Strong Clinical Leadership

Hole Ousia

The Chief Medical Officer’s third annual report, Practising Realistic Medicine, was published on Friday, 20th April 2018

It was introduced as follows: “Realistic Medicine has always had people at its heart. This latest report, Practising Realistic Medicine, aims to move the conversation on from a set of guiding principles to a discussion about how Realistic Medicine can be practically applied.”

The following is discussed within the report:

As an NHS doctor working in Scotland, this approach has my fullest support. However, I remain concerned that informed, shared decision making cannot be realised if experts, academics and doctors are able to hide potential competing financial interests. This is why I petitioned the Scottish Parliament to urge the Scottish Government to introduce a Sunshine Act.

On the day of publication of Practising Realistic Medicine, the Chief Executive of NHS Scotland supported the statement that “strong clinical leadership is required”

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‘Listen, let the people petition and be heard’

Hole Ousia

In September of this year it will be 5 years since I petitioned the Scottish Parliament to urge the Scottish Government to introduce a Sunshine Act for Scotland.

The evidence gathered for my petition confirmed that existing Scottish Government guidance was not being followed.

The Scottish Government commissioned an independent consultation with the Scottish public.  The results of this consultation were published on the 22 March 2018:

The majority view of the Scottish public consulted was that sunshine legislation is necessary.

On the 22nd March 2018, two years on from this consultation, I undertook a peaceful protest outside the Scottish Parliament. I was interviewed by the BMJ the same day:

Two years to the day after the results of the public consultation were made known,  I made Freedom of Information requests to all 14 regional NHS Boards and to Healthcare Improvement Scotland and the Scottish Medicines Consortium.

Within the statutory…

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Isle of May National Nature Reserve

Eider down First incubating Eider on nest near the lighthouse

Fulmsar Fulmar’s paired up

Sunday 22nd April comments: The Isle of May NNR seabird breeding season is underway…at long last. Eventually the weather appears to have turned the corner as the cold easterly winds have given way to bright sunshine (it felt like summer yesterday!) and it was most welcomed by visitors and birds alike.

As a direct result the breeding seabirds have responded and the first incubating Eider duck was discovered sitting yesterday (21st) whilst Greater Black-backed Gulls were on eggs from 16th April. We still have a long way to go but its a start.

The Auks look more settled with thousands of Puffins present whilst the cliff-tops are slowly coming into life with Shags collecting nest material. We’re still some way from calling it a full-on breeding season but that will happen in due course. As they say, onwards and upwards.

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Experience is the best teacher

Hole Ousia

2000 years have passed since Cicero said that: “experience is the best teacher” [Usus magister est optimus]

This is the current dictionary definition of experience:

Experience - dictionary definition

As a doctor, scientist, and artist I have come to consider experience from many stances.  I welcome every view from every stance.

A recent publication of a meta-analysis on antidepressant prescribing has encouraged  a wider sharing of experience. My sense of this wide-ranging discourse is that we all share a determination to ease suffering.

Lancet study on antidepressants, Feb 2018 - title

Following the publication and reporting of this meta-analysis, some senior colleagues have made, or shared public comments, that invoke war-like or shaming terms:

“All in all it has been a bad few days for the anti-medication cult and their followers”

“It feels like there is a war on antidepressants at the moment”

Some of my senior colleagues, including the President of my College, have publicly shared this:

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‘How to lose your fear of Data’

Hole Ousia

Through work, this invitation recently came my way:

How to lose your fear of data - HIS - Dr Brian Robson - April 2018

As part of this Health & Social Care Digital Leaders Summit the expert panels and workshops will demonstrate “how to lose your fear of data”.

I have previously offered my concerns about the following dictat which is widely shared by “improvement scientists”:without data

The dictionary definition of ‘data’ is:

data definition

It is however vital to appreciate that science is based on method and observation, which is then recorded in words, before finally being converted into numbers (data). At each stage there is a representational loss of actual experience. It is scientifically and philosophically impossible for data to fully represent reality.

Having been recently engaged in the Scottish Government’s Draft Suicide Prevention Action Plan, Mrs Chrys Muirhead offered this pertinent response“I am concerned that data analysis may be impersonal and exclusive, missing out stories about suicide”.

Mary Midgley, now aged 98, has been

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Mattering and measurement

Hole Ousia

I have found this quote by William Edwards Deming to be widely shared by “improvement scientists” involved in healthcare:

without data

My concerns about this aphorism are on a number of levels:

  • Implicitly it reduces subjective experience and thus the person.
  • Implicitly it is stating only that which is measurable is important.
  • Science is based on method and observation; this is then recorded in words (‘labels’ if you like) and this is then converted into numbers (data). At each stage there is a representational loss of actual experience.
  • It lacks philosophical understandings of reality. What I mean is that it is impossible for numbers to fully represent reality.
  • Healthcare is not the same as engineering [the original context of this quote]
  • In reality there is no clear divide between objectivity and subjectivity. Science strives to be objective but cannot do this simply by ignoring the subjective.

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The sacramentum

Hole Ousia

In ancient Roman law, the sacramentum was an oath or vow that rendered the swearer ever loyal to the Legion.

Healthcare Improvement Scotland

NHS Scotland has recently focussed on this dictat: “without data you’re another person with opinions”.

Healthcare Improvement Scotland has to date introduced eleven “cohorts” of “improvers” to Scotland. NHS Scotland is being “transformed”.

“Improvement science” methodology was originally introduced by a few key individuals who were keen to introduce approaches developed outside Scotland and based upon engineering principles. These approaches have been exported across the world by the Institute for Healthcare Improvement, Boston:

The growing “legion” is expected to follow the “improvement science” sacramentum. However concerns have been raised that this follows a reductionist approach that often fails to consider ethics:

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