9th October 2023
(With lessons from, and for, all other health services around the world)
Whilst awaiting the Judgement on my libel trial – three months from the hearing and counting – I decided to write about things other than statins and cholesterol. Lest I damage our case in some unforeseeable way. I do this humbly, as a public service. To keep people informed, and perhaps amused. Today, I shall touch upon the issue of:
Spending vast amounts of time on things that are almost completely useless.
Guidelines. Guidelines, guidelines, and more guidelines – and other mandatory stuff. These cascade down upon all health services from on high. As a starting point, and mainly because it is the most recent thing to hit my desk, we can cast our eye over gambling.
It’s true that many people’s lives are destroyed by gambling. But is it an illness, or a disease? NHS mental health director Claire Murdoch certainly thinks so. In the most recent missive from National Institute for Health and Care Excellence (NICE) Dr Murdoch not only describes gambling a disease, but a ‘cruel’ disease. Unlike all those cute and cuddly diseases we deal with on a daily basis. As she states:
‘Gambling addiction is a cruel disease that destroys people’s lives. We will work with NICE on this consultation process.’ 1
Here from the draft guidelines:
‘Health professionals should ask people about gambling if they attend a health check or GP appointment with a mental health problem, in a similar way to how people are asked about their smoking and alcohol consumption, according to new draft guidance from NICE.’
As you may have gathered from this, asking people about their gambling hasn’t happened yet, but it will. Once NICE has reached the dread stage of a consultation process, it is basically a done deal. ‘We shall consult with all relevant ‘stakeholders*’, then do exactly what we have already decided to do’. Yes, I do love a consultation. ‘We consulted, but we heard only what we wanted to hear, and ignored everything else.’
*stakeholder is a word that, in my humble opinion, should be removed from the Oxford English Dictionary. It increases my BP to dangerous levels.
As for asking about gambling, and all the additional work that will inevitably be associated with this. Forms to be filled, appointments to be made, audits to be done. But if it helps people with gambling then this is all fine, wonderful, super great?
Or maybe not. As I say to nurses, when some new ‘thing’ – which absolutely must be done – thuds onto their desk. Ask them (whoever them may be) what you can now stop doing. If we assume that nurses are busy, and they sure are, you can’t simply squeeze extra stuff into their working day. Something has to give.
But in the health service nothing ever gives. Everything is additional work. Everything is an add-on to a service that is, currently, on its knees. Does anyone ever think. Hold on. It would be nice to do this, if there was any time left in the day. But right now, there isn’t.
Last week I spent two hours of my life, that I shall never get back, doing the Oliver McGowan Mandatory Training course on learning disability and autism. This was recently introduced by another body, the Care Quality Commission (CQC) – don’t ask. The CQC employs dementors, who descend upon their victims and suck out their very soul. ‘And why have you not met the falls audit target of 99%.’ Evil cackle.
As for the Oliver McGowan training itself:
‘The requirement states that CQC regulated service providers must ensure their staff receive training on learning disability and autism which is appropriate to the person’s role. Employers can refer to The Oliver McGowan Mandatory Training.’
Again, fine, wonderful, super great? We should all know how to work with these people better. In truth I found it repetitive, dull and patronising. And I learned nothing that I did not already know. In my opinion it could be summed up in nine words ‘Be nice to those with learning disability, and autism.’ Or else?
However, it is mandatory. Which means I had no say in the matter. Nor do the other 1.27 million people who work in the NHS. The on-line system also detects if you have wandered off for a chat and a coffee, then takes you right back to the beginning. Bastards.
I feel that you can look at this a couple of ways.
One: It is just two hours of around two thousand or so that make up your working year. One thousandth of your working life. So, suck it up and stop complaining. Get with the programme.
Two: 1.27 million people spending two hours on a mandatory training course represents 2.54 million hours. This is one thousand three hundred years of NHS staff time. Gone, never to return. At a cost of many, many, many, millions. Millions that could have been spend on something else. Such as patient care?
Earlier this year I was interested to discover the following fact. If every doctor in the US were to follow all the guidelines for disease management that are issued by various medical groups, it would require them to work twenty-seven hours a day.
‘Primary care providers (PCPs) were estimated to require 26.7 h/day, comprising of 14.1 h/day for preventive care, 7.2 h/day for chronic disease care, 2.2 h/day for acute care, and 3.2 h/day for documentation and inbox management. With team-based care, PCPs were estimated to require 9.3 h per day (2.0 h/day for preventive care and 3.6 h/day for chronic disease care, 1.1 h/day for acute care, and 2.6 h/day for documentation and inbox management).’ 2
I am just guessing here. But I don’t believe that primary care providers in the US are actually working twenty-six point seven hours a day. Ergo, these lazy swines are not following all the guidelines. So, which ones are they not doing? And does it matter? Has anyone noticed?
In the UK NICE guidelines cascade upon doctors in the UK like confetti… silage, the plague (insert metaphor of choice here). Some of the individual guidelines are more than six hundred pages long. I read one once, from start to finish once. By the time I finished it, I had forgotten why I bothered in the first place. It took well over a week. I ended up none the wiser.
But it does not stop with NICE and the CQC. A couple of years back, there was a study in the British Medical Journal entitled: ‘Patient safety regulation in the NHS: mapping the regulatory landscape of healthcare.’
Their main finding:
‘We found that in total, more than 126 organisations are engaged in safety related regulatory activities in the NHS.’ 3
All of them, I presume, have but one aim. To introduce new stuff that simply must be done, by order of the management. Ideally by making it mandatory. Each activity, I suppose, has some evidence to back it up. Evidence that is, if you care to look, often very weak. It sometimes just seems to be someone’s hobby-horse, picked up by a politician who wants to bask the glow of introducing some ‘wonderful’ new life saving thing.
Weak or not, on it goes. And on and on….Gradually the proportion of time left to look after patients shrinks ever further. After all, it is the only part of the working day left from which you can steal time. All else is filled with audits, and measurements, and various complex scoring charts, and meeting targets and writing and writing, and writing and writing. And writing and writing.
In this short blog, I have but scratched the surface of the endless additional work that is required in NHS, and all other health services around the world. It leads to, what I call ratchet world. Each day brings an extra piece of work ‘click’. This ratchet never loosens, it only ever tightens. The pressure and stress increases with each malignant click. More and more work, less and less useful activity can be done.
