On “Health at Every Size”

August 31, 2013 at 10:55 am | Posted in Conditions, Media, Opinions | Leave a comment

Oh boy. I don’t think I’ve ever written a post outside of the realms of aggressive atheism that I knew before I even started was going to be such flame bait. That said, I will try to keep this sensible and not bash any particular demographic. My goal here is to state facts, not to tease obese people. I’m even going to add a disclaimer: I am a chubby fat-ass. Oh yes. But I’m not kidding myself about the impact that has on me.

Health at Every Size (HAES), from their own website, ”acknowledges that good health can best be realized independent from considerations of size. It supports people—of all sizes—in addressing health directly by adopting healthy behaviors ”.

That’s a good goal, and it’s one you have to approve of. Getting anybody to be healthier is a good thing; getting somebody who’s very unhealthy to be healthier is even better. So I don’t want to take issue with that. But I really do take issue with some of the methods it advocates and the messages it sends. I’ll get on to those in a moment.

So: Who invented Health at Every Size? A lady by the name of Linda Bacon (save the jokes, people), who to be fair holds a lot of qualifications in a lot of disciplines. However, while she does have a PhD in physiology she’s not a medical doctor, and that makes me a little wary of putting too much weight in her opinions about something as important (and medical) as obesity and overweight. It’s also interesting to note her list of peer-reviewed published works: Not extensive, and nothing in any of the big, high-impact journals. She calls herself an ”internationally recognized authority on weight and health”, but honestly I see nothing in her public profile that backs up that assertion, and I’m cautious about people who proclaim themselves to be internationally recognized. If it’s true, they shouldn’t need to say it themselves because other people are saying it for them – I read widely in medical and care journals, and until I started looking at the HAES website, I’d never heard of Linda Bacon.

The HAES website lists three principles that I want to talk about.

First: ”Accepting and respecting the natural diversity of body sizes and shapes.”.

Yes. Totally with you on that. We do come in all shapes and sizes, and it is nobody’s place to make judgements about an individual’s weight. There is a huge amount of body dysmorphia in the Western world, mostly thanks to media depictions of absurdly “perfect” (I use the word guardedly) bodies, faces and teeth. Anybody who doesn’t look like Beyonce or Brad Pitt* is made to feel like they’re inferior, not good enough, second class. And that’s a bad thing. So I have no bone to pick with this point at all.

Second: ”Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.”

…Aaaaand then again, there’s this one. Oh boy. How much is wrong with this one? First of all, Western diets (particularly among poorer demographics, who are also – non-coincidentally – more obese) mostly use fat and sugar as flavours. It’s a general rule of thumb that any processed food proclaiming itself to be low in fat is likely to be high in sugar, and any processed food proclaiming itself to be low in sugar is likely to be high in fat. The problem with fat and sugar (particularly sugar) is that they are incredibly calorie dense and are digested and absorbed by the human body very, very easily. A tablespoon of sugar contains 45 calories and no nutrients whatsoever except pure carbohydrate, and your body will absorb all of those calories immediately. On the other hand, a large bowl of salad will come in at less than 50 calories, not all of which will be absorbed by your body, and a shedload of micronutrients that a healthy body really does need.

The reason that this is such a problem is that sugar triggers the pancreatic feedback response, dumping insulin into your body. Insulin does two things in this context: First it enables cells to absorb glucose in your blood quickly and easily so that your sugar levels (which have already risen rapidly at this point) drop rapidly back down, and it stimulates your body to store fat. That’s right. Sugar makes you fat. It also has an addicting effect; when the sugar rush is followed by the sugar slump, your body wants more sugar. And that’s more high-density calories that your body just does not need.

The “Too Long; Didn’t Read” version of this is: Processed foods and beverages are addictive, calorie dense, habit forming, nutritionally crap, and don’t satiate hunger. They trigger a pleasure response, but it takes way, waaaay too much volume of them to fill your stomach and satisfy your appetite.

And chances are, if you’re already overweight, obese or super-obese, the foods that you respond to hunger cues with and get pleasure from are foods that you really, really shouldn’t be eating.

On to principle three: ”Finding the joy in moving one’s body and becoming more physically vital.”

Or, as it’s otherwise known, ”Doing exercise and getting healthier, which as a side effect will cause you to lose weight”. Do I even need to add anything here? Of course better cardiovascular health through exercise is a good idea. Anybody who tells you otherwise is a moron.

Now I’m going to move on to some things that come from Linda Bacon’s own promotional website.

”MYTH: Fat Kills. REALITY: On average, ‘overweight’ people live longer than ‘normal’ people.”

