Surgical errors
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Surgical errors
I've just read in the "Sunday Times," that surgeons are responsible for the majority of medical "accidents" in the UK.
Mostly, this is due to a lack of communication skills between the team, and has, according to the Royal College of Surgeons, been brought about by the arrogant attitude of some surgeons.
Is this a true reflection of the real world?
Mostly, this is due to a lack of communication skills between the team, and has, according to the Royal College of Surgeons, been brought about by the arrogant attitude of some surgeons.
Is this a true reflection of the real world?
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Couldn't find the Times article online, Banned, but it likely depends on the definition of terms. I expect that in sheer numbers, nonsurgical errors, such as medication errors, falling out of bed, etc, far outweigh surgical errors.
But leaving that big clamp in there, or chopping off the wrong leg, usually gets more attention, not to mention more cash.
But leaving that big clamp in there, or chopping off the wrong leg, usually gets more attention, not to mention more cash.
Plastic PPRuNer
"I've just read in the "Sunday Times," that surgeons are responsible for the majority of medical "accidents" in the UK."
Can't find the article, so I don't know, but I wonder what they mean by "accidents"? I would have thought that errors and misjudgements in the prescribing of medicines would be far greater than surgical "accidents", but still.
Looking back over a long surgical career I can't recall many "accidents" in the sense of major errors, which I have witnessed. Only a couple that have resulted in the death or disability of the patient. I recall quite a few "errors of judgement", some mine and some by other people, which have resulted either in a longer hospital stay or a less favourable outcome, but these hardly qualify as "accidents".
"Mostly, this is due to a lack of communication skills between the team, and has, according to the Royal College of Surgeons, been brought about by the arrogant attitude of some surgeons."
Most "accidents", whether surgical or aviation related are due to lack of communication (look at Comair in Kentucky). Truly arrogant surgeons, just like arrogant pilots, can often be unpleasant and may well be dangerous, but I haven't met very many.
The idea that surgeons are arrogant is an old canard that won't go away and I think it stems from an understandable lack of familiarity with our particular work. The public seem very attached to the stereotype of Sir Lancelot Spratt and TV series after TV series just reinforces this.
The spineless Royal College of Surgeons, now dominated by a claque of non-clinical academics pursuing knighthoods and social workers eager to demonstrate their loyalty to the dubious principles of the New Left, would now say anything, no matter how false and lickspittle, to curry favour with the Bliar government.
Surgery is a most unnatural activity. We're all familiar with the idea of "personal space", in the sense that there is a certain distance that we keep from other people physically. Surgery not only violates personal space (just as nurses and physios do), but actually breaches the skin, our ultimate physical defence, and invades the inside of the body. There's an analogy with penetrative sex, if you like. Anyway, to do this, to actually take a knife and cut into someone, especially at first, requires overcoming deep cultural and "race memory" inhibitions.
To do this regularly, and in oftimes uncertain situations, demands a significant degree of certainty. I would suggest that this certainty is what is often seen as arrogance. As Treves wrote, "He [the surgeon] must have courage, be quick to think and prompt to act, be sure of himself and captain of the venture he commands".
Surgery itself teaches us humility, often quite brutally, and the vicissitudes of chance and nature contrive early to humble most of us of any God-like illusions. Ambroise Paré, the great 16th century French surgeon said, "I dressed him and God healed him".
Aviating is an almost equally unnatural activity and demands an equal, though different, degree of certainty. Once again, this is often seen as arrogance, while in fact it is just the necessary mindset to allow a person to take 500+ people into the stratosphere at just under Mach 1 and be reasonably confident of seeing them safely on the ground at their destination.
I submit that in a world where it is unfashionable for men and women to be strong and steadfast in their purpose and which glorifies the pallid-souled, limp-wristed ditherer that more and more of us who actually know what we are doing will be labelled arrogant.
Can't find the article, so I don't know, but I wonder what they mean by "accidents"? I would have thought that errors and misjudgements in the prescribing of medicines would be far greater than surgical "accidents", but still.
