Medical Misdiagnosis
According to Professor Graham Neale at Imperial College, about 15% of conditions are misdiagnosed by the NHS. 15% is not one in six as the Times states. It’s actually nearer one in seven!
I heard him on Radio 5 last night and he was saying that this is one of the biggest problems facing health systems around the world.
Too right it is!
Let’s assume that we can cut this level by ten percent. On a straight economic case, it should cut the health care bill by at least one percent. So getting to grips with this is a major challenge that will bring enormous benefits.
The Times talks of one possible IT-based solution.
The NHS in Scotland has launched a pilot project where computer software with a diagnosis checklist is installed in GP surgeries to prevent errors. The programme, involving 25 GP surgeries, uses a commercial company called Bluebay, that gives doctors access to written information on how best to treat certain conditions.
I must admit, that I do have a special interest and knowledge of misdiagnosis. As I am a coeliac, and moderate a group on the Internet about it, I’ve come across quite a few who have been misdiagnosed for years.
But then you can see the problem, if like me you have bad skin, joint pains, severe dandruff, gallstones, mild depression and migraines, would you have thought that the problem was a gluten-intolerance?
The other problem is that there is no record of diagnosis. To me as someone who analyses data for a living, it is a goldmine, that could give a rich vein of results. Doctors always state reasons why this should not happen. But then pilots have had an anonymous reporting system for years. No-one ever complains about that!
We do not need major changes to get a decent increase in efficiency. We just need doctors and other health professionals to make the best use of the information that could be readily available.
And judging what I said earlier on saying sorry, they could learn from that too!
A Tale of Two Hospitals
I’ll call them A and B, although perhaps it would be better to call them A to G or even A to Z.
Someone I know very well has a medical problem. It’s not that serious, but it is does inhibit their modest lifestyle and if they don’t do something about it, they will have a very serious problem.
Hospital B was a disaster. There were lots of staff, but they were suffering from a lot of headless chickenism and the doctors seemed to be running round in circles. They didn’t seem to be able to work without notes and they still seemed to want secretaries to write them up. Or that was the impression they gave.
They are now in Hospital A. Everything is calm, the doctors know their patients and they do their best to make sure that the patients minds are put at rest. You may only get three or four minutes with a doctor every day, but they answer all your questions and apologise for the slowness of the service. But compared to Hospital B it’s several times faster. The patient has already been given a schedule about when they will be having their operation.
Nothing like that happened in Hospital A.
I know about planning. I made a lot of money by providing systems that sorted out these problems, so I think I can pontificate about this.
There is one rule that matters in this case. Get the management right and be honest with everybody and you will reap the benefits. But the deadwood will suffer!
Live Longer in Bury St. Edmunds
Or in fact one particular area, Moreton Hall. This is according to statistics from the Care Quality Commission, published in the Daily Mail. That’s twenty-six years more than in a deprived area of Middlesborough.
Now, I don’t live in Moreton Hall, but I do live in St. Edmundsbury, which is the local authority including the town. Strangely Bury is not a city, despite having a cathedral, which was part of one of the largest abbeys in England.
So why is the health better round here?
The hospital in the town is not particularly eminent, but most people don’t have too many complaints about it. My GP service is very good and I’ve not heard many complaints of others either. I can remember years ago, that it was a common topic, when we lived in North London, but it’s seldom heard here.
But that is only about the service you get when things go wrong.
Bury is an affluent town and that obviously helps, but it is also a town which has had virtually full employment for many years. I can remember an article in the 1980s, where it had the highest employment levels in the country, despite all the problems elsewhere.
It is also a town, where you tend to walk around the compact mediaeval centre, as parking is difficult. But everything you need is there and it is a thriving centre, with lots of shops, a market and interestingly many new houses and flats crammed into every old yard and space. I know of few towns of 50,000 people, which are so busy with such a good atmosphere. Perhaps it all helps.
You also tend not to see as many obese people in Bury, as you do in other places. As obesity is linked so closely to cancer and heart disease, this must have an affect on life expectancy.
And then there is the weather. We have one of the mildest, calmest and driest climates in the UK, in West Suffolk. Rarely do we get snow and we get a lot of fine days in the winter, where in a nice walk or a bit of gardening, you can get your daily dose of sunlight and it’s life-enhancing vitamin D. You don’t get too many cold, depressing days.
But Suffolk as well, is unique amongst English counties in that, it is the home of real ale, with two of the major brewers, Greene King and Adnams, within its borders. Greene King is one of the largest employers in Bury. So whereas most of the UK has been seduced by gassy, over-advertised, chemical lagers, in Suffolk, the long drink of choice of many is a proper pint of real beer. It used to taste good, when I could drink it!