How can I put this? It seems to me that this quote is misleading. It seems to me that a layperson probably doesn’t know the distinctions between overweight, obese, morbidly obese and super-obese. It seems to me that Linda Bacon might be deliberately using the word “overweight”, knowing that it’s probably the word most people in all of the above brackets would use to self-describe. It also seems to me that The New England Journal of Medicine (one of those big, high-impact journals I mentioned earlier) has published research which disagrees strongly with this point. It seems to me that a reasonably unbiased, well informed, outside observer might look at this point on Linda Bacon’s website and consider it to be very cynical and manipulative indeed.

Moving on.

”MYTH: Lose weight, live longer. REALITY: No study has ever shown that weight loss prolongs life”

Well this is just flat-out wrong. I can only charitably assume that Linda Bacon doesn’t know about Google Scholar, because it took me all of about ten seconds to find a study which evidences a link between losing weight and living longer. I assume that Linda has Athens access. Because I do. And there is more than one study that says the same thing.

”MYTH: Anybody can lose weight if he or she tries. REALITY: Biology dictates that most people regain the weight they lose, even if they continue their diet and exercise programs

(Emphasis mine).

And physics dictates that this point is utter bullshit. It’s really simple: Your body cannot create mass or energy out of nothing. Therefore, if calories in equals less than calories out, your body converts mass to energy to make up the difference. Conversely, if calories in equals more than calories out, your body converts energy to mass to store the excess. This is not rocket science. I would love to know what research Linda Bacon has to support her assertion here, because I guarantee you if there is any it’s based on self-reporting by study participants – Because people routineliny underestimate their own calorie intake by A LOT, while simultaneously overestimating their own physical activity levels.

I’d like to throw one more point in here before I close. Life expectancy is going up, even amongst high BMI populations. But that isn’t because high BMI is healthy; life expectancy is going up despite increasing BMI levels. The fact is, if you have a high BMI, your life expectancy is still much lower than it would be if you have a normal BMI.

The danger in the HAES movement lays in the fact that it’s impossible to take a general rule of thumb and apply it to a whole demographic. While it’s entirely possible to be both fat and healthy, it is very rare to be both fat and healthy, and everybody thinks they’re the outlier, the exception to conventional wisdom. The problem is, most of them are wrong.

The HAES movement is popular amongst what is known as the “Fat Acceptance Movement” (or self-styled “Militant Fatties”). This is a demographic that has already made up its collective mind to ignore evidence and reality in favour of confirmation bias.

That is a group of people who nobody is ever going to convince that they are harming themselves with their lifestyle choices. When their knees collapse and have to be replaced, when they’re on BiPAP at night so they don’t die of sleep apnoea, when they’re on mobility scooters to go to the shops, these are people who will insist that all of those things are coincidental, that they’re nothing to do with their weight. Ultimately, though, when they have a serious cardiac event twenty or thirty years before their healthy BMI contemporaries and lay dead on a mortuary table, they’ll still have been just as wrong.

*Disclaimer: I think she looks like a blow-moulded Barbie doll and he looks like a skinny manlette, but whatever.**

**Disclaimer 2: Yes, I just judged two people on their appearance. I’m a hypocrite. Deal with it.

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On homeopathy

July 2, 2013 at 4:02 pm | Posted in Ethics, Opinions | 5 Comments

Homeopathy is a system of treatment invented in 1796 by a German physician named Samuel Hahnemann. “Medicine” in the eighteenth century was not exactly evidence based, and Hahnemann correctly realised that a lot of it did more harm than good; however unlike some of his contempories (such as Edward Jenner and Anton van Leeuwenhoek) , Hahnemann didn’t really grasp the scientific process with both hands.

Hahnemann knew that, through experiment, effective drugs were being developed to treat illnesses, and he wanted to be a part of improving medicine; he tested many substances to observe their effects on the human body. It is pretty clear that he understood the nature of experimentation through trial and error, and he even got so far as formulating a hypothesis to explain some of his observations. Unfortunately, he also had some fairly large gaps in his knowledge. In combination with what I suspect might have been a little too much enthusiasm to make a name for himself in medicine, this lead him to some very simple errors. It should be noted before I continue that aside from homeopathy, Hahnemann’s other major hypothesis was that disease was caused by coffee. I mention that here just to give some insight into the mind of the man I’m going to talk about.

While working on the translation of a treatise on malaria, Hahnemann began to self-experiment with the bark of the cinchona tree – Commonly known as Jesuit’s Bark, or Quinine. For many years, Quinine was the only effective remedy for malaria. It was so good that British explorers made infusions of it called “tonic water” and drank it with gin (Edit: that might or might not be where gin and tonic comes from, this may be apocryphal, but there doesn’t seem to be a huge weight of evidence either way). Sadly, malaria has long since evolved an immunity to it.

Despite translating the work of others, Hahnemann was no expert on the use of Quinine. Whilst testing its effects on himself, he took an overdose and made himself extremely ill. What followed is the invention of the founding principle of homeopathy – Forged from pure ignorance.