Looking back over a long surgical career I can't recall many "accidents" in the sense of major errors, which I have witnessed. Only a couple that have resulted in the death or disability of the patient. I recall quite a few "errors of judgement", some mine and some by other people, which have resulted either in a longer hospital stay or a less favourable outcome, but these hardly qualify as "accidents".
"Mostly, this is due to a lack of communication skills between the team, and has, according to the Royal College of Surgeons, been brought about by the arrogant attitude of some surgeons."
Most "accidents", whether surgical or aviation related are due to lack of communication (look at Comair in Kentucky). Truly arrogant surgeons, just like arrogant pilots, can often be unpleasant and may well be dangerous, but I haven't met very many.
The idea that surgeons are arrogant is an old canard that won't go away and I think it stems from an understandable lack of familiarity with our particular work. The public seem very attached to the stereotype of Sir Lancelot Spratt and TV series after TV series just reinforces this.
The spineless Royal College of Surgeons, now dominated by a claque of non-clinical academics pursuing knighthoods and social workers eager to demonstrate their loyalty to the dubious principles of the New Left, would now say anything, no matter how false and lickspittle, to curry favour with the Bliar government.
Surgery is a most unnatural activity. We're all familiar with the idea of "personal space", in the sense that there is a certain distance that we keep from other people physically. Surgery not only violates personal space (just as nurses and physios do), but actually breaches the skin, our ultimate physical defence, and invades the inside of the body. There's an analogy with penetrative sex, if you like. Anyway, to do this, to actually take a knife and cut into someone, especially at first, requires overcoming deep cultural and "race memory" inhibitions.
To do this regularly, and in oftimes uncertain situations, demands a significant degree of certainty. I would suggest that this certainty is what is often seen as arrogance. As Treves wrote, "He [the surgeon] must have courage, be quick to think and prompt to act, be sure of himself and captain of the venture he commands".
Surgery itself teaches us humility, often quite brutally, and the vicissitudes of chance and nature contrive early to humble most of us of any God-like illusions. Ambroise Paré, the great 16th century French surgeon said, "I dressed him and God healed him".
Aviating is an almost equally unnatural activity and demands an equal, though different, degree of certainty. Once again, this is often seen as arrogance, while in fact it is just the necessary mindset to allow a person to take 500+ people into the stratosphere at just under Mach 1 and be reasonably confident of seeing them safely on the ground at their destination.
I submit that in a world where it is unfashionable for men and women to be strong and steadfast in their purpose and which glorifies the pallid-souled, limp-wristed ditherer that more and more of us who actually know what we are doing will be labelled arrogant.
Last edited by Mac the Knife; 4th Sep 2006 at 18:45.
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Thanks for the replies, unfortunately I can't fing a web link to the article, which basically said that the lessons from the Bristol scandal havn't been learnt, and teamwork and communication in surgical teams is still sadly lacking- leading, in some cases to disaster- an example quoted was that of a surgeon amputating the wrong leg, and a urologist removing th wrong kidney (the patient died.)
The article hinted that the team were afraid to question the almighty surgeon, which I found a little incredible.
I do remember a simillar scenario years ago, involving an airline captain (a trident I think), selecting an incorrect flap setting, resulting in a crash- at the time, it was thought that the young inexperienced pilot knew that the setting was incorrect, but was too frightened to point out the error to the captain.
Do surgeons routinely hold meetings with their wider team to discuss quality issues?
The article hinted that the team were afraid to question the almighty surgeon, which I found a little incredible.
I do remember a simillar scenario years ago, involving an airline captain (a trident I think), selecting an incorrect flap setting, resulting in a crash- at the time, it was thought that the young inexperienced pilot knew that the setting was incorrect, but was too frightened to point out the error to the captain.
Do surgeons routinely hold meetings with their wider team to discuss quality issues?
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In addition, each surgeon in the unit has to undergo a peer reviewed audit annually for CPD issues.
So the answer your question - yes we do
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Found the article, it's here http://www.timesonline.co.uk/article...7-2340502.html
Must admit, on 2nd reading, it does appear a little wishy washy, although a little frightening that their own Royal College, is being so critical.
Does a appear a little subjective.
