Ex Communicated from the Medical Religion

And I don't give a damn..........................

Dr No presents an excellent summary of revalidation. It is important to make note of Dr No's website because it will feature some excellent material on the future of medicine.

I have made an executive decision to stop writing in support of doctors and to cease writing about revalidation. I have handed over the Revalidation torch to Dr No who will do an excellent job of featuring it in his toned honed English medical manner.

Recently, I read the jaunt on Mike Broad's poorly designed website. Mike constantly side lined me as the first Whistleblower in Staffordshire. This was the case in the past with Hospital Doctor. They all sat there watching the the repurcussions whistleblowing episode unfold, assuming I would fail. Mike laments about his own kind being taken down the GMC steps for not raising concerns at Mid Staffordshire. How it hurts to have their establishment doctors face the GMC steps. Of course, I have widened the GMC's functions by my own case in R v GMC Ex Parte Pal so essentially no one will escape the clutches of the GMC. Not unless they all face Stream 1 investigations anyway. On one hand it is distressing for innocent doctors to face the GMC, on the other hand it makes it very easy for vindictive lazy doctors to be placed in there while throwing away the key.

I am of the view that there is some kind of problem - or was somekind of problem with Mike and his colleagues. It is a kind of "conceited" - " we don't like her tone and she deserves to be hung drawn and quartered by the GMC". Mike may look upon the entire issue as sour grapes on my part but I look upon his conduct as one of the reasons why many people died in Staffordshire. In the year 2000, while the mainstream media took up the tale in a skewed manner, the medical media remained tight lipped on Ward 87. They remained tight lipped so no lessons could be learned from that episode. If the medical media does not take matters seriously, in their view, it can't be serious. They continue to remain tight lipped even a decade later. We ask ourselves why? Why would the media media avoid reporting a matter that was important to junior doctors?

Mike was quite happy to accept free advertising on our websites at the start of his project but it pained him to even reciprocate the links. It was as if he was developing cramp. Then Mike's cramp has been endemic throughout the years. This has always been the problem with Mike. One cannot teach a old dog new tricks. Once a conceited toad, always a conceited toad.

This is the main problem with most of the medical fraternity whom I continue to remain unimpressed with.

When Dr Phil Hammond kindly wrote about Ward 87 in Private Eye, Mike made some comment by email to me that implied that Ward 87 was going through a re-run. I informed him that it wasn't a re-rerun, the evidence had never been featured anywhere and luckily Phil was kind enough to support me because he took the time to read the documents unlike Mike. I think it is convenient for the medical media not to inform doctors of the realities of medicine and whistleblowing. I think it makes half the medical journalists a little ill that I had hard documentary evidence to back up what they had initially discarded. Well, I can of course look upon them all with contempt - because I was right and they were wrong. Well, so what? Did it save any patients who needlessly died?

The others who try a kind of lipservice support measure often make the huge error of stating that I was suspended off the medical register [ ref Jobbing Doctor]. It is convenient for Pulse to propagate the rumour that I was somehow sanctioned by the GMC. The fact is the GMC didn't sanction me and never will. It must pain so many people that I wasn't actually sanctioned - and that I did indeed kick the GMC's butt without any of their help. They would love to say - Dr Rita Pal was sanctioned by the GMC for being a renegade doctor. Of course, its less politically correct to say " Dr Pal raised concerns that were not taken seriously and now that there is evidence for her concerns, we should all hide and pretend that she never raised them in the first place".

Those who pride themselves in the English Language fail to read basic details. The fine detail is somehow overshadowed by their view of my style or my tone. It somehow eclipses the vital statistics of whistleblowing.

So, I shall summarise the issues here - firstly I raised concerns on Midlands Hospitals in 1998-2000. No one believed me. A group of doctors from Doctors.net.uk campaigned to the GMC to get me strung up. This fell flat on its face. This rumour propagated to the BMJ and to Hospital Doctor who subsequently failed to feature anything related to Ward 87. Richard Smith of the BMJ once crowed about how Dr Peter Wilmshurst had the evidence and I didn't.

By 2005, having jousted successfully with the GMC, I extracted the documentary evidence that I was right all along. Following that, Hospital Doctor failed to feature it as did their partner medical journals. Mud sticks as they say and Mike Broad believed what he was told. As I explained to Prof Brian Jarman of Imperial College recently, inordinate amounts of time was spent examining my tone and my style rather than the evidence that was damning of the authorities. It is important to note that despite having one of the leading victories in medical jurisprudence in 2004, the medical media remained silent. This isn't my business of course but the same issues are coming to haunt doctors right now. It is clearly unsettling that someone could be defamed by the GMC in such a manner. The truth is that the GMC conduct themselves in this way everyday and this matter is kept away from doctors and medical students.

There is a type of whistleblower that is clearly acceptable to the medical media. You have to be English and you have to be a Consultant. Mike knows about that because he has spent vast amounts of time featuring Kim Holt. It is a mindset in these medical editors who have fought for the rights of consultants but failed miserably to raise concerns about junior whistleblowers.

It is interesting that I have never found this mindset to be the case in the USA. I just think Mike is a sheep follower - he follows what everyone else says and is unable to make up his own mind on various issues. The other point about Mike - ie he is your typical inept southern male who is unable to be a real man about anything.

I remain unimpressed with the behaviour of doctors and the medical media. It is for this reason, I shall flip some of my material to ride the tide against doctors in general. I have no intention of returning again. In my view I believe those who don't support their fellow medical colleagues or whistleblowers deserve what they get. And revalidation is what they have got. It is a product of doctors who are too weak to fight the system designed to sink them and as James Landon pointed out, they all deserve it. The lack of insight in doctors is astonishing. They can be likened to a herd of sheep being led by a blind border collie. I believe I have done an inordinate amount to raise issues in the Dr Scot Junior case [ ungrateful irk] and Remedy UK. I believe it is the end of the road on assisting these issues from now on.

Anyhow, Dr No will have the details of most of the material on revalidation. Captain No will do a excellent job of featuring medical matters applicable to doctors. He writes and presents better than Mike Broad of Hospital Doctor. Dr No is set to be one of the leading lights in medical blogging and I hope he does the subjects justice.

Anyhow, if Mike is a little miffed about my anti Hospital Doctor stance - he should have been a little more considerate of the issues surrounding Ward 87 for nearly a decade. They were identical to the concerns raised in Staffordshire and they were both run by the same NHS Executive. Mike of course likes to apply his condescending manner to Ward 87 considering it to be irrelevant to the issues of today.

The entries will be rare on Ward 87 as I am concentrating on drafting The Discreet Inquiry. I will though continue to write on patient safety matters on http://www.nhsexposedblog.blogspot.com .

I would be grateful if all doctors would kindly direct their queries to Dr No's Bad Medicine. Members of the Public are still free to email me.

As for the media - I have refused ITN and a number of other media outlets of late. This is due to the fact that I no longer appreciate playing second fiddle to other stories and I have never found the media supportive of my work in medical regulation or accountability. I am not a media diva, I raised concerns for the sake of my colleagues and my patients. I am not around to act as "researcher" and neither am I a well of free information. This is why I do not welcome questions from the UK Media. In my view, they can all wallow in the same Labour government pit they created in the first place. I am though open to international media who have always had a good level of respect for the issues raised.

