I like Dr. Crippen, I think that he writes well and with passion about the NHS. He also hates Patricia Hewitt. So he isn't all bad.
But there are two things that do annoy me somewhat about him. I thought it was only one, but I have since discovered a new annoyance.
The new annoyance would be an ad hominem attack on another blogger criticising their spelling and grammar. Disagree with the persons views, but to moan about grammar in a blogpost is the province of the forum troll, not that of reasoned debate.
And to quote,
Please feel free to criticise me in any way you like. I have but one request. Your spelling, your use of commas and apostrophes and your general grammar are embarrassing. All doctors have passed “O” level or GCSE English. Could I suggest you get one of them to glance at your copy before you publish?
Two small points – do all doctors pass “O” Level or GCSE English? Even our foreign doctors, including the ones who do not speak enough English to call for an ambulance or have not been properly tested? Secondly, there is a reason why the handwriting of doctors is traditionally seen as poor, and that is because it often is. I write my notes in the back of a moving vehicle and I would be hard-pressed to obfuscate the meaning as easily as your average doctor can.
But the one thing that I have the most problem with is the “I met a bad example of this profession, therefore all member of this profession are idiots”. Take for example his recent post on grief that his partner got from an ambulance worker. When someone posts a comment that perhaps some GPs don't have much of a clue what they are doing he tells us that we shouldn't engage in 'playground insults'. Which I believe translates into “I can see more clearly than you, I am more intelligent, you are foolish and how dare you disagree with me”. Or rather a shouted “Am not!”
He then goes on to call one of his commenters a fuckwit. Which obviously elevates the conversation above playground insults. He then says in reply to the 'fuckwit' commenter that he never used the phrase 'Ambulance driver'. For your entertainment I present a short excerpt,
Only yesterday we had trouble with an ambulance crew. My partner had assessed a patient, discussed him with the hospital physicians, arranged an admission and called an ambulance. The ambulance driver arrived, carried out his mickey mouse medical “assessment” and then told my partner, in front of the patient, that he did not see why an admission was necessary.
I may have accidentally bolded a word or two in that quote. I did resist putting <sic> by the uncapitalised 'Mickey Mouse'
There is a reason why ambulance crews do what they do, for most of us it is for an easy life. If we do as we are told to do then we won't get the sack, as we cost less to train than a doctor it is very much cheaper and easier for us to be sacked. A doctor has 8+ years of training to stand up in front of a coroner and explain why the patient's blood pressure wasn't measured – we ambulance crews don't.
The seeming belief that Dr. Crippen has is that the best nurse practitioner in the world is far worse than the most idiotic doctor. This is something that I do not agree with.
Take today for example, I went to a GP referral where the patient was sitting in the surgery waiting room. She was to see the psychiatrist at the local hospital. The doctor had written a letter explaining that the patient had a bottle of water with many pills dissolved in it. The patient had not only fainted in the consultation, but has also been allowed to keep the bottle. When I got her in the ambulance and took the bottle from her (handed to me when I asked for it) she told me that she had drunk half of it before entering the surgery.
The GP had taken no vital signs, had left the bottle in the patients possession and had written a referral letter that neglected to mention the faint.
If the doctor had told me that taking her observations was a waste of time and that I shouldn't bother, or that my 'Mickey Mouse' assessment of asking the patient if she had drunk from her overdose bottle would be a waste of time. If the patient died in the hospital from the unknown overdose, then you can imagine that the coroner would have some severe words for me and the LAS would probably sack me for negligence.
Finally on this post,
Ambulance crews are valuable, and have an important role at the scene of road traffic accidents but, in the domestic environment, when the problems are medical rather than truamatological, they often apply inappropriate protocols to problems they do not understand.
Which would be why GPs in my area refuse to see patients and instead tell them to 'just call for an ambulance', and this for obviously non-emergency reasons. It would also be why I have seen GPs doing CPR on patients who are feigning a fit. Why I have seen GPs taking brittle ninety year old asthmatics off oxygen because they need the examining room to see the child with a nappy rash. It's also why I've seen GPs sending people with a pulse rate of 220 walking home to wait for the ambulance and also sitting heart attack patients on the brick wall outside their surgery.
And another example from today – GPs who are unable to refer a patient to hospital in the correct manner (writing a little letter and phoning the hospital) rather than just dialling 999 and running out the house. I like Drs letters, they tell me what is wrong with the patient as I assume that they know a lot more about medicine than I do.
Uh-oh, I think I just descended into that 'playground insult' game…
There are idiots at all levels of the NHS and while the fight against the dumbing down of the NHS is an admirable one, we should perhaps stop making such sweeping generalisations.
We should concentrate more on white elephants similar to the one that he mentions in this post. And that is why I keep reading his site, because when he isn't being a arrogant twit he is being absolutely right.