Must admit, on 2nd reading, it does appear a little wishy washy, although a little frightening that their own Royal College, is being so critical.
There are some surgeons who have a seriously flawed opinion of their own capabilities,” he said. “If you are a surgeon and doing dangerous work you need to have a degree of self-assurance and confidence but it can turn into arrogance.
Plastic PPRuNer
Thanks for the link got banned.
I have to say that I think that this is an appalling article. Emotive language like "patients are dying on operating tables" (by implication, in droves), without any substantiation. I can't find Gidding's original statements on the RCS website so I can only comment on the quotes.
It is not contested that surgery in the NHS is not all that it might be and the reasons are not simple. The relentless attacks on the probity and standing of surgeons by the press and Government have had serious effects on morale, the full repercussions of which have still to be felt. That the RCS should denounce the very surgeons that it certified is a very strange abrogation of responsibility.
That surgical training is in serious trouble is indisputable, but for the RCS to fault the surgeons rather than the new training schemes which they themselves, in consultation with the GMC and the Government introduced, is disgraceful.
If, as Giddings infers (based on what evidence?), that surgeons "believe they are infallible" and "have a seriously flawed opinion of their own capabilities" then who is to blame?
Many older surgeons now feel, as I do, that the RCS no longer represents them and is pursuing some bizarre agenda of it's own that has nothing to do with either classical surgery or it's roots.
The implication that every surgical unit is a Bristol waiting to happen is bizarre, unlikely and alarmist. First of all, the facts at Bristol were complex and very far from the widespread perception of virtual homicide. Secondly, the evidence that such errors of technique and judgement are widespread is paper-thin. Quite what Gidding's purpose might be in making such an inflammatory statement is unclear.
Surgical deaths are a fact of life and aren't always someones fault. Deaths can be reduced to a very low figure, but cannot be completely eliminated, the more so since we are operating on an increasingly ageing and unfit population. The inference that surgeons are indifferent to these is fantastic. I have myself recently had an unexplained patient death and the experience is terribly distressing.
The mooted figure of 20,000 surgical deaths/year is extraordinary. Quite how the 2159 recorded by the NPSA transmogrifies into this is perplexing since all perioperative deaths must, by law, be reported. The reason given, "that only a fraction are reported" implies deception on a massive scale, for which there is precious little evidence.
The implication that Marc de Leval, a surgeon of immense experience and skill (whom I met several times when I worked at GOS) found himself incompetent is unfair and untrue. You can read a fuller story at http://www.hospitaldoctor.net/hd_new...ection=Feature To couple this with a single anonymous anecdote about a wrong kidney removal (when did this occur?) is invidious and seeks to create the impression that fatal medical blunders are the order of the day.
Yes, wrong legs get amputated (this must be very uncommon, I'd like to hear some stats on this for the last 10 years). Yes, wrong kidneys get removed (ditto). But this is neither common not commonplace.
For an excellent review of where we are and where we have come from see http://www.ctsnet.org/doc/5644
I'm glad I'm mostly private these days, and doubly glad that I'm not practicing in the NHS.
I have to say that I think that this is an appalling article. Emotive language like "patients are dying on operating tables" (by implication, in droves), without any substantiation. I can't find Gidding's original statements on the RCS website so I can only comment on the quotes.
It is not contested that surgery in the NHS is not all that it might be and the reasons are not simple. The relentless attacks on the probity and standing of surgeons by the press and Government have had serious effects on morale, the full repercussions of which have still to be felt. That the RCS should denounce the very surgeons that it certified is a very strange abrogation of responsibility.
That surgical training is in serious trouble is indisputable, but for the RCS to fault the surgeons rather than the new training schemes which they themselves, in consultation with the GMC and the Government introduced, is disgraceful.
If, as Giddings infers (based on what evidence?), that surgeons "believe they are infallible" and "have a seriously flawed opinion of their own capabilities" then who is to blame?
Many older surgeons now feel, as I do, that the RCS no longer represents them and is pursuing some bizarre agenda of it's own that has nothing to do with either classical surgery or it's roots.