Next time I will introduce you to QOF. Perhaps the greatest waste of time and resources in the history of medicine.
You may also enjoy my metaphor of the Terrible Trivium. Stolen shamefacedly from the book ‘The Phantom Tollbooth.’
2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9848034/ 3: https://bmjopen.bmj.com/content/9/7/e028663
Dr. Malcolm Kendrick 
Nice to see you back Doc. Good luck.
Such minute pressures may be overmagnified but the lateral thinker will know what I mean when every time I push a Flash Drive device into a computer I get angry.
There are two ways of doing this. Up and down, and unless a careful analysis of both flash and computer is made then 50% of the time you will get it wrong: ie upside down. (Maybe 0.001% of the time you will also bend the receptors by pushing too hard.)
$Billions spent on this miniature marvel and no one thought to indicate the correct way up?
2billion users of flash drives x 10 seconds each usage = decades of wasted time
Hi Andy. I’m a retired computer tech so I really empathize with your complaint. What you’re referring to is USB-A, which involves a multitude of USB devices, not just flash drives. For some stupid reason this plug was apparently designed by techs, with no consultation from ergonomics experts or even average humans. It’s asymmetric, so it only goes in one way, as you note. Almost all the other USB variants are the same — USB-A, and USB micro in its many subvariants (which require a magnifying glass). They finally came out with USB-C which is actually symmetrical, so you don’t have to squint at it before plugging it in.
The strange thing I find about the USB devices you mention is that, despite there being only two possible ways to insert the USB, it often takes me 3+ attempts to get it right.
Yes, I’ve noticed that too.
Thank you for your most informative articles. I believe you are the only sane person within the NHS. Apart from my Physiotherapist of course, whom I had to source privately after Stroke!!! AS you will be aware not enough care in the NHS> SADLY!!! Good luck with the Libel case.
Nice to hear from you again Malcolm, I hope you are well.
So true, my husband puts up with the same working in Erbil to arrange mine clearance etc, the UN etc force pointless time wasting courses on him & others rather than let them get on with the job in hand, useless.
Let’s give the NHS a few extra billion to write some more guidelines! Good to read your stuff again. You might enjoy this: https://www.hughwillbourn.com/book
My brother just started as a paramedic in Scotland. He has been shown this week how to get paid. There are 6 different forms. One for overtime, one for mileage, one for additional unexpected hours, one for normal shift times, etc etc. All must be printed off at the base and completed by hand, before being pigeon holed correctly. There is no remote way of doing this, or app, or online submission. One must also calculate one’s own pay, for example, night time hours get time and a quarter. So if night shift hours are 8pm-6am, and your shift starts at 6pm, you’ll need 2 different forms.
Paramedics tend to work 12 hour shifts, and so this must all be completed after a very long, possibly very difficult day.
It’s also accepted this is a time consuming exercise, and one can, if one desires, fill out a seventh form to be paid for the time taken to complete all the different forms! I wish I was joking!
This recalls the Monty Python skit wherein the British housewife tried to get her new “gas cooker” up and running but encountered endless bureaucracy embodied by the long, long line of brown trench-coated gas company bean counters, each one insisting on a different form or regulation, before she could simply get the gas hooked up to her new range.
My daughter has recently moved to Scotland and found things different in the NHS. As an RA sufferer, she went to her new GP to get a referral to a rheumatologist (and was surprised that it didn’t take too long for an appointment) – but the rheumatologist wasn’t able to give her a prescription for medication, she has to make another appointment with the GP for that!
Haven’t read the article yet, just wished to say that it is good to hear from you again, Dr Kendrick.
I was thinking about you only yesterday, continuing to wish you all the best.
The hierarchy of management has to justify its existence. I have seen it evolve since the 1980s with friends who work in the NHS. It’s the organization equivalent of atherosclerosis. The bonus (for the few) will come when drugs are available to deal with gambling addiction. In any case after the last four years I have lost faith in the past great public institutions.
“The bonus (for the few) will come when drugs are available to deal with gambling addiction. ”
Without a doubt!
Over the weekend, my octogenarian aunt, a retired nurse, was asking me what on earth was happening to the NHS as it now unrecognisable to her: I think I shall subscribe her to your posts as you’re far more balanced and even tempered than me.
Thank you and welcome back.
Fingers crossed for the verdict.
I’m glad to find another Norton Juster fan. It’s more important to know whether there will be weather than what the weather will be. Of course, to the NHS, we’re all the average person/family – one size fits all – they swim all day in the sea of knowledge but come out perfectly dry.
Thank you for a wonderful example of, er “dry” British wit. My humor is not quite to that level. In some corporate environments I worked in, in the pre-PC days, there were times I wished I could swim in the secretarial pool. See what I mean?
Not British humour. I’m pretty sure Norton Juster is/was American.
They are spending a whole heap of money on glossy corporate type, expensive videos extolling the local trust. One such was showing on a loop, on Thursday-Friday night in A&E in a Manchester Hospital, to a room full of tired, bored miserable people waiting five hours for treatment. The toilet was grubby too.
Thank you for that, very interesting.
as a little comment, I put QOF into Google, and a suggested search was, what use is QOF?
there are many intraitable problems in life. The health service seems one of them
The patient gets ignored during the consultation- during my husband’s most recent appointment, the GP, who didn’t know him from Adam, virtually never made eye contact. He was too busy on the computer. Bedside manner has been trashed – might as well speak to the computer directly without a GP present: humanity has been squeezed out of the equation for all your guidelines.
I’ve had this happen, too. I think we should tell the doctor that we won’t interact while they’re staring at the screen. Awkward? Yes. But how else can we stop this?
Well, during a telephone conversation with a GP, I questioned what she told me and she replied, ‘I’m the doctor!’
I am told that GP has 10 minutes of patient time and he/she takes 2 minutes to read notes on computer, 6 minutes to speak to/listen to patient, 2 minutes to write up notes. Then “next Patient please”. One of my GPs seems to set the timer on his watch!
But to be fair they are not a bad bunch – just 2 I won’t use.
Sad but true
Maybe pretend you’re hard of hearing and need to see the GP’s lips move!!
