annaj

Anyone else feeling quietly smug about the decision to avoid Facebook?

I would've said no-one, but after a quality 10 minutes on my old school's website I can tell you Edward Jenner, discoverer of the smallpox vaccine, went to my school. Not as cool as a bunch of celebs, obviously, but it is posssibly the only disease to erradicated worldwide by vaccination.

Sorry, to start another cat thread.... But this big, bruiser has been hanging around our garden for the last two days and coming in through the cat flap at night. We wouldn't mind, but he howls at night loud enough to keep waking us and is terrorising our two cats. Based on his back view I'd say he's an un-neutered tom and he doesn't wear a collar. I'm going to knock on a few doors later and see if he belongs to anyone, but I thought I'd put him up here too.

Just got our internet connection back after 36 long hours without. What fantastic news to come back to! Congratulations to a lovely couple. x

Speechless. The Archbishop actually sounds like he wants us to feel sorry for, or even proud of, people who have abused their position of trust and power, in the worst possible way, for decades, becuase it takes "courage" to face what they've done. It's.... I'm.... but.... I mean..... Nope, too appalled to form a sentence.

Do you really think I'm going to get draw into another medical debate? My default response to subjects like this is to see what Dr Goldacre has to say, but I can't tell you what that is, because his site is blocked at work. But I can tell you that ear infections are nothing to do with bones pressing together and often don't need antibioitcs either. Edited to say that work have miraculously unblocked bad science - hurrah - and there's an article all about it there, just put Dr Singh into the search box. Oh and also well done Reg for raising the subject.

Porky? Hardly. She's not stick thin, but she's a long way from fat. The fact that she's regarded as porky or chubby, when in fact she's pretty normal, just shows how distorted our perception of ideal body size has got.

With each other? I should hope not. What would MrsKeef and LadyMac do? Thank goodness you travel by bus Sean!

But confidentiality is an obligaiton to the patient, not the employer. Ok, one more link this time to the NMC panel's judgementwhich is extremely interesting (as an aside it would be equally interesting to know how many people on this thread have actually read it)and sets out very clearly why it was a breach of ethics and why the sanction was so strong. Edited to say that I realise you can get to the judgement linked here either via the link to the NMC website posted on page 1 by antijen or from the piece in the Guardian posted by TedMax, but I thought it might be useful to have it as a separate link so it's easy to find for anyone who's interested. Not that many people are by now.

Good thread CC Here are a few of mine The view from Westminster bridge. Fresh crusty bread and butter. Good buskers, my favourites are the man who plays the cello on the Southbank and the group that play outside the Crusted Pipe in Covent Garden. My cats (although they could also go in the small things that cause irrational rage sometimes) Eating breakfast outside. Small acts of thoughtfulness or kindness from friends. And spring spice fudge from the Northcross road fudge lady (that's one I've just discovered today)

Very good PGC. Made me giggle.

Happy Birthday AllyCat! And many happy returns to the coolest tweed wearer in ED. x

No, my standards of confidentiality would not, and do not, compromise my standards of care. If I knew or believed that a patient was being abused I would take action to prevent it, including, if they did not have capacity to consent, breaching their confidentiality if it were the only option. What I don't agree with in this case is that it was the only option, or that the Panorama programme was the fastest or most effective way to effect change. Ms Haywood started secretly filming in November 2004 and the programme was screened in July 2005. That's eight months. Not that fast at all really. And the screening itself was only the start of change, it then took questions rasied in parliment after the programme before anything happened. I have duly noted that some of your immediate family are doctors, including senior doctors, thank you. As it happens so are mine, it's a profession that for some reason often runs in families, but I don't see what bearing it has. I am talking about my own experience here, because ethical and confidetilaity decisions are something I face every day. That's why I know the system and the rules.

