Doctors Working Alone
This post was suggested by some of the comments to my post about Changing Doctors. But in my experience of doctors in the last couple of years, increasingly specialists are working alone and doing much more of the donkey work themselves.
I’ll give three examples.
- In Hong Kong, I had a consultant speech therapist, wh0 did the X-rays himself to check that I could swallow properly. He even gave me a VHS video of it.
- My cardiologist in Cambridge, did the eectrocardigram on me, himself. Whereas the in most hospitals this is delegated.
- When I had the ENT examination after my episode with A&E, the consultant did everything himself.
I have a feeling that this approach is getting more common, as it obviously is more efficient and the doctor an modify his examination depending on what he finds. There is also no communication problem.
I’ve also been told that INR tests are done by the doctor, at my new surgery, so it’s not just at the consultant level. I’ve also had two specialist x-rays recently, where the radiologist worked alone.
To me it’s seems the way medicine is going for relatively simple procedures and some specialist complicated ones too. Obviously modern medical equipment helps, as in many cases it de-skills the actual examination and lets the doctor do what he does best, the analysis of the problem.
But what are the knock on effects in the number of anciliary staff that aren’t needed? headlines such as nurses made redundant are never good publicity, even if the downside is that there were so many more patients treated.
Changing Doctors
When we moved here, getting a doctor took a couple of weeks, as the surgeries were all full. But yesterday, I got a new doctor near to my new house after a couple of phone calls. Incidentally, the one number that dhould have helped me never phoned back.
I’ve told my current GP and she is going to organise a printout of all the relevant details for me, when I go to get my next blood test on the 29th. She aso said that the bulk of the records would be moved by electronic transfer in due course.
So at last we’ve sen some progress in twenty years!
A Replacement for Warfarin?
On BBC Breakfast this morning, they were talking about a replacement for Warfarin, that would be just one pill a day.
For a lot of people, this will obviously be better and it is likely that the cost to the NHS will be less in terms of blood testing. But this new drug will not be cheap.
In a way, I think that the alternative of providing an up-to-date National Anticoagulant Service might be much better.
As an example, I’m moving to London in a few weeks, so I’ll have to get that sorted fairly quickly. But as I usually have to be tested every two weeks or so, I can envisage a few small problems, especially as I’ll be needed to be tested over Christmas.
Stem Cells and Stroke Patients
A lot of people mat well object to the fact that foetal stem cells have been used to help a stroke patient in Glasgow.
I’ve probably been fairly lucky with my stroke and it is doubtful whether I would have needed this treatment.
But, would I have said yes or no, if I had been offered the treatment. I don’t know, but I would have always wanted to get better.
It is interesting to postulate what families and the NHS will say. After all, if someone is completely disabled, it doesn’t help anybody, least of all the patient.
I must admit too, that if this treatment is a success, then the three parties involved, the patient, his family and the health service will all probably be in favour.
It will be interesting to see how the moral arguments develop.
And Now The Good News!
Well I suppose it’s good news, in that the hospital doesn’t want to see me again about the stroke! I suppose I should be pleased but I don’t think I showed much emotion as I was getting tired after the travel. In fact if I have any emotions now, it’s about going to London, hopefully for a new start! At least when it’s like tonight, I won’t have to stay inside watching nothing on the television.
How Am I Doing?
I’m going to see my Doctor at Addenbrooke’s tomorrow, so I thought I’d write down a few notes.
If I start with my body and move downwards from the top of my head, I can summarise it as follows.
I was suffering a sort of itch and a sensitive scalp, but that seems to have reduced and almost stopped since, I’ve started taking the Amitriptyline. I’m only on one 10 mg. tablet a day and I take that just before bed, so that it helps me sleep reasonably well.
My brain seems to think clearly and I’ve started programming again. I do think though, that some of my memory functions aren’t too good, in that I make a mental note to do something and then forget it a few minutes later. But the long-term memory is intact and I can remember funny tales from years back with ease.
My eyes now seem to be working better, in that I have no trouble seeing anything as I walk around. Although, obviously, I’m not driving or even cycling. I also find that I can’t see the ball when I try to play table tennis. But I can use binoculars to look at things like the moons of Jupiter, which is something I couldn’t do when I left the hospital.
I do seem to have gone a bit deaf, but then I was always going that way.
I still have pain in the left side of my face and it gets worse as the afternoon progresses towards evening. I suspect this is because the Amitriptyline I took the night before is wearing off. I find too, that typing on the computer gets more difficult from about three and my eyes are tired.
