David Cameron and the uninvited doctors: that No. 10 guestlist in full

Groups that have called for NHS reforms to be scrapped are excluded from special summit on the healt

What do you do when people disagree with you? Well, excluding them is one option. David Cameron is holding a special summit on the NHS bill today -- very special, as it will only include medical colleges and health practitioners that back the bill.

Strikingly, the British Medical Association and the Royal College of General Practitioners have not been invited, despite the fact that the centrepiece of the bill is giving more power to GPs.

This graphic by Ben Goldacre sums up the invite list:

invite

Downing Street has acknowledged that the guest list is built around supporters of the health bill, stressing that the discussion today is about how to implement the health bill, not about amending or abandoning it. On that basis, they said, there is little point inviting those who have opposed the reform from the start.

However, Cameron has been accused of playing divide and rule with health practitioners. Peter Carter, the head of the Royal College of Nursing was incredulous: "We don't know why we haven't been invited but we, like others, find it extraordinary because at the end of the day, it is nurses, doctors, physios, GPs that actually keep the health service going."

The Prime Minister, who has taken personal responsibility for pushing the changes through, will make it clear today that he believes that it is too late to change course. While excluding dissenting groups may be expedient, such tactics are unlikely to go down well with the public: a Unite/YouGov poll found that six times as many people trust health professionals over Cameron and Andrew Lansley on NHS reorganisation (60 per cent and 10 per cent respectively). Labour has opened up a 15 point lead over the Tories on the NHS. Fifty-nine per cent of people already feel that Cameron has not honoured his pre-election promises on the NHS. Visibly going against the will of medical professionals could seriously compound that loss of trust.

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

Getty
Show Hide image

A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear