Goodbye Mr Bond

Thanks to BM for this picture

Christopher Bulstrode will know all about his sister's sob story at the General Medical Council. To cry with her, more than a 100 colleagues and friends weighed it to stop her being struck off. That is nothing new, Dr Harold Shipman had a entire campaign group who supported him. To remind everyone, here is what happened

"While Shipman languished in prison awaiting trial there were a significant number of people continuing to support their former GP.

Many wrote letters to the man who, they believed, was the subject of a huge miscarriage of justice"

The interesting aspect here is that more medical professionals support Dr Jane Barton than they do a whistleblower. I think it is important that we have access to those people who did write letters of support for Dr Jane Barton at the GMC hearing. The doctors who have disliked the changes post Shipman appear unconcerned that the Barton case may well make matters worse for them all. Then few doctors publicly criticise Dr Jane Barton. I suspect it isn't the done thing to do in the United Kingdom. The profession here would rather remain silent then pay for her mistakes later, just like they did with Dr Harold Shipman.

Anyhow, I have always found the tale of potential sabotage of Dr Shipman's trial rather interesting. This behavior at the BMA was no coincidence. The BBC article can be read here. This is the kind of behaviour the establishment will exhibit when it is attempting to free one of its own.

The BBC piece stated :-

"The British Medical Association made a mistake that could have allowed serial killer Harold Shipman to walk free, the judge in the trial of the disgraced doctor said"Now the BMA is to be reported for contempt of court to the Attorney General.

The tricks of the trade is normally to roll in supporters of the doctor. Then the next trick is to roll in fellow experts who will say anything for money. In Barton's case, Sikora has appeared in his usual large nosed state. Apparently, casual observers have said that his nose grows longer with each case he appears in. Of course, this is all a game played by lawyers who get paid handsomely by doctors subscription funds to the GMC and MDU. In the end, patients are dead and someone has to be responsible. This is because accountability is essential within the current regulatory system.

It wouldn't do to have another public inquiry examining why initial complaints about Dr Barton to the General Medical Council were all screened out in 2002. Of course, in the event there is a public inquiry, that question will be asked. They will ask the GMC, why nothing was learned after Shipman. The GMC will then manufacture a tale of woe to extract themselves out of a tight situation. They do this by telling the world, they have improved. Of course, the GMC have not improved in 100 years. They have simply become more conceited and experienced at lying effectively. It is all to do with good cosmetics and layers of foundation.

This from Wikipaedia is interesting

"Despite the prosecutions of Dr John Bodkin Adams in 1957, Dr Leonard Arthur in 1981, and Dr Thomas Lodwig in 1990 (amongst others),^[13] Shipman is the only doctor in British legal history to be found guilty of killing patients.^[14] According to historian Pamela Cullen, Adams had also been a serial killer—potentially killing up to 165 of his patients between 1946 and 1956—but as he "was found not guilty, there was no impetus to examine the flaws in the system until the Shipman case. Had these issues been addressed earlier, it might have been more difficult for Shipman to commit his crimes."^[15] H. G. Kinnell, writing in the British Medical Journal, also speculates that Adams "possibly provided the role model for Shipman".^[16]"

Much is made of Dr Barton's so called motivation prior to the lethal prescriptions. Of course, a murderer never admits his motive. Even Shipman's defense was "the patients best interest". Of course, I am puzzled as to how being dead is in the "patients best interest".

Salon Du Chocolat. The Shanghai Surprise

Everyone knows that I have an addiction to chocolate. Despite going on a reducing regime to cope with my chocolate addiction, I keep abreast of all chocolate news. A fascinating item caught my eye this evening. The sweetest event in town happened in Shanghai. Read here for the report on chocolate clothes. Sporting an array of clothing easily worn on any medical oncall by all starving house officers, the above Basque provides just the support for those cold nights oncall in the National Health Service. If you get hungry overnight, you can just have a piece of your clothes. What a novel idea! It beats kicking the s**t out of the vending machine at 4 in the morning while it nicks your last bit of change. I would have definitely turned up to a cardiac arrest dressed in a chocolate Basque. Of course, in those days we had white coats to hide all slinky tops.

Asha opts to Gag The Sun

Asha Falls on Eady J's Lap

The Press Gazette today reports that Mohamed Asha, the NHS doctor cleared of a the Glasgow bombing incident is suing the Sun.

Full details can be read here.

"Asha is demanding damages for alleged libel and invasion of privacy over two stories that appeared in The Sun which revealed he was working in an NHS casualty ward under his middle name, Dr Jamil.

According to a writ filed at the High Court by lawyers working for Asha, he believed one story that appeared on 10 August last year headed: "Terror case doc works in casualty" claimed there were very strong grounds to suspect that he will be involved in terrorist bomb plots in future and is an ongoing threat to national security"

As a result of the danger created by stories, he says, he was offered police protection and the hospital had to ensure he was not the sole doctor on duty at night because of his fear of being attacked at work.

According to the writ, Dr Asha claims he was also asked to leave his rented flat and could no longer live in Shrewsbury because of fears for his safety.

