Summer and waste

Sitting in out-patients today. Slow day, lots of DNAs - 'did not attend' for the non-cognoscenti. Good weather outside, so lot of people didn't turn up. Result doctors and nurses sitting twiddling their thumbs. Lot of money wasted. Waiting lists get longer. Some hospitals and GP surgeries have suggested introducing a charge for non-attendence, ie. you pay upfront before the appointment day, if you turn up you get the money back, othewise you don't.
Seems like a good idea, however if you read the book Freakonomics then you may not be surprised if the opposite happens, especially if the charge is nominal. Logic according to the book goes like this - if you don't turn up, most people would feel guilty and hence will try and turn up, if you introduce a charge, guilt is expiated and hence less incentive to turn up. Or in layman's terms - reverse psychology. Introduce a hefty charge and you risk protests and also will target people with genuine reason for non-attendence.
No easy solutions.

Scrubs makes internal medicine cool again

Internal medicine had always been the less glamorous of medical specialities, especially compared to surgery. All those soaps featuring cardiothoracic surgeons, neurosurgeons, plastic surgeons - they are all about heroic surgeons.
Forget American TV, even British one are mainly about surgeons or A&E.
Now there are two medic centric ones - scrubs and House. House always makes me angry - outlandish medicine and even more outlandish residents who do everything from pathology to angiography. Nobody has heard of specialisation in House let alone subspecialisation.
Scrubs is my favourite medical serial at the moment. One of my young nephews now wants to do internal medicine - all due to scrubs. Couple of years ago all of them wanted to surgery, Scrubs has made it cool to be a medic again.

Bed cuts in NHS

Just read the news today that NHS has shed more than 30,000 beds over the last 10 years. As a junior doctor working in a busy DGH (District General Hospital to the uninitiated - ie. a secondary care hospital with some amount of tertiary care facilities), I guess I am in the front line of this unfolding disaster.
Our own hospital is buiding a new hospital which will result in loss of 300 beds when we move from the old buiding to the new one
To practise this bed cut, management has decided to close two care of the elderly wards resulting in loss of 60 beds in medicine.
Given that the hospital is already running at >95% bed occupancy, the logic behind this move is impenetrable. With average age of the punters coming in being around 75, closing care of elderly and rehab wards obviously makes sense!
Another reason being touted around is, with summer around the corner admissions will fall and hence if the closure doesn't lead to disaster, it can be hailed as a success and will justify further bed cuts when the new hospital comes up.
During winter we were opening temporary wards to cope with sheer number of sick people. Red alerts for bed status were the norm every weekend. With winter over we are barely coping with huge pressures to discharge early. Just how the hospital is going to cope in next winter is going to be interesting for me, as I will be moving to another hospital by then, but as you can imagine, hugely stressful for the staff here.
What all this does to spread of hospital bugs and patient care is a rant for another day.

Begining of a journey