My mouth is a bit sore, as my teeth tend to catch the inside of my left cheek. It could be that I’m cutting a Wisdom tooth, but my dentist is a long way away in Felixstowe. In addition, my teeth never seem clean. I wish there was a walk-in dental hygienist!
My right arm is a hundred percent, but my left hand is still a little wayward and there is pain the wrist. I can though now wear my heavy Rolex again, which C left for me as her last Christmas present. It has the inscription “J Xmas 2007 and Forever C” and I feel undressed without it.
I do find trouble reading newspapers, as I find it difficult to separate the pages. I had thought this was due to the stroke, but my friend, John, at the football has the same problem and he’s a fit farmer, who’s about my age. He reckons it’s the papers and the ink they use! So perhaps it’s just old age again!
There is also pain in my left humerus in the old injury, where the bully broke my arm at school. Again it gets worse as the day progresses.
I have been working on my core strength and don’t seem to suffer any pain or reactions in my trunk at all.
I do however have a bit of a problem with a mixture of constipation and diarrhoea. That’s probably the best way to describe it, as sometimes I find going a strain and at other times it’s loose like it was for most of my life before I was diagnosed as a coeliac.
Incidentally, when I typed that last paragraph, I just typed diarrhoea right for the first time in my life!
My legs are fine, although I do suffer the odd cramp at night in my left shin and my varicose veins are getting worse. But compared to my parents’ ones, they are minor.
I’m eating well and I’m now just about the same weight as I was this time last year of about 58.5 kilos stripped.
One slight problem is that I always seem to feel a bit cold during the day. But as I said, I’m sleeping well and am very warm in bed.
As to getting around, I have no problems, that others don’t have like late or missing trains and taxis that take forever to come. But how many who are recovering from strokes, have travelling as far as Inverness, Edinburgh, Middlesbrough, Sheffield and Crewe without any special assistance? I can’t wait to get to my new house in London, from where I can really explore the country.
I’m also managing well with the Warfarin. But it’s a system that is so antiquated and ill-thought out, that something should be done to create a proper National Anticoagulation Service, possibly based on pharmacies and the Internet. But I’ve not missed a correct dose and save for the odd small nose bleeds, I’ve not had any trouble.
I also think I felt a bit better after last Wednesday when I had my three-monthly B12 injection.
So let’s face it!
I could be much worse.
I sleep well, get tired, cook everything I need, travel where I want, but just feel trapped living in the country with a bit of nagging pain.
I’m moving so the first problem will go and I hope that the pain will fade away with time.
Miliband is Very Much Old Labour
Congratulations to Ed Miliband and his partner, Justine, on the birth of their son.
But the announcement of the birth with his weight in pound is very much in the past and well into Old Labour territory.
When our second son was born in the same hospital, forty years ago, his weight was given in kilograms.
So get into the present day, Mr. Miliband!
One In and One Out!
I had a bone density scan some weeks ago and as I’ve not heard anything, I asked the nurse to see if there was anything on their computer, when she did my Warfarin blood test and gave me a shot of B12 today.
There wasn’t any news and judging by how I feel, my bones may not be tip-top, but they certainly aren’t in falling apart mode, as I would have hoped that I would have been called in for the bad news.
It strikes me that there could be a big increase in efficiency here, with possible cost savings!
If you have a test that can be quantified accurately and you are well on the right side of the problem level, surely, you can be told the results either by a more or less standard e-mail and/or letter.
With my bone scan, it might say that I’m reasonably fine, but I should come back for another scan in say six months. A copy could also go to my GP, so she would know as well. I have a feeling, that a lot of communications from hospitals to GPs are actually letters not e-mails and are scanned in the surgery. If I’m wrong, which I hope I am, about these letters please correct me!
There must be hundreds of instances in the NHS, where a sensible bit of automation could save money and redeploy staff to more important duties, than writing lots of similar letters.
We are seeing instances of automation, like appointments systems that text you reminders, but we need to see more. I personally would like to see a better system for anti-coagulant testing.
Are We Finally Beating the Common Cold?
There are two stories on colds and viruses, today, that give a cause for optimism in our long search for a cure for the common cold.
One says that the Medical Research Council has made a breakthrough in the understanding of how viruses work. The other says those who exercise regularly are less likely to get colds.
This is all good stuff, that might lead to something really concrete in the future.
It’s at times like this that I get optimistic.
Best Wishes to Danny!
My best wishes go to Danny Baker, who has been reported as suffering from cancer.
Let’s all hope he makes a swift recovery!
The Anonymous Widower 