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[IPk] Why Dr Johnny doesn't read

In message <002201bf6748$bc5d4a80$email @ redacted>, John hughes
<email @ redacted> writes
>I know it is not the fashionable thing for this IP-UK
>group to have understanding or respect for diabetes teams who are not
>familiar with pump therapy.

Fashionable, me? Well, it makes a change (although the orange boots
argue against it).

When it boils down to it, no, I don't have a lot of respect or
understanding for diabetes teams who are not making themselves familiar
with pump therapy.  There is, in my opinion, one reason and one reason
only for a professional not making time to keep up with the literature:
chronic over-work.  If one is struggling to dispense yesterdays news to
all who need it, I do acknowledge that spending time finding out about
today's news, let alone keeping abreast of things which might come, in
the future, is impossible (I know this situation from my own profession,
and indeed, have been in this situation in the past).

OK, so what is the ethically correct action for an overworked member of
a diabetes team?
a) give up annual holidays to go to a conference to get up to date, give
up a social life to read papers on the Internet, and so on?
b) give up learning new stuff?
c) make judgements: balance the professional development time with
patient time, cutting the time you give to some patients (knowing that
their quality of life, even their lives will be put at risk) to ensure
that other patients have improved quality of life (or even life). 
d) leave the profession (or, at least, the NHS)?
e) take it all the way up through management, up to your professional
body, explaining that X NHS Trust is requiring you to work in a sub-
professional way?

I have no respect for those who take option B.  
I have little respect for those who do A (as I did) for a long time (we
need our holidays if we are to continue as good professionals).  
I sympathise greatly with those who do D (and, indeed, with those who do
B although they'd rather do D, but can't, as they can't get another job
on equal terms outside their current situation).
E is, as they say in _Yes Minister_, "brave".

C is the difficult one to call.  It means prioritising who gets
resources, in order that resources for the most (or the most deserving)
are available, it means acknowledging that research of current practice
could benefit patients more than meeting with them.  It begs all kinds
of difficult questions.  Questions which, from my cursory examination of
the literature, appear not to even be studied.  It's all done on
professional intuition.  

By my own analysis, pump-ignorant clinics may, of course, be those where
folk are going down path C, and reasoning that since type 1s are so few
in number, the best use of their time is to give type 1s basic
treatment, and to invest research time in providing the most effective
treatments, in the most effective way, for type 2 patients, thereby
serving the greatest number with the greatest good. 

But is this ethical?  And if it's a case of resource management, then
surely it's a case of resource provision, and hence political as well as
ethical (and we are looking at option E again, and wondering if we are
brave enough). I told you they were difficult questions!

Ah well, at least the difficult questions have interesting answers, and
interesting answers are almost as good as holidays!
Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
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