Not something I have to pretend about. But some are better than others. If the window is behind the GPS head then even if they are turned towards me the lips are blinded out!
Welcome back, Dr Kendrick! It’s wonderful to hear your cheerful, sceptical Scots voice again – even if the topic is far from cheerful.
Bureaucracy has often been compared with cancer, but I believe the parallel to be remarkably exact. The fine SF author Jerry Pournelle (who often collaborated to good effect with Larry Niven) coined the following Law:
“In any bureaucracy, the people devoted to the benefit of the bureaucracy itself always get in control and those dedicated to the goals the bureaucracy is supposed to accomplish have less and less influence, and sometimes are eliminated entirely”.
And why would that not happen? After all, most of the attention of most of the senior employees (that is, decision makers) is devoted to maintaining and if possible extending their areas of responsibility, the number of employees reporting to them, and of course their pay and privileges. Who, in such an organisation, has a real motive to care about the patients? Especially in today’s culture, where all abstract ideals like duty, loyalty, compassion, and service are looked on as foolish if not actually wrong; and where a person’s importance is measured in purely material terms.
Someone once remarked that no one has ever been able to restrain, let alone prune back, let alone eradicate a bureaucracy – with the single exception of the Mongols. Their recipe, effective if radical, was:
1. Kill every single bureaucrat and all their families and friends.
2. Burn every scrap of paper in their records.
3. Destroy all their buildings.
If done thoroughly, that might suffice.
Thank you for your reference to Pournelle’s Law of Bureaucracy. I’ve referred to that in the past when commenting in various places.
The Mongol recipe for eradicating a bureaucracy sounds extreme enough to possibly actually work. But only possibly.
Not sure about the Mongols approach, this is one of my favourite quotes on systems (Bureaucracy or otherwise)…
“If a factory is torn down but the rationality which produced it is left standing, then that rationality will simply produce another factory.
If a revolution destroys a government, but the systematic patterns of thought that produced that government are left intact, then those patterns will repeat themselves…
There’s so much talk about the system. And so little understanding.”
[Robert Pirsig, Zen and the Art of Motorcycle Maintenance]
PS welcome back Doc.
I think I love the Mongols.
Despite their ferocious reputation, there was much to be said for them. When their empire was at its height, so terrifying was their reputation, it was said that a virgin could ride naked with a bag of gold from one side of the empire to the other and never be troubled. Potential criminals were too frightened of what the Mongols would do to them to raise their heads.
When attacking a country or a city they always gace fair warning. They sent ahead and asked for unconditional surrender. If it was promptly given, they guaranteed the safety and property (well, most of it anyway) of the people. If defied, unfortunately they tended to kill everyone.
I can’t say anything about the Mongols’ approach to medicine, but it may have relied heavily on fermented mare’s milk.
Just to share other examples of NHS ‘pointlessness’: I had one sided hearing loss, facial pain etc. after an ear infection. GP noted that can be a worry so sent me for an MRI. That diagnosed Mastoiditis. So I got sent to ENT consultant. Who said ‘I doubt you have mastoiditis – the MRI says everyone has mastoiditis when they don’t. Have CT instead.’ which concluded I probably don’t have that. You have to ask why a diagnostic test which ‘always’ gets it wrong is ever used?? Example 2. Brother-in law (early 50s) had a check up because he felt generally unwell. He had high blood pressure. Prescribed medication for the same, but also statins. No blood test ever done to confirm cholesterol level (yes, as a Kendrick Disciple I know….) but because of family history its advisable. His father had lupus. So I’m sure that too was a useful spend on the drugs budget.
You have been missed
We need to make the NHS into an insurance based system like most of Europe and Israel. This would get rid of the bloated bureaucracy trying to justify its existence
Sent from my iPhone
So far as I can tell, about half of all developed countries have a tax-funded, publicly-owned system, e.g. UK, Sweden, Italy, Canada. Half, notably Switzerland, USA, France, seem to be run by private organisations with widely varying amounts of government intervention.
Some of the tax-funded systems are remarkably decentralised, e.g. even tiny Iceland (popn. 300,000). So, if about half the rich world doesn’t have insurance systems but about half does, how does that justify your proposal?
It’s good to see Dr. Kendrick back. I’ve been reading ‘The Clot Thickens’ and saw mention in there of the ‘offending article’ in the Mail. I wish you well, now that you await judgement.
I never tell the truth when any of those sort of questions are asked of me. Remember all that info is put into a database and can be used against you at any time.
Hello.
I have watched your blogs for quite a few years.
Thanks for the way you think.
It is “common sense”, which I think has gone out of the window!!
Good to see you back. I’ll be sharing this post with family and friends x
Wonderful, super great, to have you back on the Interwebs Dr K! I greatly missed your stiletoed barbs.
Hmmm… there’s something wrong with the WordPress commenta system as I just got 248 comments, in one go.
So did I!
Yeah, I thnk the system got backed up
Nice to see you back informing all of us. Thank you for your writing!
Perhaps book an appointment with Keir Starmer to put him
Hello Malcolm.
We must share some part of our genome! I too am utterly infuriated by pointless, petty-bureacracy and the types of people who peddle and profit from it. I’ve been on the receiving end of it several times in my 63 years of existence and this probably (partly) accounts for my failure to “get on” with petty-bureaucratic people & systems. I’ve worked as a self-employed gardener since 2003 after leaving the NHS. I was a registered nurse for people with learning disabilities and worked mainly supporting disabled young people, children & infants. That was until the “powers that be” decided that RNLD nurses would have to retrain as RGNs or RSCNs in order to carry on supporting children with learning and physical disabilities. Long story short; bureacracy and red tape wore me out and some of my “managers” made very silly mistakes which had me wasting time, effort and money all to no avail. So I can totally relate to your on-going frustrations and also your trial…which must have been extremely taxing and costly. But which will hopefully have a positive outcome for yourself, your supporters…and maybe even the medical profession. Miracles may happen!
Best wishes
Steve Langhorn
Caton
Lancaster
I too worked in this field and loved my work…until the bureaucrats took charge. One of the irritations was being sent on a half day course on how to use a step ladder. The tutor started by proclaiming “There is no such thing as an accident. Anything bad that happens is an incident and there is always someone to blame.” I spent most of the rest of the session pondering this and totally missed the main thrust of the course!