90210. I am ashamed.

Sherwick, yes I did say I wasn't in possesion of all the facts, becuase I'm not and neither are you, unless you were at the enquiry, and neither is anyone else on this thread. I am just the only person who seems to recognise that fact. We are all speculating and opinionating. The rest of your points are your opinion and nothing more and you are entitled to them, but I disgree, and your argument hasn't swayed me any more than mine has you. But please, stop questioning my professionalism and satndards of care, you have no right to. I have no idea what you do for a living, but whatever it is it would be rude of me to come on here and imply that you were rubbish at it, when I actually knew nothing about you or the job you do. The fact that I respect confidentiality doesn't mean I don't care about my patients and their care and to suggest that it does is most offensive.

Does this mean you're leaving? I hope not, because although we don't agree, you seem to be actually reading what I'm posting. I accept that you don't think you were pushing me for an opinion, but your posts read very much as if you were. And as Hugenot pointed out, I think I am as well placed as anyone else to have an opinion, since I have both researched this specific case and have an up to date and thorough knowledge of medical ethics in pratice. I disagree that this case shows that the rules on confidentiality have to change or that there is widespread confusion within the professions about it. This case proves that at one unit there was an unacceptable level of care and the systems in place to prevent that and protect the vulnerable failed. And it proves that if you break the, in my opinion, known and understood code of practice you will face sanctions. I do not accept that there was no possible way to take consent from the individuals filmed and I do not accept that a television expose with pictures of patients was the only way to change things and nothing that anyone has said has changed my mind. Even accepting that the normal channels of complaint hadn't worked there is always a higher level to report to - the NMC, the Health ombudsman, the police even if you have witness abuse, before the media. And even if you felt the media was your only choice than was it necessary to show individuals and if it was why on earth not take their consent? Confidentiality isn't hard to understand it's very, very simple. We all have a right to privacy and control over information about ourselves and our health. Finally, and please correct me if I wrong, but you seem to imply that abuse of terminally ill patients is a widespread problem. Is that what you're saying or have I misread? And if so, what is your evidence for that?

As I said four posts up MM, but I don't think anyone is actually reading my posts.

antijen, I'm not a moderator or andminstrator and haven't accused you of breaking any rule, because as far as I know you haven't. I did draw attention to the fact that I believed Greegz to be a friend of yours who had registered to support you, because, as I said, I prefer these things to be out in the open.

No antijen, I haven't said follow rules regardless. I have said do everything in you power to adhere to the ethical principles that guide your profession, because they are important, and if you feel you have absolutely no choice but to break them, then accept that you may lose you registration as a consequence. I don't believe that a TV programme with pictures of patients was the only way change could have been acheived. I don't believe that not obtaining consent form every patient filmed, not just every patient "featured" was justified. I do believe that this nurse believed she was doing the right thing and feel sorry for her having lost her career. As I say, I have answered every question and accusation leveled at me, you have not answered any of mine or responded to my attempts at reasoned debate except to insult me. And as for the evidence that I have been accused of not providing, and since you and Greegz are so keen on links, here are The GMC Guidelines on Confidentiality Of particular interest are points 22 and 23 Disclosures in the Public Interest, which state that consent should be obtained unless it is not possible to do so, and in this case I believe it was possible. And section 29 Disclosure where a patient may be a victim of abuse or neglet which advises that confidentiality can be breached to without consent only if the patient doesn't have capacity to consent, and then only to a senior colleague or statutory agency, which in this case could have been the cheif executive, the director of nursing or if that was ineffective the NMC or the Health Service Ombudsman, but not the nation via a television programme. Now, obviously, I realise these are GMC not NMC guidlines, but as I said earlier I am talking about doctors because that's what I know about and since I have been accused of being uninformed I felt it best to stick to what I know. And in case you're wondering why I continue to defend myself despite saying that I'm going to walk away, it is because you continue not only to misrepresent me and insult me but also to question my professional ethics, which I find not only upsetting, but very difficult to accept when you seem to have so little understanding of the issues I am talking about. Edited to say - cross posted with a couple of post there and so it looks like I ignored them, which I didn't. Greegz, no there's nothing wrong with sharing opinions and internet connections with another user, it's common knowledge that one of the other posters on this thread is MrJ, I just prefer openness. As I said in my last post I have reserched this case away from the forum and as it happens, my conclusion is that the judgement was technically right, although I think a lesser sanction than being struck off would have been more appropriate. The GMC often advises supervised practice or specific retraining and I think the NMC is harsher in it's judgements and not always rightly so. The reason I initially said I was reserving judgement was that, believe it or not, I wanted to open debate without being antagonistic to those supporting the petition. But since you insist on an opinion, there it is. Nice debating with you to, you seem to understand the concept better than your friend/aquantance/significant other/internet connection buddy antijen.