The implication that every surgical unit is a Bristol waiting to happen is bizarre, unlikely and alarmist. First of all, the facts at Bristol were complex and very far from the widespread perception of virtual homicide. Secondly, the evidence that such errors of technique and judgement are widespread is paper-thin. Quite what Gidding's purpose might be in making such an inflammatory statement is unclear.
Surgical deaths are a fact of life and aren't always someones fault. Deaths can be reduced to a very low figure, but cannot be completely eliminated, the more so since we are operating on an increasingly ageing and unfit population. The inference that surgeons are indifferent to these is fantastic. I have myself recently had an unexplained patient death and the experience is terribly distressing.
The mooted figure of 20,000 surgical deaths/year is extraordinary. Quite how the 2159 recorded by the NPSA transmogrifies into this is perplexing since all perioperative deaths must, by law, be reported. The reason given, "that only a fraction are reported" implies deception on a massive scale, for which there is precious little evidence.
The implication that Marc de Leval, a surgeon of immense experience and skill (whom I met several times when I worked at GOS) found himself incompetent is unfair and untrue. You can read a fuller story at http://www.hospitaldoctor.net/hd_new...ection=Feature To couple this with a single anonymous anecdote about a wrong kidney removal (when did this occur?) is invidious and seeks to create the impression that fatal medical blunders are the order of the day.
Yes, wrong legs get amputated (this must be very uncommon, I'd like to hear some stats on this for the last 10 years). Yes, wrong kidneys get removed (ditto). But this is neither common not commonplace.
For an excellent review of where we are and where we have come from see http://www.ctsnet.org/doc/5644
I'm glad I'm mostly private these days, and doubly glad that I'm not practicing in the NHS.
Last edited by Mac the Knife; 6th Sep 2006 at 12:49. Reason: grammar
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Mac, I have learnt a lot from your posts. But I must hit the 'wooooaaah' button.You assert that most aviation accidents are due to lack of communication. This is simply not true. A short visit to any accident investigation database (e.g. NTSB) will soon dispel this. Yes, communication in the cockpit is important, and CRM is a vital part of what is now described as TEM ( threat and error management). I agree with your analogy of an unnatural environment, which is why airlines have developed the procedures they use and require from their flight crews. These mitigate the possibility of serious consequences. Communication with other crew and ATC is an integral part of the safety net, but to identify it as the major cause of accidents is just not factual.
Plastic PPRuNer
Forgive me Re-entry. I am not an expert in aviation accidents and perhaps should have written "many" rather than "most". I used the same word that the article used - "Mostly, this is due to a lack of communication skills..." to make an analogy with aviation and should have been more careful. Additionally, I don't necessarily agree with the conclusion of the RCS - many mishaps are anaesthetic related, which doesn't seem to get a mention.
Surgery is more like general aviation than airline transport and I know that the vast majority of mishaps are in GA rather than AT. If I read the data correctly, most accidents in GA come from disregard or sloppiness of basic procedure like QNH errors, weight and balance checks, fuel management errors, flight into adverse weather and skill based errors. As one of your publications says, "there are literally thousands of unique ways to crash an airplane." Many errors in surgery are of this nature - fortunately few result in a "crash"!
I think one can stretch the aviator/surgeon analogy a bit too far - yes there are some similarities, but there are even more important differences.
In AT, CRM has vastly improved communication on the flight deck and rather belatedly surgical bodies are trying to borrow aspects of the principles of CRM to improve communication, but I believe that it is basic training, rather than CRM, that needs the most work.
Surgery is more like general aviation than airline transport and I know that the vast majority of mishaps are in GA rather than AT. If I read the data correctly, most accidents in GA come from disregard or sloppiness of basic procedure like QNH errors, weight and balance checks, fuel management errors, flight into adverse weather and skill based errors. As one of your publications says, "there are literally thousands of unique ways to crash an airplane." Many errors in surgery are of this nature - fortunately few result in a "crash"!
I think one can stretch the aviator/surgeon analogy a bit too far - yes there are some similarities, but there are even more important differences.
