Doctors

Escape velocity The evacuation of Afghanistan was likened to the fall of Saigon on 30 April 1975. What were the logistics of that operation? — Although most US troops had left Vietnam, 5,000 civilians remained. Some left during the month, but ambassador Graham Martin gave the order to evacuate everyone only on 29 April. — The only available airbase had been shelled and there were no sea or land routes, so the only way out was by helicopter. In 24 hours 7,000 people were evacuated, including 5,500 Vietnamese citizens. Helicopters took off from the US embassy compound every ten minutes. — It was a 50-minute ride to US warships waiting off the coast.

Where have all the GPs gone? Doctors were among the first to be double-jabbed, ahead of teachers in the queue precisely so they could resume seeing patients in the flesh. But while schools have long been back, GPs have retreated behind their laptops never to be seen again (at least not in the flesh). The stethoscope has been replaced by a headset — to the despair of patients with ailments that are hard to diagnose over the phone or via a laptop. In theory, GPs can claim normal service has resumed. In the pandemic the number of appointments almost halved to just over three million a week — in spite of attempts to keep healthcare running. The consequences of this drop can only be guessed at.

Everyone agrees something dramatic has to be done to help the NHS. It is crumbling and the canary in the mine is general practice. I work as a psychiatrist but my GP colleagues are almost all frazzled, overworked and frustrated at not being able to give the care they want to their patients. They’re quitting in their droves. So it makes sense that politicians, desperate for a quick and easy answer to an overwhelming and complex problem, have leapt on technology as a solution. And, in particular, on  the idea of an app that offers a GP consultation via your mobile phone. In theory, it sounds great: the patient can dial up, speak to and (via phone camera) see a doctor, who could be anywhere. The poster boy is an app called GP at Hand, run by British start-up Babylon.

Last October, Phil Coleman, a journalist on the Carlisle-based News & Star, went to cover the trial of Zholia Alemi, a 56-year-old consultant psychiatrist who was accused of forging the will of an 84-year-old dementia patient in an attempt to inherit her £1.3 million estate. During the trial, Phil realised this complex scam could not have been the work of an amateur fraudster, and suspected previous mischief. How right he was. It turned out that Alemi had been practising in the NHS for 23 years without a medical qualification. Originally from Iran, Alemi moved as a young woman to New Zealand where she claimed she had graduated in medicine from the University of Auckland in 1992.

The Royal College of Physicians will soon begin yet another consultation with its members on the subject of 'assisted dying'. The college is opposed to legalisation, but a minority are unhappy with this. They know there is no chance of persuading a majority to support such practices. So they are pressing for the college to declare itself neutral. Whether the law should be changed, they say, is a matter for society rather than for the medical profession. In one sense they are right. Whether the law should be changed to permit people to be supplied with lethal drugs to take their own lives is a social rather than a medical matter.

I am in a good position to report from the NHS frontline, having been in hospital with pneumonia for just over a week from 28 December. I was admitted following an early evening visit from a district nurse to the home I share with my younger daughter, her husband and their three children. The nurse rang A&E to advise them of my impending arrival but warned us that there was a four-hour wait for an ambulance. My daughter therefore decided to drive me in, and we arrived at a packed casualty unit. I was desperate for oxygen and my daughter begged at the reception desk for me to be triaged to access some, with no success. At 11.30 p.m. I was finally examined and hooked up to an oxygen supply. I was found a bed in the admissions ward at 4 a.m., in an atmosphere reminiscent of a war zone.

There’s a graveyard inside Henry Marsh’s head, though you’d never guess it to look at him. There he sits in his elegant flat in a small castle on a small island in the Oxford Thames: 67, attractive, restless. There he sits with the world all around him: Persian rugs, French tapestries, Japanese prints and his beautiful blonde wife (the anthropologist Kate Fox) in a separate flat below. But the ghosts of past patients are never far away. Henry Marsh is a brain surgeon, celebrated for his skill in operating on patients under just local anaesthetic. He’s famous also for his astonishing memoir Do No Harm, to which he’s now written an equally remarkable sequel, Admissions.

The builder boyfriend colicked for a week after eating a falafel kebab as he and I sat up all night with the colicking pony. And unlike the colicking pony, who was attended to by the vet and given intravenous Buscopan, the colicking builder boyfriend moaned and groaned in agony, untreated. If he had a GP he couldn’t remember who or where it was. He has not sought any kind of healthcare, nor seen the inside of a hospital, since a gang of thugs broke both his arms when he was a ten-year-old boy growing up on the mean streets of Balham. (That was the real Balham, before the independent hipster cafés came with their nut-milk lattes and sustainable sourdough fritters garnished with locally foraged pea-shoots.

Just when it looked as though Britain's vacuum Government had enough on its plate, the junior doctors row - which many had hoped had finished - will now bubble on. BMA members have just voted to reject the Government's contract offer by 58 per cent to 42 per cent. The margin was convincing enough that the BMA's chair Johann Malawana, who proved an effective combatant against Jeremy Hunt during the dispute, has stepped down. In his letter, Malawana pointed the finger of blame at the Government, saying: 'I believe the fundamental breakdown in trust caused by the government's actions over the last five years has resulted in a situation where no solution is possible, particularly when a government is so keen to declare victory over frontline staff.

Why do we assume all doctors are good? We don’t think there are no bad cooks or bad plumbers. But everyone thinks their surgeon is the best in the world. Recommended to one such, I booked an appointment. He rattled off his spiel about the pros and cons of surgery, physio or jabs for a bad shoulder, while looking at the ceiling and at his watch. He waved away my scan: ‘I never look at those. Just heaving oceans of muscle. They all look the same.’ He favoured surgery, but I asked for a jab. It hurt like hell and made no difference. So I went to another ‘top of his profession’ consultant, who gave me a jab, while looking at the scan on a monitor to hit the right spot. It worked. After nine months, I can move my arm. Yippee.

Now that Jeremy Hunt has rejected a proposed cross-party pilot scheme for new junior doctors' contracts it seems this week's strike looks certain to go ahead. The industrial action is due to start tomorrow morning and junior doctors will walk out again on Wednesday, but the war of words for this week has already begun in earnest. The Health Secretary has fired the opening salvo in his letter to Dr Mark Porter. Hunt said the strike: ‘…seriously risks the safety of many who depend on the NHS’ Dr Porter, the BMA council chair, has been on Today defending the industrial action which will see junior doctors walking out and not providing emergency care for the first time in this dispute so far.

A few months ago, paramedics were on the brink of industrial action. They had legitimate grievances. Ambulance services were being run down, their staffing levels were dangerously thin — and the mismanagement (much of it exposed by Mary Wakefield in The Spectator) was horrendous. But in the end they stepped back from the brink — for good reason. It went against their nature to endanger lives, and in addition it would have been a tactical mistake. If a single patient died as a result of the strike, paramedics would have lost public sympathy. Should a nationalised health service really use the unwell as a bargaining chip? English doctors have not shown the same strategic foresight.

Home David Cameron, the Prime Minister, made a speech in Wiltshire about a letter from Donald Tusk, the president of the European Council, on Britain’s demands for renegotiating terms of its membership of the European Union. Mr Cameron said: ‘What we’ve got is basically something I asked for.’ In the House of Commons, Jeremy Corbyn, leader of the opposition, said: ‘It’s rather strange that the Prime Minister is not here…’ instead of ‘…in Chippenham, paying homage to the town where I was born.’ Mr Tusk proposed that in-work benefits for migrants might be subject to an ‘emergency brake’.