Despite having little or no knowledge of malaria as a disease, Hahnemann seems to have unilaterally declared that the symptoms he experienced due to an overdose of Quinine were exactly the same as those experienced in the acute onset of malaria. Ten seconds on Google will be enough to demonstrate that he was quite wrong.

On the basis of this extremely shaky logical foundation, Hahnemann went on to make two even shakier logical jumps: Since he knew that Quinine cured malaria, and since he thought that Quinine induced the same symptoms as malaria, and since he had found that a large dose of Quinine was nearly fatal (or at least extremely unpleasant), it followed in his mind that 1) Any disease could be cured by a preparation of any substance that could induce the same symptoms as the disease in the person taking it (the “doctrine of opposites”, and 2) The smaller the dose given, the more effective this “medication” would be.

I trust I’m not going to have to point out the logical fallacies there.

Homeopathy has been developed (if that’s the right word – perhaps “completely made up” would be better) from that beginning. One interesting aspect (that completely trashes the “doctrine of opposites”) is the technique homeopathists use to dilute their preparations. Let me start by saying that mathematics is probably not their strong suit.

First, a solution of the substance to be used in the “medication” is prepared by diluting it one part in ten with distilled water. The vial containing this dilution is then struck hard against a leather bound book, ten times (bear with me, I’m not making this up – Hahnemann did that). The solution so produced is then further diluted, by taking one tenth of it, and diluting it again one part in ten with distilled water. Bang the book ten times and voila, you have a one part in one hundred dilution.

And now it gets a little tricky: Homeopathists believe that the more times you repeat this process, the more potent the medication becomes. Homeopathic remedies are often sold as a “potency” of “6C” – In real terms, one part in one trillion of the original ingredient, diluted in distilled water. A 12C concentration would be equivalent to a single pinch of salt in the Atlantic Ocean. But that’s not even where it gets really absurd – Some homeopathic treatments are diluted up to 200C. To give you a rough idea of what that means in real numbers, 40C would be the dilution given by one single atom of the original substance, diluted in all of the mass in the known universe, if it was all distilled water. To be sure of containing any of the “active” ingredient, a 200C dilution would actually require the existence of 10^320 more universes that this one, all made entirely of distilled water, and between them containing just one atom of the original substance.

But wait! There’s more! You might have noticed that homeopathic remedies don’t tend to be in liquid form – And you’re quite right, they don’t. They tend to be pills. And that’s because, having gone to all the trouble of contaminating distilled water and then diluting it so heavily that the contaminant is completely undetectable even compared to the chemicals the water leaches from the sides of its glass container, homeopathists then take this “preparation” (read: “water”) and put a single drop of it on to a sugar pill. They then allow it to evaporate (i.e. the pill to dry out). And the resulting sugar pill is what they sell in pharmacies and health food shops all over the world as homeopathic remedies.

Was ever a process so long-winded, so complicated and so utterly pointless?

Unsurprisingly, the research evidence (yes, people have wasted their time researching it) on homeopathy is unequivocal: It has no effect whatsoever beyond placebo. It revolves around people assuming that natural regression to mean is the same as cure. It does nothing. It is quackery at its absurd finest.

Edited 02/07/2013 to reflect uncertainty over the history of tonic water. Sources:

http://goo.gl/daT0F

http://goo.gl/yuDag (Athens or Wiley login required)

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On gender identity and empathy

June 30, 2013 at 9:30 am | Posted in Opinions, Politics | 2 Comments

Those of you who’ve come here from Twitter will know that I use as my avatar a picture of Nurse Ratched from the film One Flew Over the Cuckoo’s Nest. Some of you might also have read my “about” page here and realised that I’m not actually a mental health nurse, nor am I a woman, and nor am I quite that evil.

Most casual Twitter followers and repliers, however, are not that observant – Or maybe just not that invested; it seems to me that Twitter mostly relies less on engaging with a personality (apart from certain celebrities), more on responding to what’s been said right here, right now. I could write an essay on communication theory and why innocently intended tweets can still lead to a huge amount of butt-hurt and whining from people who are far too delicate to survive on the internet, but I’ll do that another day.

I’m increasingly finding that even amongst those like me who choose to remain anonymous, the trend is to either pick a gender-neutral avatar, or to pick one that is of the tweeter’s own gender – You can often tell by the self-descriptions, or by following links to blogs. This seems (in my experience, and I can’t back this up with data) to be a particular feature of anonymous male tweeters; there’s something that stops men in particular from using avatars of the opposite sex. I wonder if that’s a subconscious acknowledgement of gender privilege. Honestly, I don’t know, but it’s interesting.

Anyway, my point is that the vast majority of people who read my tweets probably presume I’m a woman, and many of them respond in ways that they mistakenly think are appropriate to that. You probably won’t read a lot of those responses, because a lot of it is in DMs, and because I block the offending tweeters as soon as I see them. And I call them “offending” tweeters for good reasons.

