Saturday, 25 May 2002
Once again "Doctors' Leaders" have "welcomed"
something which I venture to say most GPs would not wish to do, namely,
to treat drug users for their addiction. This will, of necessity,
involve supplying the drugs. The welcome was muted because
they believe the government have not got it right. Perhaps a more
sensible response from our "leaders" would be to reject the
suggestion until Milburn had got it right.
At this very late stage in the day "GP leaders" have set
up a committee to ensure rural GPs are not let down by the new
contract. Surely a competent group of leaders would have ensured
that before presenting the contract not after but they never did
take country practice into account properly. And, anyway,
shouldn't GPC Rural Practice sub-committee be in the best position to do
that - if, of course, it had good leadership?
Dr Bogle has warned a no doubt trembling Milburn not to use his new
QUANGO, The Commission for Healthcare Audit & Inspection as an OFDOC
inspection organisation. Again a little late. Care to
bet on the outcome?
leaders" have spoken again. This time about "safe
havens" to treat violent patients. Milburn has been
approached but has done nothing and PCTs have followed suit.
Dr Chisholm says PCTs must get their act together - or what?
leaders" have welcomed the government's 5-year licence plans for
doctors. Annual appraisals will feed into this system.
Shortly HMG will reveal options to replace the clinical negligence
system with a no-fault compensation system
GPC supports chemist prescribing - with
safeguards. ABPI has reservations, particularly about
the reclassification of a raft of drugs from POM, P to
OTC. Quite right, too. Another case of GPC
welcoming instead of rejecting until the government has got it right.
Could this be why Milburn appears to think the negotiators are a push
Rather astoundingly 54% of doctors favour the use of medical records
for "research" without consent. This despite the same
percentage believing patients may be discouraged from discussing private
or embarrassing complaints and even more that research would be
hampered. In the post-Alder Hey days one would imagine that
100% would be nearer the figure for the first question.
On site there is an article describing the goings-on at the BMA
Council meeting after "accidental" release of a discussion
document suggesting that GPs should give up the gatekeeper role.
Despite much anger (now denied by Council Minutes and a refusal to my
specific written request to amend those Minutes) at the Meeting, Bogle
has declined to publically correct the impression that the discussion
document was, in fact, BMA Policy. This leads to the
question "Was there some jiggery-pokery going on in BMA
House?". Further evidence for that is that this edition
of bmanews publishes a prominent article by two academic nurses
saying: "The traditional gatekeeper role of GPs is widening
to include other qualified health carers, a trend to which the BMA
appears to lend support". So, was it blundering which
caused the release or deliberate intent by those, Bogle amongst them,
with their own agenda for the future? To give him his due,
Bogle was astoundingly quick to wash his hands of any
responsibility. Whichever it was, the nurses certainly
believe that GPs are about to hand over the responsibility to
them. Shouldn't Bogle, as Chairman, have ensured that there
was a wider discussion within the profession than from Sun and News of
the World readers? Or at least a general apology to GPs from
the chief servant of BMA members?
Saturday, 18 May 2002
"Doctors' leaders" have urged ministers to regulate
better and improve private involvement in the NHS. Reading
between the lines, the BMA is not overall happy with private
involvement. Odd, really when the government is content to
use private services more and more to boost a failing NHS.
Oh, dear. Bath NHS
Trust has upset the government by discovering 280 patients who have
waited more than 15 months for treatment. HMG thought there was
only one patient nationwide. Hmm! What
would happen, one wonders if all Trusts were either as honest or as
diligent as Bath? A new management has been imposed on Bath
High performing hospitals are to be separated out as Foundation
Hospitals and allowed greater freedom to manage their own
resources. The BMA has some reservations about this as they
may set their own conditions for staff.
Dr Bogle quite correctly believes that PCTs need much more admin
support in view of the tasks they have been given. many are not up
to the job and "at the very least they are unprepared".
PCTs are NOT controlled
by GPs, nurses etc say 232 out of 240 PCT board chairmen, chief execs,
GPs and nurses. Number 10 says they are. In fact GP
and nurse executive chairman are not even on the DoH mailing list, are
not invited to conferences and are ignored.
A very sensible scheme has been set up in Beds and Herts. GPs
who face complaints are teamed up with a GP who has already gone through
the complaint procedure. In today's climate there should be
no shortage of such buddies.
