Sunday, February 24, 2013

I walk English, I talk English...

So it has come to pass. Finally it had to come to this...the death of someone caused by a professional who didn't have enough grasp of the English language. And for us as professionals, a sigh of relief that it now will be taken seriously enough- although the circumstances that has made this come to light couldn't be more heart breaking -especially for the family concerned.

It has always been a mystery for me. When, far back in 1997, I decided to take an exam to enter into the UK system of medicine, there was an obligatory rule to have been able to show proficiency in the English language. There was an exam called IELTS and for the purpose of this blog, I fished it out from amongst the dusty collection of one of my files. Interspersed among those early year certificates, sat ensconced the IELTS certificate. There were 4 categories that one had to pass (Listening, Reading, Writing and Speaking)- and simply put if you didn't pass this exam, you were not allowed to even sit in the entrance exams which would grant you eligibility to enter the UK medical system. And quite rightly too...I wouldn't expect or even want an Englishman to come to a rural part of Calcutta and eke out a living without the faintest understanding of what the local language was, so why should it be the other way around either? The world may think that India in its economic boom are all swanky English speaking they aren't... that's the externalised view one fact there are swaths of areas where the English language has as much understanding as say..Klingon. Anyhow, I digress.

For folks like me the exams, in all honesty, was a doddle. That was because  I or shall I say, kids who came from our background were educated in convent schools and English was the only language spoken. In fact, I still remember times when students were fined for speaking Bengali on school grounds, situated in the heart of Calcutta- as they had to know and learn to speak English, A catholic school had its advantages- and spending 12 years of your life saying the Lords prayers was no my dad said..."Not really fussed which God you pray long as you get your grades right!". You see in those days- and maybe even now, political correctness had little place for existence...did that stand me in good stead? In two words..Hell Yeah. Come the along with most of those who studied in schools such as St Xavier s school, Don Bosco School, La Martiniere, Loreto etc etc...breezed through the exams. But there were also a significant majority who either by choice or due to sheer lack of finances couldn't attend such schools...and they spent hours attending coaching classes, listening to tapes, getting ready for the exams...sometimes even failing the exams, retaking it- and THEN having to sit through the medical entrance exams..all for the proverbial pot at the end of the rainbow..the opportunity to work in Britain.The determination on their part to learn the nuances of a new language was only to be commended and admired.

And then we came find that medical graduates from the EU were..exempt. Poor souls that we were, we assumed this was "OK" because surely anyone European or coming from those countries knew all about English..surely? And then reality happened. We saw droves of people of different nationalities with shockingly poor English, people who couldn't read, write or even speak properly. Attempts to raise, even gently, any such queries got stonewalled by the political correctness brigade. After all, lets not anyone feel bad that they couldn't speak the local language...who cared if a profession based on the bedrock of communication suffered a tad or two? At the level I am, one can only reject such folks based on CVs or recommend they don't work any more in the hospital...but a nationalised system to flag such folks? A simple check to suggest that they were proficient in English? Dream on brother.

So fingers crossed..maybe things will improve. And for the Daily Mail or its readers, don't jump on to the "foreigner" bandwagon. The ones you guys spend so much time directing your ire at..those folks from the African continent, Indian subcontinent or anywhere in South East Asia...we ALL actually did an exam. Its just that there has never been any uniformity for similar folks for whom English wasn't the first language..their get out clause was that they belonged to the European hopefully finally there will be. Hopefully there won't be another incident like this..its just a sad indictment of the times that it takes a fatality to raise such issues. The million dollar question is what it will achieve.

If there ever was an example to show that political correctness for all its worth sometimes needs to take a back-seat it is. If someone who is dealing with lives doesn't know the language in which he is communicating with the patient, then asking him to stop working or withholding his permission to work isn't a breach of anyone's human rights. Its simply about actually saving someone from poor care.

Tuesday, February 5, 2013


So we have it.. The Francis report is due or is out by the time you read this- and without even pouring through the details, we pretty much know what its due to say/says, in Roy Lilley's words…”the NHS will stand there, stripped of its false pride”. And on a bigger scale, we will see what we hear happens in small measures every day in our working lives, which we have accepted as the norm… a culture of blame, lack of accountability, unwillingness to accept responsibility…the atmosphere of learned helplessness all pervading, eating into our collective consciousness.
We could and for certain will, spend reams of newspaper reel, blog updates soul searching, trying to understand, trying to explain…but what perhaps is more important should be the question…what now? Are we as a collective bold enough to bow our heads down, say sorry and then get up, as a collective to say, never again? Can we make sure we halt obfuscation in its tracks and say no more? Could this be the moment of catharsis for the NHS or would we slip back again towards a culture of acceptance, explain it away as the past and that alls well now?

Catharsis, from the Greek word “Katharsis” means "purification" or "cleansing". Could this possibly be that moment of the NHS? No longer should it be acceptable for a specialist Consultant to refuse to see a patient because “I don’t do generalism”, no longer should we allow professionals to dictate services based on their needs, not their patients, no longer should we allow a manager to lecture a doctor about "appropriate" Trust policy or complicated forms to fill, that stops him from raising patient safety concern. No longer should it be allowed to call patients “clients”- stop trying to learn from the hotel industry, the airport industry- and please, just do what is the essence of this industry- Caring.

