Adonis Diaries

Archive for July 14th, 2018

Tidbits and notes posted on FB and Twitter. Part 219

Note: I take notes of books I read and comment on events and edit sentences that fit my style. I pa attention to researched documentaries and serious links I receive. The page is long and growing like crazy, and the sections I post contains a month-old events that are worth refreshing your memory

Frappe-toi le coeur c’est la’ qu’ est le genie”? (Alfred de Musset). Le genie de survivre tous les malheurs avec l’espoir de trouver l’amour?

L’existence est un miserable tas de secrets? Apparemment, je ne suis pas conscient de petits secrets: j’ai tout revele’ dans mon auto-biographie of Not a famous person.

Pour etre habilite’ professeur en medecine, il faut publier une douzaines d’articles pour des revues Americaines et sur un support informatique.

The Syrian Kurds are located in 3 cantons in north Syria (Afrin that Turkey captured), Kobani and Al Jazirat or Cezire). They elect their own parliaments. Those in the canton of Afrin and Kobani pay ideological allegiance to Abdullah Ocalan.

This Turkish/Kurdish leader, Abdullah Ocalan. has been in Turkish prison since 1999, on an island. Late Syrian President Hafez Assad had to deliver him after Turkey warned of imminent war if Ocalan is Not transferred over.

The Kurds in canton of Al jazira pay also allegiance to the American ecologist Murray Brookchin (1921-2006). The Kurds in north-west Iraq also have same ideological allegiance to those in Syria, but the feudal Barazani clan in eastern north Iraq is for sale to highest bidder.

Where the streets have no name: Israel leaves Palestinians in postal ‘dark age’ #Occupation

Europe relied on the silk, spices, perfume, and luxury items imported from China and India through Persia, Turkey and Egypt.

The Great Wall of China is the only human made construction that can be seen from space.  Three centuries before Portugal put to sea its galleons to circumnavigate oceans, China had fleet of ships 3 times bigger than the biggest that Spain constructed.

Tacit slaving system: Les jobs precaires “Nous fournissons aux employeurs un materiel humain bon marche’.

“7adrat al mo7taram. Iza ghafelt yawm 3an al siyaam wa salayt, hal salati makboulat?” Ya benti, bonsa7ik trouhi wa dabdabi

Ma fi bil midaan 7amlaat intikhabiyyat ella Jobran Bassil. Bakkiyat ma baka min kol al siyassiyeen wa al “zou3amat” 3am yel3abo bi shi tani. Bi sheddo 7alon ta ye laa2o al jam3a wa yestaffo 3ala karaassi lama bi ye3lno assamihom ka mourashaheen

Ma b7eb kazzeb al naass: iza talla3o isha3a enno la2eem, baddi thabett hal isha3a

Under fire in Britain:
Consultants are Overpaid or undervalued?

Mary Braid and Ian MacKinnon report in The Independent:

In the he predominantly middle-aged ranks of the medical consultant, Robert Williams is distinguished by precocious talent.

At 32 he became one of Britain’s youngest eye surgeons. Six years later, his expertise in one of medicine’s more lucrative specialisms earns him more than 90,000 pounds a year.

Like two-thirds of Britain’s 18,000 consultants, Mr Williams treats both health service and private patients. His NHS salary at Worthing Hospital, West Sussex, is 44,000 for roughly 40 hours a week.

He more than doubles his earnings by working 20 hours in the private sector. On an average ‘private’ afternoon, he can perform four or five cataract operations, charging about pounds 700 each.

He admits the sums to be made in private practice initially shocked him. But he is a pauper compared with some colleagues.

Doctors in full-time private practice can make more than pounds 300,000 a year.

For those who combine NHS and private work, William Laing, a leading health consultant, says the top 2,400 consultants earn pounds 95,000 from private practice, and many double this with NHS pay and bonuses.

Those with the highest earnings are invariably orthopaedic and ENT (ear, nose and throat) doctors, who build up thriving private practices by performing the most common or expensive operations.

Specialisms like public health and geriatrics are comparative Cinderellas.

With consultants’ earnings so high, there may have been some public glee at last week’s announcement by the Monopolies and Mergers Commission of an investigation into the price guidelines for private operations set out by the British Medical Association.

The BMA rejects suggestions that its guide prices create a consultants’ cartel, preventing competition between doctors. They are, it argues, simply an indication of the ‘going rate’ for a surgical procedure. (Just set the max price and allow competition)

Consultants, however, are beginning to feel persecuted by the questioning of their practices and earnings.