The RCGP has offered GPs an A-Z of medical terms for their
patients. It may be seen on the RCGP web site.
Apparently Milburn has found the money to price a pay rise for other
NHS staff. He has not found funds to cost the GP contract.
Page 6 carries a blatant but unlabelled Advertorial for a BMA
Wanted ! How
There seems to be a great controversy as to how many GPs and
consultants are needed or how many the government has promised by 2004 -
or was it 2008? The figure varies from 2000 to 15,000 GPs
depending whether you look at BMA figures, the NHS Plan or the Plan,
version II. GPC, completely missing the point, has
given government a list of measures to attract/keep GPs in the
business. They include maternity and sick leave, family friendly
policy and changes to pensions. How aout removing some of
the over-heavy regulation of the profession and the blame culture which
GPC has welcomed over the years?
One correspondent wonders what all the fuss is about, MRI scanning
the dead. After all with current waiting lists most patients
will be dead before their turn comes round anyway.
In a statement of outstanding naivete the author of bmaview, Tony
Calland, concludes that GPC produced the unpriced contract now
because they had promised to do so and, if they hadn't, confidence in
the BMA GPs committee would have been lost. And there's
great confidence in them right now, is there? A little
blackmail creeps into the piece. It will be difficult, the author
says, to explain to the public why the profession might want to reject a
framework which encourages and rewards doctors for a high quality
service. Young GPs, he says, increasing the pressure, will
be puzzled, too. Dr Calland says that the alternative is
either to continue with PMS or the old GMS contract.
WRONG ! Have the negotiators conveniently forgotten
the alternative they were charged with? Resignation?
You can bet they will do their damnedest to wriggle out of that
one. I recall Dr Michael Wilson, then GMSC Chairman, telling
Kenneth Clarke that "Resignation is not an option" even though
GPs felt very strongly that it was.
Drugs in Sport
A very worthwhile 2 page [iece which any GP interested in sport and
sportsmen should read. The BMA has produced a book
under the same title.
Saturday, 11 May, 2002
There is an exclusive item suggesting that consultants' leaders have
almost reached an agreement for rewarding doctors appropriately for out
of hours work.
Another "Exclusive" continues the saga of the Scots pre-reg
HOs whose trusts are breaching new deal limits
GPC is said to be close to concluding a deal to help GPs modernise their
premises without losing out financially. They may not lose out
financially but they become almost irradically tied to the NHS if it
virtually owns their premises. The, some inner city GPs may be
left with old premises they cannot sell or afford to put into a saleable
Fast-track medical students claim to have been misled that they
would qualify for an NHS Bursary. Now finding that they
won't, they are £30.000 in debt just because they are less than 25
years old when they finish. Their parents will have to pick
up the bill. Does the NHS want doctors, or
what? Is it prepared to cheat to get them?
CHC abolition has
been blocked in the Lords.
...are quite rightly anxious about cost-saving measures to replace
them in some way by those ever useful NHS dumping grounds, nurses.
With signs of increasing desperation Dr Chisholm claims that GPs
missing out on quality payments may be given help to raise
standards. By doing this he assumes that these practices are
inferior and sub-standard by the Milburn standard of the
day. Talking of whom, we can guess what "help" he
will offer !
Five fewer full-time
...as five GPs become chairmen of Welsh Health Boards.
Your contract -
In a somewhat dismal admission of failure John Chisholm said that
the government had refused to price the "contract" until after
the June spending review had allocated funding for primary care.
It does not take a rocket scientist to work out from that that, as
usual, GPs will be at the mercy of the Treasury and in a take it or
leave it situation. How many times have doctors
been told the national interest comes first? All other
discussion in the full-page article is so much superfluous drivel.
...a GP in Leeds, is sold on the contract on the grounds that if he
is interested in a job he considers the pay secondarily. I wonder
whether Jonathan Reggler will be given a similar half page of space to
oppose? Don't hold your breath.
Head 2 Head
This edition asks should the private sector become more involved in
the NHS? The headline of opposer Ron Singer's piece has him
saying "The NHS is very efficient in its use of resources because
their use os based on clinical need not a profit
motive". The NHS very efficient?
