Junior doctors strike

[David N]

I am looking when we are discussing pain from an MSK/Ortho point and is for most cases but not all cases. Each patient must be treated as an individual and thus be assessed as one.

"This raises questions which are difficult to phrase, so please excuse me if this seems blunt. Are you saying that the pathology is not particularly important unless you have pain? At the very least, I would think there was useful information for preventative or mitigating measures. That principle appears to me uncontroversial. Surely the point of medicine/ general practice is not significantly a matter of dealing with pain? If that is the case, I'm absolutely horrified."

I think this really say all that is needed to be written. Again just from a MSK/Ortho point.

"I would think there was useful information for preventative or mitigating measures. That principle appears to me uncontroversial"

This is a sweeping statement with no value, unless you expand on this. Are you proposing everyone should have MRI scans every 3, 6 12 months just in case something may be found, even if it does not need any treatment?



But honestly, how often does the typical patient actually get a proper process of assessment and expert clinical reasoning at the first appointment with a GP? From the other side of the fence, it is far from a sure bet.

A GP being a generalist will not have the expertise of a specialist. Is it more important that they can assess, and refer on? simple questions need to be answered like is this cancer, is it something that needs an operation, does it need non surgical specialist input.

As with any profession we all have or strengths and weakness, knowing this is important. We also some some amazing practitioners and others who are not. We could go into pay and does the current situation encourage school children to think lets go into health care.

The current answer appears to get doctors , nurses and other health care professionals to come from abroad. Many come, but where does that leave the health care of their origin? Why should the rich nations take from the poor nations. ( I do realise there are different ways to look at this, an how it can benefit families back home) BUT we are the same nation that wants to close or boards. I move away from the topic other than saying if we paid an appropriate wage ,had working condition that were good, ( so retaining staff) and had enough places funded for new health care practitioners we may not have been in the current mess.

That then takes us back to the question asked many posts ago. What do we do with the NHS letting disappear so only the well off can get appropriate care. Make everything private? current premium for my parents both in their 90's is £15,000 per year. I guess that most pensioners will find it difficult to find that sort of money. But does it matter, a USA style health care may be one you would like.

 

[Rasputin]

The msk makes me laugh. Had an appointment last Friday didn’t know what it was for nothing on the letter only turn up. Turns out I have a partial tear on my acl the practitioner was unbelievably embarrassed that after the mri they hadn’t even bothered to tell me 5 months ago. He was cordial enough said I have bupa to which he chuckled and said just do that il probably be the same guy you see . Talk about efficiencies.

Got another two mris and a nerve test in the next few weeks all fun and games.

 

[Eddie P]

We've already chosen to pay higher tax but the problem is that the NHS, and now, apparently, its staff won't produce better care. Most people don't object too much to paying more in order to get more of something. The problem is that we keep paying more and getting less from the NHS in particular.

One can leave the politics out of it, but it still leaves the question of why doctors elected explicitly radical political activists to represent them. That leaves claims that this is only about pay and conditions for junior doctors severely lacking in credibility.

The bald fact of the matter is that even at £14/hour, junior doctors are better paid than most of the population.

How many of the population are making the same decisions for £14ph? How many people with 5 years at uni earn £14ph?

 

[Eddie P]

I am looking when we are discussing pain from an MSK/Ortho point and is for most cases but not all cases. Each patient must be treated as an individual and thus be assessed as one.

"This raises questions which are difficult to phrase, so please excuse me if this seems blunt. Are you saying that the pathology is not particularly important unless you have pain? At the very least, I would think there was useful information for preventative or mitigating measures. That principle appears to me uncontroversial. Surely the point of medicine/ general practice is not significantly a matter of dealing with pain? If that is the case, I'm absolutely horrified."

I think this really say all that is needed to be written. Again just from a MSK/Ortho point.

"I would think there was useful information for preventative or mitigating measures. That principle appears to me uncontroversial"

This is a sweeping statement with no value, unless you expand on this. Are you proposing everyone should have MRI scans every 3, 6 12 months just in case something may be found, even if it does not need any treatment?



