Misc info on Doctors

From the internet, will try to find the links

The Facts On How They Are Policed And Your Rights As A Patient

Reviewed by Dr Michael Peters

Jan 16, 2000 -- As the roll call of Dr Harold Shipman's alleged victims continues to rise, medical experts are quick to point out that the GP-turned-killer is a one-off in an otherwise caring profession. But the bungling mistakes and gross incompetency of some in the profession makes headline news every day of the week. In response, the Government has created a National Clinical Assessment Authority (NCAA), which will speed up investigations and ensure proper checks are in place. But do you know how good your doctor is? And just who or what is regulating the medical profession when incompetent practitioners appear to be slipping through the net? WebMD explains.

How can I find out about my doctor's background?

You can't. According to the Medical Defence Union, which insures doctors and defends them when a patient makes an accusation, it is practically impossible for patients to find out their doctor's professional history.

Press officer Emma Stafford tells WebMD: 'There is no central logging of any doctor's history and records which are held by us for example, cannot be released to the general public because they are covered by the Data Protection Act.

'The Medical Register, which you can pick up in Public Libraries, gives basic information about doctors, their name, address, where they qualified and any particular achievements or qualifications.

'The General Medical Council (GMC), which gives all doctors their licence to practise medicine in the UK, keeps an up-to-date register and has a 24-hour hotline (0207 915 3630). You can use this to find out if your doctor is legally registered to practise in this country or if they are under investigation. It will also tell you if a doctor has been struck off or has been restricted from practising certain medical procedures.

The other alternative, she suggests, is to ask your doctor. But they are not obliged to give any answers.

Who are doctors accountable to?

A doctor has to be registered with the GMC to practise medicine in the UK. 'But until recently a doctor could be registered but not practise for donkeys' years,' says the director of the Patient's Association, Simon Williams, 'and the GMC wouldn't know any better.'

This was because doctors were not regularly checked. 'They didn't have to go on refresher courses or keep up-to-date with the latest medical news,' Williams adds.

'It can be argued that hospital doctors are more accountable than GPs,' says Ms Stafford, 'because at least they invariably work in groups. Someone like the GP Harold Shipman worked alone.'

But WebMD's medical editor, Dr Michael Peters, argues that the vast majority of doctors demand very high expectations of themselves and their fellow professionals. 'Incompetent or negligent doctors are a tiny minority in this profession, yet someone like Shipman tarnishes the whole profession,' he argues.

The GMC is planning to introduce 12-month checks and a five-year revalidation programme for all doctors, although the Patient's Association reckons it will take at least five years to implement.

The Government-backed NCCA will make recommendations to NHS hospitals and health authorities so they can take action to check poor performing doctors and will speed up investigations.

Private doctors have to be registered with the GMC but they are not employees of private hospitals, making it difficult to find out if complaints have been made against them.

How can I make a complaint against my doctor?

There are four main routes for a patient who wants to make a complaint against their doctor.

Complain to your GP practice or hospital, which will have a complaints procedure in place and a nominated member of staff -- usually the practice manager -- will be the patient's first port of call. The Medical Defence Union says 80 per cent of complaints are settled this way.
The GMC, who will screen your complaint and decide whether to take action.
A solicitor. Through this route you can actively seek compensation.
The police, where it might become a criminal matter.
If a complaint is upheld, what action is taken against a doctor?

If a complaint to your GP's practice does not satisfy you, ask for an independent review, which will be carried out by your local health authority.

An independent lay person is appointed by the health authority to investigate your complaint. The problem with this, argues the Patient's Association, is that the appointee is often a board member of the trust and is therefore not technically independent.

A health ombudsman can be called in if you think the complaint has not been investigated properly. The health authority can sack or suspend a doctor. Or it can refer the case to the GMC, which has the power to strike off a doctor.

Others have been sued for negligence in the courts and compensation awarded to the patient. In cases of assault, a doctor can even be sent to prison.

So why have a minority of bogus or incompetent doctors been allowed to carry on practising?

As 80 per cent of complaints are settled before they go beyond a GP surgery or hospital, the problems seem to start when investigations are carried into the independent stage, says the Medical Defence Union.

Until recently a complaint was sometimes, but not always, referred to the GMC by the local health authority. If it wasn't reported, a doctor could move to another area and start practising again because, as far as the GMC was concerned, he or she was still a good practising doctor. This has now been changed.

But the main issue, as far as the Patient's Association was concerned, was the lack of checks. With the move towards revalidation, doctors will have regular check-ups and incompetent practitioners will be spotted.

