Monday, December 19, 2005

NHS Fire Death Plan

There are adverts in this country produced by the government detailing your actions in the case of a fire in your home:

o       Get Out
o       Stay Out
o       Get the Fibre brigade out

Weve got a similar one in the NHS when a fire alarm goes off:

o       Hang around
o       Look up from newspaper at colleagues to check theyre ignoring it too
o       Light up a fag youre safe till the alarm goes off
o       Look out window to see if you can see a fire engine
o       Sniff air cant smell any smoke?  Thats fine then
o       Carry on with what you were doing before fire alarm broke concentration, but if you see actual flames then walk in opposite direction

On the down side, if theres ever a fire in an NHS building all the staff in patients will be incinerated, on the plus side, its unlikely anyone will really miss them, and of course given that fire alarms go off every ten minutes in the NHS the system would grind to a halt if anyone paid them any actual attention.*

*If you are a junior doctor, remember, if you see a fire, do not waste any time telling anyone about it:

Junior Doc: Nurse, theres a fire in the sluice…’

Nurse: Sorry Doc, Im just back from holiday/a bank nurse/an imposter/drunk/on crack/a prostitute (delete as inappropriate)

JD: (dials emergency line) I want to report a fire

Emergency porter: (in local patois) sorry son, were flat out here reading the Daily Star

JD: sighs and walks off to leave patients to burn to death/fights fire bare handed and gets on front page of local newspaper*

*delete according to whether you can be arsed or not.

Wednesday, December 07, 2005

The self serving parasitic nature of nhs management

At last, a management decision more stupid than the 'dancing underpants to prevent MRSA' idea from last year:

So we've got a new 'system'* for ordering blood tests. Don't worry, it meets all the criteria for a new NHS 'system':
1. The original one worked fine
2. There are other systems in existence that drastically need updating but have been ignored.
3 The new system is worse than the old one
4. The new system costs ten times the value of the known universe.

You see, we used to order blood tests on a piece of paper - pick up the piece of paper, put the patient's details on it, write the tests you want, put the blood bottles in the plastic bag et voila, 6 times out of 10 you would get back a result not completely different to the one you requested. So they thought they'd computerise it. God knows why. I mean why? Why? There are just so many things that should be computerised, like you could get a robot to say 'no' to x rays instead of paying a radiologist to do it. What was wrong with the damn handwritten forms for blood tests? Absolutely nothing that's what.

So the new computer system is
i. very slow
ii. very counter intuitive
iii. requires another (yes another I now have two thousand) bloody password that mutates every three days and has to consist of fifteen numbers letters and smileys to be valid and
iv. only one doctor can use it at anyone time so there's a huge queue of medics at the computer in clinic waiting to print off the forms.

*Total load of sewage

So we go on the ward this morning, and the computer has run out of the request slips. So we ask the ward clerk (who is by a complete miracle actually at work and, rumour has it, with the full knowledge of the Trust) to get us some more slips. But she can't. She needs approval from Sharon Waites in management, and she's off sick with 'flu* so we'll have to wait two weeks. 'Whatthefuck?' we say, but we already know we're beaten.

*'flu ie a vague sniffle accompanied by a strong lack of professionalism.

What's worse is that management have efficiently* removed all the old handwritten forms. So if you're having a bone marrow tranpslant in our area then you won't be having any blood tests because Sharon fucking Waites is blowing her nose infront of daytime television instead of doing what she should be doing which is sacking herself and handing herself in to the police as an Oxygen theif.

*ie contrary to every bone in their body

Monday, December 05, 2005

You can email blog posts! Whatever next!

Maybe helium skis?

Nurses are always good

Have you ever complained about the nurses? Of course you haven't, that was a rhetorical question. Similar questions would include 'Have you ever tried sandpaper on your eyes?' and 'Hey, wasn't that Iraq invasion great?'. There's a scene in the French polemic 'Germinale' where a rather nasty male shopkeeper is beaten to death by the females he has been oppressing, during the beating they rip off his genitals and display them at the top of a flag pole. I can now reveal the history behind this hideous scene: the author, Emile Zola, had a medical colleague working at the Hopital Des Curses Hidieuses et Horrifique in the leprosy quarter of Paris at the turn of the twentieth century (or is that the turn of the nineteenth century?). Anyway this colleauge, let us call him Nom Fabrique, was working on a geriatric rehabilitation ward; it occurred to him that the nursing practice of recycling the patient's gastrointestinal contents using a Veronique ano-oral circulator (basically a watertight tube that joins the patient's tail end to their mouth) may have been contributing the unusually massive death rate on the ward, and he resolved to talk to the Sister of the ward. He approached her using the correct fashion, kneeling with his eyes averted and hailing 'all hail queen ra' at a fixed distance of one hundred yards; the junior nurse gave him leave to approach to fifty yards; here he prostrated himself flat upon his belly and licked the floor of the ward the requisite sixty nine times; here the senior staff nurse beckoned him to with ten yards of the ward sister; keeping his eyes averted he begged for permission to speak; the ward sister assented with a single contraction of her left pupil; Dr Fabrique then raised his concerns about the gut recycler, and asked if the practice could be abondoned. Immediately the Sister drew herself to her full height and exploded into flames, the brightness of which turned the walls black; the flames scorched Dr Fabrique to a crisp, and the senior staff nurse skewered him through his catflap with a spare drip stand; his innards were hurled to the junior staff nurses and health care assistants, and he was left hoisted infront of the hospital gates as a warning to junior doctors who would dare to complain to the nurses. And that is why you should not complain to the nurses. You're leaving in six months time anyway dammit, so what's the goddam point.

X ray can see through you

1. The X ray department are there torture you. If the X ray department are driving you mad that's good, they're doing their job.