It’s fascinating to be regularly mistaken for a woman. Really, it is. Working as I do in a female dominated profession, with mostly female bosses, I had no idea how much people condescend to women. There’s a steady stream of “darlings”, and “sweethearts”, and “cupcakes” – You read that right. I have, without irony, been addressed as “cupcakes”. I’ve had my (very qualified, thoroughly educated, highly experienced) thoughts and ideas questioned and dismissed by lay-persons (lay men, obviously) solely because they thought that I was a woman and that therefore my thinking was inferior to their man-thoughts. I regularly experience overt flirtation and sexually inappropriate messages (because all nurses are like Barbara Windsor in Carry On Matron, clearly).

The Angry Nurse is not my first anonymous online persona. I wrote for and moderated Unreasonable Faith as Custador, with a male avatar, for about four years. I had far, far more readers there than I do either here or on Twitter – At its peak, UF clocked over a quarter of a million unique hits per week, and my posts tended to be popular. Conversely, I have less than 250 Twitter followers and less than fifty people per week currently read this blog. The only thing that has changed other than my pseudonym is the gender of the avatar I’m using. Out of the millions of people who read what I wrote as Custador, only one of them was ever sexually inappropriate, belittled my ideas because of my gender, or felt the need to address me with titles like “cupcake”. For completeness, that one was a self-described “radical feminist” who took extreme offense when I questioned whether regularly posting photos of herself on the internet dressing as a schoolgirl and then stripping to graphic nude, was really a feminist thing to do (note: I did not slut-shame her or question her right to do so, only her association of it with feminism).

Conversely, as The Angry Nurse, behind a female mask, I have had perhaps a few thousand people read my ideas over the course of about six months. And the issues I’ve described above have occurred dozens of times. It’s like background radiation pervading the environment of my discussions, and to me, it’s fascinating. But I can escape it whenever I want to, because regardless of my picture of Nurse Ratched, I’m not a woman. I can have my male privilege back at the press of a button. I keep reminding myself that actual women are not so fortunate.

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On rape culture and why it’s men who have to change it.

June 19, 2013 at 9:41 am | Posted in Opinions, Politics | Leave a comment

This is a re-blog of a post I wrote some months ago for Unreasonable Faith while I was still blogging for them under the name of Custador. Since a large chunk of my discussions these days seem to revolve around feminism, I thought it was appropriate to re-blog it here, on my own blog.

This post will discuss rape, including specific instances of rape, both historical and fictional.

I want to take a little side-track from talking about religion today. I want to talk about something else instead.

I know it’s not really what we do here at UF, but I think what we do do boils down to talking about ideas; today I’d like to talk about feminism. Or at least I think I’d like to talk about feminism; the definition of that word seems to change depending upon who you talk to; I’ve always considered it to mean something like “the promotion of equality between the genders”, but I’ve had more than one person (mostly frothy-mouthed Men’s Rights Movement types, admittedly) telling me that it’s about “empowering women”, and has nothing at all to do with equality. Personally I think that women worldwide are starting off with a socially imposed gender disadvantage anyway, so empowering women pretty much does mean the same thing as promoting gender equality at this point. But however. Your mileage may vary, and I’m happy to be educated about what feminism means if anybody would care to take the time. I freely confess, I don’t know what the “waves” of feminism are/were, I’m largely ignorant about feminist history, and I don’t know who most of the great feminists throughout history have been (except I once dated a girl who was named after Ememline Pankhurst and my mother thinks Germaine Greer and Janet Street Porter are awesome).

But really, those issues are kind of peripheral to what I want to talk about today. I want to talk about something that I disagree with a feminist spokesperson about. But I’ll come back to that in a while.

First I want to set some context. It’s context that I suspect that all of our female readers will already be aware of, but which may come as a surprise to at least some of our male readers (though let’s not get started on the Male Privilege Argument, which I think we have done to death on the forums).

The context I want to set is this: We live in a rape culture. If you doubt me, then let me give you some examples:

1) The movie Observe and Report, which contains a “comedy” rape, in which the main character initiates sex with an unconscious woman (who he has drugged), but we’re supposed to think it’s okay because she wakes up and, while clearly still under narcotic influence, gives consent after the fact. I don’t even know where to start tearing Seth Rogan a new arsehole for that one, but I refuse to provide a link to a clip of it.

2) Convicted rapist Mike Tyson plays himself in cameo roles in movies like The Hangover and The Hangover 2.

3) Roman Polanski, a darling of Hollywood who won’t go anywhere near Hollywood (or even America) for fear of being arrested for drugging and having forcible sex with a fifteen year old girl while she was saying no and telling him to stop.

The next few examples I want to give are taken from an article in The Independent titled “2012: the year when it became okay to blame victims of sexual assault”.

“At Caernarfon Crown Court earlier this month, a 49-year-old man was convicted of raping a teenage girl. Jailing the rapist, the judge told him: “She let herself down badly. She consumed far too much alcohol and took drugs, but she also had the misfortune of meeting you”.”

