Mesh implants and “fully informed consent”

Hole Ousia

Since my last post on PE1571, Polypropylene Mesh Medical Devices, there has been further consideration of this petition, with evidence given by Dr Wael Agur and the petitioners Elaine Holmes and Olive McIlroy:

What follows are some of my reflections on the parliamentary committee session of the 28th September 2017:

Before the committee began I suggested to interested colleagues:

“The petition on Mesh implants will start taking further evidence today. This could potentially be a watershed moment for the Scottish Government’s Department of Health?”

Dr Agur was extremely good in giving evidence. He came across to me as open, genuine, careful, scientific and reflective. Dr Agur disabuses the stereotypical notion that surgeons struggle to combine pragmatism with philosophy.

Dr Agur was entirely open about his declarations. Here he is an exemplar.

However I retain the concern that manufacturers may have had a greater share in “shared decision making” on Mesh surgery than we…

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Isle of May National Nature Reserve

Thursday 28th September comments: Today there is something different on the blog as we celebrate national poetry day. As a way of celebrating, the small team on here wrote and produced an Isle of May poem called freedom (brilliantly read by our volunteer Simon). (Unfortunately technology would not allow us to switch the image around as you can see!)

For those who would like the wording, here is the poem in full…


Freedom is a Fulmar, soaring through the waves

Freedom is the Seals, that call their homes the caves

Isle of May is blissful, magical and free,

A home from home, in the middle of the sea.

Windy, rainy spring to fall,

Nothing compares to the Puffins call.

Seabirds galore on the cliffs so high,

Terns displaying, dancing in the sky.

People arrive from boats south and north,

To see the jewel in the Firth of…

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What is “realistic” in terms of public expectation?

Hole Ousia

On the 12th August 2017 I sent the following letter to Shona Robison, the Dear Cabinet Secretary for Health and Sport for the Scottish Government:

Dear Cabinet Secretary for Health and Sport,
PE01493 on a Sunshine Act for Scotland. Are the Scottish public being listened to?

PE1493, A Sunshine Act for Scotland was closed by the Scottish Parliament in March 2016.

The Scottish Health Council published its public engagement exercise the same month.

The Scottish Government’s last public statement about this matter was in your letter dated 22 March 2016. In this letter you confirmed that “a majority of participants felt that publication of financial payments to healthcare professionals should be mandatory. In terms of next steps, the Scottish Government will discuss the contents of this report with the appropriate regulators and scope out options of how mandatory publication of payments to healthcare professionals from industry could be delivered.”


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Improvement science: engineering 42 – ethics 0

Hole Ousia

In my last post I considered a “thought paper” entitled “The habits of an improver” and welcomed that critical thinking was considered a necessary habit.

The word “engineer” or “engineering” is to be found on 42 separate occasions in this Health Foundation thought paper.

The word “ethics” does not appear at all. Despite the fact that the introduction begins with this quote:

That ethics do not seem to be considered amongst the “habits” necessary for “improvement science” is concerning.

The last time I looked, I found this result using the Healthcare Improvement Scotland search facility:

The former Chief Executive for the Mental Welfare Commission for Scotland used to introduce me as “Bayesian Peter”. Bayesian is the name given to interpretations of probability and returns to Reverend Thomas Bayes original considerations of complexity.

Healthcare, like life, is complex. We are human and live in an ever changing world.

This is not…

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The habits of an improver

Hole Ousia

I have recently read this most interesting “thought paper” entitled “The habits of an improver” which was published by the Health Foundation in October 2015.

Several months before this was published, the Executive Clinical Director for Healthcare Improvement Scotland wrote to my employers  stating that “[this individual] clearly does not understand the improvement science approach”. This defamatory letter almost ended my unblemished career as an NHS doctor. I subsequently felt that I had no option but to resign from NHS Forth Valley after 13 years as a Consultant working in Clackmannanshire. The glowing and unsolicited feedback that I received on my resignation can be read here.

‘The habits of an improver’ would seem to confirm that it was in fact the Executive Clinical Director for Healthcare Improvement Scotland who lacked understanding of the “improvement science approach”.

I have asked for an apology from Healthcare Improvement Scotland but it has…

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