If the media wishes to contact doctors, please contact my colleagues at Doctors4Justice. For Patient Comments, NHS Debate contains many people who will be happy to assist the media.

With Best Wishes

Dr Rita Pal

Where Eagles Dare. Admiral Mary O'Rourke.

Where Mary O Rourke Dares to Go

Mary O Rourke is known affectionately as the Irish Terrier. If you are a doctor, you can rest assured that Mary will be defending you right until the end. I often smirk at Mary's antics as they are predictable and likened to a good comedy.

I wrote about her here.Mary clearly is a fan of war movies because she enacts one every day at GMC Towers. Luckily I am also a huge fan of Alistair McClean, my favorite movie being Where Eagles Dare. There is always something sexy about men in uniform especially Clint Eastwood or Richard Burton.

As a barrister Mary is a master at "getting her client out of the sh*t". She certainly held it together while squashed in between the dapper and sexy David Southall and Martin Forde QC. Everyone knows I quite fancy Martin Forde QC. Martin and I had a brief exchange by email where he wanted me to take his love hearts down but then decided he was man enough to face the music [ on the dance floor]. No woman can actually resist Martin probably because he is happily married.

Mary's stunt pulling is infamous in the medical regulatory sectors. She does it with style and as long as no-one like me notices and writes about it, everyone is happy. Mary amuses me every day. She takes thinks too seriously having whined about me once to her fellow barrister Tim Straker QC. Apparently, I am not allowed to flirt with Arpad Toth [ the claimant in one of her cases Toth v Jarman]. No doubt, Straker was of the view that this was shameless behaviour :). Mary has this view that everyone is probably conspiring to spot the flaws in her defences. Of course, none of us are. We all admire her greatly for her manner and her demeanor and frequently find her as entertaining as Dynasty or North and South or any other soap opera we were all glued to once upon a time. Even Arpad Toth, her arch enemy agrees that she defends well.

Mary is well known to me for her defence in Dr Sushant Varma's case. Varma never had a mental illness. I should know because I observed both reports from GMC Shrink C Sillence et al. I also know SV very well. Mary accompanied by her puppykins - Clueless Blueglass decided to plead something else. Of course, I knew this was all a ploy to get Sushant into the Health Gulag so that he wouldn't see the light of day. Varma was essentially trapped and I suspect he would have gone through with the legal team defence had it not been for my intervention. Mary is infamous for walking out of her client's case because I made an FOIA request, this was read out in the GMC's court rooms. Varma in the meantime had been contacting me by phone while informing me about the defenses set up. Mary O Rourke did not like this and began to huff. She finally walked out of Varma's case and the GMC wickedly failed to grant Varma an adjournment to obtain legal representation.

I would of course like to thank the wonderful Mark Ellen of the GMC. Mark knows of my involvement very well indeed. Thankfully SV was not branded with "mental illness" as his defense union had tried to do, and he was free to do anything he wanted to with his life without a hefty stigma.

Admiral O Rourke will be whipping out her steel wonderbra for the forthcoming appeal in David Southall v General Medical Council. She is often inspired when she fights the Southall cases and ceases to be a transparent legal butt shaker. If anyone is interested, March 2010 is the date to spot her in action. It may be easier on this occasion as she will only be sitting next to dapper David who has placed her on a daily diet of Thornton's Chocolates.

Sign Elsie's Law

PLEASE SIGN THE PETITION ELSIE's LAW

On November 21st 1999 Elsie Devine died at the Gosport War Memorial Hospital her life was shorten without justification or logic. Elsie was not a lone in meeting her fate at the hands of Dr Jane Barton there were many other elderly.

Elsie did not have a incline when she kissed her son good night that she was already on the terminal pathway and that the very next day she would be drugged unconscious and nor did her family. Elsie did not deserve her life to be terminated, let alone without her or her family’s knowledge. Elsie is one in many and this practicing must be stopped.

After 4 Police investigations, an Inquest and a GMC hearing it is clear that Elsie’s life was terminated at the will of one person; the Doctor who saw her as a bed blocker and worthless.We the undersigned petitioned the Prime Minister to create a law that states caring professionals alone do not have the legal right to start a patient on drugs that are included in the Liverpool Care Pathway, without the consent of either the patient or the next of kin.

Drugs used in the Liverpool Care Pathway have been under much speculation. Although an audit of Care of the Dying, by the Marie Curie and the Royal College of Physicians in 2009 found that nearly 4000 terminal patients found the framework to be of high quality, there is no doubt that some patients remain at risk.(Full Audit)) There is room in current practice for elderly, vulnerable patients to be started on the LCP without their or their family’s consent; it is not good enough to assume that in all hospitals, hospices and care homes that conversations will take place and that patients and families will be kept informed. The audit reveals that two thirds of the 3,893 patients whose deaths were assessed needed no continuous infusion of medication, and all by 4% only needed low doses of opiates.

However, there have been cases where patients have been started on high doses of opiates and sedatives via infusion and died prematurely.

We should not have to fight for justice after death; the law should be there to protect us when we are alive.

http://petitions.number10.gov.uk/Elsies-Law/

When the ‘system’ fails who will protect us when we are too vulnerable to protect ourselves. Read the full story here.

GMC Loses the Plot. Mid Staffordshire Doctors Scapegoated

I was happily reading some news stories, when Niall Dickson's creepy quote shot in front of me. This is what it said

"Niall Dickson, Chief Executive of the GMC says in a statement, “This is a distressing report that reveals significant failings at Mid-Staffordshire Trust. The report highlights a number of very serious issues about the quality of patient care, including concerns about the conduct and performance of some doctors working at the Trust.

“The Medical Director has referred several doctors to the GMC and we are working closely with the hospital to ensure that we have the information we require to investigate and, if necessary, to suspend or restrict their practice during the investigation.”

Mr Dickson added “The report does raise questions about how doctors and other professionals respond when they see poor quality care.

Dickson has lost the plot. So if doctors raise concerns they are harassed [ as I was], the GMC shows no regret. If you don't raise concerns for fear of being harassed, the GMC investigates you anyway. What did these doctors ever do to warrant referral to the General Medical Council? The GMC makes it unsafe to raise concerns then punishes those doctors for protecting themselves. This is scapegoating in the extreme. The doctors are now taking the flack for government and Trust failures.

Anyhow, the good defence for the Mid Staffordshire doctors is that the GMC took no action against all doctors who walked past Ward 87 and failed to take notice of its failures. In the end though while junior supervision was a consultants responsibility, the rest of it happened due to management failures. No manager was disciplined despite two damning reports.

I personally think the GMC is losing its duster. Niall Dickson continues to live up to the first part of his surname.

The Silence of Robert Francis QC. Mid Staffordshire NHS Trust Inquiry

How many died?

Silence says a lot about barristers. Most find that the QC title gives them the right to view other people as irrelevant. When the Mid Staffordshire NHS Trust Inquiry was first set up, I wrote to Robert Francis QC [ the person who chaired the inquiry] in the following terms below. As predicted there was no response. This is what people do to try and avoid the issue. This is often what you get from people who try and work through a half baked non transparent inquiry report. More information on this by Cure the NHS.

