As the surgeon reached for a scrub brush, the medical student lingered back, his thumbs incessantly and rhythmically tapping on the screen of his phone. The surgeon peered at him with frustration, annoyed that again his student appeared more interested in his smartphone than the pathology. In an effort to engage him back to the case, the surgeon asked: “Can you tell me what tendons lie in each of the extensor compartments in the hand?” The student’s head snapped up, and he quickly rattled off the answer with ease. Smiling momentarily, he then asked, “Could I get your thoughts on this new video describing nerve transfers rather than tendon transfers for radial nerve injuries that was just uploaded to our educational portal? See, I have it pulled up right here, it was just presented last week at the plenary session…”

JAMA

“Why do doctors feel the need to do this? A study in The BMJ in 2015 suggested that there is an association between increased defensive practice and a reduced likelihood of being involved in litigation.2 One might conclude that defensive practice is a logical behaviour in the face of a culture that leads to doctors being fearful of the consequences of making an error or even of a known adverse outcome.

“No doctor sets out to practise defensively, but a system has been created where this is inevitable. The GMC acknowledges that medicine has become more defensive.3 Doctors often lack confidence in the fairness and competence of investigations and continue to see the GMC as threatening.”

Tom Bourne quoted in the BMJ

A “world renowned” consultant radiologist has been suspended from the medical register for six months after being convicted of failing to pay more than £400,000 in tax on his private practice earnings. XXX a professor of cardiovascular imaging, was given a 15 month suspended prison sentence and fined £200,000 in 2015. The GMC argued that he should be erased from the register. But the medical practitioners tribunal concluded that he made a unique contribution to the care of critically ill patients and the development of cutting edge techniques.

Bmj September 30 , 464, 2017

“he rose because of the widespread but baseless hunch that people with little outward charisma must possess great depth by way of cosmic balance.”

FT

Modern medicine is full of doctors who are already robotic. But good medicine is like any other subject that requires one to make judgements based on prior cases. You can follow rules, or you can think. The first kidney doctor (who I saw multiple times) never bothered to actually think.

Roger Schank

And third, the internet is disrupting death as it has life. Comparison sites shed light on funeral providers’ services. And though not many bereaved relations yet “bring their own coffin”, a quick browse online gives people a far better idea of what it should cost. Startups are offering more radical disruption: rocket-launches for ashes; QR codes on graves linked to online tributes; new ways of disposing of bodies besides burying or burning.

I like that you can now go ‘direct’. Purgatory is now optional.

Economist.

(Isaiah)Berlin had learned that if you studied them with philosophical intent, certain second-rate minds grappling with first-rate problems could teach you more than first-rate minds lost in the shrubbery. (Another reason, perhaps, that he abandoned analytic philosophy.).

Mark Lilla in the NYRB

Which for some reason reminds me of a quote from the Economist:

Professors fixated on crawling alone the frontiers of knowledge with a magnifying glass.

Despite my professional area of interest, I always forget how fast fingernails grow. But no longer.

Thanks to plate tectonics, America and Europe are moving apart at about the speed that fingernails grow. (Thanks to Bill Bryson)

As anyone who has worked in a large organisation knows, people who are put in charge of a complex activity that would be better left alone, never do nothing; they seek to justify their existence by simplifying and restricting that activity so that it can be controlled.

Paul Seabright

A Wonke podcast well worth listening to featuring Matt Robb of EY Parthenon on higher education. I think it will all end in tears, but it has the virtue of laying out what is happening and — to use one a phrase I detest — the direction of travel.

Wonkhe podcast here.

Some selective notes below (not necessarily his views): there remains much misery to go around.

• increasing rate of change
• the nature of change
• HE is increasingly commercial and internationalised
• universities having to be more extroverted
• HE sector facing segmentation
• global elite versus high-end Russell and the low-end…..
• (some) protection by grouping by brand
• international students to drive research to drive rankings to attract students…
• your ranking is under threat
• rise of TEF
• the TEF proof of ‘value added’ at bottom of rankings is the only defence against the ‘too many going to university’ argument. (Well, too many are going…)
• the great challenge (for part of this sector) is to explain what teaching looks like if it is not research led teaching (which is not the mass of higher education).
• contract lecturers ……more ‘financial’ flexibility
• online / blended allowing……. more ‘financial’ flexibility
• Segmentation rules!
• University Leadership does not have the strategic competence or backup to run universities.
• a nice analogy between spreadsheets, and strategy versus planning.

Never underestimate the ability of the UK to reflect on, and then destroy its own brands, particularly if consultants are involved.  You can make a lot of money as the ship goes down.