"bealoid" wrote in message
oups.com...

Styx wrote:

snip
Would this surgeon have applied the same criteria to, for example, a
rugby player? I very much doubt it.

I don't really think a rugby player is in the same category as a
self-harmer. A person chooses to participate in a physical pursuit
hoping that they don't suffer accidental injuries as a consequence (and
most of the time they probably don't),

I accept that there are differences, but what about the person who
keeps getting injured after playing rugby? (If someone can provide a
better 'similar case' I'd be grateful.)

Boxing or another full-contact sport.

bealoid wrote:
Steve Walker wrote:
bealoid wrote:

I see that I haven't been clear enough, so here's an example:

Fred self harms.The A&E doctor tells Fred that Fred has caused
some damage that requires surgery.
snipped for brevity
The surgeon turns up and says something along the lines of "You've
done this before, you'll do it again, there's no point giving you
the surgery" and chooses not to do the operation.

OK - Here's another example :

A very good example, but there's a big difference between something
that's a feature of a complex illness, that's addictive and impulsive
etc, and tattoos.

That's perhaps arguable, if Sharon has demonstrated a repeated pattern of
this behaviour then it's probably capable of being categorised as Deliberate
Self Harm, indicative of depression or other mental ill-health.

There's also a difference between the outcomes; having a tattoo
doesn't physically stop you doing anything. Not being able to move
your (for example) little finger does.

Physically, you're right. But I could get a respectable job with a trivial
disability, and I could live my life as an ordinary member of society. If I
had a spider's web tattoed on my face however, I would be hugely impaired.

On Jan 8, 9:10 pm, Old Codger wrote:
Nick wrote:

On Jan 8, 9:30 am, "bealoid" wrote:
Steve Walker wrote:
bealoid wrote:
I see that I haven't been clear enough, so here's an example:
Fred self harms.The A&E doctor tells Fred that Fred has caused
some damage that requires surgery.
snipped for brevity
The surgeon turns up and says something along the lines of "You've
done this before, you'll do it again, there's no point giving you the
surgery" and chooses not to do the operation.
OK - Here's another example :A very good example, but there's a big difference between something
that's a feature of a complex illness, that's addictive and impulsive
etc, and tattoos.

There's also a difference between the outcomes; having a tattoo doesn't
physically stop you doing anything. Not being able to move your (for
example) little finger does.

There's another difference: Choose and Book means that Fred can go to
his GP and ask to see a number of local surgeons.

I would also like to comment on Choose and Book - leaving aside mental
health issues.

I worked closely with a C & B coordinator when I worked for one PCT.

I was therefore rather surprised to read the suggestion in this week's
Private Eye that a 78-year-old man was left by his doctor to make his
own appointment using his own PC - for some therapy, I think.

According to

http://www.chooseandbook.nhs.uk/patients/how/booking

One of the methods is:

"book your appointment with your GP or a member of the practice team"

The fault was clearly with the GP for sending him home to make the
appointment rather than making the appt for the patient at the surgery
- in fact, one of the points he made was that he didn't know anything
about the myriad options offered him - well, that is what the GP is
supposed to do with the patient.

The writer of the Eye column is, I believe, Dr Phil Hammond and it was
clearly easier to blame the NHS than his own GP colleague.If you read NHS Blog Doctor you would have noticed that he also believes
the patient has to make the actual booking. All the emphasis appears to
be on the patient having choice (actually less choice than before Noo
Labour) and therefore actually making the booking. Even the option you
reference says "book your appointment with your GP or a member of the
practice team". The clear inference is that it is still the patients
responsibility to make the booking.

As the Bradford PCT website says:

http://www.bradfordcity-tpct.nhs.uk/Choose+and+Book/

"Patients can either book their appointment electronically immediately
with the GP or other practice staff, or they can call a telephone
booking service or use the internet at a later stage"

This is supposed to be patient choice so that is the emphasis placed.
Equally if one was talking about completing a form the presumption
would be made that someone was going to fill out the form for
themselves - it would be rather paternalistic to do otherwise.