Of course, I was the first person to raise concerns about the Staffordshire set of hospitals in the Midlands. They were all ruled by the then NHS Executive. The head honcho there was none other than Professor Griffiths. Griffiths ofcourse covered the entire problem up then disappeared into the retirement meadows. In the meantime, people continued to die silently until they started to die in their droves. Then some relatives noticed.

The question though we have to ask ourselves is why did the Department of Health, the General Medical Council, Commission of Health Improvements [ which became the Health Commission then the CQC] ignore justified concerns about the state of these hospitals. Instead of conducting an investigation into the quality of care or monitoring death rates in 1999-2000, the government instigated an assassination of my character. I know this from the Department of Health files on me.

It is convenient for the authorities to side-line the person who initially raised concerns so the government does not have to address the fact that they were negligent in the first place and subsequently allowed thousands of patients to die needlessly. The only reason Mid Staffordshire NHS Trust was monitored, inquired about etc is because of the high rate of complaints by Cure the NHS. Sadly, not all Trusts have that advantage and poor care simply ends lives. There is no Patient Campaign group to fight for those who died needlessly. Trusts are hardly going to be frank with their relatives. Afterall, on Ward 87, the Hospital, the GMC and the Health Commission elected not to inform the relatives of the 2001 Report that verified my concerns.

Due to the Labour government's negligence, their stubbornness and their failure to address concerns raised by doctors [ whistleblowers], they try and paint a picture of an "isolated" event. In reality this has been going on for many years. People have been dying needlessly on elderly and acute wards throughout the Midlands where many DGH's are mismanaged. It is an irony that the HMSR scores have to hike up phenomenally costing thousands of lives before anyone will move in to take action. This catastrophe could have been prevented had the Government ordered a proper review of all Midlands Hospitals in the year 2000. They didn't do so therefore the fault likes square at their door.

Please note Professor Temple lied in his statements below because the documents internally show a different story. See this letter for details.

I enclose the email to Robert Francis QC below and also the year 2000 article.

From Rita Pal
To rfrancis@3serjeantsinn.com
date Fri, Jul 24, 2009 at 8:15 AM
subject Mid Staffordshire Inquiry
mailed-by googlemail.com

Dear Mr Francis,

I note that you are chairing the independent inquiry into Mid Staffordshire NHS Trust.

I felt I ought to raise the issue of Ward 87 - North Staffordshire NHS Trust and the problems around whistleblowing. I summarise the issues here . The government have conveniently side lined many important learning issues from this episode. Most Health Select Committees miss out the "salient features". I wrote a review for a legal journal recently called " After Bristol". I hope you will take the time to read it.

The salient issue about improvements in the future is really not what the public perceive it to be. The main failing has been the failure of the government to ensure that ward death rate recording is compulsory. The Department of Health have admitted that it is not compulsory.

I have no illusions about my own role as a whistleblower. I am simply raising these issues with you in the hope that your recommendations will not be impractical. More than 3 million was spent on compensation at North Staffordshire NHS Trust - that is probably three times the amount spent at Mid Staffordshire NHS Trust. Of course, we will never know how many patients died on Ward 87 unnecessarily because it isn't compulsory to record death rates. Ward 87 is not a "one off". It is much like many wards in the NHS.

My own case reaches the United Nations in the not too distant future. For me there is absolutely no mileage in doing what I would term "banging my head against a brick wall" in the UK and these experiences are due to be published in a book soon. Of course, Mid Staffordshire NHS Trust may have been prevented had the government paid attention to my 1999 letter to the Department of Health and Frank Dobson where I detail the problems in the Midlands.

With Best Wishes

Dr Rita Pal

First article 1999 Raising Concerns about the Midlands Sector of Hospitals

Birmingham Evening Mail



February 18, 2000, Friday

SECTION: Pg. 8

LENGTH: 1872 words

HEADLINE: DOCTOR QUIT NIGHTMARE OF THE WARD;

PEOPLE PUT THEIR TRUST IN HOSPITALS AND THAT TRUST IS SOMETIMES BEING ABUSED



BYLINE: Paula Marsh



BODY:



As the NHS is stretched to the limit, a former top junior doctor tells how the harsh reality of working in Midland hospitals drove her to quit the dream job she had longed for. Mail Health Editor PAULA MARSH reports.

DR Rita Pal had been a junior doctor for just two months when she began to despair.

As a newly qualified medical student, she had dreamed of becoming an accident and emergency consultant and, when she gained one of the top junior doctor's posts at a Midland hospital, she was over the moon.

But as the weeks unfolded, Dr Pal claims that long hours in poor conditions with little or no senior back-up turned her daily routine into a nightmare.

"I went in there very optimistic," she says. "I had it all planned, I was going to finish my training and specialise in accident and emergency work. I was quite excited about it because I'd got the top job working under the clinical director."

It was to take just one emergency situation for Dr Pal to begin seriously questioning her vocation.

An 80-year-old woman with gall bladder problems had collapsed and Dr Pal claims she was alone on the hospital ward with only one nurse on call for over 30 patients.

Collapsed

"I'd been practising for about two months when I found an old lady collapsed on the bed," she recalls. "She was breathing but not responding and she needed fluids urgently.

"I was totally on my own. The registrar was at a clinic 20 miles away and wasn't answering his bleep, my senior doctor wasn't working that day and the consultant had disappeared.

"I needed a drip to give her fluids, but they didn't have one on the ward and the nurse said she had no staff to go and get one. I had no alternative but to get it myself."

Dr Pal claims the nearest drip was 15 minutes walk away from the ward and by the time she returned half-an-hour later the patient had deteriorated.

"I managed to stabilise the patient after about two hours," she says. "In the end I got a senior doctor from a different department to look at her.

"He explained that I'd given the fluid a little too fast so he helped to sort that out. Finally, the registrar arrived and the patient was a little better. I thought everything would be fine then, but it wasn't. Afterwards, she was found with septic shock and she died."

The traumatic incident was the first in a catalogue of disturbing experiences which Dr Pal claims took place across three Midland hospitals where she has worked over the last 18 months.

At one hospital, Dr Pal claims she was forced to watch a patient die because there were no endoscopy cameras to detect internal bleeding.

"There was a man who just bled and bled because there were no endoscopy facilities," she recalls. "Nor were there any intensive care beds and in the end he died.

"The worst part was that this sort of thing happened so many times. When I told my registrar I didn't want to do medicine any more, he said I had to learn to let go and stop being so emotional about my patients. But it's soul destroying."

Not only was Dr Pal struggling to cope with making life and death decisions while working alone, she often found herself battling to stay awake.

The young doctor, who lives in Sutton Coldfield, recalls being stopped by police twice for falling asleep at the wheel.

"The hours were an absolute nightmare," she says. "Forty hours a week is a non -existent entity. Most of the time I was doing 72-80 hours a week and friends I have working in the NHS are still doing the same kind of shifts.

"You could work continuously for 48 hours on a weekend and then do the whole of Monday. They get round it by saying you get six hours protected sleep, but you never do because you get bleeped at all hours of the day and night. I never had an undisturbed sleep the whole time I was on call.