Conscious of their poor public image, few will speak on the record, but some suspect an orchestrated assault on the powerful institutions of the Royal Colleges, which critics say perpetuate an 18th-century guild model of training and education in medicine, turning on apprenticeship, patronage and promotion by preferment.

Two weeks ago, a government working party was set up under Kenneth Calman, the Chief Medical Officer, to investigate the Colleges’ failure to follow EC directives on the certification of doctors.

The directives, set out in 1977, were designed to allow doctors to work in all EC countries. A leak has already revealed that the Department of Health accepts the complaints from the European Commission that Britain’s system is ‘unlawful and discriminatory’.

Meanwhile, junior doctors are clamouring for admission to the select consultants’ ‘clubs’, arguing that the 10 to 15 years’ training needed to gain specialist accreditation is twice as long as it need be, barring them from private practice and NHS ‘merit money’ or bonuses.

Legal action is being taken to end ‘restrictive practices’.

Dr Anthony Goldstein, a Harley Street rheumatologist who has failed to gain consultant’s accreditation, has won a judicial review of the laws governing specialist medical training.

Private health insurers, increasingly concerned about poor profits and rising costs, are privately delighted by the Monopolies Commission inquiry.

Mr Laing, author of the annual review of private health care, said: ‘Health insurers want as good a deal as possible for their clients and they feel the fees are too high. How the level of fees was set in the first place is lost in the mists of time. But Bupa has never negotiated fees with doctors. They just started from the position that doctors’ charges had to be fully reimbursed.’

David Cavers, managing director of insurers Norwich Union Healthcare, has commissioned a detailed study by private health care consultants.

When it is published next week, it will show that consultant surgeons earn an average of pounds 50,000 a year from their private caseload in just one-sixth of their working week.

If they worked full-time in private practice, their annual salary would be pounds 300,000, compared with an NHS salary of pounds 50,000 a year.

‘You have to ask yourself, is that rate right?’ said Mr Cavers. ‘Initially, private insurers needed to pay a premium to attract consultants, because there were so few in private practice. But now two-thirds of consultants do at least some private work and the supply has gone up dramatically. But fees have continued to rise dramatically. In any other market you would have expected economies of scale.’

Insurers are beginning to examine other ways to force down costs.

Bupa, with the largest market share of about 44% may introduce cost-cutting clinical protocols for consultants.

The Government’s squeeze on consultants began two years ago after complaints that too many were leaving junior doctors to cope while they feathered their nests in private practice.

Ministers introduced new ‘job plans’ for consultants, formalising for the first time their NHS commitments.

Mr Williams believes that the prevalence of ‘shirking’ was exaggerated and the government’s measures to combat it have proved a waste of time.

He estimates that 10-12% of consultants neglected some of their NHS duties and that that remains unchanged. Flexible working patterns mean that much still depends on trust. The vast majority of consultants fulfill their contract or do a little more.

Under his contract, Mr Williams runs three outpatients clinics and three operating sessions a week for the health service.

NHS administrative work and private practice occupy the remaining two working days and spill into his evenings. He prefers not to operate or run clinics at the weekend except in emergencies.

He says it is difficult to know what to charge for an operation, and so the annual BMA guide prices introduced in 1989 are useful. He says rival guidelines produced by Bupa are too low and out-of-step with those of other insurers. ‘I frequently charge a great deal less than the BMA guideline price and in a couple of cases charge a bit more,’ he said.

Professor Miles Irving, chair of external affairs for the Royal College of Surgeons, claims that the BMA guide prices give little cause for concern. He says there is no intentional cartel, and many doctors prefer to follow the Bupa guidelines anyway.

Mr Williams points out that private practice involves costly overheads. He employs two administrators and three nurses part-time and has to fund his own offices. He sees no ethical conflict in combining private and NHS practice. Very committed to the NHS he has no desire to reduce his hours at Worthing Hospital. Private practice is in his own time and never interferes with NHS commitments, he says.

Professor Irving says private practice is a fact of life grasped by Worthing Hospital which is currently considering setting up a private wing in a disused ward. If Mr Williams carried out his private work there, then the hospital would get its cut of the profits which could be pumped back into the NHS.

Mr Williams says estimating one’s professional worth is always difficult. ‘In one sense I am a total parasite. I am trained by the state and I don’t produce anything. But on the other hand I am one of only 400 specialist eye surgeons in England and Wales. This is an extremely competitive profession.’

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