But honestly, how often does the typical patient actually get a proper process of assessment and expert clinical reasoning at the first appointment with a GP? From the other side of the fence, it is far from a sure bet.

A GP being a generalist will not have the expertise of a specialist. Is it more important that they can assess, and refer on? simple questions need to be answered like is this cancer, is it something that needs an operation, does it need non surgical specialist input.

As with any profession we all have or strengths and weakness, knowing this is important. We also some some amazing practitioners and others who are not. We could go into pay and does the current situation encourage school children to think lets go into health care.

The current answer appears to get doctors , nurses and other health care professionals to come from abroad. Many come, but where does that leave the health care of their origin? Why should the rich nations take from the poor nations. ( I do realise there are different ways to look at this, an how it can benefit families back home) BUT we are the same nation that wants to close or boards. I move away from the topic other than saying if we paid an appropriate wage ,had working condition that were good, ( so retaining staff) and had enough places funded for new health care practitioners we may not have been in the current mess.

That then takes us back to the question asked many posts ago. What do we do with the NHS letting disappear so only the well off can get appropriate care. Make everything private? current premium for my parents both in their 90's is £15,000 per year. I guess that most pensioners will find it difficult to find that sort of money. But does it matter, a USA style health care may be one you would like.

He's proposing a 3 monthly CT, to keep the oncologists in work in 10 years time.

 

[Dalua]

Nobody does imaging for the sake of it, there is a clinical question: the patient thinks they're ill or is concerned to exclude the chance of serious illness. It has costs for patients as well as providers.

One may sometimes get the impression that medical/veterinary investigations of one kind or another (including imaging) are done because they're covered under a particular patient's insurance cover.

As an aside, I'm not sure you're quite understanding the pathology/pain thing here.

 

[Apthorpe]

One may sometimes get the impression that medical/veterinary investigations of one kind or another (including imaging) are done because they're covered under a particular patient's insurance cover.

Indeed, presumably out of an abundance of caution, but that still means that there is an actual medical concern which has been assessed and considered worthy of examination. The contention that a significant percentage of this stuff is demanded or done without any reason whatsoever is unconvincing. Insurance or no insurance. One nevers claim on any other insurance policy without any cause at all, it is peculiar to pretend that the private health insurers are willing to reduce their profits by co-operating in the authorisation of wholly unjustifiable diagnostic procedures.

As an aside, I'm not sure you're quite understanding the pathology/pain thing here.

You're quite right about that. Numerous fatal conditions have no pain until it's rather too late. Disdaining the pathology for lack of pain strikes me as somewhat risky. These are frequently missed by the current practice. I fail to understand it. Notwithstanding that, it's rather a moot point when imaging and test results are so routinely ignored instead of being read in a timely fashion.

 

[Dalua]

You're quite right about that.

Good - I thought so too!

Indeed, presumably out of an abundance of caution, but that still means that there is an actual medical concern which has been assessed and considered worthy of examination. The contention that a significant percentage of this stuff is demanded or done without any reason whatsoever is unconvincing. Insurance or no insurance. One nevers claim on any other insurance policy without any cause at all, it is peculiar to pretend that the private health insurers are willing to reduce their profits by co-operating in the authorisation of wholly unjustifiable diagnostic procedures.

The balance of cost, risk and clinical appropriateness is complex. Many factors interact, and practitioners may swing one way or another for a variety of clinical, commercial or other reasons.

Having had opportunities to observe how these things work in both NHS and private healthcare, I'd be inclined to factor in that making profit as a private insurer means keeping customers happy. Private health insurance customers seem to be impressed with lots of investigations, particularly high-tech ones - even if they involve large amounts of radiation.

 

[Apthorpe]

Good - I thought so too!


The balance of cost, risk and clinical appropriateness is complex. Many factors interact, and practitioners may swing one way or another for a variety of clinical, commercial or other reasons.

Yes, it is obvious that medicine, like many other fields of human endeavour, is complex. That is not to alter that fact that the NHS is nowhere near providing the optimum service within its constraints, it is just another red herring.