"You get to the stage when you make mistakes because you're nearly asleep.

"It also makes driving home really dangerous.

Exhausted

"On two occasions I was stopped by the police driving home and they made me get someone to come and pick me up. On another occasion I had to stop at a service station for a few hours."

After one particularly long weekend shift Dr Pal was so tired she was found fast asleep on the pavement by her car.

"I was absolutely exhausted, but when I got to my car it had been clamped," she says. "I just thought, I'll have a rest and I sat down on the pavement. The next thing I knew I was being woken up and it had started to get dark."

After a year of what she claims were traumatic working practices, Dr Pal was finally awarded General Medical Council registration. Immediately afterwards, she quit full-time hospital work.

Now she is working as a West Midlands Police doctor and a locum.

"It's easy for me to speak out now because I have no longer got anything to lose," she says. "People are so frightened of losing their jobs that the stories which do get out are only the icing on the cake.

"People put their trust in hospitals and that trust is sometimes being abused. Nurses are short staffed and over worked and there are not enough intensive care beds.

"You only need to look at the recent flu epidemic to see that drastic action needs to be taken to prevent the scales of an already exhausted system tipping towards catastrophe."

Expert defends quality of health service

A TOP Midland health professor responsible for training junior doctors today insisted that the health service provides a "superb" quality of care, despite the extreme pressures facing hospitals.

Professor John Temple, regional post graduate dean for the West Midlands NHS Executive, says extensive work is being carried out to ensure that junior doctors are properly supervised.

And he adds that while there was a shortage of doctors in the NHS the system was managing to cope "remarkably well".

"Over the last five years one of the things which has changed quite dramatically is that doctors are supervised properly," he says.

"All junior doctors should be supervised and they're required to know who they should contact and how in times of emergencies.

"The world has changed since the times these doctors were left on their own and we're keen to ensure there's a very clear chain of command. We expect them to work as teams, not as individuals."

Prof Temple says that while the health service was clearly under pressure, hospital managers were succeeding in delivering high quality care.

"We are under-doctored but we are increasing the numbers through medical schools and bringing doctors in from other countries.

Very effective

"All this is to ensure that our medical units are properly staffed.

"We live in a very high-tech world where treatments are very effective but very expensive and the acute service is very busy throughout the year.

"The hospital service responds remarkably well to these pressures and we still deliver a superb quality of acute care."

Prof Temple says the issue of working hours was constantly being addressed in the region.

But he insists that managers are now winning the battle against long hours and says no doctors should be working the kind of 80-hour shifts that have been reported in the past.

"We've worked very hard to get doctors down to a maximum of 56 hours but we know there are instances where those hours are extended for very genuine reasons like patient care.

"We're constantly working to make sure we get those hours down and we're much closer to it now."

He says that hospitals found to be flouting the guidelines were reported to a regional task force working to implement junior doctors hours.

"We have a monitoring team which inspects hospitals on a bi-annual basis and we liaise closely with the task force on working hours," he says.

"We don't punish hospitals where doctors are found to work longer shifts but we work with them to try and rectify the situation."

Pay campaign to cut hours

CHAIRMAN of the British Medical Association's Junior Doctor's Committee Dr Andrew Hobart claims hospital trusts are taking advantage of low-paid staff in an effort to cut costs.

The accident and emergency specialist, who works at Walsall Manor Hospital, is heading a high-profile campaign to increase the pay of junior doctors, which he claims will help reduce working hours.

"The sort of working practice Dr Pal describes was meant to be outlawed by 1996, but it clearly wasn't - which is why the BMA have launched a renewed campaign," he says.

"We strongly believe that one of the reasons for these sorts of hours is the pay structure which gives employing trusts a perverse incentive to make junior doctors work as many hours as possible.

"We've been trying to negotiate a different pay scheme which places more value on out-of-hours work and brings in penalty rates for really excessive hours.

"The negotiations have been stalled, but we feel there may be some progress shortly."

Dr Hobart says that another major problem facing the NHS is the lack of senior consultants and nurses in hospitals.

And he adds that far too many trusts are now employing inexperienced "care assistants" to do the work of fully-trained nurses.

"Patients should have access to the best possible medical care which means fully trained specialists and consultants and an adequate level of nursing staff," he says.

"Out of hours the NHS is incredibly reliant on junior doctors, particularly the very junior ones.

"It's not that the consultants are lazy, it's simply that there are not enough of them. They are having to work like mad to meet the Government's waiting list targets every day and in addition they're responsible for large numbers of emergencies.

"The system is geared towards daytime working but patients don't just get sick 9am-5pm Monday to Friday.

"We need a system which has dramatically more consultants doing slightly less during the daytime in order to be available for more out of hours work.

"Staff levels differ incredibly between hospitals coping with the same number of patients.

"Some hospitals have gone far too far down the route of replacing nurses with care assistants which is fine if everything is going swimmingly but it only takes one critically ill patient to use up the capacity of staff. If there are two very sick patients then you're stuck."

PAY BATTLE: Dr Andrew Hobart is fighting to cut working hours.

TRAUMATISED: Dr Rita Pal was left exhausted and distressed by the long hours and lack of guidance she claims she experienced in busy Midland hospitals.

Colin Firth is Dapper

Well done Colin.

As everyone knows, my favourite actor is Colin Firth. I just love Colin Firth. He is the kind of guy that has always made me forget the GMC, forget all about writing radical material and forget most things. Indeed, I might as well have shaken my head and emptied by brain! I first watched Colin in Bridget Jones during a hellish workload week with R Pal v GMC 2004.

It would be wonderful if I could simply stare at him for days. Sadly, over the last decade of scrapping with the General Medical Council, I have never had the right kind of barrister representing me. None have looked like Mark Darcy. They have all been rather serious men with little in the way of a sense of humour. None have bought me lunch. Even Robert Jay QC failed to purchase a bagel or two. Such a disaster when you discover that your lawyer cannot even get you Tescos New York Bagel. All of us watched while the lawyers greedily ate their own food. Lawyers are greedy people - whether its food or money, it doesn't make much difference. Greed is like a religion to them and money becomes their God.

Secondly, the GMC have failed to hire anyone who looked like Mark Darcy. I had great hopes for Mark Shaw QC. I was told by Arpad Toth that Shaw was not bad. This increased my expectations of Shaw.

When the barrister appeared, I spent ages staring at him. One shouldn't really stare at crumpled men but you just can't help staring when you try and figure out why he has such a hunched back. Everything appeared deformed in some way - his thought pattern, his back, his curled lip, his wig. For some reason, it had all gone wrong. The amusing part is that Shaw caught me staring at him and felt terribly sheepish about it. It is important to stare at those who are so odd in many ways. Staring is a bad habit but important when you want to describe a person in a book. I referred to him privately under many times - Rumplestilskin or my favourite which is Mr Crumplechops. These names are because he takes himself so seriously but has no idea how the rest of the world perceives him. Insight is not Crumplechop's strong point.I can see why the Attorney General hires him.

This stooped gait and bad posture is something I have noticed in barristers representing the General Medical Council. My colleague Dr Pakistan who has been taken off the shop floor may be able to diagnose this back problem in Mark Shaw. Dr Pakistan is better at orthopaedics than me. Although, my time at Stanmore during my BSc year taught me a few things about biomechanics. Enough to calculate the angles of Mark Shaw's stooped gait anyway.

