We provided World Class Medicine without trying. A quote from a fellow blogger, Dr. No.
Dr No said...
Excellent post - and yes, that is exactly how it used to be. World class medicine without even trying - we just did it, because that is what we did, just as the dolphin swims, and the eagle soars. A key, even vital feature was that the doctors looking after their patients did not need to worry about money or managers. They just got on with it. There was no market to get in the way of truly integrated care. Some may point out that 13 year olds with teratomas are rare, and that is true, but what this case shows us, precisely because of its complexity, is just how capable the system was. And most of the time (of course not always), it dealt just as capably with more routine cases. "How is (sic) the new Consortia going to work out the funding and how are the three Foundation Trust Hospitals going to work out the costs." Exactly. And then: who is going to pay for the staff and their time to work out out all those costs and conduct the transactions?
What many politicians may not know is that pride in what we do is often more important than money or anything else. Our pride is one sure way to ensure quality of practice.
Do we really want to take that away now? Years of heartless re-organisation has left many of us dedicated doctors disillusioned. Many young ones have left. Poorly trained doctors that have no right to be practising medicine now even have jobs in some of these well known hospitals.
Can we continue to practise World Class Medicine even if we wanted to?
According to old Chinese advice, it is wise never to discuss politics or religion even amongst best friends.
Religious belief can often blur judgment in the wisest of people.
Thirty years ago, a patient of mine was unconscious for 23 days and it was mother's belief that it was through prayer that her daughter was saved. I did not argue with her then.
But perhaps God works through his people in his own way. Discoveries in Medicine should therefore enhance our faith rather than the other way round.
It took nearly 30 years for the real answer to her prayers to really emerge.
My recent visit to this beautiful church in Norway reminded me of my patient. and i cannot believe that it took another 30 years for the true answer to arrive.
Beautiful Church in Tromso, Norway.
Beautiful Church in Tromso, Norway.
© 2019 Am Ang Zhang
© 2019 Am Ang Zhang
Some time in early February of 1978 I was called to do a Home Visit on a thirteen year old girl by Dr Pinkerton, a paediatric consultant. Dr Pinkerton had been the local Paed for years and was generally well regarded. She had, in my short time as consultant, referred a couple of cases, most notably that of a Tourette syndrome and a boy with non-stoppable hiccups. Both cases put me in her A-list and I gathered that not many were on that list. Needless to say I realised too that her cases were never straightforward or simple. Those she would have dealt with herself. The girl had upper arm stiffness on the left side and Dr Pinkerton could not find much else wrong with her, and so it crossed her mind that perhaps there was something psychiatrically wrong. The girl was also carrying out some strange rituals around the house and Dr Pinkerton did wonder about psychosis or even catatonia.
...............
Read the whole chapter: Chapter 29 The Power of Prayers
The x-ray came back. The tell tale tooth was there and yes – a Teratoma[5], the distinctive type of tumour that can include teeth, hair, sometimes, even a jaw and tongue. I guessed just a split second before the results came back. How annoying.
Working diagnosis: Teratoma with possible toxic psychosis.
Emergency operation was arranged. Yes, she would be fine a little while after the operation, I reassured the parents.
The paediatric junior arrived and took some history and did a quick physical before she was prepared for the theatre. This petite doctor with a very babyish face told me that on her first day in her last job she had to do an emergency tracheotomy. This time she had been on call for the last three nights and the battery in her old Mini could not cope with the heavy frost so she had to wait for AA before coming. She was most apologetic for not having got in earlier.
She asked if I had seen many toxic psychosis cases and I asked if she had come across any in her psychiatric placement. As with all good psychiatrists answering a question with another is in our blood and here it worked well.
Neither of us knew what was to hit us next.
At 2 A.M. I had a call from her.
“Your patient – I mean our patient could not be aroused after the operation. Yes they removed the teratoma, complete and intact. It is bigger than any specimen I have seen but she could not be aroused. Any ideas?”
“Call the paediatrician on call in the regional paediatric unit and I will be in.”
What happened? I asked myself as I drove to the hospital.
What had we done? This was fast becoming a nightmare situation.
