Daniel Haines

Carbon monoxide poisoning

According to our paper in this issue, carbon monoxide (CO) poisoning is infrequently reported in Northern India. They are very fortunate. Perhaps, their buildings are better ventilated than ours. CO poisoning is common in Britain, and has killed many young people camping in tents, canal boats and caravans, and those using charcoal burners to cook in their shelter who do not extinguish the burner properly before settling in for the night. Faulty but fashionable wood burning stoves are causing poisoning and deaths in some of our modern homes, and CO poisoning is also a frequent cause of death in fires. Excluding the cases where CO poisoning was used as a method of suicide, with a hose from a vehicle exhaust into the vehicle, it is a common enough occurrence in Britain for several ‘no win no fee’ personal injury solicitors to advertise publicly for cases in order to benefit from them. Numbers of deaths in Britain reported by the National Health Service vary between 40 and 50 a year. The onset of poisoning may be gradual or acute. The symptoms include:

The papers we choose to publish

I have written this editorial to encourage authors, especially new authors, to submit their papers and to get them published. If they are accepted they will get a very wide and distinguished audience. They will be disseminated around the world. They should be original, short and interesting. They can be the start of a fulfilling career. The first duty of this Journal is to publish the talks given to the Society. This is for the benefit of those who could not attend the talk and as a record for those who did come. That takes about a third of our available pages. We use the remaining pages for papers offered on research, legal opinions and case reports. Letters are welcome. We are getting increasing numbers of papers submitted, and with limited space we have to decline more submissions. Potential authors may find it useful to know how decisions are made by the Medical Editor together with the Editor.

Consent: Heaven or hell?

Why do conscientious and hardworking doctors shudder when asked about consent, whilst medical claims solicitors look delighted? When I went in for total knee replacements my poor orthopaedic surgeon gave me a booklet of possible complications and their frequencies, and later wasted 10 minutes of his and my precious time going over it all. I did not want to know. I knew there were possible serious complications, but I had decided to have the surgery, and take the risks. Rubbing my nose in them was simply cruel. But he felt he had to do it to cover himself, and to reduce the risk of being sued if it all went wrong. How much better it would be for most patients if it was taken that by presenting themselves for an operation or a treatment that in itself implied full consent. Those navel gazers who really want to know the possible complication can always ask, and may well then decide not to go ahead, to their own cost. There are no certainties in this life, other than taxation and death.

Civil aircraft accident investigation

This talk reviews some historic aircraft accidents and some more recent. It reflects on the division of accident causes, considering mechanical failures and aircrew failures, and on aircrew training. Investigation results may lead to improved aircraft design, and to appropriate crew training.

Healthcare Decision-Making and the Law:

This book takes an in-depth look at how health-care decisions are made for adult patients. These are patients with capacity, without capacity and those subject to mental health legislation. It questions in a reasoned fashion the formation and structure of our present law concerning this, looking at its foundations. The book is deeply critical of the way the concept of capacity is used to allow or disallow an individual’s autonomy, despite capacity being a poorly defined and highly variable concept, including within each individual’s life. The book requires serious application to read it. Some sentences are long, and to a simple medical doctor, opaque. Try “The chapter also argues that the liberal account of capacity fails to recognise the epistemological fallibility inherent in the operation of the capacity requirement and to deal with the normative consequences to which this gives rise.” Some readers may be uncomfortable with the use of the female pronoun throughout. There is a flavour of women’s liberation. Hold your heads high, gentlemen, it may help to demonstrate your capacity!

Sick police officers, a change of culture.

In a personal reflection on his time as a consultant occupational psychiatrist to the Metropolitan Police Service, Doctor Derek Summerfield comments on his views of the grounds for early retirement on mental health grounds of some 300 officers. 1 He finds a change of culture throughout our workforce from the facing of stresses with resilience to the acceptance of vulnerability. Incapacity payments for ill-defined mental health issues, and the prescription of antidepressants, have escalated to an alarming extent since the 1990s. A similar culture change is occurring in paediatrics, where a child may no longer be diagnosed as stupid or badly behaved, but must be given a socially acceptable diagnosis such as dyslexia, or attention deficit hyperactivity disorder, ADHD. Such dubious disorders are frequently heard in the charge rooms of our police stations. Police officers have developed a culture in which retirement planning and pension entitlement are important. An officer is awarded a pension after 30 years’ service or if they retire on grounds of ill health. It is said that officers are very seldom sacked for inefficiency or other work problems, but are given ill health retirement instead. This has left a culture of entitlement to ill health retirement, and to regarding the occupational health service as a barrier to this entitlement. Dr Summerfield argues that: † Certification on mental health grounds is the leading cause of sickness absence, yet it is largely patient-led; † The medicalisation of non-specific symptoms may promote secondary handicap and prolong disability;

Whither our Police Service

At present England and Wales have a fraction as many police officers per number of population as other moderately civilized countries such as France or the USA. Each of our fiercely independent 46 forces is responsible for all crime, from serious organized crime and terrorism (first tier), through simple muggings and burglary (middle tier), to petty nuisance and drunken loutish behaviour (third tier). Any officer joining a force today may have reasonable aspirations to become a chief constable, whatever his intellectual deficiencies. We would all like better policing, but the country is bankrupt, and cannot afford even what we have now. Our present system results from the last serious review of policing 48 years ago. Even our railway system has bettered that. We need an affordable system fit for today. We might start by reverting to a two-tier entry system, with the upper tier gleaned from proper universities, looking only at real