Saturday, 4 May, 2002
Eminent cot death expert Professor Peter Fleming has been pilloried
by the think last write first hacks of the national media. They
wrongfully accused him of keeping PM specimens for himself during his
investigations. It matters not one jot to these creatures, in
today's vindictive anti-doctor country, that Prof Fleming's work has
saved numerous infant's lives. Prof Fleming runs a round the clock
bereavement service for afflicted families. It must be said
that bookseller Milburn must take some responsibility for press
Fairly typical tactics
have been used by DoH negotiators dealing with
"seniors". A 14 hour day for consultants was
rejected by the doctors but it reappeared in a DoH briefing note.
GPs are demanding more
time to fill in cremation forms if they are to be done
properly. Time is not given for full consultation with other
health professionals about the deceased.
Guys and Tommy's Med
School has had to axe 50 medical teaching jobs to help save the Trust
£3.5million a year. The government wants 15,000 new
doctors. Are the two facts compatible?
48 hour access has been
rejected as gimmicky by Scots GPs.
leaders" are asking for even more reforms. BMA juniors'
leader told Blair that doctors would welcome reforms and that it would
be better if doctors helped government get the message
across. Those statements give food for thought by over
Milburn's DoH will
establish a bedside manner training course for every doctor and
nurse. No doubt after psychometrically testing and replacing the
In a full-page feature the Association of Day Surgery says that all
elective surgery should be day case. The piece has a lot of
self-justification but not one word about those poor buggers, the GPs,
who will have to pick up the pieces for this move.
He's at it again! In a very political Opinion
Bogle is "delighted the government has rejected alternative methods
of funding". Chief servant of BMA members, Ian Bogle, is
reminded once again that when he writes as BMA Chairman he should
stick to clear BMA Policy or make it crystal clear that the opinions are his
alone. BMA policy is not that all other methods of funding
should be rejected but that alternative methods should be explored by
the BMA. In another objectionable example of political bias he
calls the Tories "profits of doom" . Apparently Labour
is all good, now he and the BMA have forced them into action, and the
Tories are all that's bad. Maybe Dr Bogle would care to
regale us all with his wisdom as to why all other methods of funding
should be rejected? That, of course, would mean that he would have
to list those alternatives and dispense with throwaway
comments. Dr Bogle told bmanews readers last week that he
held no particular political brief but, by George, he does let us know
where his sympathies lie.
The rest of this
Most of the rest of bmanews is taken up, quite rightly, with news
and features about hospital doctors. As this is primarily a GP
site, I can do no better than commend readers to obtain a copy of
Saturday, 27 April
Scottish consultants are
to be asked if they want to give up the merit award system.
unsurprisingly denies that figures for medical recruitment have been
"spun". A MoH spokesman seem to agree that they had. Dr
Bogle felt that the figures had been designed to confuse.
NI GPs say more NHS cash
would ease strains.
Proposals for nurse and pharmacist prescribing have been revealed - but
not in bmanews.
Overseas doctors, filling
the breech in the NHS dam, are being badly treated.
Army doctors - of which
there is a great shortage - have been awarded a "standstill"
pay rise. That will help recruitment no end!
The British Association
of Day Surgery, presumably without asking GPs, has said that "all
elective operations should be day cases". And who will
pick up the pieces?
Much comment about this
has already appeared elsewhere on site. That applies to GPC
statements as well comment here. As expected a significant
amount of space was used to air the issue.
Dr Chisholm did answer
some questions. One of them is worth repeating here so that
readers may tell me whether I am being thick or did he not answer
it. Certainly it was worth asking.
Although the contract deals with the problem of supply management, how
will it address the endless increase in demand for GP services?
new contract will seek to empower all patients, helping them make the
best use of professionally led services and other self-help
resources. Mechanisms for building these "empowering
patients" schemes into the new contract are being considered.
There are already initiatives under way across the UK, including
proposals to build patient education into the national curriculum in
schools. The work of the Doctor Patient Partnership, Life
Education Centres and Expert Patients Programme in England will be drawn
In short, the contract
does damn all to address the problem. Things will be much the same
as before - as anticipated - except that patients will be
"empowered" (don't politicians love their jargon?) to ask for
more or to be educated - if they want to be.
Dr Chisholm answers the
very obvious question as to why the contract wasn't costed, before being
presented, in a New Labour political fashion. Apparently
they never said it would be costed just that the framework would be
presented for approval (or not). Not an act of great political
astuteness but one which may hang them.
A final word.
The negotiators seem to think - even without pricing - GPs are in a
win-win situation. I find that a little hard to believe with
Milburn on the other side.