I so relate to this. As a teacher I put up displays on the walls using step ladders for as many years as I can remember. One day I was asked have you done a course for using that step ladder? I just could not stop laughing and carried on. I also used the tops of table to stand on but there did not appear to be a course for that!
I have long suspected that every time my GP asks me if I smoke, since he asks me every single time to which the answer remains “No”, he gets some kind of monetary recompense. I assume this will also apply to the Gambling query. And if the answer is “yes”, exactly what will he be able to do about it? Ask for a good tip for the 2.30 ?
Good to see you back Malcolm, stay strong.
Back when I was still seeing ‘regular’ doctors, and they (the intake nurse) kept repeating the same questions every appointment, I began cutting them off every time they began their litany (do you use tobacco, do you wear a seat belt, etc.), saying “I’ve answered these questions dozens of time before. I’m not wasting my time and yours doing it again. Besides, they’re irrelevant to the purpose of my visit.” I think if we all did the same, it’s the only way to stop this ridiculous nonsense.
It would be funny if I wore a seat belt. I don’t have a car.
“…my GP asks me if I smoke…”
Only from the ears when asked stupid questions over and over…
Welcome back!
I’ve missed your cutting wit.
What is not compulsory will become forbidden!🙃
And vice versa…
Yes
What a surprise, good to see you back, along with hundreds of recently approved posts on the many othe blogs 🙂
Time to read my book “Mad Medicine” and learn how to go through the statutory and
mandatory stuff with ease. You need two screens for ease of success…
I’m not sure which is worse, government bureaucracy or medical bureaucracy. Both seem to exist for the sole reason of justifying their existence and making everyone’s lives more difficult in the process.
Pournelle’s Iron Law of Bureaucracy:
https://www.jerrypournelle.com/reports/jerryp/iron.html
Wonderful to hear from you again, Dr. K.
Hello Mr K…that was a wry and informative critique of the corporate conglomerate known as a national health service. The ubiquitous on-line learning ( have done numerous!) are a complete waste of time and a way for organisations, like the NHS, to dumb down its workforce. Tick the boxes, look at the scenarios on screen, select the correct one etc, proves only that an employee is good at anticipating what might be the right or wrong answer! An employee might sail through them all 100% but doesn’t mean that they will be that ‘success’ on the Ward or in the office. Of course, some training can be done on line focused on facts but it seems to be the equality diversity stuff being given too much weight. ( as to employee suitability.) There are some excellent doctors, nursing staff ( benefited from many) but there is too much dross sliding in and staying via these on-line courses. I know you know all this. Your book ‘The Great Cholesterol Con’ was an eye-opener….prompted me to question other pronouncements from on high! Good luck going forward, keep posting as and when. Catherine Mather
Welcome back Doctor Kendrick
Thank you
Dr Malcolm,
I trust things are going well with your trial.
I’ve just read Dr Aseem Malhotra’s “A Statin Free Life” which bears out what you’ve been saying.
He has some interesting ideas about the actual causes of damage to the edothelium.
Kind regards,
George Hewitt CEng MICE
m: 07841 747176 t: 02891 898150
How lovely to have you back.
Welcome back, doc. Good luck with the courts.
“Guidelines, guidelines, and more guidelines – and other mandatory stuff.” If they are “mandatory” they are not “guidelines”, they are instructions. That is, orders.
So good to hear from you, Dr. Kendrick! These days just going to the doctor is gambling, so I guess we’re all diseased. I’ve just passed the four year mark since I’ve seen my GP, and I’m not dead yet!
Wish I could say the same. Underactive thyroid requires meds.
It’s the last medication I’m trying to get rid off. Barbara ONeill suggests cayenne pepper applied to the skin at the thyroid area for 2 hours – not sure how often. Use olive oil to allow it to adhere to the pad – she says.
Also trying a homeopathic treatment.
Can’t say it’s entirely successful.
A friend buys very expensive natural pig derived “armoured thyroid” from the US. He insists its very beneficial. His overactive thyroid was destroyed completely by radium (is that the right term) treatment. The prescribed alternative didn’t allow him to “thrive” he noted.
So, I know I’m taking a risk – tried this before, without a replacement, found my fingers cooler, and overall a little lazier & some loss of appetite. Think I found some benefit from cayenne pepper treatment but the pepper from a health food shop, ( less powdery – less refined) seemed to give me more of a boost.
More than one trial needed on this guinea pig!!
So the Cayenne is meant to do what? Stimulate the production of T3, T4 or both? A busted thyroid gland no longer produces adequate amounts of these hormones (in conjuction with the Pituitary and Hypothalmus glands). In theory, Thyroxine TSH (Thyroid Stimulating Hormone) stimulates the production of T4 which in turn gets converted to T3, the active hormone that actually triggers the production of energy in the cells. NDT or Natural Dessicated Thyroid, produced from pigs thyroids, contains both T4 and T3 and up until the 1960s, was the only treatment for an underactive thyroid, then thyroxine was synthesised and NDT ‘fell out of favour’. Part of the problem with Thyroxine is that around 20% of people with an underactive thyroid don’t respond to Thyroxine, in other words, the T4 doesn’t get converted to T3 and thus the symptoms of an underactive thyroid persist.
Ahhh.. glad to have you back. a big 🌹
Oh Boy! Where is common sense when you need it? (Or as my dear old Mum used to say, “Common sense isn’t very common”). In 2009, as a cathartic exercise after I retired, I wrote a book about my work as a dietitian (after having had a brief flirtation with nursing) in the NHS and, I’m happy to say in other areas, too. Describing the atmosphere at work, when people’s confidence and expertise were constantly undermined, I listed all the “Add-Ons” to the daily grind – 24 are in the list – and that’s not including mandatory Moving and Handling Skills; Fire Prevention; Personal Safety etc. I could give you the whole list – but let’s just say that there were “Reviews” of all kinds; Clinical supervision, audit, effectiveness, and CPD. Add to that: Mission statements, Visions (?) and Regional Champions, Policies and Procedures for everything, including a policy document for policy making! Risk assessments, Appraisals and Surveys galore. Oh … and I must mention “Centres of Excellence” and “Beacon Status”. Do you remember “The Productive Ward”, which was supposed to “release nurses’ time to care”? (Doh). Robert Merton’s splendid essay on “Trained Incapacity” comes to mind.
