous wordings, the compulsion created by the must was to ‘provide (services etc)’. In the proposed amendment, the compulsion created by the must is to ‘act (with a view etc)’. At a stroke, the Secretary of State’s duty to provide services has been transformed into a duty to ‘act with a view’ – and ‘acting with a view’ is most certainly not the same thing as providing a service. The ministerial duty has been removed."

Neither Lansley or his words impress me, he's like a tired broken record, his expensive creation of yet more bureaucracy in yet another corrupt politically motivated deckchair reorganisation is bound to fail patients.

The 'principles' and the lies

It is quite astonishing what lies are being told as the government tries to railroad through it's destructive health white paper. As always with rubbish corrupt policy, the 'principles' behind it are the common defence used, irrelevant of the fact that the actual reforms will do nothing to to respect or even live up to the so called sham of the 'principles'.

We saw the same with MMC (Modernising Medical Careers), it was a useless load of policy designed to dumb down medical training, but who could argue with the principles? The principles of 'making training better for everyone' were fine, but the problem was that the policy behind these principles was only going to make things worse, the 'principles' were just a sham, a pretence that the government wasn't going to screw everything up in a royal fashion. In the end the principles turned out to be fine, it's just a shame that they were a smokescreen for the carnage and damage that resulted from MMC.

The same smokescreen of 'principles' is being used with the government's destructive current reforms, who could argue with making every one's health better? It's just a shame that the white paper will do nothing to live up to the noble 'principles' that the dishonourable Andrew Lansley keeps rambling on about.

Dr Grumble's excellent recent talk of the 'health tsunami' is spot on. It is quite clear that the Conservative and the Lib Dems are lying through their teeth in betraying those who voted for them. Both parties have completely ignored their manifesto promised to shaft the public with this program of enforced privatisation of the NHS. The BMA are quite rightly trying to stand up to this wave of propaganda and doublespeak, the problem is that the media do not appear to understand the issue and don't give the government's lies nearly enough critical analysis.

BMJ bias: the sorry Needham saga

The following letter has been signed by a number of doctors and sent to the BMJ, the author has sent it on to me to publish here just in case the BMJ decide not to stick it up on their website. It focuses on the BMJ's strange decision to give Gillian Needham a free shot of self justification the other week. The BMA has subsequently published only a small percentage of the rapid responses on their website, they have also only published by far the least critical letters in print form. BMJ bias, you work it out:

"We, the undersigned, believe that we represent a broad cross section of the medical profession from UK shores and as such, we believe that the BMJ's decision to publish Gillian Needham's 'personal view' was a massive editorial error (1) for which the BMJ should apologise. The BMJ's consequent editorial decision to publish only two of the least critical responses to Gillian Needham's twisted and one-sided tale of self-justification in print is both disappointing and unrepresentative of the general feeling of the medical profession. Perhaps the BMJ is hoping that the focus on their initial editorial error will shift and that by failing to publish the other side of the story fairly this process will be catalysed. Whatever the motivations were behind these editorial decisions, I would like to register my disapproval of the BMJ's coverage of this whole affair. Would the BMJ care to apologise or at least attempt to justify its biased coverage of Needham’s flagrant abuse of her position of medical power?

1. Needham, G. Free speech and professional duty: why I couldn’t fight tabloid rumours. BMJ 2011; 342:d752 "

I wonder if the BMJ will respond on this, I cannot imagine they will apologise, even though it is clear they should do, the editorial decision that allowed Needham's personal view to be printed was a massive error of judgement.

Bravo Baroness!

I must apologise for being so lazy with this little blogging effort. I stumbled upon this blogging piece which links in two excellent pieces of opinion the government's disastrous White Paper. The Baroness's excellent piece has been repeated here:

"I can’t support the coalition plan for the NHS
by Liberal Democrat Peer, Baroness Williams of Crosby

Some of the health service reforms are valuable but the scale is too great and too many questions are unanswered. Being in a coalition government produces difficult dilemmas. I support the coalition agreement. I believe the coalition is necessary to tackle our immense financial crisis. But every now and then, a dilemma emerges that cannot easily be resolved. Such a dilemma for me is Andrew Lansley’s health policy.

I campaigned nationwide in the last general election on the basis of the Liberal Democrat manifesto, reiterating our strong commitment to the National Health Service. The coalition agreement, which promised “to stop top-down reorganisations of the NHS” and made no mention of insisting on competition, posed no problems. On reading it I felt the NHS was safe in David Cameron’s hands.

But a recent report by the candid and incisive Commons Health Select Committee pointed out big differences between the agreement and the subsequent White Paper, Equity and Excellence: Liberating the NHS: “The coalition programme anticipated an evolution of existing institutions, the White Paper announced significant institutional upheaval.”