What was I going to say to the parents?
Something else was going on here, and I was not happy because I did not know what it was. I was supposed to know and I generally did. After all I was the consultant now.........
Read the whole chapter: Chapter 29 The Power of Prayers
In medicine, truly new discoveries are uncommon and with the emergence of guidelines and protocols it has become even more difficult to make new discoveries. It has taken over 30 years before I could understand what happened to my Teratoma patient. Luckily for her, the treatment she received would have been in line with what we know now of the condition.
Hospital Medicine indeed has its important place and most important of all in the discovery of new conditions and establishing diagnostic and treatment programmes.
It is perhaps timely to remind the next generation of Bright Young Things that become doctors to remember that psychiatric symptoms presented by a patient may indeed be the presentation of a neurological condition.
This is more so for bizarre combinations of psychiatric and other symptoms. It was in the last five years or so that much progress has been made on what is now called Anti-NMDA Receptor Encephalitis.
Who knows, one day medical scientists might be able to decipher the most difficult of psychiatric conditions: Schizophrenia. Bright Young Psychiatrist might have noticed that Clozapine, one of the most effective drugs for schizophrenia has a marked effect on the immune system.
In the mean time Pennsylvania
For now, my patient’s parents’ prayer has been answered.
Chapter 29 The Power of Prayers
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Anti-NMDA Receptor Encephalitis
NEW ORLEANS — A mysterious, difficult-to-diagnose, and potentially deadly disease that was only recently discovered can be controlled most effectively if treatment is started within the first month that symptoms occur, according to a new report by researchers from the Perelman School of Medicine at the University of Pennsylvania. The researchers analyzed 565 cases of this recently discovered paraneoplastic condition, called Anti-NMDA Receptor Encephalitis, and determined that if initial treatments fail, second-line therapy significantly improves outcomes compared with repeating treatments or no additional treatments (76 percent versus 55 percent). The research is being presented at the American Academy of Neurology's 64th Annual Meeting in
565 cases! Not so rare!
The condition occurs most frequently in women (81 percent of cases), and predominately in younger people (36 percent of cases occurring in people under 18 years of age, the average age is 19). Symptoms range from psychiatric symptoms, memory issues, speech disorders, seizures, involuntary movements, to decreased levels of consciousness and breathing. Within the first month, movement disorders were more frequent in children, while memory problems and decreased breathing predominated in adults.
My patient was under 18 and presented with catatonia symptoms. She later lose consciousness and was ventilated.
"Our study establishes the first treatment guidelines for NMDA-receptor encephalitis, based on data from a large group of patients, experience using different types of treatment, and extensive long-term follow-up," said lead author Maarten Titulaer , MD Perelman School of Medicine at the University Pennsylvania
The disease was first characterized by Penn's Josep Dalmau, MD, PhD, adjunct professor of Neurology, and David R. Lynch, MD, PhD, associate professor of Neurology and Pediatrics, in Annals of Neurology in 2007. One year later, the same investigators in collaboration with Rita Balice-Gordon, PhD, professor of Neuroscience, characterized the main syndrome and provided preliminary evidence that the antibodies have a pathogenic effect on the NR1 subunit of the NMDA receptor in the Lancet Neurology in December 2008. The disease can be diagnosed using a test developed at the University Pennsylvania
Teratoma: finally!
In earlier reports, 59 percent of patients had tumors, most commonly ovarian teratoma, but in the latest update, 54 percent of women over 12 years had tumors, and only six percent of girls under 12 years old had ovarian teratomas. In addition, relapses were noted in 13 percent of patients, 78 percent of the relapses occurred in patients without teratomas.
As Anti-NMDA Receptor Encephalitis, the most common and best characterized antibody-mediated encephalitis, becomes better understood, quicker diagnosis and early treatment can improve outcomes for this severe disease.
The study was presented in a plenary session on Wednesday, April 25, 2012 ET at 9:35 AM at the American Academy of Neurology's annual meeting.
