Earlier this week the GMC at long last released data on the number of doctors who died while undergoing fitness to practice investigation and monitoring. The number of deaths should be extremely small — the individuals at risk are working age adults with good socioeconomic status — and the numbers are small, on average about ten a year in recent years. But are these numbers really that small? For comparison, there are currently around twenty deaths in police custody annually in all England and Wales, a conceptually similar but in other respects very different so-called never event that should never happen. When Dr No last wrote about what we might loosely call deaths in GMC custody, in 2013, the annual number of deaths, revealed after a FOI request, was very similar, around eleven, a number subsequently confirmed in a 2014 internal GMC review, which also revealed that around one in four of the deaths were suicides. In the data released this week, around one in five or six of the deaths were suicides.
Munchausen’s syndrome is the popular name for the ICD (International Classification of Diseases) 10 diagnosis F68.1: Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder]…with the aim of adopting the sick role. In rather less leaden language, a patient with Munchausen’s syndrome pretends to be ill to gain medical attention, which distinguishes the condition from malingering, in which an individual pretends to be ill to gain practical benefit, for example being excused from work. It takes it’s name from the protagonist in the 1785 novel Baron Munchausen’s Narrative of his Marvellous Travels and Campaigns in Russia, in which the fictional Baron narrates a series of impossibly tall stories, based on exaggerated exploits of one Hieronymus Karl Friedrich Freiherr von Münchhausen, a real life German baron known more recently for a habit of adding extra lard to his porkies, though in life he appears to have had ridicule of the credulous more in mind.
Recent seasons of Call the Midwife have become so sudsy that it can only be a matter of time before a baby disappears down the sluice, lost in soapy foam. Cyril has now got both religion and his girl, Lucille, and radiates joy, like a light bulb. Dr Turner, the GP who cares so much that it hurts, has had his early constant expression of quizzical amusement at the follies of his patients change into one of tortured anguish, as if all the human suffering of Poplar has been etched permanently into his face. Sister Julienne is showing early signs of being subject to a corporate take over — perhaps the writers want to warn us about what is happening to the NHS in 2021 — and Sister Monica Jones has upped her LSD habit, with deleterious consequences for her thought patterns. But even as the levels of Fairy Liquid have increased, the series has remained a true picture of traditional medical and midwifery practice, including, most importantly, tireless and valiant attempts to combat the harmful effects of the inverse care law.
What’s the most shocking thing about the chart shown in Figure 1 below, copied from this week’s ONS Weekly Deaths report? It shows the number of excess weekly deaths by place of occurrence, which ONS report from time to time, usually buried in the midriff of the report. For some, the most shocking thing might be the peak in hospital excess deaths in Spring 2020, or in the 2020/2021 winter. For others, it might be the exceptional care home peak that occurred in March and April 2020, a peak Dr No has written about before. But in each of these two settings, the peaks have been offset somewhat by other periods when the number of deaths fell below the number of expected deaths, based on the 2015-2019 average. Perhaps the most shocking thing instead is the consistent excess mortality for deaths occurring in the home. These average out at 891 excess deaths every week over the 76 weeks covered by the chart. For hospitals, the same average is 248, and for care homes it is 312 excess deaths.
Sounding today more like an episode of Midsomer Murders than a title stemming from a classic of children’s literature, the Bears of Little Brains is a reminder that those of us who work in science can all to easily become bears of little brains, falling into our own heffalump traps, and setting ourselves on the trail of a woozle. We may publish something only to find, being a Bear of Very Little Brain, that a Thing which seemed very Thingish inside us is quite different when it gets out into the open, and has other people looking at it. And so it was with the second Walach publication, the research letter about children wearing masks inhaling high concentrations of carbon dioxide, which Dr No mentioned in a comment to his last post. The demolition jobs done on twitter of Walachs et al’s research letter were swift and vitriolic, and the comments tab on the letter itself is turning into an ever lengthening dossier of the delusions held by the letter’s authors. Retraction is increasingly looking inevitable.