A Crown Court judge, victim blaming over a rape.

“In August, the MP George Galloway publicly dismissed allegations of rape and sexual assault against Julian Assange. The WikiLeaks founder, he said, was guilty simply of ‘bad sexual etiquette’ when he began to have sex with a sleeping woman who had previously consented; his actions were ‘not rape as anyone with any sense can possibly recognise it’.”

Notwithstanding that George Galloway is a complete idiot, I don’t even know where to start with this one. I’ve got quite a lot of sense, personally, and I have no hesitation in saying that if that really is what happened, then that was rape.

“In April, after the footballer Ched Evans was convicted of raping a woman who was too drunk to consent, his victim faced an appalling backlash of online abuse. Twitter users called her a “money-grabbing slut” and circulated her name so widely that she was forced to change her identity.”

I don’t know if anybody else followed the Ched Evans case, but it was a much needed victory for the relatively new and largely untested UK law which explicitly states that having sex with a person too intoxicated to consent is rape. He had sex with a woman so drunk that she was virtually comatose, having had a friend pick her up and bring her back to his hotel for that specific purpose. And the great British football loving public responded with a round of vitriolic victim blaming so severe that she’s had to move to a new part of the country and adopt a new identity.

Let’s not even bother quoting any of the US Republican party’s record on rape. It’s too long, and has been done to death in recent months.

And now onto the part I want to disagree with somebody over.

Christina Diamandopoulis from the charity Rape Crisis was quoted in The Independent as saying “We have to get together as women … to grow the seeds of the fightback, which has already started, with organisations such as Rape Crisis, Object, Everyday Sexism, Mumsnet and others. Together, women have moved mountains before – we can do it again.”

No. Sorry, but no. To imply that women will stop rape, to my mind (however unintentionally), perpetuates the harmful myth that women are responsible for rape. That is, on the whole, untrue. I’m not saying that women don’t have a role to play, they clearly do: It’s a role that they share with men, though – Educating our children so that they don’t passively accept rape culture, voting with their wallets by not contributing financially towards media which denigrates women and promotes patriarchy and rape culture, and by pressuring our political representatives to at least have a clue what rape culture is and why it’s bad.

But the reason that I disagree with Ms. Diamandopoulis’ sentiments is this: The one and only person responsible for a rape, is the rapist. And rapists, in the overwhelming majority of cases, are men.

It’s not women who need to adopt a change in attitude, it’s men. I think as men we can probably all think of instances where we’ve laughed amongst ourselves at jokes that we would absolutely never tell in the presence of a woman. I can certainly think of instances from my own youth where my attitude to women was not so much questionable as downright disgusting. I’ve given unthinking support to male friends who were accused of rape, without even stopping to think that maybe they did it. I’ve certainly had sex with women whilst we were both very drunk, and not thought to ask myself if they would have wanted to do it sober. I’ve hung around in groups of male friends discussing women like they were trophies to collect. And to my fellow men I say this: I know damned well that my experiences are not uncommon. The vast majority of us have done (or still do) these things.

And that is what needs to change to end rape culture: The things that we men do and say and are, when only men are present; the ways we interact with each other, the things that we find acceptable; the standards that we relax when we are with “the boys”.

So to that end, I’d like to make a little pledge:

I will never condone rape or support rape culture in any way. I will object, loudly, when a rape joke is told. I will not tolerate objectification of women, amongst my male friends or amongst anybody else. I will do my best to be aware of my male (and white, and straight, and middle class) privilege, and to not take advantage of it. If and when I have children, I will try to educate them to critically appraise the media to which they are exposed and be aware of the gender messages within it. I will not spend money on any product, company or media which I am aware of having promoted rape culture or gender disparity, regardless of whether they have done so deliberately.

I think that pretty much covers everything I wanted to say today. Once again, I extend my usual open invitation to educate me. Go go go!

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March 17, 2013 at 1:09 am | Posted in Uncategorized | 2 Comments

custador:

READ THIS. Really.

Originally posted on The SKWAWKBOX Blog:

In the immediate aftermath of the release of the Francis Report into events at Mid Staffordshire NHS Foundation Trust, I identified that David Cameron’s crocodile-tears and apparent humility were just a feint that would quickly turn into an attack on the NHS nationally (yet another front in their all-out war on it), using Mid Staffs as a template for attacking other hospitals – and Labour.

This morning’s headlines – covered by the BBC (website and news channel) and the right-wing press – about Professor Sir Brian Jarman’s claim that 20,000 NHS deaths could have been prevented come on the back of a 2-week long assault by Health Secretary Jeremy Hunt on Labour’s supposed failings leading to Mid Staffs.