In AT, CRM has vastly improved communication on the flight deck and rather belatedly surgical bodies are trying to borrow aspects of the principles of CRM to improve communication, but I believe that it is basic training, rather than CRM, that needs the most work.
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'Aviation is not inherently dangerous. It's just very unforgiving of errors.'
Maybe this would be an analogy to surgery. Only thing is, I screw up, I die with 'the patients'.
Maybe this would be an analogy to surgery. Only thing is, I screw up, I die with 'the patients'.
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i have done quite a bit of research on this in the past and there are some interesting facts that arise.
If you look at the lengths we go to now to minimise error in aviation, i.e Mandated CRM and Human Factors for starters, we are now in a position where we as a profession are pretty safe. In 2004, there were approximately 16 million air movements world wide. Approx 2500 people died in air incidents (many in light aircraft).
In the same year alone, it is estimated by the insurance companies that almost 750,000 people died as a result of medical negligence in the United States alone!! Yes you read the right number. The total figures are split into about 10 cause groups, of which Surgical error was one, which accounted for just over 30,000 deaths. It is estimated that the deaths run at a rate equivelent per capita of population, interestingly this turns out to be about in the right ball park as in the same year it is estimated that 70, 000 people died in the UK as a result of medical negligence of one form or another. Major contributing factors do seem to be the communication issues, fatigue, stress and lack of supervision (due to undermanning).
Back to the USA in the same year 530K people died as a result of cardiac disease, and 510K people died as a result of cancer. Therefore Human error killed more people than either Cancer or Cardiac disease. Think of the money we (quite rightly) put into research in both these disease types, and compare to how much we put into the prevention of deaths caused by Human Error in medicine!
Any Surgeons, Docs interested in a little (infact huge) project? Pm me.
If you look at the lengths we go to now to minimise error in aviation, i.e Mandated CRM and Human Factors for starters, we are now in a position where we as a profession are pretty safe. In 2004, there were approximately 16 million air movements world wide. Approx 2500 people died in air incidents (many in light aircraft).
In the same year alone, it is estimated by the insurance companies that almost 750,000 people died as a result of medical negligence in the United States alone!! Yes you read the right number. The total figures are split into about 10 cause groups, of which Surgical error was one, which accounted for just over 30,000 deaths. It is estimated that the deaths run at a rate equivelent per capita of population, interestingly this turns out to be about in the right ball park as in the same year it is estimated that 70, 000 people died in the UK as a result of medical negligence of one form or another. Major contributing factors do seem to be the communication issues, fatigue, stress and lack of supervision (due to undermanning).
Back to the USA in the same year 530K people died as a result of cardiac disease, and 510K people died as a result of cancer. Therefore Human error killed more people than either Cancer or Cardiac disease. Think of the money we (quite rightly) put into research in both these disease types, and compare to how much we put into the prevention of deaths caused by Human Error in medicine!
Any Surgeons, Docs interested in a little (infact huge) project? Pm me.
Plastic PPRuNer
Urrr... Where is the 250k and what is it an underestimate of?
Anyway, checkout the UK deaths data for 2004 at http://www.statistics.gov.uk/downloa...31/DH2No31.pdf
Download http://www.statistics.gov.uk/downloa.../Table2.19.xls and look at rows 945 (ICD Y40) to 1065 (ICD Y84.8)
Row 991 (Y60-Y69) - 'Misadventures to patients during surgical and medical care' - (11 males and 21 females) is worth a look.
Now, either Stats UK are out by an order of magnitude or two OR there is a cover-up of holocaust proportions going on OR the bash-medicine brigade are telling porkies. You decide.
And Tigs2, next time you get some chest pain or your kid breaks an arm falling out of the apple-tree you'd best stay home and figure it out yourself!
Anyway, checkout the UK deaths data for 2004 at http://www.statistics.gov.uk/downloa...31/DH2No31.pdf
Download http://www.statistics.gov.uk/downloa.../Table2.19.xls and look at rows 945 (ICD Y40) to 1065 (ICD Y84.8)
Row 991 (Y60-Y69) - 'Misadventures to patients during surgical and medical care' - (11 males and 21 females) is worth a look.
