1296
BRITISH MEDICAL JOURNAL
One often finds that an emotional response such as that of Dr Hughes starts by misquoting, and such is the case here. The booklet's authors do not actually advocate "a single allpurpose pathologist with two technicians and limited equipment." What they say is, "Although a laboratory can be entirely operated by one pathologist, an excellent case can be made for either direct partnership or loose association with other pathologists...." His suggestion that small private laboratories charge "first-class fees for what can only be third-class service" is not only insulting to his colleagues running such laboratories (and probably even actionable), but also demonstrates prejudice of a high order. How many private laboratories has he intimate knowledge of, and what does he regard as third-class service? One of the strong points of small laboratories of any kind is that they tend to give a quicker, more personal service than the massive emporia now fashionable in the NHS. He also does not appear to realise that the bulk of these laboratories are dealing with the commoner type of investigations-about twothirds of all patients, for instance, have blood counts, and only about a fifth anything more esoteric than urea, electrolytes and liver function tests. I think most pathologists would allow that quality control on most of these bread-and-butter investigations can depend as much on technical skill as on expensive machinery. Therein lies the attraction of these laboratories to the highly skilled personnel who work in them. I know of at least one laboratory where the innovative pathologist in charge wished to further automate his enzyme assays by adding yet another electronic black box to those he had designed and built on to the spectrophotometer, but was dissuaded by his staff. They did not want to become mere button-pushers again. There is a lesson for the NHS here. On Dr Hughes's point concerning "free access" to NHS laboratories for all doctors treating private patients-presumably he means UK citizens only-I am simply amazed. I cannot believe that he is really suggesting that pathologists should be the only doctors effectively debarred from private practice, but this is what it would mean. To expect our NHS employers to recognise the "simon purity" of their pathologists in this event by coughing up a uniquely high salary is to postulate cuckoos at stratospheric level. I believe that Dr Hughes is now retired and therefore has left the fray. I would exhort practising pathologists, however, to examine carefully the possibility of establishing independent laboratories in their areas. The financial rewards may not be very great but the
personal satisfaction and experience gained will be by no means slight. I cannot believe that the independent turn of mind that is so essential in all consultants has atrophied in pathologists. If it has, and Dr Hughes's attitudes prevail, then it can only signal the death knell of the specialty. There is a need for private laboratories, and if pathologists do not set them up others will.
J P LEE-POTTER Department of Pathology, Poole General Hospital, Poole, Dorset BH15 2JB
SIR,-Unless the small private laboratories are taking part in appropriate national quality control schemes, as many are, there is no way
of knowing whether or not they are attaining their high standards. Modern equipment does not by itself guarantee accuracy and precision. D N BARON Department of Chemical Pathology, Royal Free Hospital, London NW3 2QG
Out-of-hours services by medical laboratory scientific officers SIR,-Some heads of UK laboratory departments are probably having to review their arrangements for out-of-hours services just now. In my own department the Association
of Scientific, Technical, and Managerial Staff group of medical laboratory scientific officer (MLSO) staff presented the Lothian Health Board (that is, management) with a set of proposals for a non-rostered service. These proposals were in breach of Whitley Council regulations, impracticable in concept, and financially outrageous in their potential application. Management had no alternative but to reject the proposals, and the ASTMS group then withdrew from all out-of-hours work on 1 November, at the same time blaming the board for having forced the group to take this step. By withdrawing from the duty rosters the MLSO had crossed the Rubicon, having on various occasions in the past few years merely threatened to cross it. The die is now cast, and things can never be quite the same again. The time will come when negotiations on the staff-side claim are resumed at national level, and some form of agreement will eventually be reached. In preparation for that day, on 7 November I drafted for consideration by the local ASTMS group, and thereafter for discussion with me, a set of principles on