He also claimed his neurosurgery training programme had been disrupted after three hospitals were reluctant to employ him.

This should be an interesting day in court where we should get a response as to why a number of reporters witnessed Dr Asha embrace his terrorist friends.

The Daily Mail reported.

"When Abdulla was convicted of conspiracy to cause explosions and conspiracy to murder, and Dr Asha was cleared, the two men embraced in the dock"

Of course, it is very interesting to note that the General Medical Council and many databases have the doctors place of work. It is probably a matter of public record these days. The debate may be whether a public sector worker responsible for treating vulnerable people has the right to privacy. Given his obvious attempt to conceal his real name from the public, do they have a right to know who they are being treated by? I would say "yes".

A landmark ruling on Privacy was the disclosure of identity regarding the blogger Nightjack.

Eady J stated

"I do not accept that it is part of the court's function to protect police officers who are, or think they may be, acting in breach of police disciplinary regulations from coming to the attention of their superiors," Eady added.

If anyone else goes to court to seek their rights, the General Medical Council brands them as a vexatious complainant, questions their mental health and conducts a discreet inquiry. Not with Mohammed Asha though. Mr Smooth Operator has got them wrapped around his little finger. Actually, lets put this more bluntly, he has got some very good lawyers who can spin when they want to. Lawyers are of course masters artists at getting their clients off on a technicality.

If the GMC have so much confidence in him, perhaps he should now apply for a job as GMC Committee member or even panelist. He has enough references supporting him.

Dr Mark Jeffries said: "I think that Mohammed is one of the most decent and disciplined people I know. He is a man of integrity.

"He has fantastic dedication to his career and patients obviously remember him. He is without doubt one of the brightest doctors I have ever met and could go on to be one of the top neurosurgeons in the country."

Diamorphine Queen

Intellectual killing by Dr Jane Barton

Unknown to the vast majority of the world, the General Medical Council is currently deliberating over UK's new Dr Harold Shipman. This lady is known to the world as Professor Christopher Bulstrode's sister, Dr Jane Barton. Both are Oxford Graduates. The good thing about being an Oxford Graduate is that you can walk into any job known to man no matter what kind of killing ideas you harbour. There is a uncomfortable silence in the British Media in relation to this case. It should be headline news in all newspapers but it isn't. It is a relatively quiet affair where the GMC have denied public access to many of their discussions and deliberations.

To recap, when I told the General Medical Council in the year 2000 that there was a serious problem with diamorphone overuse in the United Kingdom, they decided to conduct a "discreet inquiry into me". When Jane Barton handy work with diamorphine was presented to them by families in Gosport UK, the General Medical Council threw the complaints out in 2002. The GMC has been in complete and utter denial for sometime now until the families achieved a positive inquest result. They assume that doctors don't notice or that this will be nicely swept under the carpet.

Of course, I have acutely noticed how the GMC have punished my friends because they spoke out of turn or because they did not follow the Etonian or Oxfordian path of etiquette. This is the problem with upper class English snobbery. They assume they are better than the rest of the world when in reality we can find better people with more integrity on the floors of Howrah Station. I trust the GMC is paying attention here as this comment is directed right at them.

The organization is unfit to regulate and has been for a while. The reason it continues to regulate is because the British doctors are rather spineless creatures. They will watch, discuss in the confines of their own privacy but say very little in public.

Tea at the Manor

Cary Grant is sexy

I read the obituary in the doctors mess and there I found out that Lord G had died. Apparently, Lady D had died the year before.

Lord G and Lady D were my patients over Christmas 1999 until the 2nd January 2000. No one wanted to do the oncall at the Private Hospital. I though needed to earn a living to pay off my student debts so I worked 24 hours each day between 24th December -2nd January 2000. After the shift, I had major cabin fever. Nevertheless, Lady D had kept me going.

Lady D was a character. She was tall, had white curly hair and a long pink silk gown with one of those feathery collars.

When I first met Lady D, she asked me to pick the tissue from the floor and sit next to her. She started to pat my long hair and asked me what part of India I was from.

"Now sit down and have a croissant with me," she said.

She shooed the nurse away and then started to talk to me in detail. She told me she had been a nurse in the war and that she didn't care very much for the poor quality of nursing in this country now. She called the head nurse Cruella and had her unflattering pet names for the rest of the staff. Lady D was interesting and told me about all the things she would do in the War. Since Lady D, I have always sat and listened to many tales of the war from many patients. Memoirs fascinated me. I was always honored to have met so many brave people from the time where survival meant everything. Lady D though had been a nurse in the war and she knew her onions.

Through the two weeks, she fed me croissants while I took steps to lower her ragingly high potassium. While I sat with her monitoring her heart rate, she told me about Princess Diana and tea with the Queen and endless garden parties she attended at Buckingham Palace. These tales were always rather fun. At least they kept her awake and alive.