So is this a factor? Note sure. But there is nothing better than winding down with a good pint and perhaps that is very good for you.
But why is Moreton Hall at the top of the list?
It is an unusual estate in that most of the two thousand or so houses there are quite large. So there must be a high proportion of the affluent and we know that there is a relation between lack of wealth and lack of health. I would also suspect that if you surveyed Moreton Hall, you’d find very few smokers and heavy drinkers. It’s just that sort of place.
But it also has a unique factor that may or may not affect health.
It lies to the east of the sugar beet factory and for a large part of the year, you know of the factory’s presence by its not-unpleasant smell. So does it bathe the area with a health-giving elixir?
Probably not!
Can’t Sleep
I put this comment on the Norman Borlaug post last night.
You up too!
I suppose I have two excuses; I’m working on the software and I’m watching the tennis.
The trouble is too, that I’ve not had an alcoholic drink all day and my brain keeps thinking of more things to do with the program. Perhaps, it’ll be worth it in the end!
I did see the end of the tennis. That was certainly worth watching, although I did wish Federer had won.
But this morning I was awake at 6:20 and I’m up now working.
I should be sleeping more, but the adrenalin of programming is thumping through my veins.
Thunder Thighs Are Good
That is the message being posted on the news this morning, but it is not quite that if you read the news report.
I heard it that if your thighs were less than 60 cm. then this was bad for your heart. It’s actually, if your thighs are less than 55 cm., then this is true. Here’s what the report says.
The study looked at more than 2800 men and women with an average age of around 50.
It found that the risk of heart disease more than doubled for both men and women who had a thigh circumference of less than 55 centimetres.
Those participants with thighs between 55 and 60 centimetres received a protective effect against heart disease, the study reports.
But that protective effect reduced for people with thighs above 60 centimetres in circumference.
So because my thighs are only 48 cm. (19 in.) does that put me at risk? Possibly not, as my waist is only 75 cm. (30 in.)?
Probably not, if I read the next bit.
Associate Professor David Cameron-Smith, of Deakin University in Melbourne, says this is very powerful research.
He says a growing body of research is showing the increased risk of heart disease associated with living a sedentary lifestyle.
According to Cameron-Smith, thigh circumference is a broad indicator of physical activity and muscle mass is related to how much exercise you do.
I don’t live that sort of lifestyle all the time. In fact when my fitness was last checked a few months ago, it was probably that of a man ten years younger than me. It wasn’t always so and has improved over the last few years since I was diagnosed as a coeliac and have gone on a gluten free diet.
I also get a lot of exercise trying to find good clothes that fit properly.
Hospital Food Worse Than Prison Food
A report today from Professor John Edwards at Bournemouth University has said that hospital food is worse than prison food.
Here’s the e-mail I sent to the BBC.
Luckily, I’ve not been into hospital overnight, but the Professor’s research bears out the experiences of my relatives and friends.
I also moderate a list on the Internet for coeliacs, who need a gluten-free diet. Some of the experiences are not good at all, with it seems kitchens unable to provide the correct diet.
The last bit worries me.
Deaths, Public and Private
Every death is a tragedy for someone. Even the most noxious individual, had a mother, even if they didn’t know their father, or have any children.
Years ago, I was phoned by Haringey Council, because my great uncle had died in their care. He’d returned from Australia to find his family and after failing had ended up in an old peoples’ home in the borough. But a guy in the Legal Department of the council had taken the trouble to trace those few remaining relative after his death. He felt it was more than a pity, that he hadn’t been able to find us before my great uncle had died.
We’ve recently had a lot of coverage about Lockerbie, where unlike my great uncle, 270 died in a very public and violent way.
Over the years, I’ve met many who like myself, have lost someone very near and dear to them. But all of these, like my great uncle have been very private and the most public they have got would have been a notice in the paper. And usually only the local one.
But is the grief felt by those left behind any different?
When my wife died of an aggressive and incurable cancer of the heart, I felt totally powerless. It just gripped her body and drained the life out of her. But at least we said good-bye properly and if I can keep my dignity like she did in her last days, I will be surprised, as I don’t think I have it in me. I do want to get even, but it will be by helping those in the fight against cancer and other life-threatening diseases.
Others I know lost their partners, parents and children to accidents and heart attacks, where they didn’t have my luxury of a slow parting. They seem to take much longer to come to terms with their new circumstances. After all, they were not told to get on with their life. Or fixed up with a blind date! Many too, don’t have the financial circumstances that I have, to carry on in the same way as before.
