Junior doctors strike

[norcan]

True in a very narrow sense, but in real life it’s genuinely a distinction without a difference.

 

[Eddie P]

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....

If you can buy less for any given day's work it is a decrease, not in numbers I agree. But still.

 

[Apthorpe]

True in a very narrow sense, but in real life it’s genuinely a distinction without a difference.

There are differences depending on the balances of your spending. If, for example, you're a junior doctor driving some distance to a hospital daily, your motoring costs have most likely fallen in both real and nominal terms over the past year, with cost of diesel having dropped significantly within the last year. The CPI basket is very arbitrary and does not reflect many people's reality. More generally, costs have risen a lot, ironically much of that is the consequence of decisions made to accommodate the interests of junior doctors. They also need to learn to take their medicine, like everyone else.

 

[Apthorpe]

Have you mentioned any faults of private healthcare?

In a thread about the NHS, it hasn't seemed appropriate, but I have certainly not denied or given inappropriately low weight to them when it has been part of the conversation, and have made comments that both accept and imply my understanding of the existence of faults in the private sector in at least six posts in this thread. Now that we have dealt with your evasion of the question, would you mind answering this: "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."? I Invite you for a third time to reflect and retract an accusation you have made without any reasonable basis for doing so.

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.

This is confirmation of the point you were contesting. It is an invalid claim that the patient is too stupid to understand that poor service and bad practice is actually first-class behaviour. What evidence is there to sustain this opinion? How often?

Even if you were right, which I certainly do not concede at this point, why should patients have to tolerate irritation, inconvenience and discourtesy in settings usually festooned with notices stating that staff won't tolerate the same?

Anyhow perhaps in an area where so much is based on the opinions of particular practitioners, discussion is futile:

This is only because medical practitioners won't accept discussion on any other basis than their own opinions. So we are to accept the failure of our healthcare model, simply because it is futile to alter anything. What a thoroughly depressing, but accurate, opinion - national decay because the beneficiaries of the current health system won't permit the population a decent health system through fear of change or the erosion of their advantages over the rest of the population.

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

What?? That would seem to be a description of private healthcare rather than the NHS. In the NHS we are forced to pay our money, in increasing sums, with no positive correlation to the quality of service, and have no choice.

 

[norcan]

There are differences depending on the balances of your spending. If, for example, you're a junior doctor driving some distance to a hospital daily, your motoring costs have most likely fallen in both real and nominal terms over the past year, with cost of diesel having dropped significantly within the last year. The CPI basket is very arbitrary and does not reflect many people's reality. More generally, costs have risen a lot, ironically much of that is the consequence of decisions made to accommodate the interests of junior doctors. They also need to learn to take their medicine, like everyone else.

Ah yes; it’s definitely their fault, and has nothing to do with corporate greed or anything.

 

[Apthorpe]

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.

Really? As a doctor you genuinely can't see any use for more testing, imaging or diagnosis than is currently done? How do you do evidence-based medicine when you refuse to accept the suggestion that more evidence is worthwhile?

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?

I can see no harm in routine screening MRI scans at appropriate intervals, nor in routine screening blood tests, or other forms of imaging or diagnosis - except for the fact that many people's doctors will ignore the results. One cannot diagnose diseases particularly well without evidence. The NHS ignored the signs of my wife's cancer for over two years despite numerous visits, and it was picked up in routine private health checks which cost far less than the useless GP appointments. One of the big problems in the NHS is that there is a tendency to want to allocate more of the money to the staff member than to the test or treatment. In this case it missed one cancer, early menopause, another pre-cancerous condition. She was not unusually unlucky that happens all the time in large numbers and the NHS simply does not know, not least because you won't collect the data.

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?

Yes, if that is what they do. On the current situation, there is a strong argument that it might be better to dispense with most of them, in favour of a more productive means of gatekeeping, and have them trained as specialists in those areas understaffed.

simple questions need to be answered like is this cancer, is it something that needs an operation, does it need non surgical specialist input.

And routinely they are not answered quickly, correctly or even at all. You're just issuing a platitude here. You're not accepting that medicine is done better anywhere else.

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.

Yes it does because medical schools are heavily oversubscribed with extremely talented, motivated and intelligent applicants being turned down in large numbers each year. As you know.

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.

Partly because it is the official position of the Medical Schools Council to do so: "

• The suggested figure falls short of the number of graduates required for the UK to have a fully sustainable medical workforce because MSC believes that medicine is a global profession and the input of doctors trained overseas is invaluable to the NHS."

Note this is a belief, not a position supported by evidence.

( 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.

In good faith, you cannot believe that the UK would be unable to manage self sufficiency in doctor numbers when the number of applicants each year is around 28,000 relative to a total current number of doctors being 280,000.

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.

I think you also know that if the magic money fairy landed, that would not be a solution to the number of doctors trained. We could also retain staff by having medical students contractually required to work in the NHS for a certain number of years as has long been the practice in other areas where the state largely funds very expensive training. Oddly the medical profession is not calling for that.

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.

There's a sensible debate to be had about healthcare provision in this country. I had written a long and detailed reply to this post, but towards the end of it, I realised the futility of it if medical practitioners are going to post deliberately facile and absurdist contributions, and maintain a perspective of denialism, so have cut it back.