I was indeed the cardiac arrest team if I had not seceded in bringing her potassium down. My job during those days was to keep her alive, awake and to ensure her electrolytes returned to normal. This meant fiddling with her drug regime and keeping a close eye on her. My principle in life is to stabilize patients. This was not only for the patients welfare but also for a quiet oncall. It sounds rather selfish to say that but I really didn't like dealing with patients on the road to heaven or hell.

She would say " I never cared much for Princess Diana but the Queen is wonderful".

I of course was very interested in the Queens Corgies. I have always been a fan of the Queens Corgies. Lady D showed me her albums and there were a few pictures of her at Buckingham Palace.

During the days with her, she offered to ring the Queens secretary to get me audience with the Queens Corgies.

"Typical you Rita, you never want to meet Her Majesty but you keep insisting on meeting the Corgies," she would witter

Lady D was always lovely and hilarious. We watched a few old films together and she would say
"Isn't Cary Grant sexy?" I had to agree with the 88 year old aristocrat. Cary Grant movies were her favourite. We had endless videos to watch and she would always insist I wrote my notes or did my paperwork while sitting next to her.

She would then move the conversation and tell me that her husband was just as sexy as a Conservative peer. She would then add " Of course, I am sure I could have stolen a kiss from Cary Grant had he met me in those days". Lady D had indeed been startling pretty in her younger days. The glint in her eye was still there, so was her wonderful smile. False teeth and polygrip always did wonders.

Her husband was Lord G. Lord G was next door to her at this Private Hospital. He was recovering from a operation. Every day, I checked on him and he would insist that I read the Telegraph. Lord G even at 89 was a good looking guy with a gruffy voice. A newspaper wrote of him

" Lord G was a tall (6'4"), handsome man. He represented an older tradition of public service and gained the reputation of being “the most honest and decent man in politics”.

" Come and sit next to me dear and read me the Telegraph". We would then discuss the latest in Conservative Party politics. Lord G is the reason I always read the Telegraph in the mornings. He would tell me all about his days as a politician in the 60s.

Lord G often got tired quickly so he would tell me to take the rest of the Telegraph away to read. Our conversations daily were pleasant. Lord G clearly loved discussing intelligent politics. We both loved dissing the current Labour government. Lord G and I had one thing in common, we mocked the Labour Party and had so much fun watching Prime Minister's Question Time. Lord G would laugh outlout at Tony Blair.

" Dear, you know someone has to speak up against the atrocious Labour Spin machine. I know a lot about the corruption you know. Nothing honest about this government Rita."

" Look at Tony Blair. Just because he couldn't make it as a barrister, he became the PM. He is no statesman".

"You know Rita, there is no integrity anymore in politics".

We both munched on our jam doughnuts and agreed with each other. This was the great thing about Lord G, he always loved jam doughnuts and had them delivered specially for him. "Being rich has its perks", he would tell me. He insisted I drank coffee with him in the afternoons. In the mornings, he insisted I ate a full English breakfast and watched the news with him. These habits stayed with me over the years. Sometimes he would even have me bleeped to check whether I had lunch that day.

The best tales about the House of Lords were the Lord Denning tales. He remembered all the discussions he had with Law Lord Lord Dennings and all the Acts that were debated. I was of course starry eyed and fascinated. These English breakfasts and doughnuts were making both of us very fat. He needed the extra calories but I didn't. He insisted that I completed all the food with him or else he wouldn't eat.

He told me that he had felt lonely since he started to grow old. Everyone of his children had gone and no one spoke to him anymore because they were all too busy with their lives. Lord G was a very intelligent man but something struck me about his sadness. This was a man with everything in the world - but no one was there to spend the days with him. I found Lord G witty, fascinating and wonderful. I am sure he would have loved to be surrounded by people.

"Tell Lady D, that I am going to take you away and marry you. That may just make her jealous and she may just come and see me," he told me one evening

This was one problem with Lord G, he insisted I take messages to his wife next door. She in turn replied curtly back. They would refuse to ring each other on the telephones.

As messages go, I told Lady Diana nothing of the sort. I told her that Lord G was missing her and that he had told me that he loved her very much. Sure I had to edit what he had actually said. In addition, I told her that he had invited her next door for a romantic dinner that evening to get over the argument they had had over the fact that he always left the loo seat up at home. This feud had continued for 2 months. Finally, that evening I spotted them both with silk dressing gowns sharing a candlelit dinner on hospital trays and watching Gone with the Wind.

These were my wonderful patients . Daily ward rounds were pleasant. Lady D would be heard having another gruffy argument on the phone with the housekeeper of the manor over teabags and the right duvets that were not delivered to the hospital.

On New Years Eve, the Consultant finally rolled in to review the two patients. He told me that they were both DNR and they weren't to be told. I had serious problems with Do Not Resuscitate Orders done without informing the patients or their relatives. Quietly I had decided that neither Lady D or Lord G were going to die on my oncall. Indeed, I watched everything related to them like a large hawk. I managed to get Lady D's potassium down and alter the medication to get her out of the high risk category.

Lord G was recovering rather well post operatively. We just had to get him up and mobile and he was slowing getting there.