But offering someone help if they needed it.

One doesn't know if the fellow was trying to be independent and this
was rather complicated - or the surgery didn't offer him the help that
they should have done - but the most sensible would have been for him
to contact his surgery for them to sort it out.

Nick

On Tue, 9 Jan 2007 19:30:05 +0000, "Steve Walker"
wrote:

Physically, you're right. But I could get a respectable job with a trivial
disability, and I could live my life as an ordinary member of society. If I
had a spider's web tattoed on my face however, I would be hugely impaired.

Perhaps slightly off the topic but perhaps tattooists should be more
controlled. If I go to an S&M parlour and have some heavy duty sexual
procedure which causes me injury, I can sue for assault even if I have
given my consent to the "treatment". If I go to a tattooist, I could
have a totally disfiguring tattoo but the tattooist is not liable
provided I gave consent.

I think anyone going for a tattoo should have some counselling about
the possible adverse effects of the procedure.

--
Alasdair.

On Wed, 10 Jan 2007 02:00:07 +0000, Alasdair
wrote:

On Tue, 9 Jan 2007 19:30:05 +0000, "Steve Walker"
wrote:

Physically, you're right. But I could get a respectable job with a trivial
disability, and I could live my life as an ordinary member of society. If I
had a spider's web tattoed on my face however, I would be hugely impaired.

Perhaps slightly off the topic but perhaps tattooists should be more
controlled. If I go to an S&M parlour and have some heavy duty sexual
procedure which causes me injury, I can sue for assault even if I have
given my consent to the "treatment". If I go to a tattooist, I could
have a totally disfiguring tattoo but the tattooist is not liable
provided I gave consent.


What on earth makes you think that?


--
Alex Heney, Global Villager
Madness takes its toll. Please have exact change.
To reply by email, my address is alexATheneyDOTplusDOTcom

Nick wrote:


Resource issues are clearly a fact of life, but I don't think that
doctors are supposed to take that in to account when dealing with
individual patients.

The General Medical Council says otherwise: see Good Medical Practice
2006 section 3j.

On Jan 10, 6:45 pm, (Andrew Cook) wrote:
Nick wrote:
Resource issues are clearly a fact of life, but I don't think that
doctors are supposed to take that in to account when dealing with
individual patients.
The General Medical Council says otherwise: see Good Medical Practice
2006 section 3j.

Thanks for that link.

http://www.gmc-uk.org/guidance/good_...MC_GMP_V41.pdf

But to be fair the full list is as follows:

"3 In providing care you must:
(a) recognise and work within the limits of your competence
(b) prescribe drugs or treatment, including repeat
prescriptions, only when you have adequate knowledge of
the patient's health, and are satisfied that the drugs or
treatment serve the patient's needs
(c) provide effective treatments based on the best
available evidence
(d) take steps to alleviate pain and distress whether or not
a cure may be possible
(e) respect the patient's right to seek a second opinion
(f) keep clear, accurate and legible records, reporting the
relevant clinical findings, the decisions made, the
information given to patients, and any drugs prescribed
or other investigation or treatment
(g) make records at the same time as the events you are
recording or as soon as possible afterwards
(h) be readily accessible when you are on duty
(i) consult and take advice from colleagues, when appropriate
(j) make good use of the resources available to you.

This is preceded by:

"2. Good clinical care must include:

(a) adequately assessing the patient's conditions, taking account of
the history (including the symptoms, and psychological and social
factors), the patient's views, and where necessary examining the
patient
(b) providing or arranging advice, investigations or treatment where
necessary
(c) referring a patient to another practitioner, when this is in the
patient's best interests

One would have to ask the GMC about this but clearly _not_ making good
use of resources available to the doctor would not be to the advantage
of the patient.

Nick