But it takes doctors years to qualify. Aren't they vetted along the way?

Doctors have to take a five-year medical degree followed by a pre-registration year before they are fully registered by the GMC and at that point they are looking at several years of further training before they become either a GP or a hospital doctor.

If they want to be a GP, doctors must train for a further three years in a mixture of hospital posts and GP surgeries before they are awarded a Joint Committee of Postgraduate Training in General Practice certificate.

If they want to work in a hospital, they have to work their way up from senior house officer to specialist registrar to consultant, if they choose. It takes another six to seven years to work their way up from SHO to senior registrar and, eventually, consultant.

Many Collude With Patients To Ignore Truth About Serious Illness

Reviewed by Dr Michael Peters

Dec 1, 2000 -- Once it was either referred to as the 'Big C' or just passed over in silence. But now patients expect to be told the truth, even if it does mean they have cancer. Yet new research casts doubt on whether we really are prepared to hear the worst news, or would still rather doctors glossed over the cruel facts.

The study, published in today's British Medical Journal, shows that while patients want to be informed about their chances of a recovery, few are prepared to accept ultimate bad news. Doctors, meanwhile, are happy not to force the issue, focussing instead on treatment plans even though the prognosis is poor.

'The evidence shows that eight out of ten people with cancer want as much information as they can have. But they obviously prefer to have good news,' says Professor Lesley Fallowfield, director of the Psychosocial Oncology Group at University College, London. 'And faced with someone who is desperate for a good outcome, a doctor's natural reaction is to jolly them along, feeling that it's in their best interests to stay positive.'

The Royal College of Surgeons tells WebMD the study highlights an issue 'at the heart of the doctor-patient relationship'. College spokesman Charles Collins says a growing number of doctors acknowledge that dealing with the dying patient is 'one of the most serious problems at the heart of health care today'.

Researchers from the Department of Social Medicine at Vrije University in Amsterdam originally set out to investigate the relevance of euthanasia to a group of 35 people suffering from small cell lung cancer -- a rapidly-growing tumour that is often fatal.

But the team soon became more interested in the almost universal state of over-optimism in the patients and their families over the outcome of their illness.

'Virtually all patients showed a "false optimism" in the sense that their interpretations of their prognosis were considerably more optimistic than those of their doctors,' they write.

'It was not unusual for a patient to tell relatives and friends that the doctor had informed them that they were cured, when actually the cancer was not cured and the life expectancy of these patients was a maximum of two years.'

The researchers discovered doctors and patients often collude to ignore a poor prognosis. But they warn that while this excessive optimism helps patients and relatives to endure the treatment phase, there was regret in the long-term. Sufferers and their families complained they didn t have sufficient time to say farewell, make necessary arrangements and reach 'sensible and well considered treatment decisions that are not based on fear'.

One woman whose husband died just after Christmas last year told the researchers: 'My son cannot get over the fact that he went on holiday last Christmas when he could have spent time with his father. Perhaps the doctors should have told us more often and more clearly that it was the end.'

Mr Collins, chairman of the Royal College of Surgeons' Doctor-Patient committee and a surgeon in Taunton, says the medical profession is working hard to improve things.

'The days when surgeons talked about sticky wickets to people who were still undressed after an examination at a busy out-patients, is long gone,' he says.

'But for most doctors, it's still a nightmare, the worst part of their job which is why so many take refuge in technicalities. Or they rationalise their behaviour that as doctors, they want to make people feel better rather than harshly stating cold stark facts. After all, as long as there's life, there's uncertainty. Above all, doctors don't want to deny people hope. Miracles can happen and doctors can believe that just as much as anyone else.'

But other experts believe it's important to distinguish between hopefulness and denial. Psychotherapist Josephine Speyer, director of London-based Natural Death Centre -- which promotes the view that accepting death gives extra meaning and resonance to life -- says: 'The problem with this kind of false optimism is that underneath, many people know the truth, yet each person is alone with that truth because they can't actually say anything. It's hard on everybody, including the doctor.'

How doctors and patients hide from the truth

Doctors:

When asked 'How long have I got?' doctors say things like; 'It's extremely difficult to give any indication of the general prognosis because each patient is unique' or 'We never know how an individual patient will respond to this therapy.'
If a patient doesn't ask questions about the outcome of the illness, the doctor may assume they do not want to know the truth.

Patients:

When told a cancer has returned, the patient is likely to interrupt to ask: 'What can you do about it?' Both the patient and doctor then restrict further discussion to forthcoming treatments.
Phrases such as 'this tumour can be treated' is interpreted as meaning it can be cured and 'this therapy has had optimal effect' that they already have been cured. In the case of small cell lung cancer, however, both phrases refer only to marginally prolonging life.