At the end of my time there, Lady D sat me down and told me

"Here is my address dear, it is the address of the Manor". When I leave this place, you are coming to tea and I shall ask the Queen so that you can have an audience with her corgies. Thankyou so much for looking after me and Lord G".

Lady D got out of her bed and gave me a big hug.

"Safe journey home dear and see you soon"

Lord G told me as follows

" Remember Rita, those who speak out about the truth are the people who change the world. Tell Lady D that if I make it out of this hospital, you are coming for a ride in a fast car".

Lord G was a rogue at the best of times. Even at 89, he was a huge flirt. Lady D simply sighed.

As I bundled my car full of my suitcase, steth, medical books, endless fan heaters etc, I could see Lord and Lady G waving from their respective windows.

Well, that was probably the last time I saw them. Lady D never contacted me again nor did I go to her house for tea. I realised why on the day I read the obituary a few years later. Both had died peacefully.

I rang the Manor up and the house keeper told me that they had meant to invite me and had set up the tea party but never made it to the day. The House Keeper told me that Lady D kept talking about the long haired asian doctor she had come across and how she would become a regular visitor to the Manor in the future. Had they lived, I am sure I would have visited them regularly because they were fun. No doubt, Lord G would have insisted we were driven in a fast car.

I have very fond memories of Lady D and Lord G. They were from an era where politics had integrity. They were both wonderful people who cared about everyone including me.

I never got to have tea at the Manor nor did I meet the Corgies - but I had the pleasure of meeting two very wonderful elderly people who were not just my patients but also become my friends. The Manor was sold off and their belongings auctioned.

To this day, when I watch Cary Grant in the old movies, I do agree with Lady D, he was rather sexy. After all, a 88 year old lady can never be wrong.

El Governor

As a whistleblower and a doctor, in order to survive financially, you have to be ready to do any kind of dirtbag medical work. I worked in Prisons to raise capital for the case against the GMC in 2004. I decided that I disliked the GMC more than I disliked crimimals. Actually, criminals are quite pleasant when you get to know them. The GMC aren't pleasant even when you do get to know them. Large numbers of GMC officials should be locked up and others wrongly imprisoned should be let out. This is the idea I had when I met a asylum seeker who was given a 2 year prison sentence for stealing food.

I have probably had a phenomenally varied amount of medical experience simply because I have worked many hours, in many places and under extremely bad circumstances.

Prison medicine is always dire. I only did it when I needed to raise capital. It always made me feel terrible. Healthcare is generally bad in prisons. It depends on the doctors available of course. I think prisoners deserve a better deal myself.

If male prisoners know there is a woman doctor around [ you may look like a large butch whale], they line up with one common problem " testicular pain". Of course, I am a little cleverer than your average prisoner so I managed to get away with taking a history and recalling them to a male doctor. I have worked in a number of prisons during the weekend shifts. I must say it taxed me quite badly because you honesty have to work under quite bad situations where your safety may well be compromised. Your ability to do your best for the patient is always met with obstruction by El Governor and his merry men. Healthcare is variable in many prisons. One thing is for sure, getting an emergency out of a prison and into a hospital is a feat in itself.

Prison Medicine can be quite careless. My friend Geoff Monks experienced this quite sometime ago. Geoff credits me with saving his life. His partner at the time had come running to me and begged me to write to the Prison requesting that they immediately administer medication. Without it, he would have gone into a cardiac arrest. They finally did do so after I faxed the letter.

In 2007, this letter was used by the General Medical Council to investigate me. Apparently, it wasn't good enough to save the patient, the debate was whether I should have written the word " Psychiatrist" under my name. After losing me my job during the 2007 GMC investigation, the GMC cleared me. Apparently, I could call myself a psychiatrist because I was working as one at the time. It took 6 months for the GMC to come to this conclusion. A four year old could have done it in three minutes. Geoff in the meantime was livid about the GMC abusing his data. He had told the GMC that he never wanted a complaint against me, there was no question I was a psychiatrist and that was irrelevant anyway since I acted to save him. The GMC wrote to Geoff unconcerned about the entire affair. Geoff had nothing good to say about the General Medical Council and still huffs about the manner in which he was treated.

So thats Geoff's experience of the prison service healthcare and my experience of saving a patient but then falling foul of a vexatious complaint. This is akin to the Good Samaritan Act. No good deed goes unpunished as they say.

Another tale terror commenced when I was called to the medical block of a well known prison on a cold winters night. The man was listed as a murderer and therefore on high security. You can read all about prisons here.

The patient also had substantial problems. It is a sad fact of life that no one had read his blood results for weeks. They kept coming and being filed. His renal function had been deteriorating considerably. He needed to be in hospital. Just by looking at him and examining him, you could tell his blood gases were not going to be normal at all. He was deteriorating, had a raging Urinary Tract infection and was just left. I was called because he insisted on seeing a doctor. He had been insisting on seeing a doctor for 7 hours.