Hope you feel better after your polemic!
Take care and keep the BP under control!
Jill Leslie
There are so many things that could be streamlined… saving the medical staff time and avoiding mistakes… and saving money… and therefore saving lives… my husband was in A&E last Monday and whilst they tried to admit him, they couldn’t – we ended up returning to A&E on Tuesday – where he was finally admitted – but the catalogue of errors and things that generally made you think “What the ?” were… well…. I have seriously lost count. From calling out the wrong parts of his name, so we waited half an hour more than we should have… and only finding out that they were ready for him, through them calling my mobile (after they’d tried our home number twice) to find out where we were………… to trying to give him an anticoagulant injection in his tummy, at least once per day… despite us both telling them that he doesn’t need it, as he is taking an alternative remedy – he shouldn’t have both – his cardio knows about this… it’s on his records… and we must have spoken to at least a dozen people now… all saying “OK it won’t happen again… we’ll make a note on his records”… then it happens again… A week later and it’s “Time for your blood clotting injection…”……. all I can say is that I’m grateful he has his wits about him… if he’d got dementia, he could potentially have had a life-threatening outcome… he’s still in and will still be fending them off tomorrow I’m sure…
I am not understanding this. Surely your husband handed over the ‘alternative remedy’ to the Charge Nurse or does he have it in his bedside locker and is administering it himself?
I am thinking the cardio stopped the ‘alternative’ in favour of the tummy injection?
Gambling? Lol! Everybody gambles all the time. All. The. Time. Most people don’t realise, as other names are used to give respectability to gambling, such as investing, or making a wise choice. If you put your money in a bank, you’re gambling that the bank will remain solvent, or if it goes bust that the govt. will bail it out. You gamble with your selection of pension fund. Whether a bottle of wine that you’ve never tried before will taste nice. You might consider it a wise choice to buy a five year old Toyota rather than a new Ford, but it’s still a gamble.
In Australia, tv adverts for “gambling” must now have a warning, á la “Smoking will kill you” warnings that you are almost certainly making a mistake. “What’s gambling really costing you?”, “The chances are, you’re going to lose” or “What could you be buying instead?”. Curiously this only seems to apply to sports gambling (we have Ladbrokes here too) but not the $120m lottery tickets or $5 scratch-its. Or investing your pension. Or buying a car, dishwasher and obviously not buying OTC medications. Buying a lottery ticket is clearly regarded as ‘investing’, just like the stock market.
So when your GP or whoever else is mandated to ask you if you gamble, I urge you to tell the truth, and the whole truth about your gambling habits (“I took a gamble just coming here that I wouldn’t be involved in a car accident compared to being hit by a tiny meteorite while gardening”), that you are so addicted that you can’t make a single decision (broccoli or cauliflower?) without taking a gamble. Spend hours going over your problems in this area, clog up the enormously bloated bureaucracy until it collapses because this is the ONLY way that any such organisation can change, especially govt. funded ones.
In 2021 I took a REAL gamble – whether or not to have a COVID jab! I got the right answer and declined. My partner did the same and also won her gamble.
My only concern is that the experience might tun us on to gambling!
David… you’re on to something!? The COVID Vaccine program could be a gateway to gambling addiction! Beware of lawsuits for being a COVID Vaccine denier! 😂
Thank you Malcolm
“Stakeholders” – the tip of the iceberg which is management jingo, makes my teeth grate. I have some stakes in my garden shed so that makes me a genuine stakeholder. I keep them next to the pitchfork which might come in handy one day.
Thank you, Dr. Kendrick for another cool draught of refreshing mental ale. On this (American) side of the pond most of the healthy (+70 years old) people I know have sworn off doctors who must follow flawed protocols and barely give them a glance during appointments. These seniors now do self-education on general health and chronic ailments through the internet and attempt to avoid problems with better diet, exercise, sleep and stress management practices. It seems that most know of someone who either never improved on or was damaged by either prescription drugs or questionable procedures (statins, stents, CABG, joint replacements etc.). Dr. Suneel Dhand’s advice to own your own health is well taken in this age of Rule of the Ignorant in medicine and many other fields. Good luck.
Right on, you guys!
When I worked in the NHS as a child psychotherapist, during the 1990’s and beyond more and more bureaucracy was instituted. Auditing is what they called it. Endless forms and reports – did anyone collate or read them? And the corporate language crept in as soon as managers who were not doctors were installed. You mention some of those meaningless words, like accountability, and stakeholders, outcomes and whatnot. And more and more managers were employed, each one outdoing the other with requirements for new forms and monitoring. All this extra work was not only exhausting, but made a huge impact on the number of patients who could be seen. Some of my colleagues spent more time on paperwork than on clinical work, but I refused, was told off, and retired as soon as I could. It was all part of what I now understand to be the Deep State.
Not read any of your stuff since you signed off the COVID debate. V nice to have you back. Didn’t know you were involved in a libel trial. Good luck with that
Malcolm,
Will you please comment on the idea that it is oxidized cholesterol that causes heart disease, with seed oils largely to blame. This explanation has been gaining traction from what I can see. This is what Dr. Mercola says:
“One of the first things that happens in atherosclerosis, which is the precursor to heart disease, is that your macrophages (a type of white blood cell) turn into foam cells — essentially a macrophage stuffed with fat and cholesterol.
Atherosclerotic plaque is basically dead macrophages and other types of cells loaded with cholesterol and fat. This is why heart disease is blamed on saturated fat and cholesterol. However, researchers have found that for foam cells to form, the LDL (low density lipoprotein cholesterol) must be oxidized, and that is precisely what seed oils do.
Seed oils cause the LDL to oxidize, thereby forming foam cells. So, LDL in and of itself does not initiate atherosclerosis. LDL’s susceptibility to this oxidative process is controlled by the LA [linoleic acid] content of your diet. Excess PUFAs also make cell membranes more fragile, allowing them to be easily damaged by oxidation.”