As a Liberal Democrat parliamentarian, I am under no obligation to support policies outside the agreement. Indeed, I have a moral duty to the voters I asked to support us to find out exactly what Mr Lansley intends and its implications for the NHS. So I have a few questions.

But first let me say what is valuable in his proposals: the recognition that the NHS must become more efficient if an ageing population is to have good care; the joining-up of healthcare and social care vital to the wellbeing of sadly neglected elderly people; reducing bureaucracy, though it will be easier said than done; ending Labour’s often niggling interventions in professional judgments, which left a legacy of resentment. There is, however, an unresolved tension between an emphasis on good management for obtaining efficiency savings, and the plans for radically reducing NHS staff.

I have four questions: the cost of the reorganisation, the accountability of the new GP consortiums, the role of the private sector and patient choice.

The cost
What is the cost? The Government must reduce public spending from 2011- 2015 by £80 billion. If it can’t, its strategy will have failed. The NHS accounts for a third of England’s revenue budget and 11 per cent of its capital budget. It faces relentlessly growing demand.

David Nicholson, the chief executive of the NHS and now of the National Commissioning Board, noted in 2009 that the NHS must find £15-£20 billion in efficiency savings in the next four years. But he himself believes that “to do so will require clear and effective management every step of the way”.

Key to this is a 40 per cent cut in management costs. Already hundreds of managers have left Primary Care Trusts at a cost of about £1 billion. The impact of this is not yet known, but GP commissioning consortiums are bound to look for good managers, some of whom will be hired from outside the NHS. They are likely to cost more. Some 20 per cent of the savings will come from moving patients from specialised hospital care to treatment by GPs or nurses in the community.

The final 40 per cent will have to come from clinicians and hospitals, an estimated £2 billion a year. Such huge savings will almost certainly entail an element of rationing. Waiting lists for routine operations are lengthening, and in some cases they are being postponed or cancelled. As the National Audit Office observed: “Government reorganisations … frequently entail higher costs than anticipated”.

Accountability
What arrangements are there to hold GP consortia accountable for quality of care? Primary care trusts (PCTs) were accountable to Strategic Health Authorities and, ultimately, to the Secretary of State. They were overseen by local authority committees. Meetings were held in public and the minutes made available. The new consortia, responsible for about £80 billion, are not obliged to meet in public. Local health-watch groups may scrutinise them but have no power to hold them accountable. Suggestions for adding knowledgeable lay people, members of other medical professions such as clinicians or nurses and elected local representatives have come from many quarters, but it will be up to each consortium to decide for itself.

Accountability upwards will be to the Secretary of State via the NHS Commissioning Board, but the board has no powers of oversight.

The private sector
What are the Government’s intentions here? Private medical practices work closely with NHS colleagues and were encouraged by Labour to bid for contracts at a price determined by the NHS tariff. Competition for these contracts depended on the quality and effectiveness of service. There is a cap on the proportion of private beds in Foundation Trust hospitals, which varies according to earnings from private patients and is much higher in London. Last year the private sector treated 220,000 patients.

The Government is now preparing to remove the cap, renegotiate the tariff and require the National Commissioning Board to promote competition. This will open the door to competition on price, not just quality. Many clinicians fear that the private sector will skim off profitable routine operations, leaving expensive, complicated treatment to the NHS.

The body that will license health providers is Monitor, which oversees foundation trusts. Its chairman, David Bennett, wants healthcare exposed to competition like gas and rail. British Gas raised energy prices by 7 per cent last year, while making £700 million in profits. Since rail privatisation, the UK had paid the highest fares in Europe. Should this inspire confidence?

Patient choice
How does the Secretary of State reconcile this with the need for large savings? Mr Lansley puts great emphasis on the involvement of patients in their own treatment. That’s good but achieving it in practice is hard. Articulate and self-confident people are likely to benefit, but elderly or busy patients will have little basis for their choices beyond rumour or GPs’ advice. Choice must be balanced against the realities of a publicly funded service.

Underlying the debate about health is another about values. For some of us, health care is a public service, strengthened by partnership and co-operation, the model in most Western European countries. For others, it is a market in which price determines quality, the US pattern. A June 2010 study of 11 health systems by the US-based Commonwealth Fund said of the US system: “Compared with … Australia, Canada, Germany, the Netherlands and the UK, the US system ranks last or next to last on five dimensions … quality, access, efficiency, equity and healthy lives.” The NHS was the second least expensive per person after New Zealand, and came first on effective care, efficiency and cost-related access, and second on equity and in the overall ranking. Why we should dismember this remarkably successful public service for an untried and disruptive reorganisation amazes me. I remain unconvinced."