Having had opportunities to observe how these things work in both NHS and private healthcare, I'd be inclined to factor in that making profit as a private insurer means keeping customers happy.

I’m sure you would. What is the evidence that private providers are delivering sub-optimal healthcare to increase customer satisfaction? Are we not factoring in that keeping patients alive and healthy makes them happy? As a reluctant user of private healthcare, by far the largest factor in keeping customers happy is administrative competence. The NHS has intentionally gone down a path of outrageously bad administrative incompetence which is costly, wasteful and dangerous. Yet when this obvious truth is raised, the inevitable response is one of various forms of denial or evasion.

Private health insurance customers seem to be impressed with lots of investigations, particularly high-tech ones - even if they involve large amounts of radiation.

The implication being that private customers are getting worse health outcomes than NHS patients because of needless and harmful processes? I really think this is disappearing down a highly implausible rabbit hole. We both know that this is, at best, mere obfuscation. My point was that evidence-based medicine works better when doctors have evidence, and when they use it. Debating increasingly marginal points in opposition to a wider point which is so obviously correct isn't worthwhile use of anyone's time.

Certainly I agree that private health customers are more impressed by plenty of investigations in contrast to artificially inflated waiting lists and little investigation with evidence being systematically ignored. However, I really cannot credit any plausibility at all to suggestions that private healthcare providers are in the business of unnecessarily reducing their profits and harming the health of their customers in order to make them happier.

 

[Dalua]

However, I really cannot credit any plausibility at all to suggestions that private healthcare providers are in the business of unnecessarily reducing their profits and harming the health of their customers in order to make them happier.

I know you can't, but I think that's because your are just as blinkered to the faults of our private model as you (possibly quite rightly) suggest the supporters of the NHS are blinkered to the faults of that very faulty system.

The key word in your sentence above in 'unnecessarily', I think. It is necessary to keep the practitioners and providers of diagnostic and laboratory services happy too, otherwise the whole thing falls down.

 

[Apthorpe]

How many of the population are making the same decisions for £14ph?

This is a stupid question. Nobody is permitted to. Large numbers of people make decisions of similar potential consequence on that sort of money.

How many people with 5 years at uni earn £14ph?

Very large numbers indeed.
How many medical students lack the mental capacity to make a rational career choice? I'd suggest zero. The pay, progression pathways, benefits and security are no secret. This is not a case of morons being mis-sold fraudulent investments.

 

[Apthorpe]

I know you can't, but I think that's because your are just as blinkered to the faults of our private model as you (possibly quite rightly) suggest the supporters of the NHS are blinkered to the faults of that very faulty system.

I don’t think that’s an assertion you can reasonably support on the evidence. I’d invite you to reconsider it.

The key word in your sentence above in 'unnecessarily', I think. It is necessary to keep the practitioners and providers of diagnostic and laboratory services happy too, otherwise the whole thing falls down.

I’m sorry Dalua, but you cannot seriously be making this comment in good faith. It falls very far below your usual standard of reasoning.

 

[Eddie P]

This is a stupid question. Nobody is permitted to. Large numbers of people make decisions of similar potential consequence on that sort of money.

Very large numbers indeed.
How many medical students lack the mental capacity to make a rational career choice? I'd suggest zero. The pay, progression pathways, benefits and security are no secret. This is not a case of morons being mis-sold fraudulent investments.

It is borderline a fraudulent investment, they take out loans at the start of uni, then during their course and future career have progressive pay cuts. All they are asking for is to earn the same as when they started. Many are leaving to to go Australia for more money and a better life style, if that continues then there will be none left.

 

[Apthorpe]

It is borderline a fraudulent investment, they take out loans at the start of uni, then during their course and future career have progressive pay cuts.

That is a flagrant misrepresentation of the facts making an argument that is factually completely false. Senior doctors do not have lower pay than when they started.

All they are asking for is to earn the same as when they started.

They are not. You find me a single striking doctor who wants the same salary as when they started work. They are asking for more money.