I suspect the prison was just hoping he would die. The next issue was trying to get him to an accident emergency. El Governor was not a happy man when I requested a transfer. He moaned about shortages of staff and how he didn't have the manpower to allow this patient to go to the hospital. He then wanted me to jusfify why he had to be sent. So, being a polite kind of person during workhours, I told him this

" Mr X, this patient has been deteriorating for 4 weeks. The blood results have gone unnoticed. He has a urinary track infection with phenomenally high urea and creatinine. His potassium is rising and is already abnormal. If this man is not taken to accident emergency within the next hour, he will be dead. This will increase the death rate in this prison. You will recall the recent suicide death criticised by the newspapers last week. According to the records, 7 people have died in the last 5 days. I look forward to an officer to escort this gentleman and I am just about to call 999. Do I assume I have your permission sir?

"How did you know all about all that?," said El Governor

"I read the paper with the prisoners his morning and they told me about it," I calmly told him.

He shouts down to his colleague

"John get the Prisoner 415 an escort for accident emergency".

I then said " Thankyou El Governor. I am most appreciative of your assistance".

The patient in the meantime was smirking to himself while I got him ready for the ambulance. Trying to find his darned slippers was a feat. I wrapped him up in various bits of clothes and told him that at his age, he didn't want to get pneumonia. By the time I finished, he looked like a large ball. Well, at least I knew he wouldn't get cold in the journey and then in Accident Emergency while he was waiting to be seen.

He told me :-

"You told him didn't ya". Bet he ain't had a woman talk like that to him for years. Thanks doc, you saved my bacon".

I waited until the ambulance came. Paramedics are always great. I gave them my detailed summary letter, listing his millions of drugs, his allergies and his blood test results. I then had to summarise the issue for them. I told them that he already had IV access because I had done it for them with a green venflon. He needed some fluid infused slowly and his main risk was high potassium. It needed to be reduced immediately in Accident Emergency to prevent a cardiac arrest. His ECG done with the paramedics showed the usual findings in someone with hyperkalaemia. These peaked T waves and widening QRS complexes were not looking good. Luckily, he was an asthmatic who was wheezing. I thought, great, Salbutamol nebuliser will temporarily lower his potassium until the doctors get to him. So, we fixed him up and wrapped the paramedics blanket around him. The strapping tall paramedics took him in the ambulance and I followed. He was finally looking a little better despite the wait while there was paperwork clearance. In that period, the monitor showed the peaked T waves decreasing slowly while the nebuliser was at work for a while. This was one of those tricks you learn while trying to sort emergencies out. At least this was a temporary fix for a few hours while they got him a more permanent solution.

It was a surreal experience having a murderer have a fairly normal conversation with you and then waving good bye.

So for a murderer, he was fairly polite and rather more amenable than El Governor. The El Governor just required a little nudge. Not really sure why governors tend to be gruffingly large creatures with a howling booming voice but there we go. HMP must train them that way on some kind of super marmite diet supplied by the Home Office.

Practically Dead

Jobbing Doctor has written a post about how junior doctors do not understand General Practitioners. I am about to write a piece on how General Practitioners do not know how to refer patients properly to hospitals.

Now, I have come across many General Practitioners in my time, some very good and others who are careless and extremely bad. One general practitioner springs to mind today. I was oncall quite sometime ago at St Mary's IOW. I had taken a job at the IOW with the assumption that it would be a easy ride and a easy job. Of course, it was probably the busiest job I have ever done. It wasn't a summer holiday. Instead it was hard graft for hours. To help matters along, my PRHO [F1] had been victimised by her University and been sent to the IOW to repeat her 6 months as PRHO. She learned fast because I made her learn fast and stop moping around. There is no point pissing around when people are dying around you.

On bright and breezy Thursday morning, I landed in Accident Emergency as the SHO Medicine oncall. It was about 7.30. I saw a number of patients, all relatively simple, a few MIs, a few chest infections etc. All fairly mundane stuff. This was until I got a bleep from a General Practitioner. The posh GP said " Hello, are you the SHO Medicine oncall? I would like to send this old chap in who is fine really but has probably just developed a chest infection. He is fine, talking and I have examined him. He just needs a once over and he can return back to the care home".

One hour later, the patient attended with the GP referral letter. This particular General Practitioner clearly had not examined the patient because he was practically dead.

The GP letter stated " No oedema". I had never seen such large tree trunks as legs before. The man was practically unresponsive, the GCS did not match the one sent by the GP. The chest examination note from the GP stated " minor basal creps". Fluid was filling his lungs as we rapidly, and froth was flowing out of his mouth. The man was practically moribund. As everyone knows, in Accident and Emergency, you have to multitask, this means dragging the oxygen in, sticking the monitor on, inserting the large venflons, taking the bloods from the venflons, rapidly take some blood gases, examine the patient, order all kinds of xrays and scans immediately. Speed is of the essence because if you delay, the patient dies. Examining the patient was traumatic because the stench was bad. He had cellulitic legs that were weeping badly. His back was caked with pressure sores that had become infected. Clearly no one had taken care of him for quite a while. While I had a high amount of Oxygen being given to him, went through and examined him rapidly. My guess, Congestive Cardiac Failure, probable renal failure, probable bilateral limb cellulitis and extensive infection in his pressure sores.