The apparent basis of the
new contract seems to be that if the GP wants to reduce stress and
work-load he can - but his pay will drop alarmingly (?). Not
quite what the doctor ordered after slogging his guts out for little
reward for decades. Ergo, to keep his pay up the GP will have to
work harder and isn't that where we came in?
I had a go here at Ian Bogle about the source NHS funding,
suggesting there was an alternative to totally through
taxation He replied. We differ. Members
have not been asked. CLICK
BMA GP Poll
THis has been mentioned elsewhere and seems to confirm opinion that
PCTs will not improve care.
This long piece bemoans the repeated fact that there is a shortage
of GPs and that there are few if any applicants for even the most leafy,
rural practices. Anger is expressed that notice was not
taken of warnings to the DDRB over many years. Few suggestions are
made as to the cause or the remedy but there were a lot of words.
Perhaps the small item
from Haroon Mann, an orthopaedic research fellow says it all - or
nearly. He "places" a small ad which is very
worthy of being repeated:
students with A and two Bs at A-level to work long hours a week for
approximately £5.76 per hour. Ability to make life or death
decisions essential. Experience not necessary - full
training given (six years compulsory). Successful applicants will
be at high risk of suicide, alcoholism and divorce, but those who
persevere may reach top positions after 18-20 years.
Saturday, 20 April 2002
The Headline concerned
the new GP contract, continuing on to the next page with the GPC
wish-list. No comment about wishing to be paid adequately or
at all, even. At the time bmanews went to press negotiations
were continuing. No doubt the subject will have exhaustive
coverage next week. Up-to-date news about the Contract is
elsewhere on this site (via Headlines).
There is a headline on
page 2: "21st century doctors need strong
leaders". Quite. But they don't have them.
Other items cover stories which have previously been posted on this
site, such as organ collections, locum pensions and MRI PMs. The
latter being just one consequence of the irresponsible and
ignorant mouthings of the Secretary of State over Alder Hey which may
cost lives in future.
An interesting side piece
tells us that former Aussie PM Gough Whitlam has donated his brain for
research. There is a rumour that the GPC negotiators rather
liked this idea but couldn't find one between them.
Scots LMC Conference is
to make a call for the NHS to be freed from politics. Seems
a good idea considering the experience since 1997 when the loonies were
let out of the bin.
Talking of loonies,
bmanews tells us that the RCN, under its new American branding, is
taking the NHS to an Employment Tribunal to bring nurses pay in line
with doctors. The RCN makes some comment about work of equal
value and equal pay. Although this is absolute rubbish one
has to recognise that the RCN leadership, although being atesticular,
does have balls.
In the "he would say
this, wouldn't he" section, the NHS director of Human Resources (as
opposed to canine, perhaps?) says that it is crucial that doctors
deliver on government targets (? no matter how ludicrous) if the NHS is
to reap the rewards of greater funding.
Knifeless PMs by
This has been alluded to above and on-site.
National Primary Care
Trust Development Programme (NatPaCT)
I still find it amazing that the doctors' trade union magazine can
publish political articles without political comment. In this case
a page is devoted to the inevitable formation of another QUANGO lead by
ex-GP Barbara Hakin. NatPaCT is part of the Modernisation
Agency and is intended to help PCTs meet demands from the centre without
compromising local flexibility (it says). The fact that GPs,
despite all the past government promises, have little influence on all
this, is glossed over on the grounds that PCTs are a good thing, anyway.
"It would be unrealistic for GPs to expect quite the degree of
influence they had in PCGs" says Dr Hakin - except that is just
what GPs were promised in the worthless Milburn propaganda.
An interesting and increasingly important dilemma is facing
GPs. Whether to offer guidance to patients who break the law in
this way. The conclusion at the end of this page-long piece
is that patient confidentiality still obtains - so be careful.
Doctors in Sarajevo, a GP who received a new kidney and making
employment law work. All these are well worthwhile items and
deserve the attention of bmanews readers.
Saturday 13 April, 2002
PM MRI scans
The magazine quite rightly carries criticism of another air-headed
idea from the DoH. Where do they get tham all from?
The department is suggesting that to avoid the problems created by their
own-goal at Alder Hey (PM refusals are now the norm), PMs may be carried
out by a less accurate and less informative MRI scan. Erm,
isn't there a national shortage of scanners and radiologists to scan the
living? Alan Milburn to answer, in one word, please.