2. Your consultant will demand an expensive test you have never heard of on a patient you have never met and you will be made to go and request it. Your consultant will make it clear that your job depends on you arranging this test. As you leave the ward, X ray request card in hand, the nurses will laugh out loud. Your colleagues will cross themselves.

3. If your ward is at point A and X ray is point B, the distance between point A and point B will be longer than the circumference of the hospital. This is impossible.

4. There will be no-one in the X ray department except for one old lady on a trolley singing the Serbian national anthem. You will look for a single human being for ten minutes. You will decide that it must be Sunday and you have come to work by mistake.

5. You find a technician in the scanner room but there is no radiologist. You ask where you can find one. She doesn't know. She doesn’t know anything and wouldn't help you if she could. She hates you and so does everyone else in the X ray department.

6. You are now in limbo. You can't go back to the ward and your consultant without an answer. You can't stay in the radiology department. You are in Radiology Limbo. (The longest single period or radiological limbo was spent by Dr Yves Verland, a visiting French clinical fellow in urology. His consultant had requested a reverse micturating anal atomic spasmogram, a test that had only been previously performed on Squirrels at a research center in the Andes. The equipment to perform the test did not exist, and most importantly of all, the test was of absolutely no clinical value. It thus met all the criteria for a standard consultant radiological request. The entire X ray department were on a 3 month conference in Bermuda. A single lone radiologist was manning the department for this time and Dr Vercland made a total of 74 separate requests for the test, relaying the replies, always in the negative, back to his urological consultant. At no point did the two consultants speak directly to each other to resolve the dispute, despite the fact that they were husband and wife. The reasons given for refusing the tests were as follows:
1) Incorrectly filled in request form - 62 times
2) Incorrect form used - despite not owning an Atomic Spasmogram, the department still had specific Atomic Spasmogram request forms, and would refuse requests written on other radiology tests*. - 4 times
3) Servicing of the Atomic Spasmogram - 2 denied requests - despite not having an Atomic Spasmogram, the department still paid £2000 yearly to have it serviced
4) No staff available - 3 times - the department paid 3 radiographers
£21000 per year each to man the non existent device.

*No copies of this form were ever made. This is normal.

7. In keeping with radiological thinking, at no point was the Atomic Spasmogram refused because it was not clinically indicated. This particular denial is reserved for tests that are absolutely vital to save a patient's life.

8. The issue was only resolved when the patient died from malnutrition, having been kept nil by mouth the entire time in the hope that if the test became available he would be ready to undertake it.. This occurred on Dr Vercland’s last day, the entire process having taken every single day of his urological placement, including holiday. He immediately gave up medicine and now farms butterflies in Occitane region of France.)

Park or die

1. Parking. Christ.

2. You will have to drive to work. Hospitals are built on cheap land away from stations, and the Trust pay fanatics in four wheel drive cars to patrol the local roads running over anyone who cycles. If you walk you will be mugged or raped or both.

3. You cannot drive to work. The radius of full parking spaces around the hospital swells and contracts daily. One day you will be able to park close enough to see the hospital through powerful binoculars, another day you will actually have to drive further away from the hospital than you actually live and catch a plane.

4. Don't try and get a parking pass - the process will be too complicated and you won't be clever enough. You're just a doctor. Einstein could have got one, but only with help from a supercomputer yet to be built.

5. Wherever you park a parking attendant will find you. The hospital has run out of money for porters, leaving you to fill the gap, but they will never, ever run out of funds for their army of car park attendants. If you are lucky they will clamp you, and you can abandon your car and job, and make a happy if simple life selling shells to tourists in a Scottish fishing village. If they don't have any clamps they will put stickers on your windows that do not use glue but a special agent that can only be removed by weapons grade plutonium. After 30 days your car be hidden under a pile of stickers and will have to be scrapped. It would be better to buy a bike and die quickly, it really would.

The unbearable pointlessness of induction

1. As a junior doctor you will be moved from post to post, city to city, specialty to specialty for no apparent reason at very regular reasons. This sounds terrible, but it is worse than that. 97% percent of the NHS budget goes on the costs of this massive bi-annual exodus. If you ask your seniors why you are being moved they will look at you as if you have smeared faeces in your hair and recited the lords prayer backwards. For Christ’s sake they did it didn't they? And it didn't do them any harm did it?

2. You will be invited to induction at each new post. Induction is a joke by the General Medical Council. The whole department is completely dependant on you and cannot spare you for induction, so to be successfully inducted and orientated to a post would in effect directly result in the deaths of several patients. Everyone knows this, but despite this you will be sent to an induction day when you arrive, from which you will be bleeped within a fraction of time so short that it can be only measured in a Swiss particle accelerator.

3. The only thing worse than being bleeped out of an induction day is not being bleeped out of an induction day. The program will be designed by a total loser of a consultant , almost certainly banned from patient contact because of 'inappropriate behaviour'*, and someone from Human Resources. The only person with less idea on what information you require on your first day will be the woman from Human Resources, who will be utterly useless. She will make up for it by providing ten thousand forms, all of which duplicate the same questions on different coloured paper. If you make a single mistake on a single form you will not be paid.

4. *GMC doublespeak for serial rape. Doctors cannot be struck off for this under current GMC rules (see Snodgrass vs The Crown, 1522). The GMC repeatedly tops the Cambridge Philosophy Club's top 100 utterly illogical committees, having made eighteen thousand completely stupid decisions since its inception. See section 73.

5. You will not be paid anyway.

6. This is your problem and you have to sort it out. You will have no time to sort it out or someone will die and it will be your fault. Payroll will be permanently engaged, and when you get through will not help as you do not have a payroll number. They put you through to Human resources who do not exist. You try medical personnel and medical staffing then give up and work for free.

7. You tell your colleagues. They don't care. It's your problem.