Are we ready to do this? Yes, individually, we all must be. This should not degenerate into a debate about whether the private sector could do better. Yes, the NHS of old has failed them- but it’s the personalities within who have, not the concept of the NHS. We talk about the profit margins the private sector would aim for, cutting services. Please let’s not disillusion ourselves its not happening already…every referral that is stopped by a vetting centre inappropriately is exactly that, every debate one has about QoF points and profits for GP surgeries is nothing more. Competition only goes so far…but when you run out of money, you collaborate and work together within your means, not cut corners to maximise the profits and balance the spreadsheets. The day you start doing it…you have on your plate what Mid Staffs has presented us with….a naked, shameful saga without any excuses…a tale where doctors, nurses and managers forgot what they chose this job for.

Maybe it’s the naivety of youth which prompts such despair, maybe it’s the ethos that my dad taught me but we must do better. We are at a situation where nurses have to pledge to the 6 C….a great concept- but why do you have to remind people of compassion and care? Isn’t that what this is all about? I feel bitterly disappointed that as a collective we have failed patients to this extent and it burns me to think that so much of it was preventable. It is a shameful indictment of what we have let things to become.

NHS Pledge Day approaches and rather than convert that day into yet another sound bite, there’s only 1 collective statement and pledge to make..”..We are sorry. And never again”. Anything else is simply...meaningless.

Saturday, February 2, 2013

SoMe & Diabetes..a happy marriage?

So what is SoMe (social media)...just a new fad or something which could help the world of diabetes care? The words "Facebook" and "Twitter" seem to generate 2 opposite poles of viewpoints in the world of diabetes. There are the evangelists who believe the key to improvement lies only with this medium, an untapped source begging to be used and a forum which could dissolve the divide between professionals and patients. And then there are the traditionalists who see this as a passing fad, one that is for "youngsters", one that is fraught with the risk of confidentiality issues or even patients getting too close.
The truth as usual perhaps lies somewhere in between and below are my experiences of my foray into this world where not many tread...
As someone who uses all these forums regularly, my personal choice has been to reserve Facebook for close family and friends, intermittently using it to highlight any local accolades but generally for personal messages, contacts, networking but as a rule, never for any patient contact. I have had "requests" from patients but have steadfastly stayed away from them, as I have always regarded this forum to be my personal space. However, there is the potential for this forum to be used for patient benefit. Prime example?Ninjabetic, which over the last year or more,has become a strong forum for type 1 patients, local and afar, interacting and communicating, learning from each other, appreciating they are "not alone". On a personal level, I have helped with generic advice such as "tips for the festival season" bearing in mind teenagers, their love for music and alcohol and simply put, the struggle of adolescent hormones while having to deal with Type 1 diabetes. Tips given on this forum have been appreciated, but I have stayed away from personal advices and when asked, have asked them, if appropriate to contact their local professional. Some departments are also setting up Facebook profiles to use as an information portal for their patients, perhaps more aimed at the younger group, but one underestimates the potential of Facebook by simply tagging it as one for the youngsters.

Twitter has however been a different matter altogether. Again, personal experience suggests that the benefits have been two fold. As regards patients, it has been educational, if not sometimes humbling, to learn of the challenges they face, the lack of services they perceive to have or even the desperate cry for psychology support needed at all ages. It has also reinforced my belief that we, as professionals, need to change, not see patients on our terms, but perhaps, at times of convenience of patients. Access is a big problem and twitter has given me the education that we need to provide this in a much more innovative way than we do now. The world has moved on from traditional letters, even emails nowadays are passé...we are now in the age of direct messages, texts...and we need to perhaps respond accordingly.

Twitter has also been fantastic in interconnecting people with perhaps similar mind sets, passionate, committed and with strong views. Once again, I have found this to be extremely useful, exchanging views with policy makers, debating issues with primary care colleagues and constantly learning. it makes you see the bigger picture, or at least, for me, certainly has helped me develop. One could even say that this exchange of information,Whether it be patients or fellow professionals, has been worth more as regards continuous professional development, than any lectures I have sat through in the event past. Once again, I have stayed away from personal health related queries for confidentiality issues and advised guidance from local professionals.

Finally as regards blogs, there have once again been a 2 fold benefit. Firstly, Twitter is a forum restricted to 140 words. On one hand, it encourages people to come straight to the point without leaving any room for preamble etc, while on the other hand, it leaves one a bit incomplete as to whether the whole picture has been conveyed. Patient blogs have been fascinating to read (take your pick from Laura, Hannah, David, Yas, Dannie et al) and once again been an educational and learning experience for me as a healthcare professional. Secondly, personal musings on a blog, albeit my own views, not only gives one a forum to air views about healthcare, what one can change, what should change but also perhaps cathartic. Criticism is what makes a democracy tick, (and constructive ones help people and organisations, if wiling, to develop further) but this should not extend to personal attacks laced with vitriol. if anything, such occurrence, lessens the impact of the blog and the writer.

Personally, I see social media developing as an adjunct rather than replacing anything big in the healthcare sector. As an educational forum, it can be an excellent vehicle and perhaps could also become a vehicle to help professionals interact better with patients and fellow professionals. The confidentiality issue will however need to be tackled and security of these vehicles still need further work before any direct health related advice can be given. The GMC has some available guidance for professionals, as are the RCGP coming out with one. However, the key is to use any of the forums in a manner which is professional and not seen by any individual or organisation to be compromising confidentiality or questioning integrity of others.Examples abound of professionals who use this forum in a responsible or judicious manner, whilst also contributing to diabetes care- step forward Dean, Annie, Simon and Sandeep!

At the end of the day, we need to ask ourselves whether any of this will help the patient or for that matter, any specific group.. If the feedback from patients is that "this" is the forum they would like to use, then as professionals, it's our responsibility to make it work. As mentioned previously, the days of "us" seeing patients on our own terms is dying a slow death...we need to ensure that we can rise to the challenge and use existing forums to suit patients, especially in a disease process, where engagement is the key mantra.