[PL01.001] Clinical Features, Treatment, and Outcome of 500 Patients with Anti-NMDA Receptor Encephalitis
Of 100 patients with anti-NMDA-receptor encephalitis, a disorder that associates with antibodies against the NR1 subunit of the receptor, many were initially seen by psychiatrists or admitted to psychiatric centres but subsequently developed seizures, decline of consciousness, and complex symptoms requiring multidisciplinary care. While poorly responsive or in a catatonic-like state, 93 patients developed hypoventilation, autonomic imbalance, or abnormal movements, all overlapping in 52 patients. 59% of patients had a tumour, most commonly ovarian teratoma. Despite the severity of the disorder, 75 patients recovered and 25 had severe deficits or died.
Related paper:
Post Script:
“Ten years later mother came to see my secretary and left a photo. It was a photo of her daughter and her new baby. She had been working at the local bank since she left school, met a very nice man and now she had a baby. Mother thought I might remember them and perhaps I would be pleased with the outcome.
“Ten years later mother came to see my secretary and left a photo. It was a photo of her daughter and her new baby. She had been working at the local bank since she left school, met a very nice man and now she had a baby. Mother thought I might remember them and perhaps I would be pleased with the outcome.
I was very pleased for them too but I would hate for anyone to put faith or god to such a test too often.”
Wednesday, March 27, 2019
Tuesday, February 19, 2019
The NHS: This Good?
Best Health Care: France & The NHS
Friends moved to France after their retirement and lived in one of the wine growing districts.
They were extremely pleased with the Health Care they received from their doctor locally. After all, not long ago, French Health Care topped the WHO ranking.
Then our lady friend had some gynaecological condition. She consulted the local doctor who referred her to the regional hospital: a beautiful new hospital with the best in modern equipment. In no time, arrangement was made for her to be admitted and a key-hole procedure performed. The French government paid for 70% and the rest was covered by insurance they took out.
They were thrilled.
We did not see them for a while and then they came to visit us in one of our holiday places in a warm country.
They have moved back to England.
What happened?
Four months after the operation they were back visiting family in England. She was constipated and then developed severe abdominal pain. She was in London so went to A & E (ER) at one of the major teaching hospitals.
“I was seen by a young doctor, a lady doctor who took a detail history and examined me. I thought I was going to be given some laxative, pain killer and sent home.”
“No, she called her consultant and I was admitted straight away.”
To cut the long story short, she had acute abdomen due to gangrenous colon from the previous procedure.
She was saved but she has lost a section of her intestine.
They sold their place in the beautiful wine region and moved back to England.
Now we know.
Let us keep it that way.
NHS: Best Health Care Days!
NHS & Private Medicine: Best Health Care & Porsche
Do we judge how good a doctor is by the car he drives? I remember medical school friends preferred to seek advice from Ferrari driving surgeons than from Rover driving psychiatrists.
My friend was amazed that I gave up Private Health Care when my wife retired.
“I know you worked for the NHS but there is no guarantee, is there?”
Well, in life you do have to believe in something. The truth is simpler in that after five years from her retirement, the co-payment is 90%.
He worked for one of the major utility companies and had the top-notch coverage.
“The laser treatment for my cataract was amazing and the surgeon drives a Porsche 911.”
Porsche official Website
He was very happy with the results.
“He has to be good, he drives a Porsche.”
Then he started feeling dizzy and having some strange noise problems in one of his ears.
“I saw a wonderful ENT specialist within a week at the same private hospital whereas I would have to wait much longer in the NHS.”
What could one say! We are losing the funny game.
What does he drive?
A Carrera.
Another Porsche.
We are OK then.
Or are we.
He was not any better. And after eight months of fortnightly appointments, the Carrera doctor suggested a mastoidectomy.
Perhaps you should get a second opinion from an NHS consultant. Perhaps see a neurologist.
“I could not believe you said that, his two children are doctors. And he has private health care!” I was told off by my wife.
He took my advice though and he got an appointment within two weeks at one of the famous neurological units at a teaching hospital.
To cut the long story short, he has DAVF.
I asked my ENT colleague if it was difficult to diagnose DAVF.
“Not these days!”
He had a range of treatments and is now much better.
All in the NHS hospital.
“I don’t know what car he drives, but he is good. One of the procedures took 6 hours.”
