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    What can it be like to lose the life of a loved one to an institution? Clinical care is currently running the risk of burying its head in the sand of less than adequate regulators, and being dehumanised in a swathe of bureaucracy. It struck me recently that the 6Cs of nursing, which arose from NHS England’s “Compassion in practice”, can be, to some extent, applied to patients as well as clinicians.   [graphic source] The 6Cs are: care, compassion, competence, communication, courage, and commitment. One of my issues is that, while the 6Cs are elegantly branded and themselves slickly […]
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    Sickness is something that no-one can plan for. It is only right that those who pay their taxes get a quality National Health Service. We pride ourselves on providing free care to people from every background, in every stage of life and at every level of need. So why do we discriminate against car drivers with this stealth tax on the sick? First of all, it is important to make clear that these hospital parking charges are a real burden on many people living in England today. After years of receiving countless letters from constituents who were outraged by the charges, […]
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    Doctors are rarely accountable for the average quality of their work in terms of outcome. They have to answer for exceptional events, unexpected disasters lying outside the normal range of experience, but rarely for assessment of average process, and virtually never for average outcome. If disasters don’t occur, or don’t reach the ears of authority, quality of work is assumed to be satisfactory. Even if it is so obviously unsatisfactory as absolutely to demand enquiry, that enquiry will use process rather than outcome measures. For example, the expected mortality of a planned operation for repair of inguinal hernia in a […]
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    Within the Osier paradigm, doctors have generally accepted accountability in two directions; to their professional colleagues collectively, and to their patients individually. In each case, accountability has been at two levels: a formal level of official complaint, disciplinary action or litigation; and an informal level of custom and expectations. Because in Osier’s time doctors had so little influence on the outcome of illness, accountability for outcome was not possible. Even the traditional Hippocratic rule ‘primum non nocere’ (above all, don’t harm) was not enforceable; desperate fear condoned desperate remedies; so doctors were encouraged to add substantial risks from treatment to […]
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