Now, either Stats UK are out by an order of magnitude or two OR there is a cover-up of holocaust proportions going on OR the bash-medicine brigade are telling porkies. You decide.
And Tigs2, next time you get some chest pain or your kid breaks an arm falling out of the apple-tree you'd best stay home and figure it out yourself!
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Row 991 (Y60-Y69) - 'Misadventures to patients during surgical and medical care' - (11 males and 21 females) is worth a look.
It's going to be more than 21 a year. There are surgeons out there who get all heroic and do things they shouldn't, but in general it's on people who are going to die quite soon anyway. So they don't kill the patient as such, but maybe they make the final weeks a bit more uncomfortable than they should be. But hey, that's what diamorph is for
One thing that has changed recently is that in the brave new NHS world surgeons are more likely to stab their colleagues in the back for personal advancement. So any underperforming surgeons are going to be turned in by their mates a lot more than in the past. In the old days it was not the done thing, the two guys who turned in the Bristol lot had to become GPs, lol.
But in general I'd not be too concerned about going under the surgeons knife myself, and besides it's the anaethetist you should really be worried about
Plastic PPRuNer
Quite possibly (don't men count too?), but if you extrapolate the 750,000 quoted from the USA to the UK population it comes out at 150,000/year rather than 32. With about 500,000 deaths per year in the UK that implies that just under 1/3 are due to medical negligence.
That works out at the equivalent of 300 fully-loaded 747s crashing fatally every year in the UK alone.
Since medical care probably saves less than 150,000/year in the UK then abolishing medicine will obviously save many lives.
Sorry about the 250k thing- wrong post.
I do remember reading somewhere that the mortality rate in North America did drop dramatically, when there was a doctors strike, but I can't remember the fine details. Wasn't it Ivan Illich who reported this?
Since medical care probably saves less than 150,000/year in the UK then abolishing medicine will obviously save many lives.
Last edited by gingernut; 19th Sep 2006 at 15:15.
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Illich was a bit of a radical, quite enjoyed reading his stuff. Think it might have been Israel but might have happened in the US too. Of course a reduced death rate could be explained by not having people at work to sign death certificates, and you ain't dead until a doctor says you are
Mac, I don't think there is a conspiracy and I also think the vast majority of surgeons are very well trained and very competent. I don't accept the high figures given, and apologies for my poor arithmentic. However a coronor can only act on the information given to him. If he does want to know more he will genrerally get somebody to call the houseman, and we all know the joke about housemen and mushrooms. More often than not the houseman's bumbling answers will be enough to keep the coronor happy. They missed Shipman for gods sake.
Mac, I don't think there is a conspiracy and I also think the vast majority of surgeons are very well trained and very competent. I don't accept the high figures given, and apologies for my poor arithmentic. However a coronor can only act on the information given to him. If he does want to know more he will genrerally get somebody to call the houseman, and we all know the joke about housemen and mushrooms. More often than not the houseman's bumbling answers will be enough to keep the coronor happy. They missed Shipman for gods sake.
Plastic PPRuNer
Aha, Gingernut is a deconstructionist, lekker! A disciple of Derrida, no less! A Medical Nemesis indeed! That explains a lot (like maintaining the futility of schooling, but we can come back to that later).
The late great Richard Asher (who first described Munchausen syndrome) is supposed to have arranged outpatient sessions where the patients never actually saw a doctor (or a nurse).
The old people drank hospital tea and had a good gossip about life, the neighbours & everything and then went home. Allegedly it was a great success.
Not really possible in today's Metropolis world of strict appointments and censorious receptionists, but that's progress for you...
A lot of old people (particularly in these days of the nuclear family) are very lonely and a visit to the doctor lends importance to the day. [These days of course, the Practice Nurse would soon send them packing so as NOT TO WASTE THE DOCTOR'S TIME and get the social workers to put their dog down and bundle them off to Supervised Housing]
Asher also remarks that the schoolboy says, "I scored two goals today!", while the old person says, "I had two funny turns today" - he was a very wise man.