Best health care.
I always knew: Porsche or otherwise.
Best Health Care: NHS GP & NHS Specialist
Does having a good hunch make you a good doctor or are we all so tick-box trained that we have lost that art. Why is it then that House MD is so popular when the story line is around the “hunch” of Doctor House?
Fortunately for my friend, her GP (family physician) has managed to keep that ability.
My friend was blessed with good health all her life. She seldom sees her GP so just before last Christmas she turned up because she has been having this funny headache that the usual OTC pain killers would not shift.
She would not have gone to the doctor except the extended family was going on a skiing holiday.
She managed to get to the surgery before they close. The receptionist told her that the doctor was about to leave. She was about to get an appointment for after Christmas when her doctor came out and was surprised to see my friend.
I have always told my juniors to be on the look out for situations like this. Life is strange. Such last minute situations always seem to bring in surprises. One should always be on the look out for what patient reveal to you as a “perhaps it is not important”.
Also any patient that you have not seen for a long time deserves a thorough examination.
She was seen immediately.
So no quick prescription of a stronger pain killer and no “have a nice holiday” then.
She took a careful history and did a quick examination including a thorough neurological examination.
Nothing.
Then something strange happened. Looking back now, I did wonder if she had spent sometime at a Neuroligical Unit.
She asked my friend to count backwards from 100.
My friend could not manage at 67.
She was admitted to a regional neurological unit. A scan showed that she had a left parietal glioma. She still remembered being seen by the neurosurgeon after her scan at 11 at night:
“We are taking it out in the morning!”
The skiing was cancelled but what a story.
Anorexia Nervosa: Chirac & Faustian Pact
Tuesday, February 12, 2019
NHS Consultants: Successful, Skillful and Sought After.
Nothing like the reeds of Finland
©2012 Am Ang Zhang
After all Finland
Some of us might still remember the times when becoming a consultant in the old NHS was a prestigious thing and that has nothing to do with the monetary reward. Once appointed, many would have some private work whilst keeping the main NHS consultant post. After all, there is only so much to be made in private medicine and in England
There is thus quite a difference in the earnings of the different disciplines but having the same pay scale for all disciplines and across the whole country was a very smart design for our NHS. On top of that having the same pay across the whole country barring London allowance have meant that it was a bit easier to recruit to some areas.
Whoever designed that is a true genius.
Hospital Consultants then had a fair bit of say in how the hospital should be run. And generally it was well run.
Then came Thatcher, Major soon to be followed by Blair and Brown. Each had a go at dismantling what was essentially a good community service: on the principle that only some of us would fall ill and it is fair we all share in the cost of health care.
The problem with the NHS Reform is the NHS itself. Because it is still to be funded by Taxpayers, there is much money to be made.
It would be different if we separate out Private Health Care and State provided one.
That the management consultants found out a long time ago. No! No! No! Let Private Providers make money from the so called NHS.
Soon the government will discover that money would drain from the state to Privateers with no improvement in the actual care delivered.
Is it really that difficult to grasp! I wrote a little while back:
There is a good deal of time and effort wasted in discussing GP commissioning and some lip service paid to integrating Primary and Secondary Care.
Yet, those in power had little regard for Parliamentary democracy and all the signs are that Privateers are waiting in the wings like the Barracuda for its yummy meal.
Most people in well paid jobs (including those at the GMC) have health insurance. GPs have traditionally been gatekeepers and asked for specialist help when needed. If we are honest about private insurance it is not about Primary Care, that most of us have quick access to; it is about Specialist Care, from IVF to Caesarian Section ( and there are no Nurse Specialists doing that yet), from Appendectomy to Colonic Cancer treatment (and Bare Foot doctors in the Mao era cannot do the latter either), from keyhole knee work for Cricketers to full hip-replacements, from Stents to Heart Transplants, from Anorexia Nervosa to Schizophrenia, from Trigeminal Neuralgia to Multifocal Glioma, from prostate cancer to kidney transplant and I could go on and on. China
When there are not enough specialists to go round in any country money is used to ration care. Just look at Canada
There is unfortunately little realisation that soon, a large number of consultants would no longer be working in NHS Hospitals.