Mark Shaw QC sadly was no Colin Firth and it was a huge disappointment for me. I came home and rang Arpad and whinged mightily about the fact that even in this last hearing, the GMC had failed in hiring a dashing barrister. I moaned that all casinos have good looking men - what happened to the RCJ? The judge appeared sporting his rather large beak and Shaw just sported his hooked nose.

Dr Pakistan recently showed me the cost schedule for Mark Shaw QC. Shaw gets paid for destroying doctors livelihoods. I have often dubbed him as the Medical Assassinator. I nearly fell of my chair at his cost schedule though. Each swish of his gown must cost around £100 per millisecond. It is almost as much as Colin Firth gets paid but Colin earns an honest living.

Today, I was really pleased to see Colin Firth winning the BAFTA. I have always wanted him to win an award because he is such a versatile actor and I appear to have watched everything he has ever starred in. Here is hoping that one day Colin reads this and sends me a signed picture that I can hang up on my wall. As various barristers have let me down in their looks, I have to revert to the original dapper fictional barrister - Mark Darcy. At £1000/hour plus VAT, at least Mark Darcy is a sexpot and lets face it, quality is vital especially when emptying your bank account!

The Spectacular GMC " F*** up" [that is not admitted].

GMC Message

The farcical nature of the General Medical Council is exhibited below by me. The GMC investigated me for 6 months only to find out that I was indeed a Psychiatrist, something they had accepted in 2000-2004. Their allegation was that I was to be investigated because I used the term " Psychiatrist" without being on the specialist register. I wasn't sure whether to laugh or cry at this statement because I initially thought the GMC must be joking.

Of course, they were not joking, they were being deadly serious. As matters evolved, I discovered that Anna Neill, their air headish Assistant Registrar did not know that the vast majority of the workforce who were not on the Specialist Register were also referred to as"Psychiatrists" by the National Health Service. Investigating this resulted in the loss of my job [ which apparently the GMC isn't responsible for] and discord with the Trust. This incompetence left me with a nice present which means that despite a cleared complaint, I will have to declare this to all and sundry in every application form, medical or non medical. This is the post Shipman effect.

This is a source of great amusement for the General Medical Council and the complainant but I consider it a devastating blow for doctors in general. If the GMC cannot understand the term" psychiatrist" what can they understand? The GMC case examiners finally put a stop to the General Medical Council's stupidity and agreed with me after they lazed around on my pre-action protocols. All well and good, but where does that leave me with my job and my references? What do I say, " I was fired because the GMC fucked up big time - again". Or shall I say that " The GMC keep fucking up repeatedly, once in 2004, then the breach of Data Protection Act which they apologised for then the 2004 discreet inquiries which they apologised for [ the distress bit only] and now this". People get tired of hearing about how crap the GMC really are.

This is what happens when you deal with a regulatory body whose intelligence level is far below that of an amoeba.

It raises the question, can the GMC deal with anything properly? Some years ago, the GMC themselves admitted that they had duty to be fair to the doctor. What they practise and what they preach are two different issues. I resent the fact that the GMC's failure to understand the term " Psychiatrist" cost me rather a lot. Afterall, this is the highest regulatory body in the land and they failed to appraise themselves of the way of the NHS. There is no reason I should pay for their incompetence. Of course, the reality is that I have paid for their incompetent and reckless behaviour. Then I believe the GMC relishes in the idea that doctors suffer. It is a kind of sick malevolent pleasure that they derive from causing others grief.

For the sake of my friends on Doctors4Justice.net, I penned the entertaining missive below. The missive is designed to show the stupidity of the General Medical Council and the judiciary to a certain extent. The case finally ended up in court in a further comedic event. R v General Medical Council Ex Parte Pal . As Arpad Toth tells me, " Rita you misunderstand the judicial system, you are going into a casino" :). The email below summarises the fairly amusing evidence on the " psychiatrist" issue. My argument is that the GMC should not have investigated the matter. The GMC's argument of course is that " We fucked up and we don't want to be blamed for it". Thats alright, we can just blame you online.

By the way, just to clarify a point, when you have faced as much stupidity by the GMC as I have, your rate of expletives becomes proportional to the GMC's stupidity. Those who have experienced this will understand what I mean. This post was written to outline the stupidity of the GMC for those who are facing revalidation etc. The situation at the GMC is probably worse than this and it doesn't give us faith in Registered Medical Practitioners Fitness to Practise issues or Medical Student Fitness to Practise issues.

----- Original Message -----
From: Rita Pal
To: ndickson@gmc-uk.org ; doctors4justice-@googlegroups.com ; Jack Straw1 ; Jack Straw2
Cc: Neil Marshall (020 7189 5153) ; Cowlin, Martyn ; Emma Kelly-Dempster
Sent: Saturday, February 20, 2010 8:03 AM
Subject: Re: "Psychiatrist"


Dear All,

Further to my email below describing the bizarre behaviour of the General Medical Council, the BMJ refers to Dr Osbourne as a " psychiatrist". The enclosed document has the title "Psychiatrist accused of dishonesty for prescribing drugs to a patient under a false name". In the interest of equality, I invite the GMC to investigate Fiona Godlee of the BMJ for falsely referring to a " Psychiatrist as a Psychiatrist" because Dr Osborne is not on the " specialist register" [ justification by the GMC for a 6 month investigation on a British Asian].

It has to be said that the GMC exceeded themselves. Having accepted the term " Psychiatrist" for me in the transcripts of Pal v GMC 2004 and accepted the numerous references that referred to me as a "Psychiatrist" in 2004, they then took up a complaint for 6 months in order to establish whether I was a " Psychiatrist" because the GMC themselves didn't know what a psychiatrist was. Their own GMC panellist Michelle Shepherd, my previous referee referred to me as a " Psychiatrist" by letter. Counsel for the GMC Mark Shaw QC who also works with the Attorney General referred to me as a " Psychiatrist doctor" :) in his adjournment application dated 26th February 2009. The GMC was then asked by email about the definition of a Psychiatrist. This is what they stated " A Psychiatric doctor - or psychiatrist - is a doctor who has undergone basic medical training then specialises in psychiatry, that is treating people affected by mental illness" [ Email reference SR1242890776 ].

Indeed, in the interests of equality by ethnicity and workforce, I invite the GMC to investigate ALL "Psychiatrists" who are not on the " specialist register" and not " affiliate members of the Royal College of Psychiatrists". According to the Department of Health statistics, there are a fair number of " Junior Psychiatrists" [see email below]. I therefore officially request that the GMC investigate more than 1000 Psychiatrists as per the terms set out by R v GMC Ex Parte Pal. The judgment by Collins J suggested that any allegation "capable" of being "misconduct" should be investigated under Stream 1. In the event, no investigation takes place, everyone would be interested in the reasons why such investigations have not taken place and which analysis of "misconduct" has been used by the GMC this time.