Many PCTs are not yet up to the job with which they have been landed
with since April 1st. Too few staff and many of those are
not trained in primary care. Hands up all those surprised at
GPC on the road
...with details of the new contract but beware of CBEs bearing
It seems that ex-cons are turning up at surgeries, without medical
records (like the rest of the population) demanding diazepam etc
etc. GPs are concerned about this. Maybe some
worry that the cons will complain when the drugs are not automatically
handed over and that the GP will lose his job over it.
The delay in compiling the list of non-principals and the effect on
superannuation worries Scots GP. English locums are concerned
because Milburn has reneged completely on their pension rights.
GPs in the province are concerned about the chaotic bureaucracy in
the province. Maybe the quaintly titled public safety
minister in charge (shades of the French revolution) is not up to the
job and has thoughts in other directions.
Another worry for GPs
In these extremely litigious, fast-buck-for-nothing times bmanews
rightly comments about the anxieties of GPs who are asked to certify
that patients are fit for this, that or the other activity.
Unless the GP has a special training, or loves living in the high risk
lane, he should be very wary of such requests in future.
A later piece comments
similarly on GPs and sports meetings. An item on this very subject
was posted here a year ago. Return to Headlines and scroll down.
Bogle and the Budget
Ian Bogle looks forward
to the expected massive increase in NHS spending from Mr
Brown. He comments that we (BMA) will be interested to work
to see it produces a better service to patients and doctors etc
etc. He further comments that he (Ian Bogle, because BMA
members haven't been asked) favours funding the Labour party way, from
general taxation. He (Ian Bogle) would favour raising taxes for
that. Well, bully for him. I (David Roberts, a BMA Council
member) would not and my opinion is worth just as much as his although
he is promoting his views on the back of his office as BMA Council
Chairman - and he shouldn't. A letter to this effect has been sent
to bmanews but will it be printed?
The future of medical
There is unfair funding of the research system and this could
adversely affect some medical schools to the extent that they may have
to close. The BMA correctly agrees. Milburn, who needs
doctors badly, should look into this urgently. Time for a QUANGO?
More than 80% of patients are satisfied with their GP and 51% very
satisfied according to a MORI poll.
Avon Health Authority
Going out with a bang the HA says that GP treatment rooms for minor
surgery do not meet new standards. The LMC says they are
unattainable and that the serrvice may have to cease.
Meantime, the LMC says, there is no evidence of patient harm coming from
GP minor surgery. The terrified HA backed off and then said the
standards were a gold standard not hard and fast rules.
Two long articles...
...on the shortage of paediatric pathology staff (post Alder Hey)
and the NHS Frontline (about violence to doctors) are both highly
& Tony Calland
Tony reminisces about all the changes that he has experienced in his
30 years in the NHS and he concludes that the devolution to primary care
has been round the wheel before. He further states that PCTs
are not up to the job due to cash and trained staff
shortages. The conclusion is that governments should think
in ten year cycles, he believes. The corollary to that is
that major medical politicians should not be so eager to embrace
incoming government's latest wheezes even if they do vote for the Party
in question. I have no idea how Tony votes but he has held a
position of some importance for some years now. The BMA
eagerly dumped the Tories and jumped on Tony's waggon when they had an
opportunity to put chocks under its wheels in 1997.
An excellent piece by John Sinclair on MMR and single vaccines and
the murky waters surrounding the controversy. He mentions the
speculation about government advisers having financial links with MMR
companies. Undoubted links considering today's hidden
announcement that the smallpox vaccine contract has been awarded,
without good reason, to a company which funds Labour despite there being
This is a short debate between professor Black, who favours the view
that the NHS should be run by an independent institution and Dr Howard
Stoate, who does not. Interestingly, bmanews says that
Howard is an MP but does not say he is a Labour MP - a fact that colours
his views. Although personally not agreeing totally with the
professor I do find Dr Stoate's reasoning bizarre.
"Imagine", he says "an NHS under the control of a chief
executive and board who are not up to the job". It would be
very little different, perhaps even better, than an NHS under the
control of a third rate Labour party bookseller.
From Winner takes All - a piece on personal injury claims:
A BMA commissioned MORI
poll in February found that only politicians and government ministers
scored a lower satisfaction rating than lawyers. Doctors and
nurses, meanwhile, topped the poll.
And whose surprised at
that with Ministers of the calibre of Byers, Mandelsonn, Milburn, Blair,
Robinson etc etc.