*sigh* Greegz, ignoring the fact that that you registered four minutes after antijen was last online specifically to post on this thread, I'm going to give you the benefit of the doubt and assume that you're not in anyway related to antijen and answer you're accusations (probably against my better judgement since I've been persistently misunderstood, misrepresented and insulted on this thread) I have read all the links posted, but I still don't consider myself to be in possession of all the facts, because I wasn't at the enquiry and so didn't hear all the evidence presented. The links only provide selectively reported highlights and have all been posted by those who disgree with the panels conclusion and so are inherently biased. Wider research on the case reveals, not surprisingly, a wider range of opinions, some which reflect my own, but none of this gives me the full facts of the case. I was offended by the Neuremburg reference, because at no point have I said that I, or anyone, should "just follow orders". To say that I have is either to have entirely misunderstood me or it is a deliberate attempt to undermine my argument by alluding to nazis. I think I had every right to be offended by it and to counter it. I resent being called uninformed when, in fact I am very well informed on the subject of medical ethics, whereas antijens posts are scattered with misinformation, from her original assertion that we all swear the hippocratic oath to the misunderstanding of the issues around end of life confidentiality. I don't consider myself better than anyone else just because I have a qualification, but this is something that I know a lot about and I think it's ok for me to engage in debate about it. I have answered, I think, every point rasied against me with reasonable, rational and well informed arguments and in return I have been insulted and accused of all kinds of things from not caring at all about my patients to reminding antijen of Neuremburg (although, of course, that wasn't calling me a nazi). I think it's time to walk away from this one. Think what you want of me antijen and Greegz, I'm proud of what I do and the way that I do it and I live quite happily with my conscience.