I enclose the Department of Health statistics below. Perhaps Niall Dickson would like to read the words " Psychiatrist" as listed below by the Department of Health. Indeed, if Collins J could read statements by claimants instead of concentrating on his " sunny days" [ as referred to at the end of his judgment] then it would be a plus for all litigants in the United Kingdom. Reading is a great skill rarely bestowed upon those paid by the tax payer. The above information is part of the public record for R v GMC Ex Parte Pal and placed in front of Collins J.

In conclusion, the complainant, a ex criminal and jail bird known to have made more than 60 complaints to the GMC did not know what a Psychiatrist was due to her low education level, the GMC itself didn't know what a psychiatrist was because lets face it, the GMC has got got anything right for centuries and finally the Judiciary, in this case Collins J whose [brother Mark Collins is a Psychiatrist] did not know what a Psychiatrist was. It should be noted that Collins J has spent sometime editing the rules of the Royal College of Psychiatrists as admitted by him at the hearing of R v GMC Ex Parte Pal. This is why the Rules fail to make sense upside down and the right way up.

The above has been written for the sake of my colleagues on Doctors4Justice by way of entertainment at the dire state of the General Medical Council.

Regards

Dr Rita Pal

DOH EMAIL

27 October 2008

Dear Dr Pal

Thank you for your email of 9 October asking, under the Freedom of Information Act, for information regarding psychiatrists not on the specialist register.

The information which we hold is as follows:
The data requested is shown in the table below. The figures for 2008 will not be available until March 2009 when the next NHS Workforce Census is published and will be available on the NHS Information website, www.ic.nhs.uk/.
As at 30th September Headcount
2005 2006 2007
Associate Specialist 423 473 475
Junior Psychiatrists* 1,267 1,326 1,332
Registrar Group 1,032 1,022 2,796
Staff Grade Psychiatrists 1,073 1,236 1,245
* Counted as doctors in training

I hope that this is helpful. If you have any queries about this letter, please contact me. Please remember to quote the reference number above in any future communications.

If you are unhappy with the service you have received in relation to your request and wish to make a complaint or request a review of our decision, you should write to:
Section Head
Freedom of Information Unit
Department of Health
Room 334B
Skipton House
80 London Road
SE1 6LH
Email: freedomofinformation@dh.gsi.gov.uk

If you are not content with the outcome of your complaint, you may apply directly to the Information Commissioner for a decision. Generally, the ICO cannot make a decision unless you have exhausted the complaints procedure provided by the Department. The Information Commissioner can be contacted at:
The Information Commissioner’s Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF

Yours sincerely

Colin McDonald
FOI Manager
Customer Service Centre
Tel: 0207 210 4940

The GMC Hates Black Shoes

"I am not prepared to clean your shoes, GMC"

It is a fact of life that the General Medical Council is institutionally racist. The fact is they have not progressed beyond the Last Days of the Raj. The token asians invited to join them and the minority pictures on their website are simply lip service. I do not make these statements lightly. I am a British Asian doctor with a clipped English accent yet my colour matters to the General Medical Council. Indeed, everything about my demeanor matters because I am not English. I summarised the research on Institutional Racism at the GMC here. The most important summary is research provided by the BMJ last year. The abstract stated

"Doctors who qualified outside the United Kingdom or Europe are still falling foul of the General Medical Council, the UK medical regulator, in greater numbers than their home-grown counterparts, new statistics from the GMC show.

Despite research looking into the disparity in 2000 and 2005, the GMC is still trying to identify the reasons; the disparity remains despite reforms to the council’s fitness to practise procedures in 2004.

The GMC’s 2008 fitness to practise statistics show that when initial complaints were triaged, 44% of those involving international medical graduates (those from outside the UK or Europe) went into the "serious" stream (stream 1, where a full investigation is carried out) compared with only 29% of those involving UK graduates"

Many many years ago, a doctor called Aneez Esmail decided to do a study on the General Medical Council. Those brave days are over for Aneez, nevertheless, this speech of his is interesting.

"It is fair to say that the GMC's action did not endear us to them nor them to us and we decided that the next avenue for investigation should be the GMC. We had receive anecdotal evidence that ethnic minority doctors were more likely to be disciplined compared to white doctors. Of course no one kept any information on this so we decided with the help of the BBC to investigate the GMC complaints procedure. We looked back over ten years of records and identified all the cases that had come before their Professional Conduct Committee. What we found was quite amazing. Ethnic minority doctors were six times more likely to be brought before the Professional Conduct Committee of the GMC than white doctors. When we published our findings the GMC's position was that this was nothing to do with them, that all they did was act as a clearing house for complaints. There was of course an incredible outcry about this and because of our investigation they were forced to hold an internal inquiry into the whole issue of complaints. Not only did our investigation find that there was a disproportionate number of ethnic minority doctors brought before the GMC but there are some very interesting differences in the actual charges that were laid against those doctors. That research was published in the BMJ as well and I don't want to go into too much detail about that work, but suffice to say that the case against the GMC was quite damning as was their response to this finding. The subsequent enquiry that was headed by an academic researcher called Isobel Allen concluded that the GMC's procedures were archaic, and that whilst the charge of racial discrimination could not be levelled against them it could also not be disproved. The GMC has now had a complete overhaul of its procedures and has agreed to ethnic monitoring of its complaints procedures. Interestingly one of the criticisms made by the GMC against us was that it wasn't their problem because they just dealt with complaints. In fact the independent inquiry found that in terms of complaints there were no more complaints against ethnic minority doctors than there were against white doctors. The problem was that the GMC seemed to take the complaints made against ethnic minority doctors much more seriously which is why so many more cases appeared before the Professional Conduct Committee. This is important because I have also maintained that it is not the problem that the doctors that are brought before the GMC are in some ways mis-tried, it is just that I believe a lot more doctors should be brought before the GMC. My conclusion is that if you are white you have more chance of getting away with misdemeanours than if you were an ethnic minority doctor"

Esmail did his study many many years ago. The BMJ then reported the matter here.

"Doctors from ethnic minority groups in Britain are six times more likely than white colleagues to be brought before the conduct committee of the General Medical Council (GMC), according to research released last week by the Medical Practitioners' Union. Dr Sam Everington and Dr Aneez Esmail found that between 1982 and 1991 a total of 402 doctors had been brought before the committee, of whom nearly 60% were from ethnic minorities. Fewer than one in five doctors in Britain is from an ethnic minority. The authors, who studied data collected from the minutes of the committee's proceedings, used doctors' surnames to estimate the number from ethnic minorities. "If anything, our figures underestimate the imbalance," said Dr Everington. "We worked on the assumption that most doctors from ethnic minorities are Indian or Pakistani. We are not saying that these doctors did not deserve disciplining...."

The situation has not changed from 1994-2009. It also shows us that between these years, the GMC has done little to mend their ways. I have of course caught the GMC out a number of times. In 2004, they took up a complaint in defamation against me. Prior to that in 2002, they refused to take up a complaint of defamation against Dr Neil Bacon, a caucasian doctor. In 2007, the GMC wrote me a letter stating that they did not deal with defamation cases. We then ask ourselves the question, why was I investigated for 6 months?