IOW A and E is different in that - you do everything yourself even if you call for help. The patient was still breathing so all I had to do was stabilise him. The worst issue is despite Frusemide and everything you can think of, the patient deteriorates. Time ticks, you call your Registrar oncall.

Now my Registrar at IOW was quite fantastic, he was just very busy. We got on well as a team.
Dr Speedy as we called him, arrived late because he was stretched everywhere. He had five bleeps plastered all over him. He handed me two of them and said " You can deal with any further Reg calls from the wards and the cardiac arrests because I have no running energy left". Dr Speedy had sweat coming down his forehead and he was worried about the state of our current patient who was not responding to any treatment.

I always breathed a sigh of relief when he appeared in circumstances that were going out of control. We managed to do a CVP line and secure a better room for proper assessment. My Registrar was flaked and just didn't know what was going on either. On further interview of the care assistant, the patient had been in a nursing home, 5 General Practitioners had seen him, none had examined him but prescribed anti biotics. The patient lay flat and continued to be breathless and was found relatively moribund this morning. We asked whether the GP examined the patient, she told us it never happened. He apparently just wrote the letter and sent him in to Accident Emergency. The patient had not communicated for days.

The blood tests came back, the patient was in severe renal failure and his blood gases where everywhere. He arrested twice before we managed to secure a Accident Emergency bed for him. We struggled for four hours in Accident Emergency to stabilise him. He was taken to ITU but died before our second Ward round. We were essentially fighting a losing battle because the 5 GPs had not communicated with each other.

The patient had been neglected by the system. He was just one of many elderly people in nursing homes or care homes who are neglected like this.

So when Jobbing Doctor tells us how great GPs are, we have to ask ourselves whether ALL GPs are great or just a select few. My experience of GPs are that many are extremely good. By the same token, a lot are fairly neglectful. They just get away with it because they always have done and their colleagues never say a thing about it. That's how medicine works or doesn't work as the case maybe.

Isabel Nisbet. The Bed Pan Qualifications of the Wicked Snow Queen

"Those who are not qualified to clean bed-pans in an NHS hospital are ruling the roost and regulating doctors and medical specialists"
An NHS Doctor

Yesterday, I wrote about the Wicked Snow Queen's conduct in relation to me. Of course, my colleague kindly points out that Isabel Nisbet has had an interesting journey to the corridors of power. Nisbet's Wicked Snow Queen image has been built up all by herself. She was in the Telegraph again. Here is what they said

"She [Isabel Nisbet] said: "The best thing is for young people to do the exams when they planned to do it, because they’ve been working all over the holidays for them and you can see that’s part of their learning plan."

Pupils unable to attend their examinations may have to rely on an estimated grade based on their overall performance.

But there was widespread concern last night that this might put those who are particularly good at final exams at a disadvantage and rob them of crucial grades needed to get into the university of their choice.

Even those who managed to battle through the snow and ice said the adverse weather had badly affected their preparations with thousands of homes suffering power cuts in the days before the exams.

Shane Chowen, the National Union of Students' Vice President for Further Education said the disruption caused to A-level pupils as a result of the bad weather was adding to stress of exams and could affect their performance.

He said: "We urge universities to put in place contingency plans to ensure that no applicant is disadvantaged because of the current bad weather."

So, Isabel is being unreasonable and impractical. Thats nothing new. Essentially, she is being the mean old bat we know her to be. She fits the image as well with her poorly cut hair , her school marm glasses and her poor intellect. Clearly, her position as head crackpot at the General Medical Council taught her nothing about style.

My colleague has kindly done some homework for me. Clearly, he was stuck in the snow today with his laptop superglued to his fingers.

This is what he had to say about the Wicked Snow Queen.

"And that is not all. Isabel Nisbet has also sat on the governing board of the General Council for the Bar at least until 2007"

Moreover, here is the statement Ms Nisbet gave to the Shipman inquiry

' I am the Acting Director of the Council for the Regulation of Healthcare Professionals ("the Council). I have been seconded to the Council from theGeneral Medical Council {"the GMC") since 24 March 2003 and will remain on secondment to the Council until March 2004.'

Ed Note - The Council for the Regulation of Healthcare Professionals formally known as CHRP and and affectionately known as CR*P oversees the performance of the General Medical Council. Despite record numbers of complaints against the GMC, the CHRP now known as the CHRE [ due to obvious reasons and insults hurled in its way] ruled that the General Medical Council was doing an excellent job. CHRP/CHRE of course does little apart from paper flick. The staff from the General Medical Council abuse their power then shift to a different organisation. This is of course what happened to Isabel Nisbet. Despite a judge ruling that her conduct was like a totalitarian regime in Pal v GMC 2004, she continued to progress forward.