Stent, Hips and others
They will be working for Private Hospitals that initially will be offering services to NHS patients. But because of shortage of the said consultants, those that are concerned that at 78% obstruction, their heart and life may not last the wait and they will pay for the job.
US $ 50,000 for Stent Procedure©Am Ang Zhang 2011
My friend just did in Hong Kong: a bargain at US$ 50,000.
What about your painful hips, the CCG may decide to impose a wait time to limit cost. So you too will pay for it. That is what my golfing friend did in Flroida for a bargain US$90,000 as he paid a co-pay of 25%.
So there are not enough Consultants and shortage creates demand and you can name your price. Consultants do not really want to waste time in CCGs arguing about the price of Stents or Hips.
Soon with changes in the amount of private work FT Hospitals may do, what successful, skillful and sought after Consultant would want to stay within the NHS only to have his pension contribution increased and ultimate pension reduced.
Why not be 100% private and where are FT Hospitals going to find consultants for the phantom private patients.
Private hospitals will continue to provide NHS work but more to fill in their money making gaps. Very smart management indeed.
Consultants in private hospitals are generally extremely well treated, not like the way CEOs of old NHS Hospitals used to sideline them.
In Hong Kong , private Consultants work with several private hospitals and all private hospitals knew that these are the geese that lay the golden eggs. All hospitals provide excellent facilities for them including free valet parking as time is precious.
Could this be why so few consultants are objecting to the changes? I remember one such Private Hospital in Sheffield where there is no charge for parking and there was even free Cappuccino!
What about the quality of work?
Remember, in England
Saturday, February 9, 2019
Humming Birds & CAMHS::Anorexia Nervosa & NHS Privatisation.
It has been a few years since The Cockroach Catcher retired and in that time, the landscape of Child & Adolescent Psychiatry has changed. Can CAMHS survive the storm like the pelican?
Without much public notice, much of this sub-specialty has shifted into private hands. Just around half the last time I looked. Now there is talk of looking at CAMHS with the offer of money! Wow! Or was the outcome going to be: lets sell the profitable parts of CAMHS such as Anorexia Nervosa and leave the rest! i think I know what it would be. Just look at Dermatology!!!
Dermatology shows how NHS being decimated
By Dr David Eedy, President of the British Association of Dermatologists - 15th December 2014 11:24 am
The news that a third of NHS contracts in England have been awarded to private sector providers since the service was reorganised in 2013 is a fact that dermatologists and their patients are all too aware of.
In fact, some estimates put the figure at 70% of NHS contracts going to private providers in just the first year.
Dermatology is a prime example of how government meddling is decimating the NHS, despite the fact that each year, 54%of the population is affected by skin disease, and 23 to 33%of the population at any one time has a skin disease that would benefit from medical care.
I have personally dealt with "gaming" by private insurers. Now, it looks like the gaming is over as the payer is the NHS. You only need to look at the papers to realise that Anorexia Nervosa in particular is a growth industry. They are difficult to treat, recovery is not guaranteed and when the payer is the NHS: WOW!
©2019 Am Ang Zhang
In the field of medicine, to promote something one needs to publicise something that is not directly related to what you want to promote. Vitamin D deficiency is one such item in recent times. Instead of promoting limited sunshine, the tablet or capsule is being promoted, everywhere! We have for a long long time various hints of Statin and its various beneficial effects. Yet a close friend had dementia and diabetes and another had double vision. The latter recovered 6 weeks after stopping the Statin, not so my friend with diabetes. She could no long remember me.
Another friend had open heart surgery and her surgeon told her to throw away the Statin.
There may indeed be some good doctors left, in the NHS.
Looks like the attack is now on Anorexia Nervosa. The Cockroach Catcher had to face a team from a private hospital wanting to make money from the NHS by asking the NHS to continue to fund anorexia treatment as she has USED UP her health insurance money. Now the situation is much worse in our beloved NHS as there is a number of closures of NHS Adolescent Psychiatric inpatient units and many such In Patients are sub-contracted to the private sector even before the term AQP emerged.
Has it not occurred to anyone that there are some very clever people working for the so called AQPs.