Is the public death of a loved one any different?
In a way it is not. You still have the same grief and personal problems, although interestingly in some cases, you may well have received much more financial help and counselling.
But surely the real problem is that whereas I have been able to restart my life, the endless publicity and digging up of the issues, by newspapers and often well-meaning politicians, doesn’t help.
My heart goes out to those who can’t be left alone to suffer their grief in private with friends, family and any professionals they need, so that they can be left to rebuild the rest of their life.
An interesting aside to this is that because my wife was a barrister, we often discussed various legal issues and cases in the courts. She could not understand, why if someone was murdered, increasingly relatives seem to spend every day of the trial of the accused in Court. I agreed and if she had been murdered, I would have quietly withdrew and had nothing to do with case. She would have done the same if it had happened to me. How can you get any satisfaction from watching justice unfold, so close to home?
So to return to Lockerbie. I can’t understand the mentality of those who keep pushing themselves through all the grief again and again, by appearing on the radio and demanding more and more vengeance.
But then I think all deaths are generally a private affair, for those that are involved.
I like to think that by now, I would have moved on and built a new life that was a credit to the memory of those that I had lost.
Cooked Meats and Cancer
The World Cancer Research Fund are now saying that cooked meats, such as ham and salami and bacon, can cause cancer and should be banned from lunch boxes.
They have form in this area and have been warning for some time. Do I eat much cooked meats? Not really, as I possibly eat them once or twice a month. I did eat a bit more at the weekend, but it was my party.
They also provoked this blast from the Daily Mail. I’ve read that and that perhaps says one important thing and that is moderation in all things.
But what is missing from all of this research and rants is any degree of statistical sense.
We could take a silly example, which states that if you spend all your time on a computer, playing computer games as a child that this is bad for your health. Other research could also say that playing on railway tracks is also bad. They both probably are, but the second is many times more dangerous than the first and people these days tend to lump everything as equally bad.
Now my worry about this “ham sandwich is bad for you” scare is that I’ve never seen any relative risk information compared to say cigarettes, obesity, excessive drinking or spending eight hours a day on a sunbed. So you get the obese smoker giving up cooked meats as his bit towards better health.
So what are the relative risks?
The best book on the subject is The Skeptical Environmentalist by Bjorn Lomborg. He analyses the risks and prints them in detail. Everyone should read his book. You may not agree with everything he says, but it will certainly make you think.
But bear in mind one thing; if you want to live a long time, you can increase your chances by not smoking, eating a good diet, exercising and maintaining a healthy weight. I do all four. But then so did my late wife and she died at fifty-nine!
One point about diet is that diagnosed coeliacs on a gluten-free diet have a twenty-five percent less chance of cancer. That more than mitigates the bad affects of a ham sandwich in gluten-free bread.
The Power of Twitter
It would appear that Twitter has been having a hard time, as a war of words goes on about the NHS between Britain and the United States. Or at least between some people with axes to grind.
I am quite a regular user of NHS services in that I am a coeliac and have a B12 injection every three months, free prescriptions for bread mixes, ongoing issues with cholesterol, my left foot, which got injured on a beach by a shell and my left humerus, which got broken by a bully at school. Nothing is that serious and I suspect, I’m quite a way below average in my consumption of services. I never have a problem and I can always get an appointment when I want with my GP.
If I look at the last few weeks of my late wife’s life, I can’t fault the services she got from both the hospital and from the GP. She eventually died at home in her own bed, which is surely the way we’d all like to go. If we have to go at all!
But I’m not saying the NHS is perfect, but on the whole in mine and my many of my friends’ experience it works pretty well. I think we’re also lucky here in West Suffolk, in that we have two hospitals within reach; Addenbrookes and Bury St. Edmunds. For specialist problems, Papworth and London are not too far away. So if I have a problem, I’d make sure I get the right consultant from a choice of several.
I have never used the US healthcare system so I can’t comment directly, but whereas none of my friends in the UK would put healthcare to the top of their list of worries, many of my American friends do. I worry about living alone and perhaps having a heart attack by myself, but I don’t worry about the care I would get.
Recently, I’ve had experience off two other health systems in Europe; Italy and Holland. So in the latter it’s only indirectly, but the episode in Naples was only the second time, I’d had a ride in an ambulance. The ambulance was rudimentary, the hospital was very tired, but the care was good and there were lots of doctors and nurses. Compared to the UK, the buildings are a lot worse, the staff seem to work a lot harder, but the result is probably about the same.