The claims are utter nonsense – but they are being used by the press and the government as

A sledgehammer to smash the NHS – and Labour

Image HSMRs – the wrong sledgehammer…

View original 3,337 more words

On Short-sighted Executives

February 28, 2013 at 1:29 pm | Posted in Nursing, Politics | Leave a comment

Nurses in Britain will probably have at least some peripheral awareness that national negotiations are currently in progress to determine our Agenda for Change terms and conditions (i.e. what we get paid).

What a lot will not be aware of, however, is that our colleagues working for 19 NHS trusts in the South West of England are facing real terms cuts to their pay and conditions, thanks to the South West Pay Cartel – Basically, 19 trusts in the South West have banded together in an attempt to adopt a regional pay structure. This despite the Health Minister telling the Cartel that regional pay is a terrible idea, and they have no legal right to leave the Agenda for Change T&Cs.

Well, this is depressing.

I think I need to address the people who live in the South West of England at this point. It’s an older population than most parts of England, because many people retire there, and the economy is not vibrant, so many young people leave to work elsewhere. In other words, it is disproportionately dependant on the NHS, because older people = more use of healthcare.

So to the people of the South West: Let me tell you what is going to happen where you live, if regional pay is adopted there, and pay is cut as a result (it will be, that’s been the transparent goal of the Cartel from day one).

Medical schools, nursing schools and schools for allied practitioners such as physiotherapists, occupational therapists, radiologists, turn out a class of fresh, eager new professionals every year. And those professionals look for jobs. Do they look for work in a part of the country they know to be more expensive than average in terms of living cost, and where they know they’ll get paid less? No. They do not.

Existing healthcare professionals in the South West will suddenly be faced with a choice: Stay and get paid less, or go and get paid more. What happens? Those who can move away, move away. It’s not hard to get a job as a qualified healthcare professional. Really. I get sounded out or asked to apply for one at least once a month. We can work anywhere; our qualifications are universal, and our professional registrations are good enough for the whole world.

So at this point, no newly qualified professionals will be moving to the South West, and a lot will have left, leaving hospitals desperately short-staffed. What do they do? The only thing they can do; they’re legally obliged to maintain safe staffing levels, so they get agency staff at an average cost of £146 per hour to cover the shortfall.

So what do you, the patient, get? You get inconsistent care, where you rarely see the same nurse twice during your hospital stay. You get a lack of continuity because the nurses looking after you are not a part of the team, and they have no real incentive to make sure your needs and requirements are handed over to the next nurse on shift.

What do the trusts get? Well, let’s just look at nursing a minute, because that’s what I know: A newly qualified nurse on Agenda for Change terms costs employers around £11 per hour in all. That’s about £125 for a twelve hour shift (note: That’s not what the nurse takes home, that’s what they cost the employer including pay). An agency nurse, on the other hand, costs £146 per hour (the best paying agency offers a flat rate of £32 per hour, the rest goes to them), or around £1750 for a twelve hour shift.

In other words, by cutting pay for nurses the South West Pay Cartel will ensure that everybody, including themselves, loses out financially. The only people who win will be nursing agencies and their very well paid employees.

And let’s not forget the bigger picture: We need newly qualified staff, who’ve been trained in the newest and best ways of doing things, to come and tell us when we’re doing something in an old-fashioned way. Medicine should be evidence based, and evidence improves and changes. We don’t all have the benefit of being able to sit down and plough through the journals every day to stay up to date, so those new staff are a crucial part of keeping our practice up-to-date.

I think what scares me the most is how very obvious this all is. Executives at those trusts are in dire need of opening their eyes, taking off their financial blinkers, use whatever metaphor you like. They’re going to bankrupt their trusts, and they’re going to do real harm to patients in the process.

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On Stafford, and Judgementalism

February 13, 2013 at 10:56 am | Posted in Media, Nursing, Politics | 2 Comments

I guess I can’t really blog about nursing and not mention the Stafford Hospital report. For anybody who’s been living under a rock, the tl;dr version is: Care was not good enough at the Stafford Hospital, and unnecessary deaths resulted.

Ouch. I can only imagine how nurses at that hospital feel right now. Frightened. Embarrassed. Defensive. Angry. Probably a cocktail of all those and more. But that report has been pored over and analysed and quote-mined to death; the only thing that I want to say about it directly is: The report’s author has already admitted that he was wrong to name the whole hospital as the problem, when in point of fact the issue was isolated to two wards – And he even narrowed it down to specific staff on those two wards.

And yet, on the basis of this report, nursing in Britain is going through what feels like a witch hunt. This isn’t a nice time to be living through, speaking as a nurse. The media cannot wait for us to screw up and sell more papers for them, and the government are eager to push any agenda which makes the NHS as-is look inferior, because they’re ploughing ahead with privatisation by stealth (if you doubt that, read the full text of the Health and Social Care Act, then come back to me) and want to minimise resistance from the general public.