which I would seek to base any new arrangements for out-of-hours services. I believe your readers might be interested to see these principles, which are: (1) Inclusion of staff in out-of-hours duty rosters will be voluntary. However, any member of staff who wishes to be considered for inclusion in any or all of the rosters will be expected to provide the head of department with a written undertaking that he or she will be prepared to give not less than one month's notice of intention to withdraw from the roster or rosters. (2) Staff who volunteer to take part in out-ofhours duty rosters will be doing so on the understanding that they will each be expected to perform an equitable share of the duties relating to those categories of out-of-hours work appropriate to their training and experience; due allowance will be made for any relevant personal conditions that might affect the application of this generalisation to individuals. (3) It will be for the head of department to determine which members of staff, from among those who volunteer, will be included in the various arrangements for out-of-hours work. The opportunity to volunteer for inclusion in these rosters will be open to university academic staff, NHS medical and biochemist staff, medical laboratory scientific officers, university medical technical (TM) and UTSS (technician grade) staff, and any combination of these various categories of staff may, from time to time, be included in the various rosters if the head of department considers this appropriate. (4) The out-of-hours duty rosters referred to in (2) will relate to the following categories of work: (a) weekday evenings; (b) overnight, resident in hospital; (c) wveekends (that is, other than Saturdays from 9 am to I pm); (d) statutory and public holidays. Not all the categories of staff mentioned in (3) will necessarily be expected to
17 NOVEMBER 1979
take part in all these different forms of out-of-hours work, but only those who have volunteered for particular categories and who are also considered to be suitable for inclusion. (5) Whitley Council conditions of service will apply to staff employed by the NHS, and university conditions of service to University employees, for the calculation of on-call payments or other payments for out-of-hours work and related allowances, as appropriate. I also issued to my staff a set of background comments or explanation, to be read in conjunction with these five principles. However, this second document is somewhat more parochial, and it would not be appropriate for inclusion in this letter. Nevertheless, your readers might expect some explanation of why I included principle (3), or at least those parts of it that might appear contentious. I have considerable respect for the Institute of Medical Laboratory Sciences (IMLS). However, I feel that the professional ethic of some IMLS members has been lost or become seriously tarnished by their having responded to the ASTMS call for action recently issued by the union's national negotiating officer, Mr R A Bird. I believe that the institute could play a statesmanlike role at this stage if it were to try to reinstil the professional ethic into those of its members who are at present putting personal gain before the interest of patients. I should perhaps add that I would hold the same view for other groups of health service workers, not just for MLSO, if they were to try to use patients' welfare as a bargaining counter. It seems of paramount importance to me that my laboratory should never again be placed in the kind of difficulties that we are at present facing. Out-of-hours clinical chemistry services for one of the country's leading teaching hospitals are at present being provided by three honorary consultant members of staff. I was warned that if I had attempted to involve other members of my graduate staff in the present arrangements for out-of-hours work the union might take such other action as it deemed appropriate. In saying this, the members of the ASTMS group have ignored the fact that most of my graduate staff have at some time in the past gained experience in this laboratory of out-of-hours work by working, unpaid, on the overnight rosters as part of their professional training. Indeed, there was a time not so long ago when the overnight on-call services available from this laboratory were entirely provided by graduate staff. It would appear that ASTMS officers consider that MLSOs have a right to be the providers of the out-of-hours emergency laboratory services. It is high time that this monopolist view was challenged. In doing this I would hope that your readers would not expect me to rely for support only on HM(55)14, although this document has in fact never been revoked, on the 1972 statement by Dr J L Stafford prepared for the Association of Clinical Pathologists, on the views expressed in 1977 by the Consulting Pathologists Group of the BMA, on the various pronouncements of the Royal College of Pathologists about training requirements, or on minute 79/34 of the Medical Laboratory Technicians Board (meeting of 18 September 1979). Instead, I would hope additionally to have support from all branches of the medical profession, and indeed from most MLSOs, for my belief that all professional staff in laboratories should gain appropriate experience of out-of-hours work as part of their in-service