My colleague continues :-

Here is another one of her 'achievements' as she manipulated herself into the position of Chief Executive of the Council for the Regulation of Healthcrare Professionals in Jul 09

'PMETB will ‘go live’ on 30th September 2005 and a ‘launch event’ is being planned for 11 October in London.

The Chief Executive of PMETB is Paul Streets OBE, John Tuck is Director of Finance, and the newly-appointed Chair is Prof Peter Rubin. Pro Rubin chaired his first meeting of the Board on 17th June and at this meeting the College’s Medical Education Adviser, Dr Gareth Holsgrove, gave a presentation on Workplace Based Assessment. Isabel Nisbet, former Director of Operations and Standards, took up her new Chief Executive post at the Qualifications and Curriculum Authority on 4th July. PMETB will shortly be moving to its new home at Hercules House (near Waterloo, in London).'

My colleague goes onto finally say :-

This proves that Nisbet is close to 'Prof' Rubin the spirit of Finlay Scott lives---those who are not qualified to clean bed-pans in an NHS hospital are ruling the roost and regulating doctors and medical specialists.

NB Many thanks for the additional intelligence provided by a good friend and colleague.

The Wicked Snow Queen. Isabel Nisbet. The GMC Slacker

New Wig Required.

Isabel Nisbet has been making lives miserable for students. Here she is crowing about the current exams despite the horrendous weather. She has gone from being the prime General Medical Slacker to being acting chief executive of Ofqual. We just have to observe how hot air rises. In Isabel's case it rises right up to being responsible for educating the kids.

In the statement related to R Pal v GMC 2004, Dr Jennifer Colman testified to the following

"The only time when I discussed Dr Pal at the GMC was when Sir Donald Irvine, the then president had invited me to have lunch with him on 23 June 2000 in thesmall dining room at 44 Hallam Street. The only other person present was Miss Isabel Nisbet, the then Director of Fitness to Practise. During the course of that conversation we touched on a number of topics including my experiences as a junior doctor. It was at that time that I told Sir Donald Irvine that I had had the conversations with Dr Pal and that I had advised her that she should not write things on her website which, no matter how valid they were, would more likely be used against her by the GMC and that she would be subjected to a health inquiry as the best way for them to undermine her credibility both personally and professionally would be to spread the view that she was suffering from a psychiatric disorder. Neither the President nor Isabel Nisbet made any attempt to deny this or that they would begin an inquiry around Dr Pal. There appeared to be an implicit understanding between us that this was how they did their business and that in view of my own past experiences with them, then I would know that that was the case. It was only very recently that I realised that even as I sat discussing this with the President the GMC had already started an inquiry into Dr Pal"

The full statement can be read here.

Some years ago, while reporting the R Pal v GMC case, we wrote on NHS Exposed. We stated the following

"Also on the 6th February 2005, the Observer newspaper reported that the General Medical Council had been aware of serious concerns about the paediatrician, Professor Sir Roy Meadow, since the year 2000 - long before he gave evidence which led to at least two mothers being wrongfully jailed for murder. According to the Observer’s report, internal emails sent by Isabel Nisbet, then the GMC’s head of Fitness to Practise Directorate, show that the Royal College of Paediatrics and Child Health (RCPCH) had been attempting to contact her for “some weeks” but that she was “not up to speed” on the case. The full story from the Observer is available here.

Intriguingly, the slow-motion Ms Nisbet was, later that year, consulted during the early stages of the GMC’s secret two-year investigation of Dr Pal. This investigation, which included printing out and circulating copies of this web site and making “discrete, confidential inquiries” into her background after she raised concerns about poor standards of elderly care, ultimately proved to be groundless"

So there we have it, Isabel Nisbet is not fit to be let out of her cage never mind allowed to be chief executive and resident government poodle. In my view, Isabel should have been criminally prosecuted for allowing a illegal discreet inquiry in R Pal v GMC without justified reasoning. The GMC spent £82K plus of members subscription funds justifying Isobel Nisbets decision making process in the case.

Of course, we live in England where everyone appears to be blind to those who abuse their position. Instead of holding them accountable, they are promoted. Hot air rises as we know. It is basic physics.

Rationality is not Isabel's strong point at all. She is devoid of logic and lacks in intelligence. Then I suspect, you don't have to be that bright to be head of a hotshot authority. All she has to do is throw he weight around and she does that very well indeed. She can happily appear on BBC Breakfast because her current position means there will be no scrutiny of her integrity or ability. The researchers on there are hardly going to know the truth behind this specific person.

As everyone can guess, I don't think much of Isabel. In my view, she should get off her butt and try doing some proper work as opposed to forcing these poor kids to brave the weather conditions . She is quite happy to sit around in her comfy office. If I was a student, I would set about instigating an immediate strike action against her and demand a new chief executive. Students in the UK deserve better than a large old crow like Isabel Nisbet. No doubt she will be known as the wicked Snow Queen.