AA Milne(Christopher Robin loathed the stories and refused to visit his dying father) wrote a sticky but apposite poem called "The Dormouse and the Doctor"
There once was a Dormouse who lived in a bed
Of delphiniums (blue) and geraniums (red),
And all the day long he'd a wonderful view
Of geraniums (red) and delphiniums (blue).
A Doctor came hurrying round, and he said:
"Tut-tut, I am sorry to find you in bed.
Just say 'Ninety-nine' while I look at your chest....
Don't you find that chrysanthemums answer the best?"
The Dormouse looked round at the view and replied
(When he'd said "Ninety-nine") that he'd tried and he'd tried,
And much the most answering things that he knew
Were geraniums (red) and delphiniums (blue).
The Doctor stood frowning and shaking his head,
And he took up his shiny silk hat as he said:
"What the patient requires is a change," and he went
To see some chrysanthemum people in Kent.
The Dormouse lay there, and he gazed at the view
Of geraniums (red) and delphiniums (blue),
And he knew there was nothing he wanted instead
Of delphiniums (blue) and geraniums (red).
The Doctor came back and, to show what he meant,
He had brought some chrysanthemum cuttings from Kent.
"Now these," he remarked, "give a much better view
Than geraniums (red) and delphiniums (blue)."
They took out their spades and they dug up the bed
Of delphiniums (blue) and geraniums (red),
And they planted chrysanthemums (yellow and white).
"And now," said the Doctor, "we'll soon have you right."
The Dormouse looked out, and he said with a sigh:
"I suppose all these people know better than I.
It was silly, perhaps, but I did like the view
Of geraniums (red) and delphiniums (blue)."
The Doctor came round and examined his chest,
And ordered him Nourishment, Tonics, and Rest.
"How very effective," he said, as he shook
The thermometer, "all these chrysanthemums look!"
The Dormouse turned over to shut out the sight
Of the endless chrysanthemums (yellow and white).
"How lovely," he thought, "to be back in a bed
Of delphiniums (blue) and geraniums (red.)"
The Doctor said, "Tut! It's another attack!"
And ordered him Milk and Massage-of-the-back,
And Freedom-from-worry and Drives-in-a-car,
And murmured, "How sweet your chrysanthemums are!"
The Dormouse lay there with his paws to his eyes,
And imagined himself such a pleasant surprise:
"I'll pretend the chrysanthemums turn to a bed
Of delphiniums (blue) and geraniums (red)!"
The Doctor next morning was rubbing his hands,
And saying, "There's nobody quite understands
These cases as I do! The cure has begun!
How fresh the chrysanthemums look in the sun!"
The Dormouse lay happy, his eyes were so tight
He could see no chrysanthemums, yellow or white.
And all that he felt at the back of his head
Were delphiniums (blue) and geraniums (red).
And that is the reason (Aunt Emily said)
If a Dormouse gets in a chrysanthemum bed,
You will find (so Aunt Emily says) that he lies
Fast asleep on his front with his paws to his eyes.
These days it would be a PC Social Worker rather than a doctor but the moral of the tale is even more appropriate.
BTW, Illich was nothing if not consistent. During his later years, he suffered from a cancerous growth on his face that, in accordance with his critique of professionalized medicine, he attempted, unsuccessfully, to treat with traditional methods. He regularly smoked opium to deal with the pain caused by this tumor. At an early stage, he consulted a doctor about having the tumor removed, but there was too great a chance of losing his ability to speak, he was told, so he lived with the tumor as best he could.
His confused Hubbardian rhetoric (deconstructionists speak a special metalanguage that is deliberately obscure) is no longer fashionable, but his legacy lives on in a functionally illiterate generation.
"The absence of the transcendental signified extends the domain and the play of signification infinitely."
Good stuff!
The late great Richard Asher (who first described Munchausen syndrome) is supposed to have arranged outpatient sessions where the patients never actually saw a doctor (or a nurse).
The old people drank hospital tea and had a good gossip about life, the neighbours & everything and then went home. Allegedly it was a great success.
Not really possible in today's Metropolis world of strict appointments and censorious receptionists, but that's progress for you...