Saturday, 6 April, 2002
The main topic is the
anger amongst GPs that Milburn has offered a bribe of £50K to some if
they joined PMS before the end of March. GPC says this
discriminates between GMS and PMS GPs. They have "expressed
concern" to the DoH. I suppose one day they will have the
courage to face Milburn and say what they really think in no uncertain
terms. "Expressing concern" invites the GPC to be
ignored. As, of course, Milburn will.
GPC and LMCs also express
concern, on the front page, that, surprise, surprise GPs will have less
influence on PCTs. Surely this was blindingly obvious to a
doe eyed rat when Milburn announced the scheme? It just shows what
an ineffectual lot GPs have as representatives. The leadership was
far too concerned sucking up to Blair and Co. to do their job properly
in the early days. Hence the CBE, perhaps?
ELSEWHERE in BMA News
Milburn damands that death rates be included in individual surgeon's
appraisals. There will be no meaningful discussion about
this. The consequence will almost inevitably be that
surgeons will decline to take on difficult cases for fear of being
adversely appraised. Well done, Alan. True to form.
On the same topic, the
government has reassured (it hopes) consultants that inaccurate data
about them will not be published. And the next flying pig comes by
at 4 o'clock. The BMA consultants committee has
"expressed deep concern".
The RCGP says they are not an efficient use of GP time. Having
seen this report the DoH is now about to issue a directive to GPs to
hold telephone consultations.
Wider range of GPs
should stand for GPC election
Hear, hear, I say and, considering that the negotiators almost to a
man evade regional elections and creep onto GPC through the back door of
LMC Conference and BMA ARM, perhaps they should set an example.
At last the government has been shamed into supporting a Liberal
Bill to ban tobacco advertising. It seems they failed to
find time for an identical bill last session and didn't mention it in
themost recent Queen's speech. However, its progress through
the Commons has embarrassed Blair to adopt the Bill as a Labour
one. He will, of course, grab all the credit, as usual.
The right to prescribe
The BMA and the Pharmaceutical Society have got into bed to discuss
the extension of prescribing rights. Ostensibly the conference is
about nurse prescribing but the chemists have a certain self-interest
here in that Milburn is about to announce similar rights for
chemists. The conference takes place at the Commonwealth
Institute on May 23rd.
In a very sensible letter Vice-Admiral Sir John Rawlings comments
about the unecessary nature of revalidation. As he says,
doctors are very respected and there are ways of complaining about
us. Why don't the BMA and the Colleges survey members on the
need for revalidation? Answer was there none!
This Opinion from the Editor in Chief is mainly about NHS funding
but doesn't say much about it except that an increase is needed and the
BMA was ignored some years ago when it said so. He comments
also that now the PCTs have been formed doctors have very little
influence on how the money should be spent. He sets his
place out clearly when he says he believes "unequivocably that the
NHS should be funded through general taxation"". With
all due respect he is in no position, as a trade union leader, to say
that. He should be unbiased and listen to both arguments and
Council should make a decision, not the Chairman. In this case,
Bogle appears to dismiss the Opposition's view point out of hand by
sticking unequivocably to the Labour line.
Why is he still sucking up to Blair on our behalf?
Off the record
Andrew Dearden of GPC recently gave evidence on bed blocking to a
Commons Select Committee. During the hearing a smug Labour member
of the committee accused the BMA of overstating the problem.
Quick as a flash, as they say, Dearden apparently said that doctors
could never be accused of that and perhaps the politician was joking, or
at least, Dearden said, "I will take it as a humorous remark"
and, if the problem weren't as serious "as we say we wouldn't be
debating it here today". Full of sharp remarks, Dearden told
a triumphant Tory "I'll slander everybody
equally". Make what you like of that but BMA News
devoted half a page to the exchange.
Mentally Sick doctors
A useful double page spread sets out a case for caring treatment by
specialists away from the area of practice. Apparently the DoH is
not unsympathetic to the idea which is not the same as saying they will
do something about it. The piece emphasises the problems for
doctors who fear being in the same waiting room as their patients and
therefore are tempted to self medicate. A mentally sick
doctor is unlikely to get his own diagnosis right. A short
supplementary piece by a manic depressive doctor bemoans the fact that
few GPs know much about mental illness - in his opinion.
Consequently he shops around regularly to find one who does thinking his
life may depend on it one day.