training. The present dispute has made me realise that all professional laboratory staff should ideally, even when fully trained (if indeed such a stage is ever reached), continue to take some part in this very important practical aspect of a laboratory's work. I have been appalled recently to hear of some laboratories where the senior staff have so lost touch with practical realities of laboratory diagnostic service work as to have been powerless in the
BRITISH MEDICAL JOURNAL
17 NOVEMBER 1979
face of the ASTMS-inspired actions that the NHS is presently experiencing. I consider it essential that ASTMS-dominated MLSOs should never again be able to feel that they have achieved a monopoly of the out-of-hours duty rosters operated by this laboratory, and I trust that other heads of laboratories will share this view. L G WHITBY Department of Clinical Chemistry, Royal Infirmary, Edinburgh EH3 9YW
SIR,-I refer to a thoroughly misleading comment by "Scrutator" (3 November, p 1159), where he deals with the claim by medical laboratory scientific officers for improved emergency duty payments. Firstly, our claim for a call is £7 50 not £8 50, and a call can involve two hours' work. It is true that management have offered £5 80 a call but negotiations have not broken down on that. If that were all that was involved we might ultimately reach a settlement. Negotiations have broken down because management refused to offer anything at all on a payment of £3-00 for being available all night at home to be called in-that is, as much as 16 hours-or be available in the hospital for the same period of time for £420. In fact management concede that they get their complete emergency duty service-that is payments for standing by or being on call and work done-for a total of 8 4', of the normal pay bill. As much as 131 hours a week, including nights, weekends, and bank holidays, may be covered in this way. The reference to consultants' payments is also misleading. In fact, the Review Body's report for 1979 (para 33 p 22) says, "The fee for the first hour should be £7 50," and then goes on to say, "As the average time that consultants spent on each recall is 1' hours on the basis of the 1977 survey, the average payment will be around £12 50 per recall." Travelling time to and from work is included subject to a maximum of half an hour in each direction. In addition to this a consultant with a commitment to be on recall one night in two or one night in three would receive approximately £1500 per annum for t-he obligation and "In addition he would receive the emergency recall fees." We certainly do not begrudge our consultant colleagues a recall fee system if they want one, and from our point of view the Review Board recommendation, which the Government accepted, amply demonstrates that money is available or can be provided to improve conditions if it is so desired. So perhaps next time "Scrutator" writes about the conditions of medical laboratory scientific officers he or she will make a bigger effort to present a fairer picture-to present all the facts and get them right. R A BIRD Association of Scientific Technical and Managerial Staffs, London NW1 7DT
***Scrutator has corrected and apologised for his mistake over the £7-50 per call claim (10 November, p 1234). He still stands by his general comparison with the now defunct emergency recall fee for consultants, who do take ultimate responsibility for patient care and who would have been unlikely to have matched the present average earnings of "about £50 per night" of an on-call medical laboratory scientific officer reported by Professor L G Whitby of the Edinburgh Royal
1297