My most interesting development is the discovery of two competing analysis of the word "misconduct" currently being touted through the courts. The first is regarding me, a British Asian. The GMC gives me a strict definition. The second is that regarding Caucasian senior doctors [ R v GMC Ex Parte Remedy UK], the GMC gives them a lax definition. The analysis of Professional Misconduct is presented by Doctors4Justice. It is notable that Collins J in discussion on R v GMC Ex Pare Pal, has agreed that the decisions of factually identical complaints can be diametrically opposite for two different individuals. Collins J has therefore effectively agreed that racism should be continued at the General Medical Council.

The Late Debra Shepherd. A Review of the GMC

Debra Shepherd ended her own life a few months after a GMC Investigation.

My Story about the GMC

In October 2002 I was arrested in a stationary vehicle in a car park over the alcohol limit for driving. This was the culmination of a turbulent 2 years living with an undiagnosed and untreated bipolar illness. I was convicted of drink driving in February of 2004 which resulted in GMC involvement.

At the time both GMC examiners agreed I was fit to practice generally but one recommended a period of medical supervision ...’due to the relapsing nature of my illness’.

The GMC concluded that my fitness to practice ‘might be impaired by reason of bipolar disorder’.

In July 2004 I agreed to medical supervision and the associated supposed ‘voluntary’undertakings.

One of the standard undertakings being to permit the GMC to disclose certain undertakings to any person requesting information about your registration status

On 11th July 2005 I received a letter from the GMC informing me that a number of my undertakings would be made available on the GMC online search facility and would remain their historically even if my registration status changed.

I wrote immediately to them forbidding them from disclosing information in this way and asked if I could appeal against ongoing medical supervision. I was told rather scathingly that of course there is no recourse to appeal. In response to this I formally withdrew from the previous undertakings.

The GMC responded by referring me to a fitness to practice hearing to be held in October 2005.

I took the following steps:

1. As a member of the MPS I was provided with a solicitor and a barrister.
2. I requested all GMC held paperwork on my case using the data protection and freedom of information acts.
3. I requested 3 independent medical opinions in addition to the 2 GMC appointed examiners.
4. I requested testimonials from all consultants I had worked with since being a psychiatry trainee in the UK (2000) explaining my situation and asking them specifically to comment on fitness to practice.
5. In addition I requested testimonials from my colleagues at the time. CPN’s and my secretary contributed!
6. I downloaded the health specific information from the GMC website and sent it to the information commissioner with a request for his comments

One week before the hearing was due to take place it was cancelled by the GMC on the advice of their lawyers. At that point they were in possession of 4 of the reports all stating I was fit to practice.

I quote from the GMC’s legal opinion;

‘It is unusual to find this degree of unanimity in 4 psychiatrists. In the light of their reports it is my opinion that the GMC would not be able to prove that Dr Shepherd needed to be under supervision nor that she needed to have conditions placed on her registration.’

I am no longer under GMC supervision. In addition I have in writing from the GMC that there is no longer any history against my registration and therefore nothing to disclose on the online search facility.

It was a very stressful time but one thing became quite clear. The GMC are not used to doctors defending themselves and basically don’t seem to know what to do when their usual intimidation doesn’t work.

On the basis of my experience I would encourage doctors to stand up to the GMC.

The GMC’s behaviour towards doctors with mental illness is illogical, prejudiced and I am convinced illegal. Unfortunately some of my psychiatric colleagues collude with the process and I have contacted RCPsych expressing my concerns regarding this.

The Late Debra Shepherd.

NHS Appraisal. The Pen and Paper Solution

The NHS Appraisal Fiasco is being covered by Pulse. Following the recent security blip covered by the Register, the Department of Health has apparently been writing placatory letters to the local PCTs.

"The Department of Health has written to PCTs stating doctors should not be ‘penalised’ because they are unable to complete their appraisals, after the NHS Appraisal Toolkit was taken offline because of its vulnerability to hackers"

I thought the whole idea of appraisals and revalidation was to prevent the next Dr Shipman. It is clear by the above statement that the Department of Health does not believe that patient safety would be put at risk by the delays caused by their incompetence.

"The move - made in agreement with the BMA and RCGP – has led to huge upheaval in the appraisal system at its busiest time of the year, and could delay the passage to revalidation for those taking part in pilots of the system"

Does this mean, the Department of Health agrees that there should be delays in spotting the next Dr Harold Shipman?! Surely not! All that pomp and circumstance about harassing doctors and punishing them with the sole aim in deviating the pointed finger from the real people responsible for Harold Shipman.

Dr Charles West, a GP Appraiser in Shropshire and parliamentary candidate for the Liberal Democrats, condemned the decision to take the site offline.

‘Technical staff running the system say knowing the potential problem would have allowed them to monitor it for any incorrect use. But the health minister decided the service should be shut down without notice.’

For a target driven National Health Service, it is rather amusing that the Department of Health cannot meet its own targets to prevent the next Dr Harold Shipman. This of course leads us to question whether the Department of Health is really convinced that appraisals and revalidation is the way forward to catch the next serial killer. If they were convinced, they would have made a damn sure that the system was hacker proof before implementing it thereby preventing delays.

There is of course a different solution, the Department of Health could supply all doctors with free pens, a Department of Health Serial Killer Prevention Folder and some NHS Headed paper, envelope and free postage. It may well be more reliable :).

Sadly, it is clear as the light of day that the Department of Health's Microsoft driven system is not hacker proof and never will be. Microsoft's record has not been wonderful.

Of course, there are people like Gary McKinnon who would probably be able to hack past anything the Department of Health creates. It is good to know that doctors' professional assessments can be accessed by any reasonable hacker anywhere in the world. This will no doubt warm the cockles of every doctor who is sitting there with their vast array of appraisals completed by their medical friends.

Of course, again vast numbers of doctors continue to be asleep. Must be all those late night oncalls and low pay in the NHS because few fail to understand what this admission of a potential security breach means. This is of course just another day in the NHSHIT system.

Centralised data = Access by Hackers = No System is Secure.

Read more coverage by the Register here.

NHS Appraisal. No Maximum Security

DOH - No guarantee of Maximum Security

Of late, I have been discussing the various databases that have been created by the National Health Service for appraisals and revalidation. The main discussion has been about the collection of data. Centralized data collection always has serious problems. The Register today reports the predictable problems that are due to be seen in all other medical databases.

"The UK's Department of Health has taken the highly unusual step of suddenly taking a doctors' appraisal website offline for three weeks over concerns it was vulnerable to hacking attacks.

The NHS Appraisal Toolkit was taken down on Tuesday (9 February) and is not expected to return until 3 March.

The site provides an online database that allowed NHS doctors to prepare for their annual appraisals. The database therefore contains confidential information about all GPs' performance, along with a large amount of named patient data including near diagnosis misses, critical incidents and the like.

www.appraisals.nhs.uk was pulled offline without warning to the 27,000 doctors who use it after a security audit sparked fears that the site was insecure, an NHS statement explains. It stresses that the site takedown is a precautionary move and that no attack has actually taken place"

A Reg reader and doctor who first told us of the site downtime explained that the site was used by almost all GPs and many hospital doctors, adding that the takedown could hardly have happened at a worse time. "This at a a time when a huge chunk of GPs in particular are due their annual appraisals," he said.

And that is of course the stupidity of doctors in the United Kingdom. Instead of asking the question " What data is the Department of Health collecting and what will it be used for", they quietly just insert said data and progress forward until disaster strikes".