Antijen, I took this this to be a reference to nazis, as did most people I would guess, and I was both uspet and offended by it for several reasons. Now, to try and unravel and answer your points. I think it's very reasonable and healthy to try and avoid EDs wherever possible, after all, as the name suggests they are for Emergencies and most of us hope not to encounter too many emergencies in our life time. I didn't say that my department is a utopia or that the NHS is perfect, I said that I am proud of the standard of care provided in the department I work in. I know a lot about the inequalities of care in different areas as my specialist training requires me to move around departments in the South East. So, for example, a few years ago I moved from a major teaching hosptial to a an outlying district general with an ED scheduled for closure. The difference in the standard of treatment we were able to offer, due to lack of resources and staff was noticable (although the standard of basic and nursing care was good in both departments) and I did everything that I could on and individual and departmental level to improve that for my patients. Because, of course, I agree that it's unacceptable for the standard of care to be different depending on where in the country you live. But regional inequality in health care, the reasons for it and the solution to it is a completely different debate. Now, to move on to your example of the family of a dying patient being told their diagnosis. If the patient had expressed a wish for their family to be told, obviously they would be. If the patient had expressed a wish that their family not be told, then they should and would not be told as this would be a breach of confidentiality. If the patient had expressed no opinion either way and was not in a position to do so and the doctor had no reason to believe that the patient wouldn't want their family to know, it would be reasonable to tell the family the diagnosis and prognosis, because it would seem to be in the patients best interest as it is reasonable to assume that most people would want their family to know. But there is not "tradition" amongst doctors of routinely breaching confidentiality of terminally ill patients, far from it, in the context of end of life decisions confidentiality is arguable even more improtant. When a person is facing death one of the few things they can retain control over is their own information and we have a duty to maintain that for them. As for patients' names being called in a waiting room, well, that's interesting. You are right that strictly speaking it does constitue a breach of confidentiality, as do the patient name boards in wards that are being phased out now, but it is different to the old man being shown in the background of a TV show without his consent. In a clinic the only people who hear the name being called are medical staff and other patients and relatives. It's not ideal, but in terms of exposure, it's a long way from showing pictures of someone on national television. In areas where confidentiality is particualrly important, like the GUM or HIV clinic, patients are called by number not name, and you could argue that this should be done in all healthcare settings. Now, back to the point. I'm going to say this for the last time now, so please, read carefully. I am not saying that this nurse was wrong to drawn attention to the failure of care that she witnessed. I believe passionately in the rights of all patients to recieve an acceptable standard of basic nursing care. I am saying that confidentiality is an extremely important principle and cannot be tossed aside on the grounds that the ends will justify the means. And I am saying that in this particular case, partly because I don't know all the facts and partly because it's complicated and I just can't decide, I don't know if the breach of ethics was justified or not. The doctor patient relationship relies entirely on trust and respect. Being a doctor and having people, literally, trust you with their lives is and honour and a piviledge and we owe it to our patients to treat them with respect, dignity and privacy. Without confidentiality and trust the relationship just doesn't work.

Happy Birthday LadyG Hope you're drinking something lovely somewhere fabulous. x

Just two more things, then I think I'll leave this alone... But it is confidential information. So an elderly man, whoses consent was not taken, is shown in the background. He's not just an anonymous old guy on a ward he is a person with a right to privacy and confidentiality. What if no-one knew he was on that ward or even ill and he didn't want them to? What if he finds his illness and infirmity embarassing and was humiliated to see himself on TV? There are numerous reasons why that could've caused harm and the fact that fortunately, as far as we know, it didn't doesn't mean it didn't break the rules. It's not ok to break the law as long as there are no consequensces, is it? And antijen, back in your original post you mentioned The Hippocratic Oath which, just FYI, nurses have never sworn and doctors haven't, in this country, for years (have a careful read of it and you'll probably see why, it's pretty dubious in places by modern standards), but if you read it you'll see that even that ancient document recognises the importance of confidentiality...

Oh dear, I go away for a few hours of hands on patient care and look what happens. Let's be clear here, I started by saying, and have said several times, that I'm not sure what the answer should have been in this particular case and I'm neither supporting nor condeming the panel's decision. What I was trying to say is that it's a bit more complicated than the ends justifying the means in that it involves a complex and important ethical principle which was breeched. Ted Max, interesting. The panel's statement certainly does seem to contradict itself, or at least make a major U-turn, but as I say, I'm neither supporting or condeming their decision as I wasn't there and didn't hear all the evidence. Antijen, your post seems to imply that anyone who doesn't entirely support this nurses actions doesn't care about their patients which is unfair on those of us who spend our lives caring, but also believe in the underlying ethics of what we do. As for your emotive tales of patients waiting untreated in A&E corridors, I'm fairly sure I spend more time than you in our local A&E department and have more first hand experience of the standard of care provided and I have to say I'm fairly proud of it. And then you went and compared everyone who doesn't agree with you to nazis which is, well, nonsense. On a personal level I feel deeply saddened that this nurse felt she had no choice, but to take the action that she did and that the system failed so completely to care for it's most vulnerable patients, but was the decision right, I still don't know.

Jeremy, it's clearly popular as it's usually busy in the evenings and weekends, so yes, there's a demand. And as I said, as far as I know it's just redecoration, not a seared tuna and couscous invasion.