Infirmary in a letter to the Scotsman (6 One of my patients took thyroxine for several November, p 12).-ED, BMJ. weeks by mistake for thymoxamine, fortunately without ill effect. I am not so certain of the details of the second case, but if I remember "Inducement allowance" for shortage correctly the patient was given tablets of specialties? chlorpromazine 50 mg in mistake for carbimazole 5 mg.... SIR,-In the revised contract package it is stated that to help consultant recruitment in some shortage specialties the area health Cryosurgery for haemorrhoids authorities will be able to advertise any consultant post at the maximum of the scale if it Mr PHILIP SCHOFIELD (Withington Hospital, has been vacant for at least a year and unsuc- Manchester M20 8LR) writes: I have read cessfully advertised at least twice.' with interest the excellent article by Mr I do not think this half-hearted measure will M R B Keighley and others (20 October, produce any positive result. Shortage special- p 967). The authors are to be congratulated ties such as mental handicap (psychiatry) are on making a logical attempt to classify suffering even more as the standard of care haemorrhoidal disease in order to give the cannot be adequately provided without most satisfactory treatment.... The method of sufficient medical staff. Those medical staff in cryosurgery which they indicate, however, post are also much pressed with extra work would not in my view be expected to be sucwithout any monetary compensation, and they cessful. Cryosurgery to haemorrhoids should may switch to some other specialty. Also young attempt to produce the cryolesion in the pile psychiatrists who wish to join general psychia- mass itself. The results produced in this try know that it takes only four years to get to article for cryosurgery seemed to conflict with the top of the pay scale, and the extra income the majority of results previously reported from domiciliary visits, court cases, and private in the literature, and this may well be a repractice in general psychiatry soon offsets the flection of the method used. initial difference in salary; so there is no need for a psychiatrist to switch to mental handicap. This reasoning will be similarly applicable to Epilepsy in general practice all other shortage specialties, and I foresee no real improvement in medical staffing in the Dr C W M WHITTY (Department of Neurology, future even if this measure is adopted. Radcliffe Infirmary, Oxford) writes: The The only way to attract medical staff is by report by Dr L I Zander and his colleagues giving them an extra allowance of 10% of (27 October, p 1035) quotes a rather high their basic pay as an "inducement allowance" prevalence rate of 7 6 per 1000 for patients to work in these. shortage specialties. Perhaps it with epilepsy in the general practice studied; is not too late to implement this scheme and but 52 patients in a practice of 8500 gives a improve the medical staffing. Otherwise, in my rate of 6-1 per 1000. If the 12 rejected view, there is no way to improve the medical patients are included, the prevalence would be staffing of shortage specialties and the standard 7-5 per 1000. of care will remain below the acceptable level; and I am sure the authorities responsible will Friedreich's ataxia and realise this. U J DEY electrocardiographic changes Brockhall Hospital,
Blackburn, Lancs BB6 8AZ I
British Medical J7otrnal, 1979, 2, 1087.
Points Drug names that look or sound alike
Dr R E SMITH (Warwickshire Postgraduate Medical Centre, Coventry CVI 4FG) writes: I read William Evans's contributions with pleasure. He says that the electrocardiographs of two brothers (13 October, p 930) with Friedreich's ataxia showed heart block and some other changes. He exaggerates when he says that subsequent investigations of 38 patients with this disease had similar electrocardiographic changes. The facts in his article' are that 12 had conspicuous or significant changes, 10 had slight changes, and 16 were physiological.
Dr W T HOULSBY (Aberdeen ABI 6AG) writes: Of the 103 pairs of drugs listed by Dr H McNulty and Mr P Spurr (6 October, p 836) as having caused or being potential causes of confusion because the names look or Evans, W, and Wright, G, British Heart3Journal, 1942, sound alike, 71 are pairs of proprietary names 4, 91. and only 28 pairs of approved names (the remaining pairs are a proprietary and an approved name). There is surely an important A use for savings from abolishing AHAs? lesson to be learned from this. Dr DAVID HASLAM (Ramsey, Cambs) writes: With the recent announcement that area health Dr R N PALMER (Medical Protection Society, authorities are to be abolished next year, I London WIN 6DE) writes: A further pair of cannot help but wonder what is to become of drugs (6 October, p 836), confusion between the countless pieces of paper, such as hospital which led to the death of a young man, is notepaper, that bear AHA headings, to say Inderal and Intal. The case is reported in the nothing of the many sign boards and so on.... annual report of the Medical Protection The experience of the speed with which these Society for 1979 (p 37). signs and headings appeared when AHAs were first introduced implied that old stocks of notepaper were destroyed, and many people Dr F V SIMPSON (Scarborough Y013 ORA) were employed full-time repainting vans and writes: I can add to the useful list of drugs sign boards. Is this what the savings from which have been confused (6 October, p 836). abolishing AHAs are to be spent on?