Their Hands, Coats And Even Pagers May Be Riddled With Bugs

Reviewed by Dr Michael Peters

Nov 6, 2000 -- The white tiles, polished floors, bright lights and antiseptic smells in Britain's surgeries and hospitals create an image of super hygiene.

But scratch the surface and there are bugs almost everywhere -- and quite a lot of them are in the most unusual places.

While the buildings and equipment are often spotlessly clean, research suggests it's the doctors and other health care workers themselves who can be walking health hazards.

Last week, researchers revealed the latest culprit in the spread of hospital infections -- doctors' pagers. A study published in the American Journal of Infection Control involving 36 doctors found all their pagers were riddled with bugs. After excluding bacteria commonly found on the skin or in the environment, they found half of them were still contaminated with at least one disease-causing organism.

But a more fundamental problem, it seems, is basic hygiene. A recent report in The Lancet highlighted poor hygiene among workers in a hospital which ran a cleanliness campaign. Although the campaign cut the number of hospital-acquired infections, researchers note this was mainly due to better hygiene among nurses and nursing assistants whereas, in doctors, it remained notably poor.

'Reasons for not washing hands include skin irritation, inaccessible handwashing supplies, wearing gloves, 'being too busy', or 'not thinking about it', the report noted. 'Poor doctor compliance remains an unsolved and vexing issue.'

Other research has suggested that there can sometimes be more life on doctors' stethoscopes and white coats than in some of their patients.

One team who tracked senior doctors reported that during 21 hours of ward rounds, they washed their hands only twice. Another team observed male health workers in the toilet and found only 59 per cent washed their hands.

'Healthcare workers are failing to understand the important of washing hands,' says Dr Louise Teare, chairman of Hospital Infection Society's Handwashing Liaison Group. 'Staff who are horrified by lice on a patient fail to consider the potentially far more serious consequences of bacteria present on their hands.'

'We believe that this issue is very important and that it is now time for an explicit standard to be set -- that hands should be de-contaminated before each patient contact. I personally would like to see alcoholic wipes at the end of each bed.'

Dr Barry Cookson of the Public Health Laboratory Service says: 'We have to convince people that they should wash their hands. One of the problems is that this is seen as a low-tech solution to a high tech problem. I think a lot of them would rather that there was a sexier way of getting rid of infection risk.'

A recent Audit Commission report warned there are around 100,000 hospital infections each year, costing the NHS 1billion to treat.

However, it's not only dirty hands that can spread bugs. Other health hazards include:

Stethoscopes:

These can come into contract with dozens of people on a typical ward round. Researchers who looked at possible contamination of stethoscopes found 11 different types of bacteria, including the potentially virulent Staphylococcus aureus. They say that the risk of infection could be reduced substantially if doctors simply cleaned the diaphragm with an alcoholic wipe after each patient.

White coats:

Most doctors feel at home in a white coat, but so too, alas, do colonies of bacteria. According to a report in the British Medical Journal, white coats are often used as overcoats by doctors, or dumped in dirty areas during rest breaks, as well as being worn when doctors deal with open wounds. The report suggested that in the light of the findings, NHS trusts should reconsider dress codes which often demand that doctors wear white coats.

Pens:

Doctors and nurses who fail to wash their hands can contaminate pens kept in their top pocket. Research shows they can become contaminated with MRSA, the deadly bacteria that is resistant to many antibiotics and which can kill vulnerable patients. Latest advice is that pens should not be taken out of clinical areas.

Ties:

When ties are worn without a jumper or waistcoat, they can come into physical contact with a range of different patients and infections during a typical day. Because doctors tend to bend over to examine patients, the tip of the tie can be colonised by more than a dozen different types of bacteria, studies have shown. More importantly the tie can also transfer infections from one patient to another.

Surgery toys:

Many surgeries and hospital wards have toys for children to play with, but soft toys in particular can be a breeding ground for bugs. A child with a viral respiratory infection could pass that infection on through infecting the toys themselves.

Glasses:

Doctors and nurses who wear glasses can have a particular problem. They may constantly adjust and re-adjust their glasses several times while dealing with patients resulting in bacteria being transferred onto them.

Visitors:

Relatives and friends bearing gifts may also be carrying bugs and can be a major risk health risk for the unwell and the vulnerable. Even a common cold or flu could be hazardous to someone whose defences against infection are low. The warm environment in hospitals necessary for the welfare of patients also encourages bugs to multiply.