Source:
https://www.globalresearch.ca/linoleic-acid-most-destructive-ingredient-your-diet/5818645
Cause and effect. Effect and cause. Medicine, and most people are poor at getting these things in the correct order. Inflammation as the cause of anything, for example. There can be no such thing as spontaneous inflammation. Yet many people tell me, in all seriousness, that inflammation is the underlying cause of CVD. Just as inflammation is the underlying cause of a twisted ankle, no doubt.
As for oxidised cholesterol. There is no such substance. If someone means oxidised LDL maybe. Then ask them why endothelial cells have OX-LDL receptors. They prefer it to LDL.
I sometimes wondered about the same thing. When people bang their toe and start limping the next day, and other people ask them why they’re limping, they don’t answer that they are limping because of inflammation. Even though inflammation is clearly present in their toe. And yet, internet is filled with articles about how this or that condition is caused by inflammation. Often together with remedies you can buy to reduce inflammation.
Thank You!
Will you please explain further? Does endothelial cells having OX-LDL receptors mean oxidized LDL is a cause of atherosclerosis, or not a cause?
I found this paper that says:
“Receptor-mediated oxLDL uptake results in cellular dysfunction of various cell types involved in atherogenesis and plaque development.”
https://pubmed.ncbi.nlm.nih.gov/37171285/
Oxidation of LDL molecules almost certainly occurs within the artery wall. Macrophages use NO to attack and break down ‘alien’ substances and then ingest them. This is their primary weapon.
Finding oxidised LDL within foam cells is to be expected if macrophages are doing their job. Once again finding something ‘abnormal’ then deciding this abnormal thing is the underlying cause of a disease is a recurring theme in medicine. See under amyloid plaques in Alzheimer’s.
Thank you, I think I get it!
Oxidized LDL are at the scene of the crime, but are not causative in plaque formation, and this is evidenced by the fact endothelial cells have OX-LDL receptors, which are part of a natural process and not a pathogenic one.
Since massive consumption of seed oils is relatively new, could it be that these oils do contribute to plaque formation, but more because they cause insulin resistance, or something else?
I believe seed oils create dysfunction because they introduce too many unsaturated fats into cell membranes interfering with many critical cell activities. Trans fats are clearly the worst as they are not generally found in nature.
Which is why various margarines have been quietly shelved from the market. Overall, however the human body likes saturated fat. It is why the liver turns excess carbohydrates into saturated fat. Primarily palmitic acid 16 carbon atom chain.
This is very helpful, thank you.
Agenda:
Privatise NHS
Increase prices for pills pushed by ‘Doctors
Increase the number of ‘illnesses, thereby increasing scope for more sales of pills
Reduce acceptability of supplements and vitamins otc. Serrapeptase is no longer a food ….
Good to see you back. Hope the libel case will soon be over so we can get back to more tidbits of medical wisdom.
Having read all of Kendrick’s books, I was under the assumption he is a cardiologist. Now granted that I’m just a layman, but I find it curious that a heart doctor would be expected to deal with autism or learning disability cases. Dr. Kendrick, your NHS really HAS gone downhill, I fear.
On a related theme, here in the States we have some of the health screening questions. I don’t think they ask about gambling, but they do inquire about:
Have you had thoughts of self-harm, wanting to hurt yourself?
Have you been a victim of domestic abuse?
Do you have a firearm in the home? (Recall, we ARE gun-happy Americans).
Etc.
At a recent opthamologist appointment, I was asked if I had taken the flu or pneumonia shot (but curiously, no query about Covid).
To date, I have meekly answered these questions. But in the future I’m going to be a bit more reticent and reply, “Those are none of your business, unless you can convince me it is essential to the care I will receive today.”
I missed Dr Kendrick’s interesting musings but not most of the commenters. The tiresome loons who have Big Pharma and Feds under their beds.
I wish this was still a site about medical issues. Ah well, no more reading comments, just the Doctor’s clever stuff.
When I started as a UK hospital doctor in training, guidelines were relatively few and generally quite useful. They covered things like cardiac arrest when you had to work as a team with people you did not normally work with, or rare and serious conditions with complex treatments. I did a year in an ICU in the USA to find out how guidelines were used in a totally different context. In the UK we would assess the patient, decide on treatment and it would be unusual to call in a consultation from another consultant specialist. In the US, it was normal to have at least 5 or so different consultants called in to give their opinion. If we thought there might be some abdominal pathology, we would ask a surgeon. They would not normally examine the patients, but ask for a full set of tests, a barium study, CT scan, labeled white cell scan and an ultrasound. Cynically, this allowed more bits of the financial cherry, but also avoided litigation. If you used your clinical judgment without all possible tests being done, you were probably in serious legal trouble if something had gone wrong. Over the subsequent years, guidelines have proliferated enormously in the UK, and similarly, although lip service is paid to the principle that a guideline is a guideline that you can deviate from if you judge appropriate, this is less and less easy to do so. Trainee doctors find there is a guideline for nearly everything and less and less critical thought is needed. They know that if something has gone wrong and the guideline has not been followed, they will be first in the firing line when blame needs to be apportioned. I believe in GP practice in the UK, their practice income is tied to satisfactory adherence to guidelines, protocols etc etc.
[heart] Mae Philippe-Levy reacted to your message: ________________________________
Thank you for showing that your brain and soul are still engaged for the benefit of humanity.
I really don’t need the health care professionals (I gotta laugh) screening me for much of anything. If I want to play fantasy football or go to a casino or play the lottery, that is my business. These are the same clowns who try to put limits on everything you do so they can declare you unfit to live or try to drug you to death. I hate the one-size-fits-all world.
The manlet Mayor Khan of Londonistan conducted a ULEZ consultation with some 76% of respomdents being against. What a shocker the globalist Khan carried on regardless.
‘Learning to communicate with people with autism’
The funny part being that they wouldn’t have autism but for all those jabs the Doctor pumped into them earlier on.
Glad you’re back.
Thanks for the article, it’s great to read common sense.
Thanks yet again for your very informative information.
Another time waste is sending emails to poor unhealthy people like me trying to persuade yet again to get a certain jab. Has no one in the NHS got the message that we dont want it now or ever?
The problem with these damn texts (get this jab get that jab) is that you can’t reply to them! In even have trouble deleting them on my iphone!
I don’t have that problem. I don’t have a phone.