BRITISH MEDICAL JOURNAL
One often finds that an emotional response such as that of Dr Hughes starts by misquoting, and such is the case here. The booklet's authors do not actually advocate "a single allpurpose pathologist with two technicians and limited equipment." What they say is, "Although a laboratory can be entirely operated by one pathologist, an excellent case can be made for either direct partnership or loose association with other pathologists...." His suggestion that small private laboratories charge "first-class fees for what can only be third-class service" is not only insulting to his colleagues running such laboratories (and probably even actionable), but also demonstrates prejudice of a high order. How many private laboratories has he intimate knowledge of, and what does he regard as third-class service? One of the strong points of small laboratories of any kind is that they tend to give a quicker, more personal service than the massive emporia now fashionable in the NHS. He also does not appear to realise that the bulk of these laboratories are dealing with the commoner type of investigations-about twothirds of all patients, for instance, have blood counts, and only about a fifth anything more esoteric than urea, electrolytes and liver function tests. I think most pathologists would allow that quality control on most of these bread-and-butter investigations can depend as much on technical skill as on expensive machinery. Therein lies the attraction of these laboratories to the highly skilled personnel who work in them. I know of at least one laboratory where the innovative pathologist in charge wished to further automate his enzyme assays by adding yet another electronic black box to those he had designed and built on to the spectrophotometer, but was dissuaded by his staff. They did not want to become mere button-pushers again. There is a lesson for the NHS here. On Dr Hughes's point concerning "free access" to NHS laboratories for all doctors treating private patients-presumably he means UK citizens only-I am simply amazed. I cannot believe that he is really suggesting that pathologists should be the only doctors effectively debarred from private practice, but this is what it would mean. To expect our NHS employers to recognise the "simon purity" of their pathologists in this event by coughing up a uniquely high salary is to postulate cuckoos at stratospheric level. I believe that Dr Hughes is now retired and therefore has left the fray. I would exhort practising pathologists, however, to examine carefully the possibility of establishing independent laboratories in their areas. The financial rewards may not be very great but the
personal satisfaction and experience gained will be by no means slight. I cannot believe that the independent turn of mind that is so essential in all consultants has atrophied in pathologists. If it has, and Dr Hughes's attitudes prevail, then it can only signal the death knell of the specialty. There is a need for private laboratories, and if pathologists do not set them up others will.
J P LEE-POTTER Department of Pathology, Poole General Hospital, Poole, Dorset BH15 2JB
SIR,-Unless the small private laboratories are taking part in appropriate national quality control schemes, as many are, there is no way
of knowing whether or not they are attaining their high standards. Modern equipment does not by itself guarantee accuracy and precision. D N BARON Department of Chemical Pathology, Royal Free Hospital, London NW3 2QG
Out-of-hours services by medical laboratory scientific officers SIR,-Some heads of UK laboratory departments are probably having to review their arrangements for out-of-hours services just now. In my own department the Association
of Scientific, Technical, and Managerial Staff group of medical laboratory scientific officer (MLSO) staff presented the Lothian Health Board (that is, management) with a set of proposals for a non-rostered service. These proposals were in breach of Whitley Council regulations, impracticable in concept, and financially outrageous in their potential application. Management had no alternative but to reject the proposals, and the ASTMS group then withdrew from all out-of-hours work on 1 November, at the same time blaming the board for having forced the group to take this step. By withdrawing from the duty rosters the MLSO had crossed the Rubicon, having on various occasions in the past few years merely threatened to cross it. The die is now cast, and things can never be quite the same again. The time will come when negotiations on the staff-side claim are resumed at national level, and some form of agreement will eventually be reached. In preparation for that day, on 7 November I drafted for consideration by the local ASTMS group, and thereafter for discussion with me, a set of principles on which