What’s worse is, nursing can’t get a mention on social media without a barrage of comments from uninvolved lay-persons who think they know how to fix all of nursing’s woes. From dead reckoning, at least ninety percent of the people making such comments can be summed up as “Bring back Matron!”, even though Matron never actually went away in the first place. Personally I think that there is a small but very vocal minority of sexually deviant people who fantasise nightly about Hattie Jakes in a white tabard and starched cardboard hat, and who want to populate our hospitals with her.

My point here is this: Nursing is a profession that people have so little respect for (until they actually see us in action) that they feel perfectly comfortable with telling us how to do our work, in spite of their own absolute ignorance. Dunning-Kruger effect – They’re too stupid to know that they’re stupid.

Of course, in amongst the Hattie Jakes fans, there are always one or two comments along the lines of “my mum laid in her own faeces for hours!”. Actually, that’s a really good example to use because it’s so common and yet usually such obvious tosh. How would you know that your mother had been laying in faeces for hours unless you were actually there to see it? And if you were there to see it, why didn’t you nag somebody until they came and cleaned your mother up? Now, I’m not saying that anybody visiting a hospitalised relative should ever be in a position to have to provide care, but honestly? If I was visiting my elderly grandmother in hospital and nobody had cleaned her up after a few minutes and repeated requests? I would just do it myself. And I know that’s not really a fair generalisation, because I am a nurse, and cleaning poo from elderly people is very much in my job description, but I think the point remains valid.

People in general don’t seem to provide care for elderly relatives as much as they used to. There is a very sad tendency to expect the NHS and/or Social Services to do everything. And that really isn’t the point of socialised health and social care.

I have encountered my share of families who pick up on every single detail of their relative’s care, and get angry and upset and claim that it isn’t good enough even when it’s absolute gold standard. They’ve all had one common feature: Guilt. In general, it’s often the family of an end-stage terminal patient who’s been an inpatient for weeks or months, but whose family have never been to visit until the day they’re phoned and told that their relative is fading fast and now would be a good time to come and say goodbye. That’s the point when you know as a nurse that you’re in for a challenge, because the family are justifiably upset that their relative is dying, and they’re feeling guilty about not visiting while he/she was still actually conscious and able to interact with them. They lash out at staff, and it’s our job to take it and to never, ever judge them. We don’t know why they never visited, and it’s not our business.

It’s also our job to deal with patients who are confused and/or demented. I personally know four or five nurses and auxiliaries in the last year alone, who have been assaulted severely enough by dementia patients, to have needed time off work to recover. This is something that is poorly understood: If a person has dementia so advanced that they form no new memories and have few or no original memories, then as far as that person is concerned, they are always in a strange place, surrounded by strange people. A lot of they time they won’t even know who they are, let alone the people in blue who want to come and give them a wash. Fear and anger are natural responses to that, so sometimes as nurses we get physically assaulted. I’ll leave aside the issue of people who assault us because they’re just plain horrible people, because that is rare outside of the ED.

Now, I don’t want to play the martyr here. Honestly, I don’t; I think that’s a terrible and manipulative thing to do. Everybody who ever trained as a nurse knew very well that they were getting into a hard, physical job which comes with a lot of responsibility and very little financial reward. We all knew from the outset that we’d be working twelve hours without a break, often followed by four hours of unpaid overtime. We all knew that our home life would suffer for our choice of profession. We knew that we were going to get insulted, spat at, berated and punched.

We knew all of that. But we never agreed to be whipping boys and girls for every politician and bored journalist in Britain. And that, sadly, is what we are becoming.

If I get any message across in this post, I hope it’s this: On the basis of a report about specifically identified staff on two wards in one hospital, the government and media now seem to be on a mission to destroy the working reputations of more than a million clinical staff working across almost four hundred NHS trusts. They’ve totally ignored patient’s opinions (the last CQC survey showed that 91% of patients who responded rated the care that they received as excellent, very good or good), and they’re completely blanking the vast majority of clinical staff, particularly nurses, who deliver that excellent care against stacked odds.

So if you’re a nurse or an HCA or an NA or an AP or even (whisper it) a doctor, then hold your head up. The vast majority of your patients think that the vast majority of you are brilliant. And really, do any of us care what anybody else thinks?

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Hospitals are Not Entertainment

February 11, 2013 at 3:17 pm | Posted in Death, Emergency Unit, Ethics | Leave a comment

For my first proper post, I thought I’d talk about a placement I had as a student, at a large Emergency Department (ED) and some of the experiences I had there. Then I thought about it some more and realised that the vast majority of them were probably not fit for public consumption (for example, the man with a broken-off neon light-bulb tube in his rectum, always a good one for Foreign Object Top-Trumps) and that I should be a little bit careful about what I talked about. So I decided I’d talk about TV crews.

TV crews are maladjusted.

I’ll let that sink in.

Sunk in?

Good. Now I’m going to justify it.

