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Good enough for whom?

Itís the nagging sense of creeping unfairness, seemingly designed into the system, and plague of double standards

good enough for whomIt's the nagging sense of creeping unfairness, seemingly designed into the system, and plague of double standards.

That's what blights old Blighty and is probably a big part of the reason why, as verified recently by the Office of National Statistics, thousands of folk are leaving these shores each month and moving to Italy, France, the US and Spain to live.

They're fed up with intrusive cameras and non-thinking parking wardens blindly issuing financial penalties and harrowing notices of 'prosecution' based on mis-guided and biased edicts handed down from politicians (ie, those slightly plump and pompous people too dim to become doctors or management consultants).

Cheery eh, this month? Blame the weather. As you may well have noticed, however, there is a paradoxical thread running through a lot of British opinion at the moment, in that people's views, as informed often by our vast media, are marred by contradiction and, when expressed, full of 'good enough for you, but not for me' undertones.

People seem to be both right and wrong at the same time, and what I'm talking about here can be seen in many aspects of society, ranging from adult education to nurse prescribing.

For example, should independent nurse prescribers be able to prescribe 'complex' medicines from a list? 'Yes,' say people who see the benefits to patients, 'as long as they're trained appropriately'. But here's the rub: to be a doctor (and be able to prescribe complex medicines) you need to have been a bright child with a string of A-grades at GSCE and A-level to your name, supported thereafter by evidence of your extraordinary understanding of the links between health and society required to begin your five years of 'basic' medical training. After many subsequent years of intensive brain-filling and expert guidance, you may be allowed to prescribe a complex drug, if you're careful and a more senior medic supports your diagnosis.

Compare that, with the (as reported) training for independent nurse prescribers: a 26-day theory course including 12 days of mentored practice and a handful of 'assignments'. Here's your hypodermic, off you go love. Try not to poke yourself in the eye with it.

Now, there's facetiousness for you. But, and forgive me if I've got onto my high horse without looking behind me properly, but when it comes to the prescription of complex medicines for the benefit of my person, I really, seriously, want the doctor - with all their many years of study and expert understanding of exactly what's going on - to decide how, when and why I require it, and to write it out.

Or do I? Maybe I just think I ought to, whereas in fact I, like most I imagine, would readily defer to a talented and experienced nurse prescriber for help, particularly if it meant I could get the drugs sooner. Would I then vote for 'nurse prescribing' as a general idea? Well, it would be easy to find many good reasons to support this and I may well do.

In the same paradoxical vein, (pardon the pun), it's easy to support heartily the entry of young people into 'vocational' (ie, non-university degree) higher education.

Why bother racking up university debts of GBP 20,000+ if you're going to be a carpenter, plumber, actor or television presenter for example. And yet, if it was my own child would I be able to steer them away from university, even if they didn't want to be a medic, or even a nurse prescriber? Indeed, would I feel differently about nurses prescribing key drugs if my child, partner or best friend did it for a living? Maybe.

See, this is what I'm talking about. We've all got our opinions but if we look closely enough at them, it's possible to flip them over and over, back and forth - which is, evidently, quite troublesome for people making decisions about how to deliver care in the UK.

And some of these are clever people. As was quoted in a recent issue of Pulse: Nurses' knowledge of diagnosis is pathetically poor... Only a country with not enough doctors would go down this cheapy line. The man who said this is a professor - none less than professor of prescribing and former member of the Committee of Safety of Medicines, Professor Hugh McGavock. So he knows, right?

And yet, the man who defends the role of nurses and describes their prescribing capability as an important part of the solution in improving access to medicines and cutting waiting times is a blinkin' medical doctor - Dr Peter Carter.

So what the heck are we supposed to believe? Frankly, the only solution is the British one: choose your opinion to suit your mood and circumstances. Or else, give up on life and social equity entirely and become a parking warden.

17th September 2007

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