I would seek to base any new arrangements for out-of-hours services. I believe your readers might be interested to see these principles, which are: (1) Inclusion of staff in out-of-hours duty rosters will be voluntary. However, any member of staff who wishes to be considered for inclusion in any or all of the rosters will be expected to provide the head of department with a written undertaking that he or she will be prepared to give not less than one month's notice of intention to withdraw from the roster or rosters. (2) Staff who volunteer to take part in out-ofhours duty rosters will be doing so on the understanding that they will each be expected to perform an equitable share of the duties relating to those categories of out-of-hours work appropriate to their training and experience; due allowance will be made for any relevant personal conditions that might affect the application of this generalisation to individuals. (3) It will be for the head of department to determine which members of staff, from among those who volunteer, will be included in the various arrangements for out-of-hours work. The opportunity to volunteer for inclusion in these rosters will be open to university academic staff, NHS medical and biochemist staff, medical laboratory scientific officers, university medical technical (TM) and UTSS (technician grade) staff, and any combination of these various categories of staff may, from time to time, be included in the various rosters if the head of department considers this appropriate. (4) The out-of-hours duty rosters referred to in (2) will relate to the following categories of work: (a) weekday evenings; (b) overnight, resident in hospital; (c) wveekends (that is, other than Saturdays from 9 am to I pm); (d) statutory and public holidays. Not all the categories of staff mentioned in (3) will necessarily be expected to
17 NOVEMBER 1979
take part in all these different forms of out-of-hours work, but only those who have volunteered for particular categories and who are also considered to be suitable for inclusion. (5) Whitley Council conditions of service will apply to staff employed by the NHS, and university conditions of service to University employees, for the calculation of on-call payments or other payments for out-of-hours work and related allowances, as appropriate. I also issued to my staff a set of background comments or explanation, to be read in conjunction with these five principles. However, this second document is somewhat more parochial, and it would not be appropriate for inclusion in this letter. Nevertheless, your readers might expect some explanation of why I included principle (3), or at least those parts of it that might appear contentious. I have considerable respect for the Institute of Medical Laboratory Sciences (IMLS). However, I feel that the professional ethic of some IMLS members has been lost or become seriously tarnished by their having responded to the ASTMS call for action recently issued by the union's national negotiating officer, Mr R A Bird. I believe that the institute could play a statesmanlike role at this stage if it were to try to reinstil the professional ethic into those of its members who are at present putting personal gain before the interest of patients. I should perhaps add that I would hold the same view for other groups of health service workers, not just for MLSO, if they were to try to use patients' welfare as a bargaining counter. It seems of paramount importance to me that my laboratory should never again be placed in the kind of difficulties that we are at present facing. Out-of-hours clinical chemistry services for one of the country's leading teaching hospitals are at present being provided by three honorary consultant members of staff. I was warned that if I had attempted to involve other members of my graduate staff in the present arrangements for out-of-hours work the union might take such other action as it deemed appropriate. In saying this, the members of the ASTMS group have ignored the fact that most of my graduate staff have at some time in the past gained experience in this laboratory of out-of-hours work by working, unpaid, on the overnight rosters as part of their professional training. Indeed, there was a time not so long ago when the overnight on-call services available from this laboratory were entirely provided by graduate staff. It would appear that ASTMS officers consider that MLSOs have a right to be the providers of the out-of-hours emergency laboratory services. It is high time that this monopolist view was challenged. In doing this I would hope that your readers would not expect me to rely for support only on HM(55)14, although this document has in fact never been revoked, on the 1972 statement by Dr J L Stafford prepared for the Association of Clinical Pathologists, on the views expressed in 1977 by the Consulting Pathologists Group of the BMA, on the various pronouncements of the Royal College of Pathologists about training requirements, or on minute 79/34 of the Medical Laboratory Technicians Board (meeting of 18 September 1979). Instead, I would hope additionally to have support from all branches of the medical profession, and indeed from most MLSOs, for my belief that all professional staff in laboratories should gain appropriate experience of out-of-hours work as part of their in-service