Wonderful to have you back. I have missed your common sense blog. We need it more than ever in this current crazy world.
A breath of fresh air in my day, good to hear from you again Dr Kendrick, best of luck with your case. I have family members with many years between them in the NHS, in patient transfers, nursing and admin. Listening to their experiences I equate the NHS with that bus company a few years ago, who didn’t pick up at some bus stops because that would interfere with the schedule, much as patients and medical staff get in the way of bureaucratic practices.
Try this for a slogan — FOQ the QOF!
Good to have you writing again, Dr Kendrick.
2.54 million hours equates to a mere 290 years according to my reckoning. Nevertheless, point taken.
Not many people work 365/24/7.
Like everyone else here, I am really grateful that you are back online again. I began to think that someone had organised a legal process that would cause your court case to last indefinitely. We are also all rooting for you to win.
The process you describe extends outside of medicine. The guy who cuts our hedges told me that he has to go on a regular course explaining how to use a hedge cutter safely. Since he uses his almost every day, he felt that that was pretty pointless. Also, people who own a personal hedge cutter (and thus only use it occasionally) don’t have to attend such a course, even though they are far more likely to hurt themselves.
I guess I now understand why when I attend my local surgery (fortunately rarely) it is almost empty, and yet doctor’s appointments are always weeks ahead.
I fear the next phase will be that the NHS will completely fold up
Here in South Africa we bought a petrol mower for our apartment complex to save money on garden service. Our cleaner was willing to do the mowing for a bit of extra cash, but the managing agents put a stop to it.
They said the mower is a power tool and the cleaner has to go on a power tool course and get a certificate before he is allowed to operate it. Plus we have to pay extra to Workman’s Compensation.
The upshot was that yours truly has been pushing the mower around for the last 20 years. No course, no certificate, still got all my fingers and toes, *touches wood*. Sprained a muscle trying to pull-start the damn thing on a winter’s morning, though.
The trouble is once you start a committee it has to continuously produce bumf to remain in existence. 45 years ago the accounting bodies in the uk started a committee to produce accounting standards, to make sure companies’ accounts are stated correctly and can be compared easily (apples with apples). And the first few were common sensical, easy to understand and implement standards. Then, it started to get more esoteric. “Accounting for inflation, SSAP16” was just a pigs breakfast of meandering rules that achieved nothing and what results it did produce were meaningless unless you knew and understood the standard – i.e. limited pretty much to new graduates who had had to learn it for the exams. It was eventually abandoned (just after I’d learnt it!). But the juggernaut moves on! Now there are reams and reams of standards, rules, advisories etc. etc. meaning that to comply with it all company accounts have become a huge mass of incomprehensible numbers and text and, of course, a real boon to accountants and lawyers who charge enormous fees to ensure “compliance”, as well as feeding the Standards Committees.
Workplace Health and Safety has gone the same way. In Queensland a builder cannot place a ladder against a gutter without filling in a form. Fortunately I’m not a builder so it’s not a problem for me.
And look at the way the MOT has developed in the UK. More and tighter regulations, testing every year, great for garages and government officials expensive for drivers. In spite of an RAC report in the ’80’s confirming that 97.5% of accidents are caused by the nut behind the wheel, and only 1.5% a mechanical problem (the other 1% being genuine, tree-falling-on-car type accidents). In Qld we only have an inspection when the car is sold. Random inspections of cars for being defective, not that we’ve ever been stopped and our cars have almost always been old (currently 1985 and 2000 models).
And there you have it. Follow the money. As usual. Powerful industry groups prevail once they get a foot in the door. I’m not a licensed plumber, so I cannot replace a tap in my own home. Or a licensed electrician so I cannot replace a light fitting or a socket (light bulbs were ok, but most of them have been banned now), yet I can rebuild the brakes and steering on my car. Where’s the real risk to me and others? Fortunately I’m not a doctor either, which meant it wasn’t illegal for me to give people ivermectin – fortunately for other people, that is.
So the NHS is doomed. It will eventually be suffocated under the mass of its own bureaucracy, the collapse probably forming a black hole. And the sooner the better.
“I began to think that someone had organised a legal process that would cause your court case to last indefinitely”.
A natural mistake, but that’s just the normal course of “justice”. If it’s true, as the old saying has it, that “justice delayed is justice denied”, we no longer have justice.
Ha ha … https://www.theregister.com/2023/10/12/excel_anesthetist_recruitment_blunder/?td=rt-3a
Thanks Neil,
That is a must-read, and should act as a warning to all NHS managers!
After a quick read it has similarities to the Post Office and their Horizon “system” Lots of innocent people harmed and the people running the system denying anything was wrong.
Great to see you back. Your article reminds me of meeting a fellow working for our electrical utility whose job was to follow the chain of submitted field reports to see if it actually led to someone who needed them. Oftentimes not.
Great to see another post, I have missed them! Good luck with the case
As a relevant (perhaps useful ?) contribution to the discussion of unnecessary work in the NHS…
Speaking as a retired engineer, I have always thought what the NHS needed was a more systems engineering based approach. Having done a good systems analysis of the flows of people; information; materials, etc. in health care you could apply a standard engineering technique of “Value Analysis” where for each flow/process etc. you ask what value it adds, and then remove those that add nothing.
Some years ago I had the dubious pleasure of teaching undergraduates systems analysis.
One assignment they had to complete was an analyse their own jobs in SSADM (structure systems analysis and design methodology). One student who worked for the NHS had a job of collecting lots of information from various departments, putting it on a spreadsheet and then filing it.
I asked her “who then used it?” she said she didn’t think anyone did it just got filed, so I asked what was the point and shouldn’t she find out if someone did use it? Perhaps to improve it etc.?
Or perhaps she should think about getting a more useful job, her answer was no she got well paid.
The point I tried to make was the point of doing an analysis is to understand and then help improve a situation, but some you win some you loose.
The most important question in any process improvement:
“What would happen if you didn’t do it?”
I agree with your post (as a pedant it is ”some you win, some you lose’). I watch nurses do immense, time-consuming audits every month that get sent somewhere, for some reason or another. Nothnig changes, there is no feedback. At one point I audited the accuracy of drug charts when they were sent over from the main hosptial. Did the chart match the drugs that were sent over. Did they match the discharge summary etc. etc. Out of one hundred drug charts, none was fully accurate. I presented my audit. This was two years ago. Two months ago I did another audit. Same result. None out of a hundred.