This is all absolutely spot on. The Liberal Democrat MPs who are supporting the White Paper should hang their heads in deep shame, they can have no excuses at all, they are selling their souls. There was also an excellent bit of journalism on the Channel 4 news tonight exposing some other problems with the proposed system, huge conflicts of interest indeed.

Politicians and managers expect NHS silver service

One thing that I have noticed as a bit of a recurrent theme during my time in the NHS has been the way that politicians and NHS managers expect to be treated like private patients on the NHS, they do not tolerate the treatment that normal 'mere mortal' patients receive, they insist on being treated differently, they want to be shunted ahead of the others, they do not want to ever wait for anything, they expect the silver service on the NHS and it tells you a lot about the kind of people that they are.

Obviously doctors and nurses themselves will generally get treated a bit differently by their colleagues, but it's the way that they so rarely push for it, they generally politely accept whatever they are given, the doctors and nurses are generally a very different breed to a medical manager or politician.

The NHS managers and politicians are often not the most pleasant of individuals, they lack manners and frequently bully their way into getting preferential treatment. They care not for the other patients that will be delayed by their own special treatment, they only think of themselves. I will obviously mention no names, but certain rather high profile individuals have bullied and threatened their way to an NHS silver service in recent years.

The worst thing about this is that these very same managers and politicians have often so frequently done absolutely nothing when front line staff have complained to them about the lack of resources, the long waits that patients are being subjected to et cetera. When their health is not directly affected they care not, they hide in their ivory towers and ignore the problems. However when their own health is on the line, they expect the rules to be broken, the normal service others get is not good enough for them, they will force the best for themselves at a cost to other patients. This kind of behaviour makes them hypocrites of the highest order and it really stinks. Obviously the image above of Tony Blair is nothing to do with the above article, it is but a pure coincidence.

Scottygate revisited - Needham shoots herself in foot

It was hard to miss the 'Scottygate' scandal of a couple of years ago; if you missed it then Dr Rant has covered a lot of it in excellent detail. Essentially various senior doctors in management positions used their power in a completely disproportionate manner and this resulted in a junior doctor being inappropriately suspended from work for a significant period of time. It was a classical case of the medicopolitical abuse of power.

One of the senior doctors behind this scandal was Gillian Needham. She has now felt the need to give her 'side' of the story, really she should have simply let sleeping dogs lie, instead she is amazingly trying to portray herself as the victim in the whole affair, while her lack of remorse and her complete inability to admit to having made a big mistake are unbelievable, it is quite simply beneath contempt.

The BMJ have also made a massive error in giving this woman the space with which to try to justify the unjustifiable, she deserves no sympathy from the BMJ's readership and she will not get any I am sure. Several letters are already flooding into the BMJ's rapid response section and it will not be very favourable for Needham. I have taken this excellent and eloquent response to Gillian Needham, it is written by a senior doctor who sums things up very nicely indeed:

"I fully expect that this message will be but one of the deluge that will flood your inbox over the coming days, but I was so incensed by your self-serving patronising and utterly complacent article published in the BMJ this weekend that a direct response was needed. You should be thoroughly ashamed of yourself, behaving as you do; like a petulant talentless teenager on a popular reality television show.

I will pass briefly over the gross affront accorded to retired doctors who you glibly dismiss and compartmentalise as having passed through a medical death by asking just from where do you derive this imperious arrogance and disconnection from reality?

The facts of this matter are, that by over reacting you precipitated a maelstrom which damaged the offending trainee far more the fleeting discomfort you experienced. It is of course very frustrating when something is in the public domain and as an office holder you cannot reply. Believe me I know this only too well, having managed a number of very high profile problems and having been misrepresented myself. Get over it; it goes with the territory. The true professional does not respond then, or ever after. Certainly never in a such a whinging, self serving way that can only ignite the original grievances again. You will certainly be further diminished by doing this.

You, and your colleagues in medical education perpetuated a disastrous re-organisation of post graduate training, introducing a system more akin to the Soviet era in its total disregard of the personal needs of trainees and focus on standardised production. You do not seem to appreciate that because of what you did, there are thousands of young men and women out there who have been permanently damaged by your slavishly idealistic and dogmatic attitudes.

You Madam are depised and loathed by these doctors whose development you and your colleagues let down so badly. The fact that you have published this account shows how little you understand that. Doubtless you will now be thinking about another intimate piece of disclosure to show how unfair you think the hostile response to your self-indulgent pleading is. Like the petulant teenager, you know no shame.

You brought the wrath of others upon your head by your overzealous and disproportionate reaction in the first place, and now you are doing the same by this ridiculous attempt at self justification. When will you ever learn?

Yours etc"

Hear, Hear.