A lot of old people (particularly in these days of the nuclear family) are very lonely and a visit to the doctor lends importance to the day. [These days of course, the Practice Nurse would soon send them packing so as NOT TO WASTE THE DOCTOR'S TIME and get the social workers to put their dog down and bundle them off to Supervised Housing]
Asher also remarks that the schoolboy says, "I scored two goals today!", while the old person says, "I had two funny turns today" - he was a very wise man.
AA Milne(Christopher Robin loathed the stories and refused to visit his dying father) wrote a sticky but apposite poem called "The Dormouse and the Doctor"
There once was a Dormouse who lived in a bed
Of delphiniums (blue) and geraniums (red),
And all the day long he'd a wonderful view
Of geraniums (red) and delphiniums (blue).
A Doctor came hurrying round, and he said:
"Tut-tut, I am sorry to find you in bed.
Just say 'Ninety-nine' while I look at your chest....
Don't you find that chrysanthemums answer the best?"
The Dormouse looked round at the view and replied
(When he'd said "Ninety-nine") that he'd tried and he'd tried,
And much the most answering things that he knew
Were geraniums (red) and delphiniums (blue).
The Doctor stood frowning and shaking his head,
And he took up his shiny silk hat as he said:
"What the patient requires is a change," and he went
To see some chrysanthemum people in Kent.
The Dormouse lay there, and he gazed at the view
Of geraniums (red) and delphiniums (blue),
And he knew there was nothing he wanted instead
Of delphiniums (blue) and geraniums (red).
The Doctor came back and, to show what he meant,
He had brought some chrysanthemum cuttings from Kent.
"Now these," he remarked, "give a much better view
Than geraniums (red) and delphiniums (blue)."
They took out their spades and they dug up the bed
Of delphiniums (blue) and geraniums (red),
And they planted chrysanthemums (yellow and white).
"And now," said the Doctor, "we'll soon have you right."
The Dormouse looked out, and he said with a sigh:
"I suppose all these people know better than I.
It was silly, perhaps, but I did like the view
Of geraniums (red) and delphiniums (blue)."
The Doctor came round and examined his chest,
And ordered him Nourishment, Tonics, and Rest.
"How very effective," he said, as he shook
The thermometer, "all these chrysanthemums look!"
The Dormouse turned over to shut out the sight
Of the endless chrysanthemums (yellow and white).
"How lovely," he thought, "to be back in a bed
Of delphiniums (blue) and geraniums (red.)"
The Doctor said, "Tut! It's another attack!"
And ordered him Milk and Massage-of-the-back,
And Freedom-from-worry and Drives-in-a-car,
And murmured, "How sweet your chrysanthemums are!"
The Dormouse lay there with his paws to his eyes,
And imagined himself such a pleasant surprise:
"I'll pretend the chrysanthemums turn to a bed
Of delphiniums (blue) and geraniums (red)!"
The Doctor next morning was rubbing his hands,
And saying, "There's nobody quite understands
These cases as I do! The cure has begun!
How fresh the chrysanthemums look in the sun!"
The Dormouse lay happy, his eyes were so tight
He could see no chrysanthemums, yellow or white.
And all that he felt at the back of his head
Were delphiniums (blue) and geraniums (red).
And that is the reason (Aunt Emily said)
If a Dormouse gets in a chrysanthemum bed,
You will find (so Aunt Emily says) that he lies
Fast asleep on his front with his paws to his eyes.
These days it would be a PC Social Worker rather than a doctor but the moral of the tale is even more appropriate.
BTW, Illich was nothing if not consistent. During his later years, he suffered from a cancerous growth on his face that, in accordance with his critique of professionalized medicine, he attempted, unsuccessfully, to treat with traditional methods. He regularly smoked opium to deal with the pain caused by this tumor. At an early stage, he consulted a doctor about having the tumor removed, but there was too great a chance of losing his ability to speak, he was told, so he lived with the tumor as best he could.
His confused Hubbardian rhetoric (deconstructionists speak a special metalanguage that is deliberately obscure) is no longer fashionable, but his legacy lives on in a functionally illiterate generation.
"The absence of the transcendental signified extends the domain and the play of signification infinitely."
Good stuff!