training. The present dispute has made me realise that all professional laboratory staff should ideally, even when fully trained (if indeed such a stage is ever reached), continue to take some part in this very important practical aspect of a laboratory's work. I have been appalled recently to hear of some laboratories where the senior staff have so lost touch with practical realities of laboratory diagnostic service work as to have been powerless in the
BRITISH MEDICAL JOURNAL
17 NOVEMBER 1979
face of the ASTMS-inspired actions that the NHS is presently experiencing. I consider it essential that ASTMS-dominated MLSOs should never again be able to feel that they have achieved a monopoly of the out-of-hours duty rosters operated by this laboratory, and I trust that other heads of laboratories will share this view. L G WHITBY Department of Clinical Chemistry, Royal Infirmary, Edinburgh EH3 9YW
SIR,-I refer to a thoroughly misleading comment by "Scrutator" (3 November, p 1159), where he deals with the claim by medical laboratory scientific officers for improved emergency duty payments. Firstly, our claim for a call is £7 50 not £8 50, and a call can involve two hours' work. It is true that management have offered £5 80 a call but negotiations have not broken down on that. If that were all that was involved we might ultimately reach a settlement. Negotiations have broken down because management refused to offer anything at all on a payment of £3-00 for being available all night at home to be called in-that is, as much as 16 hours-or be available in the hospital for the same period of time for £420. In fact management concede that they get their complete emergency duty service-that is payments for standing by or being on call and work done-for a total of 8 4', of the normal pay bill. As much as 131 hours a week, including nights, weekends, and bank holidays, may be covered in this way. The reference to consultants' payments is also misleading. In fact, the Review Body's report for 1979 (para 33 p 22) says, "The fee for the first hour should be £7 50," and then goes on to say, "As the average time that consultants spent on each recall is 1' hours on the basis of the 1977 survey, the average payment will be around £12 50 per recall." Travelling time to and from work is included subject to a maximum of half an hour in each direction. In addition to this a consultant with a commitment to be on recall one night in two or one night in three would receive approximately £1500 per annum for t-he obligation and "In addition he would receive the emergency recall fees." We certainly do not begrudge our consultant colleagues a recall fee system if they want one, and from our point of view the Review Board recommendation, which the Government accepted, amply demonstrates that money is available or can be provided to improve conditions if it is so desired. So perhaps next time "Scrutator" writes about the conditions of medical laboratory scientific officers he or she will make a bigger effort to present a fairer picture-to present all the facts and get them right. R A BIRD Association of Scientific Technical and Managerial Staffs, London NW1 7DT
***Scrutator has corrected and apologised for his mistake over the £7-50 per call claim (10 November, p 1234). He still stands by his general comparison with the now defunct emergency recall fee for consultants, who do take ultimate responsibility for patient care and who would have been unlikely to have matched the present average earnings of "about £50 per night" of an on-call medical laboratory scientific officer reported by Professor L G Whitby of the Edinburgh Royal
1297