Many are leaving to to go Australia for more money and a better life style, if that continues then there will be none left.

Indeed. And what is the ultimate reason for this? Life is more rewarding and better in a country where the state consumes under 30% of GDP, compared to a country where the state consumes around 45%. Do doctors go to Australia because it has a better funded version of the NHS? No. They go because it has a better health model.

 

[Eddie P]

That is a flagrant misrepresentation of the facts making an argument that is factually completely false. Senior doctors do not have lower pay than when they started.

They are not. You find me a single striking doctor who wants the same salary as when they started work. They are asking for more money.

Indeed. And what is the ultimate reason for this? Life is more rewarding and better in a country where the state consumes under 30% of GDP, compared to a country where the state consumes around 45%. Do doctors go to Australia because it has a better funded version of the NHS? No. They go because it has a better health model.

In real terms that's all that is being asked for. Below inflation increases are still a decrease.

 

[Dalua]

I don’t think that’s an assertion you can reasonably support on the evidence. I’d invite you to reconsider it.

I’m sorry Dalua, but you cannot seriously be making this comment in good faith. It falls very far below your usual standard of reasoning.

I'm not sure that either my observations or reasoning based on them are too far out - but I think our experiences of both healthcare systems, and our resultant perceptions of the ways in which they work and fail, are markedly different.

 

[Apthorpe]

In real terms that's all that is being asked for. Below inflation increases are still a decrease.

They are making unreasonable demands based on a highly selective choice of time period and a complete exclusion of the context of their other benefits and extremely high future pay.
A junior doctor earning the same hourly rate as 1968 would be on around £3 per hour using the same methodology, and using any methodology on considerably less than they are paid in 2023.

 

[Apthorpe]

I'm not sure that either my observations or reasoning based on them are too far out -

I'd challenge you on that to find one single observation where I have been blinkered or made a demonstrably incorrect representation about the faults of private healthcare.

but I think our experiences of both healthcare systems, and our resultant perceptions of the ways in which they work and fail, are markedly different.

They certainly are. Yours has included receiving money from them and mine has included paying money to them and dealing with the patients’ experience of healthcare both inside and outside the premises. It is an unusual feature of debate about standards in healthcare as opposed to any other service, that the user experience is always subordinated to the interests of the provider, whereas elsewhere one does not find the same concerted and deliberate process of always deflecting into insisting the customer is wrong and seeking to deny the real validity of their opinion.

 

[Dalua]

I'd challenge you on that to find one single observation where I have been blinkered or made a demonstrably incorrect representation about the faults of private healthcare.

Have you mentioned any faults of private healthcare?

It is an unusual feature of debate about standards in healthcare as opposed to any other service, that the user experience is always subordinated to the interests of the provider, whereas elsewhere one does not find the same concerted and deliberate process of always deflecting into insisting the customer is wrong and seeking to deny the real validity of their opinion.

I think that a problem with medical (or veterinary) services is that patients/customers often don't understand enough about the subject to know what is medically sensible and what isn't. They can easily tell what is irritating, inconvenient, discourteous etc. - and that tends to skew opinions despite other considerations.

Anyhow perhaps in an area where so much is based on the opinions of particular practitioners, discussion is futile: we pay our money and make our choices - which may or may not involve paying more money for what we see for one reason or another as a better service

 

[norcan]

It really takes a special kind of stupid to look at the USA’s extortionate health-care racket and think: “We should be more like that.”

 

[merlin]

Below inflation increases are still a decrease.

No they are not. They are just less of an increase.

If someone gets paid £100.00/day, inflation is at 10%, then an inflation-matching increase means person X gets paid £110.00/day.

If they get a sub-inflation increase of, say, 5%, then they get paid £105.00/day.


.....so a rise not matching inflation, but definitely not a decrease. A decrease would occur if for some reason the person got paid less than £100.00/day moving forward.

I'm not disputing the erosion of relative spending power over time, but an increase - of any magnitude - is not a decrease.

I'll take my pedant's hat off now....