DR MAX: I worry about nurses who can’t speak English

One of the scariest experiences I ever had as a doctor was a few years ago while working a night-shift in AE.

In the course of my career, I’ve been sworn at, slapped, punched, threatened, spat at, you name it … but this was totally different.

I was on duty in a busy inner city hospital casualty department. It was a tiny team — just me and a nurse. The usual nurse was off ill, so an agency had supplied a replacement.

As soon as I introduced myself, I realised that her spoken English was very poor. She was from Portugal and lived there most of the time, coming to the UK to do stints as an agency nurse.

While it is quite right that foreign nurses should work in the NHS, it is vital that they should conform to the same high standards, writes DR MAX PEMBERTON

After a brief, hesitant discussion, I became aware that she didn’t believe in mental illness — the area of medicine with which we were dealing that night.

She described people who suffered from mental illness as being merely ‘weak in the head’, and said that they should be told to pray. Aghast, I presumed her real view had been lost in translation.

But then I spotted her giving a patient medication to sedate him, although it hadn’t been prescribed. Worse still, it was in fact potentially dangerous considering how unwell the patient was.

The Mail’s revelations this week that more than 1,000 registered and licensed doctors have criminal convictions left me flabbergasted. I sometimes wonder what has become of my profession. The cases include cardiologist Dr Steven Burn, who was found to have 65 child abuse pictures on his work computer. Also, trainee anaesthetist Rupert Pemsel was allowed to continue working as a doctor despite having had sex with a prostitute while on duty in a maternity hospital.

I’m horrified that they are still allowed contact with patients.

It makes me wonder what exactly a doctor has to do to be banned from practising.

When I reprimanded her, she shrugged. (To be honest, I’m not sure she understood me.)

Problems continued when the family of another patient, a female, complained that the Portuguese nurse couldn’t understand them and they didn’t want their relative to continue under her care.

She then discharged a patient who was suicidal, and I had to call the police to find him and return him to the hospital.

Finally, the nurse went missing for several hours when she was supposed to be monitoring a disturbed patient with dementia. I found her asleep in the office. By this stage, I was so worried about her interacting further with patients that I told her to stay there while I made the rounds alone.

The following morning, I reported what had happened to our manager, who duly informed the agency and told them we wouldn’t have the nurse back.

Of course, this woman may have been a one-off bad apple and a liability, even if her English had been impeccable. But I can’t be certain that the language barrier wasn’t the problem.

Either way, the truth is that the NHS hiring system is unable to do proper checks to ensure that health staff who come from fellow EU countries are capable of doing the job. There is no requirement for language tests, or even a test of basic medical competency.

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I am the first to accept that the vast majority of nurses and doctors from EU countries who work in the NHS are highly competent and skilled. Their ability to speak English as a second language puts my own schoolboy efforts with French and Spanish to shame.

Nevertheless, it is not right that EU employment laws mean we cannot make checks on foreign staff before they are hired.

Under current rules, regulators must register all EU nurses as ‘safe’ without carrying out any checks — even if they have not practised for decades.

The rules are that only nurses from non-EU countries may be subjected to competency tests.

This week, the Nursing and Midwifery Council called for loopholes that prevent nurses from European Union countries being tested to be closed. In a damning report to the Commons Health Committee, the Nursing and Midwifery Council warned that the current situation is ‘unsafe’.

This ludicrous state of affairs demonstrates how EU rules risk the welfare of the sick.

My hope is that Brexit will result in sensible changes and improvements to the standards in nursing care. Hopefully, such changes will include more stringent checks on abilities of staff from EU countries.

Figures show that in 2015/2016, nearly 10,000 nurses and midwives from EU countries registered to work in Britain. In total, about 40,000 nurses working in the UK trained elsewhere in Europe.

This is a vital issue because poor nursing care affects the most vulnerable: the elderly, the disabled and those with mental illness.

To highlight this basic truism is not xenophobic. The issue is about providing best patient-care.

And the unarguable fact is that there is a worrying difference between the standards we demand from British-trained nurses, compared with those who come from EU countries.

While it is quite right that foreign nurses should work in the NHS, it is vital that they should conform to the same high standards.

As well as new agreements on trade, environmental regulation, border controls etc, Brexit also offers the ideal opportunity to reinforce proper patient-care standards in our Health Service. 

Is your cat affecting your mental health?

I don’t mean their incessant yowling or the way their claws damage your furniture. What I’m talking about is how cats can carry a parasite called toxoplasma gondii that may affect how you behave and could even trigger depression.

A study has found an association between the infection and the extreme premenstrual tension experienced by some women.

The idea that infections can alter our mind may sound like something out of science fiction, but there are instances where we know this happens.

The bacteria Treponema pallidum — which is responsible for the sexually transmitted disease syphilis — can, if left untreated, cause neurosyphilis, symptoms of which include depression and psychosis. It can also affect memory.

I once saw a patient who had been wrongly diagnosed with Alzheimer’s when his memory problems and confusion were down to a syphilis infection that he probably contracted while in the Navy many decades previously.

There’s another condition known as PANDAS (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) which affects children. It is caused by a bacteria which can trigger a reaction that results in either Obsessive Compulsive Disorder or Tourette’s syndrome — a psychiatric condition where the sufferer has uncontrollable tics or swears inappropriately.

While it’s perfectly possible that parasites in cats can affect human behaviour, I fear the dangers are exaggerated. It might be easy to blame some microscopic bug — indeed, some researchers claim toxoplasma gondii can cause road rage — but the truth is that we humans have the power to moderate our behaviour.

So don’t blame the cat when you feel moody. That’s just a cop-out.

The young minds warped by porn 

Ministers are considering whether sex education should be made compulsory in schools in a bid to tackle the hateful, pernicious effects that pornography is having on some youngsters.

As a general rule, I’m very wary of making anything compulsory, especially when it involves parenting.

But as a doctor, I’ve seen the scale of the problem deriving from pornography and I now concede that the state should step in.

It’s very hard for generations who grew up before the age of the internet to comprehend the impact it can have on a young person’s understanding of sex. I have seen countless teenagers in my clinic who think, for example, that pubic hair is dirty and wrong because in the pornograghy they’ve seen, people shave themselves.

Also, the images they are exposed to are often violent and extreme, with the result that many children now consider such depravity as normal sexual behaviour.

As a society we need to respond to this normalisation of pornography. We need to ensure that every child is taught about consent, about sex in the context of loving, committed relationships and about the realities of human biology.

It makes me uncomfortable that this burden has to fall to schools, but the alternative is that children will get their sex education solely through perverted clips shared on their mobiles. We owe it to our young people to intervene.

Don’t force old into care 

Thousands of elderly people face being moved against their will into residential care homes because it would be cheaper for local authorities than providing them with care at home.

What a disgrace.

Certainly, some people benefit from being in care homes — but to enforce this on pensioners is inhuman.

There has been extensive research into the effects of older people being dumped in care homes, and it shows this can result in a rapid deterioration of their health and is associated with increased confusion and disability.

The mind has a powerful attachment to routine and familiar surroundings. It is amazing how well some people can cope, even in the grips of dementia, if they can be cared for at home.

Institutionalising older people against their wishes is shamefully immoral.