As we move into the gaming era of the NHS, The one diagnosis that will be on AQP's list will be Anorexia Nervosa. Unlike hip replacement, the variation of the condition is such that it is ripe for Private Providers to make a case for a fairly long drawn out treatment. AQP will not worry as "the longer, the better". Of course the patient must not die and if you think I am skeptical, I am as I have seen it even before all this Reform or Deform.
That is why I have argued that where there is such an incentive, "gaming" will happen and Mr Cameron. Don't say that nobody told you.
That is why I have argued that where there is such an incentive, "gaming" will happen and Mr Cameron. Don't say that nobody told you.
The NHS
“….Ethics in medicine has of course changed because money is now involved and big money too. What was in dispute in this case was that the private health insurance that sustained Candythrough the last eighteen months had dried out. The private hospital then tried to get the NHS to continue to pay for the service on the ground that Candy’s life would otherwise be in danger. The cost was around seven hundred pounds a night….’
Let us not forget that many private hospitals can make more money from the NHS because the NHS does not exclude. The NHS pay for everything including those Private Health Insurers chose to exclude.
This is my take on my patient:
“……A quick calculation gave me a figure of over a quarter of a million pounds per year at the private hospital. No wonder they were not happy to have her transferred out. Before my taking up the post, there were at one time seven patients placed by the Health Authorities at the same private hospital. Not all of them for Anorexia Nervosa, but Anorexia Nervosa required the longest stay and drained the most money from any Health Authority. I have seen private hospitals springing up for the sole purpose of admitting anorectic patients and nobody else. It is a multi-million pound business. Some of these clinics even managed to get into broadsheet Sunday supplements. I think Anorexia Nervosa Hospitals are fast acquiring the status of private Rehab Centres. Until the government legislates to prevent health insurers from not funding long term psychiatric cases, Health Authorities all over the country will continue to pick up the tabs for such costly treatments……”
Creativity is key to the resolution of many Child Psychiatric problems and the fact that Anorexia Nervosa patients can change dramatically in a split second is testament to the need for such an approach. (The Chapter “Seven Minute Cure” in The Cockroach Catcher describes such a case.)
But when there is good money involved and especially when it is the taxpayer's, creativity of treatment no longer comes into play. Patients will suffer!
Please Mr SoS, explain to me the good of the AQP of your new world order!
In the new world order of our NHS, private provider (AQP)for commercial reasons need not let the public have access to information about their activities etc, and even the doctors they provide.
Just look at one of the OOH, one doctor for 950,000 population! As they say, be very afraid.
Even as we like our NHS as much as our woods: looks like private providers for public services is in the PM's mind. Sometimes it is public (taxpayer) money for private failures: catastrophic failures when it is someone's life.
Wait, most of the time they are the same doctors so introducing competition is not going to improve anything.
Choice? Really!!!
Anyone who cared to Google Private Health Insurers will find that many conditions are excluded from their "comprehensive" Health Care. The full list is too long and I might be infringing their copyrights. See if dialysis and intensive care treatment are covered. What kind of "comprehensive" Health Care is it to exclude both.
Check out the John Lewis Hospital, sorry Circle. Same story: exclude baby intensive care, dialysis and mental health.
Just try not to get this funny E. Coli. As when you need dialysis you may have to choose NHS. But then, you might be so ill and unconscious.....mmm interesting thought. How does one choose when very unwell?
In 2009 the total value of the market for PH(Private Healthcare) in the UK was estimated at just over £5.8 billion. Private hospitals and clinics account for the largest part of the overall PH market, generating an estimated £3.75 billion in revenue during 2009. Fees to surgeons, anaesthetists and physicians generated an estimated £1.6 billion in 2009.
The total number of UK citizens with Private Insurance is estimated to be around 90,000. Not millions!!!
It is not difficult to work out what good value the NHS has always been.
The NHS was not perfect, far from it and yet successive attempts at fixing it has produce the opposite effect: it needs more fixing.
If you read that line again from the NAO report, it was clear where the problem was: fees to surgeons, anaesthetists and physicians!!!
Yes, that was the main recipient of Private Health income.