We shouldn't have to remind everyone that during her time at the General Medical Council, Isobel Allen released a damning study criticising the General Medical Council. Isabel Nisbet was also responsible for the disasters conducted during the Harold Shipman case. The criticisms made by Dame Janet can be read here. Enuff said :)

Phil Hammond

Phil wrote to me recently. I think he finds me a little amusing given I told him that as a spotty, grubby medical student, I actually quite liked Struck off and Die. He tries to avoid my overt deterioration into a giggly uncontrolled fan and keeps talking about whistleblowing. I think he feels that letting his guard down around me is not a good thing!

Phil tells me he has finally listened to me and is going on tour. Yes, I believe that was called "nagging". Anyhow, this is Phil's spruced up website [www.drphilhammond.com]. Not sure about the pink effects but there must be a subtle reason for it.

I also suggested that he launch his material in the blogsphere because if he did he would be the next Stephen Fry. Phil is actually an amazing comedian. His best material was done in his early days. These days, he does sit on various panels/meetings etc and probably dislikes every minute of it. He recently wrote to me and said

"I guess someone's listening but you have to hook them early, which I suspect is why they're so reluctant to turn over your stone. However, your bravery is not forgotten!"

Phil is nice to me these days. He likes to say sweet things to me probably because he feels I have been kicked by the medical profession into oblivion. It is a kind of fatherly "I should take care of Rita" kind of thing. I like Phil these days as well so I don't mind a little attention from him now and then. Charming, admirable men are always welcome. The attention is minimal because famous men are busy men. The conversation last year was really fun. It was hilarious because we were both stuck in the snow with communication by email. Phil has the same kind of warped, rude sense of humour has I have. It is though always wonderful to talk to Phil because he is infectiously funny.

He has the advantage of reminding me that I did quite fancy him when I was a teenager, went off him for a while as a junior doctor but now that he is turning normal again, he appears to be quite attractive in many ways. These things always help in holding my attention. Believe me, when you are a whistleblower, it takes a lot to hold your attention permanently. I have such a low boredom threshold these days.

As a medical student, I was given Struck off and Die in cassette format [ cripes, remember them?]. It was funny as hell. This tape got passed around everywhere. Phil was in his prime before the establishment tried to tame him. He isn't quite tame yet and he has this rebel streak still glittering out. I think the younger generation of medics would appreciate his rebellious streak in these bleak times of establishment rule.

Everytime I get one of his emails I often feel like I did when I was twenty one - all fizzy and excitable. It is probably uncontrolled oestrogen in superpower fast overdrive. I probably did one of the worst things and the world and asked him for a autographed photo. Phil though totally ignores these requests and starts talking nervously about more intellectual things. Hey, I can do "intellectual" too.

It is often very amusing to watch him strategically ignore any admiring glances by email. It is the kind of thing men do when they haven't a clue how to react or what to do. I am surprised even even wrote a book about sex and here it is :).

I would never get away with this kind of behaviour with any other TV doctor. You can get away with this kind of shamless behaviour with Phil because you know he will just look at you, smirk ,shake his head, sigh and walk away. I wonder if Phil knows about his sex appeal. Sex appeal sells books of course and if I find him deliciously charming, I am sure many other women in the world would. If you can't have Phil, the next best thing is to bag one of his books!

I really dislike superslimeball Dr Hilary Jones who I believe to be the most unfanciable doctor on the media waves. You would have to be a bored housewife with no window cleaners to start fancying him. Any intelligent well meaning girl with half a brain would probably go for Dr Phil Hammond. Even if you buy his books, it is probably enough to get into Phil's brain. He never takes his shirt off sadly. Perhaps only his wife succeeds in certain things.

I suppose if I met Phil in person, I would sit on his lap shamelessly and inform him that I still had my wonderbra - this would probably drive him into some state of shock. The shorter the skirt at this stage, the more likely hood of resuscitation no doubt but one should be gentle on senior doctors. At his age, it would have to be a state of shock because I think he has been sitting in too many stuffy meetings with too many stuffy people being forced to say stuffy intelligent things.That is what happens when you get famous. In reality though, Phil is rebellious, funny and extremely witty. People try and tame you to be like "them" when you become famous. There is an expectation that as you get older, you have to behave yourself and be respectable. Not sure why Phil has allowed them all to marginally tame him - because he was fabulous as the no nonsense daring personality that made him famous. I hope he gets back to his roots, it is where he is most comfortable. When he isn't influenced by those around him, he is charming, witty, wonderfully entertaining, engaging and fabulous. And that is him with his shirt on.

On a serious note, I am very appreciative of Phil's article he wrote on Ward 87 in Private Eye. Hell, no other journalist bothered to read the evidence. At least Phil reads unlike the rest of the high flying editors in the world of newspapers. It took me a few ratty sessions of emails flying back and forth to get him to read the material though. Then I discovered Phil was just a cute bunny in real life. It is so difficult to be mean to a cute bunny - it is a bit like the Richard Marks effect. One just can't be mean to cute men and that is one of my weaknesses. Anyway, I ought to plug his stuff really because he is quite a gem when it comes to writing. I am plugging his early material below in the hope that I get an autographed picture in the post :) with his shirt off [ ha ha]