Holland is interesting in that everyone has to take out insurance, even if you’re unemployed. If you don’t then you don’t get treated. So take your European Health Insurance Card with you! One guy in Holland got charged 740 Euros to remove a tick!
So we can find holes in every health system and these are going to get publicised all of the time. But they actually stop real debate about the way we’re going to have to manage health care in the future.
When I had my last B12 injection, the nurse told me that increasingly her time is taken up by the problems of the obese. It would appear that what the US and the UK do, that they can’t get to grips with this problem. I suspect it may be solved in the US, by the health insurance companies charging a lot more and people will either have to diet or take the consequences. So perhaps, their system has this control and that because the NHS is free at the point of delivery for all, the system will overload here in a big way in the next few years.
And then there is smoking! And excessive drinking, that leads to all sorts of problems. And don’t forget illegal drugs.
So to me the key to getting health costs under control, is to take action against obesity, smoking, excessive drinking and drug abuse. Do this and I suspect that the money will be there in the NHS for all the exotic drugs coming on stream.
According to this article in the Telegraph, in 2007, the NHS spent £750 million on drugs to combat unhealthy lifestyles. That is about 9% of the total drug spend of £8.37 billion.
But I do wonder about some of these drugs. And also the effects of the drug companies.
I am a coeliac and although it has been shown to affect about one-in-a-hundred of the population, there is very little research into the subject. Why? Because, everyone knows that the cure is to keep to that gluten-free diet and that if a drug came, that allowed you to eat gluten, most coeliacs wouldn’t trust it and would leave it in the pharmacy. You could argue too, that if we tested everybody for coeliac disease, this would save quite a bit of the drug bill, as many undiagnosed coeliacs suffer all sorts of problems like arthritis.
I wasn’t on any drugs before diagnosis, but I nearly had a couple of serious operations on my knees. Luckily I didn’t!
So better and earlier diagnosis would probably cut the drug bill.
I should also say, that many patients think that for every disease they need a magic pill. We are prescribing Tamiflu to all and sundry, when many commentators, think that bed, whisky and paracetamol might well be better for the run-of-the-mill cases.
I’m not taking it for a start, unless I get a serious dose of flu.
My late wife had a horrific cancer and they tried to use a drug to prolong her life. It failed and made her life worse. So on another point, I would never take a drug unless I had all of the facts. We must not judge success by an extra day of life, but by the quality of that life as well. The number of people in favour of assisted suicide shows that the general public rate the quality of life pretty high.
But we must also remember that over half the costs of the NHS are staff costs, whereas the total cost of drugs is a lot less than that. I can’t find accurate up-to-date figures, but the drug cost is probably between ten and fifteen percent.
So to get a better health service, we need to cut out those bad lifestyles and provide the tools for the NHS, so that we get more greater value for the large amount we pay staff.
I’ll give one personal example here.
To be diagnosed for coeliac disease, you need to have a full endoscopy. I’ve had two and they’re not that bad, but they cost the NHS a lot of money. On the other hand, before I had the first endoscopy, I was diagnosed as a very likely coeliac by just a simple blood test. I went on a gluten-free diet, my chronic dandruff disappeared immediately and I felt a lot better. In other words why bother with the endoscopy?
NHS rules say you can’t get gluten-free goods on prescription unless you are diagnosed by endoscopy.
There are several things wrong with this policy.
- Some coeliacs have a negative diagnosis by endoscopy, despite losing all symptoms on a gluten-free diet.
- My wife said that it could be construed as child-abuse to use a gluten challenge and endoscopy on a child.
- A lot of coeliacs get little on prescription, as much better offerings are available in the supermarket. I only get a bread mix.
How many other areas could better and more scientific procedures make the NHS more efficient?
Whoever wins the next General Election in the UK has a lot of scope for efficiency improvements in the NHS, but the entrenched views of those who work there will make it difficult.
What am I going to do?
Keep slim and fit! And not stand on any more razor shells on Holkham Beach.
And also use Twitter to publicise all the waste. It has a lot more power than anything else.
Shower and Exercise
My morning regime has changed now that I live alone.
Our/my bedroom used to have a two large wardrobes and since I only need one now, I removed the wardrobe, extended the bathroom and put a walk-in shower in the extra space. It has no door and is electronically controlled so that I just switch it on and never bother about the temperature. It has been completely reliable.
After my shower, I perform a set of exercises for my shoulder. As I said in Bullying, this has almost completely cured the problem, so it is very much worth doing.
But it does set me up for the day.
The Anonymous Widower 