Great to see you post again Dr Kendrick. I’ve been hoping you hadn’t been eaten alive by the court case.
I have recently had a number of conversations with people bemoaning how they are endlessly asked to do more in less time and with less resources. Tasks always being added and staff whittled away. It feels like we are racing to the bottom in many areas, not just the NHS.
From a personal perspective, having spent every year from my son’s diagnosis with autism aged 3 (he’s now 24) fighting for any additional help at all (there was none), it strikes me as nothing short of tragic that every GP will have to go on a course about being nice to people with autism but no actual help going to those with autism. It makes me want to weep with frustration. Imagine what a transformative difference would have been made if instead of doing a repetitive, dull and patronising course for 2 hours every health professional spent 2 hours actually helping an individual with autism.
Anyhow, I look forward to being asked about gambling if I ever visit my GP again!
I agree! As an adult with autism there’s virtually no NHS help. Nobody wants to check up on me. No regular appointments.
And I suspect it’s because there’s no profit and no big pharma in autism (yet!).
The same goes for heart disease, the NHS stents you and dumps you
Welcome Back. Good Luck in your Libel case. No doubt the lawyers are going through the minutiae of every legal sentence in the Libel laws and generating billable time and ££ for the great wealth of the Mails Law team. I hope the judge sees common sense and you win with enormous costs awarded to you so you can continue your good work in exposing the impacts of Drug companies manipulating data for their sales.
On the NHS, it has become bogged down in inefficiencies and so many management consultants and advisers it has become the Nation Hierarchical Service where the actual health providers are lower down the scale to the HSE and Advisers. It does need reform but having more PWC or JP Morgan to advise reform is perverse. I’d vote for you as Health Minister and Wes Streeting isn’t bad either .
Come on back with more insight please.
From my biased viewpoint, having just suffered the stress of a loved one spending six weeks in hospital for one thing and then being discharged with two hours notice with two things. The problem with the NHS is that:
N – it’s not national, it’s made up of competing fiefdoms;
H – It’s not primarily concerned with actual health, rather: bureaucracy, DIE, Pill Pushing, Politics;
S – it doesn’t provide a service, more like a lottery, take it or leave it.
I’m sure there are still some great people within the organisation but they are now the outliers.
What happened to Dr. Sebastian Rushworth ? Sorry its off-topic, but people here or even our host might have heard something ?
Here is his website, but he hasn’t updated it for some time:
https://sebastianrushworth.com/
There is a link to contact him (see top right).
I did that once but will again. Its just so weird to see a someone drop away with no explanation whatsoever.
Sorry, no, I haven’t heard anything. His Twitter account seems to have closed. His last blog was mid-2022.
I agree, nice to see you back online.
Certainly seems that the ‘jobs worths’ are getting the lion’s portion of the health care budget.
Useless pen pushing at ‘I don’t care’ costs …, who lets this happen ??
Anecdote about chronic health problems improving…
Wife was on the downhill fast. Type 2 diabetes, CKD3, low hemoglobin, nightly leg cramps, fatigue, weakness, knee problems. Low BMI. Losing cognition. Arthritis.
Got her to ditch statins & increase vit D & increase protein intake. Taking K2.
Last check wife’s A1C was 5.6, gfr was up from .27 to .4, hemoglobin was up to 10.4, leg cramps gone, knee pain gone, walks more normally, but has leg weakness from statin damage. Arthritis much improved. Mentally much sharper.
Oh, noes, 25OHD was 122!!! Scary!!! Wife dc’d vitamin D supplementation. Facepalm.
I wanted to halve vit D supp., not DC it.
PCP asked wife if she was still taking her statins. Wife lied to avoid a conversation about it.
Physician daughter will check 25OHD 3 wks after dc’ing vit D.
The dead hand hand of bureaucracy – can make us social beings lose the will to live.
Perhaps you, as a Doctor, should write some directives for our 650 MPs in Westminster.
Homilies could perhaps start with:
‘Westminster has XXX licensed bars all serving ridiculously cheap alcohol. History has shown that inebriated MPs do not serve their constituents effectively, nor is the Defence of the Realm enhanced by sozzled MPs piling into ‘Yes for war’ lobbies having never acquiainted themselves with the salient issues at hand’.
‘Human life is sacrosanct. If you think that callously murdering 1 million foreigners can occur on the back of 550+ MPs not having the first clue about US imperialism, the oil industry’s history in the Middle East, the distinct differences between Western nations and the Muslim world in terms of many cultural sensitivities, then you might like to consider your fitness to be an MP.’
‘If you continuously vote through annual budgets with enormous deficits so that government debt:GDP approaches 100%, then don’t be surprised if the rapacious banksters raise interest rates from 5-7% to bankrupt nation states and turn the Western world into private autocracies.’
‘If you think that bankers, journalists, lawyers, Russians and Muslims are all untrustworthy, why on earth do you think that scientists, doctors and Jews are all saints?’
‘If you seriously think that the USA are our friends, not our bullying imperial masters, then do you not think that you are a little too credulous to be a public representative?’
‘Pfizer and Moderna’s primary raison d’etre is to make money for their shareholders. It is not to improve human health’.
‘The Security Services have fully infested the BBC, ITV, the Civil Service, the NHS and all of our major Universities. So why do you think that some of their bullies and blackmailers don’t sit on the benches of the HOC?’
A start to the list of Directives:
1. Do not ever accept an invitation from anyone without first confirming that they do not represent the Mossad, the CIA, MI5/6, the WEF, the Project for a New American Century or other war-provoking non-organisations.
2. Put the interests of your constituents ahead of the interests of pressurising lobbyists.
3. Don’t presume to vote on anything you don’t understand.
4. Never, ever give a Chancellor of the Exchequer carte blanche to waste taxpayers’ money willy nilly via an execreble Act of Parliament called the Coronavirus Act.
5. Never ever vote away Sovereign Power from the UK people, nor hand it to unaccountable globalist cabals called the World Health Organisation.
I’m sure you could expand those first five directives out to about 100 pages each, after all…..