To become a Consultant in the NHS used to be prestigious and even those aiming to doing mainly private work will have to wait till they achieve Consultant status in the NHS.
The NHS for all its sins tried to keep every consultant as close to the MAYO ideal by insisting on the same pay-scale.
Several levels of Distinction Awards were used to keep some professors and top consultants happy. Later the name of the Awards was changed and yet it was still the same soup.
If Consultants were prepared to give up one session of pay, then there is no limit as to the private work they can take on. It was a safe way to start your private work and you keep the rather nice NHS pension.
What is generally not talked about is that you keep one foot in your NHS hospital and one in your private one.
So far so good and yet this is where the problem starts.
©2019 Am Ang Zhang
It does not need a genius to work out that people worry about their health and do not want to wait for a suspicious lump to stay in their body too long. They will pay. We need not even mention the manipulation of waiting lists, etc. Then big companies realise that they can attract staff by offering Health Insurance and the rest is as they say history.
Then the rules changed and every consultant can do a maximum of 10% of their NHS pay in private work without having to give up anything. Some hospitals even allow you to use their facilities for a small fee.
Why not, more private patient means less expenditure for the NHS.
Private Insurers discovered that too and they started offering a small fee if you can wait for your operation at your free NHS hospital.
There has never been any control of Health Insurers and I suspect it was not even because they have a strong lobby: just the feeling that the NHS was for everybody so no one could be excluded.
But Health Insurers are cleverer, they exclude chronic conditions, many psychiatric ones belong to that group and often they will exclude after a while.
So, indeed it was a clever move by the present government to simply hand over a portion of money to the GPs and say: get on with it, the best price or better still, why not treat them yourself. You are all doctors, forgetting one of their own just had neurosurgery done at Queen Square.
Until, now Consultants are to be excluded from the consortia. Most are not making too much noise for a very good reason.
There just are not enough of us Consultants and the reform is really COVERT rationing by any other name.
©2019 Am Ang Zhang
Mar 01, 2008
This is not about Stephen Hawking's famous book that sold over 9m copies world-wide, but a collection of material that relates to Anorexia Nervosa in a chronological order. You see, I believe in free sharing of knowledge ...
Mar 19, 2011
Not all of them for Anorexia Nervosa, but Anorexia Nervosa required the longest stay and drained the most money from any Health Authority. I have seen private clinics springing up for the sole purpose of admitting anorectic patients and ...
Jun 17, 2008
Anorexia Nervosa comes to mind and this is one of the conditions that have for want of a better word captured the imagination of sufferers and public alike. I have already posted an earlier blog on its brief history. ...
Feb 23, 2010
This is not about Stephen Hawking's famous book that sold over 9m copies world-wide, but a collection of material that relates to Anorexia Nervosa in a chronological order. You see, I believe in free sharing of knowledge ...
Apr 30, 2010
Not all of them for Anorexia Nervosa, but Anorexia Nervosa required the longest stay and drained the most money from any Health Authority. I have seen private hospitals springing up for the sole purpose of admitting ...
Feb 21, 2010
Anorexia Nervosa: Chirac & Faustian Pact. Reading a new book sometimes brings you the unexpected. In Ahead of the Curves, the author told of the story he heard of Jacques Chirac and his pact with West African marabouts, ...
Feb 29, 2008
Anorexia Nervosa: a cult? I have long recognised that Anorexia Nervosa is really only a symptom, like a headache, for which there is no “one-size-fits-all” cure.
Jun 08, 2011
... to full hip-replacements, from Stents to Heart Transplants, from Anorexia Nervosa to Schizophrenia, from Trigeminal Neuralgia to Multifocal Glioma, from prostate cancer to kidney transplant and I could go on and on. ...
Jul 20, 2009
Edward Burne-Jones.
Without the effect of drugs that would double the bodyweight, we have in the end one of the most beautiful portraits of the Pre-Raphaelites. Burne-Jones’ life is of course another psychiatric book: his mother died when he was six days old and many felt that all his life he was searching for the perfect mother he so missed. It is indeed ironical that the art world has been much enriched by what was essentially untreated bereavement.