Infirmary in a letter to the Scotsman (6 One of my patients took thyroxine for several November, p 12).-ED, BMJ. weeks by mistake for thymoxamine, fortunately without ill effect. I am not so certain of the details of the second case, but if I remember "Inducement allowance" for shortage correctly the patient was given tablets of specialties? chlorpromazine 50 mg in mistake for carbimazole 5 mg.... SIR,-In the revised contract package it is stated that to help consultant recruitment in some shortage specialties the area health Cryosurgery for haemorrhoids authorities will be able to advertise any consultant post at the maximum of the scale if it Mr PHILIP SCHOFIELD (Withington Hospital, has been vacant for at least a year and unsuc- Manchester M20 8LR) writes: I have read cessfully advertised at least twice.' with interest the excellent article by Mr I do not think this half-hearted measure will M R B Keighley and others (20 October, produce any positive result. Shortage special- p 967). The authors are to be congratulated ties such as mental handicap (psychiatry) are on making a logical attempt to classify suffering even more as the standard of care haemorrhoidal disease in order to give the cannot be adequately provided without most satisfactory treatment.... The method of sufficient medical staff. Those medical staff in cryosurgery which they indicate, however, post are also much pressed with extra work would not in my view be expected to be sucwithout any monetary compensation, and they cessful. Cryosurgery to haemorrhoids should may switch to some other specialty. Also young attempt to produce the cryolesion in the pile psychiatrists who wish to join general psychia- mass itself. The results produced in this try know that it takes only four years to get to article for cryosurgery seemed to conflict with the top of the pay scale, and the extra income the majority of results previously reported from domiciliary visits, court cases, and private in the literature, and this may well be a repractice in general psychiatry soon offsets the flection of the method used. initial difference in salary; so there is no need for a psychiatrist to switch to mental handicap. This reasoning will be similarly applicable to Epilepsy in general practice all other shortage specialties, and I foresee no real improvement in medical staffing in the Dr C W M WHITTY (Department of Neurology, future even if this measure is adopted. Radcliffe Infirmary, Oxford) writes: The The only way to attract medical staff is by report by Dr L I Zander and his colleagues giving them an extra allowance of 10% of (27 October, p 1035) quotes a rather high their basic pay as an "inducement allowance" prevalence rate of 7 6 per 1000 for patients to work in these. shortage specialties. Perhaps it with epilepsy in the general practice studied; is not too late to implement this scheme and but 52 patients in a practice of 8500 gives a improve the medical staffing. Otherwise, in my rate of 6-1 per 1000. If the 12 rejected view, there is no way to improve the medical patients are included, the prevalence would be staffing of shortage specialties and the standard 7-5 per 1000. of care will remain below the acceptable level; and I am sure the authorities responsible will Friedreich's ataxia and realise this. U J DEY electrocardiographic changes Brockhall Hospital,
Blackburn, Lancs BB6 8AZ I
British Medical J7otrnal, 1979, 2, 1087.
Points Drug names that look or sound alike
Dr R E SMITH (Warwickshire Postgraduate Medical Centre, Coventry CVI 4FG) writes: I read William Evans's contributions with pleasure. He says that the electrocardiographs of two brothers (13 October, p 930) with Friedreich's ataxia showed heart block and some other changes. He exaggerates when he says that subsequent investigations of 38 patients with this disease had similar electrocardiographic changes. The facts in his article' are that 12 had conspicuous or significant changes, 10 had slight changes, and 16 were physiological.
Dr W T HOULSBY (Aberdeen ABI 6AG) writes: Of the 103 pairs of drugs listed by Dr H McNulty and Mr P Spurr (6 October, p 836) as having caused or being potential causes of confusion because the names look or Evans, W, and Wright, G, British Heart3Journal, 1942, sound alike, 71 are pairs of proprietary names 4, 91. and only 28 pairs of approved names (the remaining pairs are a proprietary and an approved name). There is surely an important A use for savings from abolishing AHAs? lesson to be learned from this. Dr DAVID HASLAM (Ramsey, Cambs) writes: With the recent announcement that area health Dr R N PALMER (Medical Protection Society, authorities are to be abolished next year, I London WIN 6DE) writes: A further pair of cannot help but wonder what is to become of drugs (6 October, p 836), confusion between the countless pieces of paper, such as hospital which led to the death of a young man, is notepaper, that bear AHA headings, to say Inderal and Intal. The case is reported in the nothing of the many sign boards and so on.... annual report of the Medical Protection The experience of the speed with which these Society for 1979 (p 37). signs and headings appeared when AHAs were first introduced implied that old stocks of notepaper were destroyed, and many people Dr F V SIMPSON (Scarborough Y013 ORA) were employed full-time repainting vans and writes: I can add to the useful list of drugs sign boards. Is this what the savings from which have been confused (6 October, p 836). abolishing AHAs are to be spent on?