I had the terrible misfortune to spend a couple of months working in an ED at the same time that a well-known TV company were there filming for a fly-on-the-wall documentary program about amusingly lodged foreign objects the sterling work of the heroic medical professionals who staff these bastions of all that is good about humanity.

Some of what the TV crews did caused me to have… Let’s call them “ethical doubts” about their presence.

Case 1: Morbidly Obese Man in Cardiac Arrest.

Most EDs have a Resuscitation Room (“Resus” for short) right next to the ambulance entrance. It’s where you’re taken if you’re:

a) Already dead and we want to try to bring you back, or;
b) Looking like you’re about to die and we want to try to stop you.

Think of a big, brightly lit room full of excitingly medical looking kit (a surprising amount of which is used for putting various tubes in various orifices) and wired-looking people in scrubs. Now add a slightly nervous looking yet ruggedly handsome student nurse to the picture and you’ll have it about right.

On the day in question, an ambulance came in under blues and twos (blue flashing lights and two-tone siren) with a very obese man on board in cardiac arrest (his heart had stopped). The paramedic was pumping on his chest as the doors opened, and we got him out and on the table in double-quick time. Pretty quickly he had various tubes inserted in various orifices, various needles inserted in various vessels, various sticky things stuck on various exposed flesh, and the tightly controlled chaos of a crash unfolded.

Folks, this bit is going to shock you: “ER” is full of crap. Most crash calls are not successful. Even the few that are successful are very rarely followed by successful rehabilitation and discharge of the patient. If you have a cardiac arrest, it is extremely likely that you will die.

So our very obese man passed away in a frenzy of activity.

Do you remember the picture you formed earlier of Resus? Kit, tubes, caffeine-addicts, student nurse? Add three more people to the scene.

A camera man.
A sound man.
A producer.

Now imagine the events of the day again, but this time imagine the TV crew filming the whole thing, from the back of the ambulance and through Resus.

Imagine, if you will, your ruggedly handsome student nurse threatening to turn the boom mic into just another Amusing Foreign Object, sans lubrication, if the sound man doesn’t get it out of the damned way of the damned lights. Imagine the crash team, already under immense pressure to get every single decision right because every single one of them might dictate whether their patient lives or dies, and now imagine how much more pressure is on them because it’s being filmed for national TV. Imagine how the patient would have felt – stripped to his underwear, bowels and bladder voided on the table, wobbly bits wobbling. Imagine a nurse doing chest compressions and having to pump hard enough to break the patient’s sternum just to get his chest moving – Crack! “That’s great TV!”, says the producer.

Afterwards, I asked the producer to explain the ethics of their presence to me.

“Well,” he said “If the patient lives, we ask permission to film afterwards. You know, retrospectively. If they die, we ask their family.”

I think I must have looked puzzled at this point, because he went on to say a lot more, using much longer words like “demographics” and “public right to know”. It didn’t really add content to the opening reply, though.

Case 2: Dying Lady who Didn’t Know She Was Dying

Later the same day, we had a patient brought in by her family following a collapse and loss of consciousness at home. Much testing and scanning revealed that she was in the extremely advanced stages of cancer and had collapsed due to metastases in her spine and brain. Oncology gave her a few days to live, and were frankly baffled that she’d still been upright and able to mask the symptoms from her family for so long. The job of breaking the news to the family fell to a young, newly qualified doctor, who was accompanied by a nurse (nurses are generally better communicators than doctors) and a student nurse (who needed to learn how these things are done).

Unknown to us at the time, there was also a TV camera poking through a gap in the curtain, filming the exchange.

News was broken. Weeping ensued from family, comfort was given as far as possible by medical persons present, grief counsellor was recommended via information leaflet.

And then: Curtain is drawn back, smiling TV producer with clip-board in hand turns to family and says:

“I wonder if I might talk to you about consenting for us to show that discussion you just had on TV. You want to be on TV, right?”

The TV crew were forcibly ejected by nursing staff at that point.

I’ll end this post, which is already longer than I planned, by telling you that I refused to sign a consent for the TV company to show any footage of me – so they couldn’t use any of the film they shot that day, because I was in almost all of it.

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Welcome to Oh, Matron!

February 11, 2013 at 2:17 pm | Posted in Humour | Leave a comment

Hello, good [insert time of day here], and welcome! I am Custador, AKA The Angry Nurse, and this is my new blog. I’ve blogged on many topics unrelated to being a nurse, over a period of several years, as well as moderating blogs for other people for a long time. But I thought that what the internet really needs is: More graphic stories about bodily fluids, from a trained professional body fluid handler. The internet is short of those, right? In all seriousness, I hope that this blog will cover a plethora of subjects, from professional and ethical issues, to sharing experiences, to gross-out tales about the incredible size of some of the turds nurses see (I’m not even kidding, some of them have been gigantic).

And that’s that. Now I’d better start writing something with some actual content to it. Stomach content, maybe. Hmmmm…

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