Many will recall that this was the problem with the MMC/MTAS issue. There was a security breach. Robert Goss tells us about the flaws of the system here.

On the flip side of the coin, it is interesting that the GMC reports a hike in complaints against General Practitioners. Those who know the GMC's database well will know all about Siebel and how even the most vexatious complaints are recorded on their databases to create a " fitness to practise history" of the doctor.

A GMC trial of revalidation has has found clear concerns with the system

"A GMC trial of revalidation has identified ‘clear concerns’ with the system, which doctors are believed to have found excessively bureaucratic and time-consuming, Pulse can reveal"

We should all remind ourselves that appraisal and revalidation were only created because the General Medical Council was incapable of stopping Shipman. No one thought about actually appraising or revalidating the General Medical Council itself. I suppose that would be such a simple solution. Too simple and cost effective for the establishment's liking I suspect. It will be fun to watch the revalidation meltdown while the doctors caught in the middle will run around like headless chickens. That is exactly what happens when the vast majority follow like large sheep in a field. This is called a complete lack of independent thought and misguided faith in a failing system.

Scientific Love

Does the slipper fit?

Valentine's Day is due. I have always found that the day is far too commercialized for my liking.

Love science has always fascinated me. The BBC have an interesting section on the stages of love. Actually, the Science of Love has baffled scientists for centuries.

Four years ago, Andreas Bartels had just finished a Ph.D. on the neurobiology of vision and had some time to kill. Over dinner and after a few glasses of wine, he decided to use science to tackle a question that has stumped poets for centuries. What, he asked, is love? "We said, 'why not do a fun project?'"

It went on "Bartels reasoned that romance is a physiological phenomenon".

Cornell University economist Robert Frank had pointed out that people would leave their mates the first time a more attractive partner walked by if love were not a pretty powerful force. To find this glue, Bartels and his adviser, Semir Zeki of the Imperial College of London, used a machine called a functional magnetic resonance imaging (fMRI) scanner to peer into the brains of 17 people who had been madly in love for an average of about two years--around when other research had suggested commitment and devotion were at their peak. By comparing the brains of these people as they looked at loved ones and then as they looked at friends, Bartels and Zeki produced what they believe are the first pictures of the brain in love.

The Economist has a different take on all of this. As one person told me "love is free but condoms are expensive".

Anyway, I prefer the Independent's view on love.

"Psychologists have shown for the first time that you are more likely to find a happy-looking face that looks directly at you sexually attractive than the equally smiling face of someone who is averting their eyes. The findings support the theory that both men and women use the direction of a person's gaze as a signal of whether that person finds you interesting enough to look you directly in the face – and that sign of interest is, in itself, seen as attractive to the observer".

Psychologists know what they are all talking about.

ESRC deals further with the Science of Love. They say

"By comparing the NGF levels of the madly in love with those of established couples and singletons, the researchers concluded that romantic love dies within a year". Why we love is even more fascinating. A trio of neurotransmitters - dopamine (also activated by cocaine and nicotine), norepinephrine (adrenalin) and serotonin - are implicated in our behaviour at this stage. While Tallis argues that romantic love is similar to manic depression, Fisher suggests its behavioural patterns are more akin to obsessive compulsive disorder - a condition characterised, like romantic love, by low levels of serotonin, hence the suggestions of drug therapy.

"So far, so good. So, what about affairs and unfaithfulness? Fisher argues that that comes down to the independence of the lust, romance and attachment systems. You can, in fact, feel all three, at the same time, for different people. Not exactly a stable, happy situation. "We are not built to be happy but to reproduce," says Fisher.

For many sociologists, these theories of love from anthropologists and psychologists miss the point. They point out that the definition of love has varied through history and that the concept of falling in love, for example, did not exist until the 16th century.

For sociologist Bernadette Bawin-Legros romantic love doesn’t boil down to timeless brain activation patterns and evolutionary imperatives. Romantic love is a narrative that has long-dominated popular culture. It is fragile in its contemporary form, she argues, because that form involves the impossible union of two ideals - fusion with another and the modern aspiration for autonomy and self-development. Whatever the desires of dreamy romantics for love to last forever, those two ideals are simply irreconcilable"

Pseudoscience of love is a witty blog and worth visiting today. The MSNBC is worth a read as well. He talks about sex of course. The miserable police have launched an operation to prevent teenagers from having sex. Of course, police men ought to first set an example by being celibate.

NY suggests that we all get in shape for Valentines night. Studies show that to most people, confidence is sexier than a perfect body. "When you feel smokin' in your own skin, you'll instantly amp up your sex appeal," says Sadie Nardini, director of East West Yoga near Union Square. Nardini has designed a yoga workout to put you in better shape for great sex. Errrrm yes, I have a better idea - Sexercise.

"The NHS has some new advice for people struggling to schedule a fitness routine into their daily lives - a workout between the sheets. According to the NHS Direct website, "sexercise" can lower the risk of heart attacks and helps people live longer. Endorphins released during orgasm stimulate immune system cells, which also helps target illnesses like cancer, as well as wrinkles, it states. Sexual health experts said such claims could not be scientifically proven.

"It's good to see the NHS are promoting sexual well-being," Dr Melissa Sayer told the Guardian newspaper. "Yes, there is evidence that sex has benefits for mental well-being, but to say there is a link with reduced risk of heart disease and cancer is taking the argument too far." If you're worried about wrinkles - orgasms even help prevent frown lines from deepening" says NHS Direct.

The Daily Mail of course is the best newspaper to read if you want tips on seduction. The Psychology of Seduction is fascinating. It says "

If you want an intelligent partner - seek out a man with body hair. A recent study conducted by psychiatrist Dr Aikarakudy Alias, who has been working on the relationship between body hair and intelligence for 22 years, showed that hairy chests are more likely to be found among the most intelligent and highly educated than in the general population. Excessive body hair could also mean higher intelligence. Dr Alias's research, which focused on medical students in the United States, showed that 45 per cent of male doctors in training were "very hairy", compared with less than 10 per cent of men overall. In a region of southern India, research among medical and engineering students and manual labourers found that both groups of students had more body hair on average than the manual workers. Further investigations showed that when academic ranking among students was examined, the hairier men got better grades. Taking this study one step further, Dr Alias studied 117 Mensa members (who have an IQ of at least 140) and found that this group tended to have thick body hair. Some of the most intelligent men were those with hair on their backs as well as on their chests". I quite like the Nigella Lawson key to seduction. She said "But I know men like the whole strappy thing of suspenders, so I’ll wear them. In fact, thinking about it, I’ve actually worn them with nothing but a pair of shoes in bed before,”

In 2007 there was an interesting study about romantic encounters between doctors and nurses.

"Passionate encounters are inevitable among doctors and nurses working in emergency medicine - or at least that's what romance novels have us believe" said the BBC. "A tongue-in-cheek study of the genre suggests the GP surgery is also a hot spot for romantic escapades"

The books say many things but as we all know, those you may adore the most will almost always walk past you, never notice you then almost always belong to another.

"True love is never selfish, and will die if it is not fed by thoughtfulness, courtesy, kindness, and work" Billy Graham.