A final prognosis
By Margaret McCartney
Published: April 19 2008 03:00 | Last updated: April 19 2008 03:00
This is my last column for FT Weekend so, taking the opportunity to look forward, here are 10 health-related subjects to watch.
1)The pharmaceutical industryBoth Vioxx, the anti-inflammatory drug subsequently withdrawn from the market, and SSRI antidepressants were widely in use before side-effects became apparent. In spite of this, the industry has still not agreed to publish all the results of its clinical trials. This means that patients cannot be sure that their treatment is effective, and that the benefits of many of the drugs we use may be outweighed by detrimental effects. The industry needs to prove it has a conscience; government to legislate. There is no excuse for non- publication of clinical trials.
2) Caring Most people do not mind where they get their medical care for minor illnesses. But when people are truly unwell, they are often in pain, in distress or fearful. They do not just need rapid access to a doctor. They need continuity of care from staff who know them and their needs. In the UK, we have already seen problems generated by fragmented out-of-hours care. The same will occur in in-hours care if the large polyclinics that are planned go ahead.
3) Check-ups If you decide to go for one of the "check-ups" including blood pressure, cholesterol and kidney tests, promised recently by prime minister Gordon Brown, do ask what your chances are of benefiting from being on cholesterol-lowering, blood pressure-lowering or "renal-protective" medication. Do not accept a percentage of how much these will lower your risk unless they can also tell you what your risk was to start with. The first number is meaningless without the second. You may learn that your chances of benefiting from any of these are likely to be rather small.
4) Privatisation I believe there will be further privatisation of the NHS and have concerns about the quality of services that will result. Despite little evidence for Independent Sector Treatment Centres being anything except more expensive and less good than the NHS, private providers are allowed to persist.
The mechanism for selecting companies to manage doctors' surgeries is not concerned with qualifications of staff. So far, mainly short-term locums have been employed, making it difficult for patients and doctors to get to know each other. It is the most unwell, immobile and disadvantaged who have most to lose. 5) DeathSome deaths are better than others. Though our final exit can never be completely planned, some people are able to decide whether they would prefer comfort and palliation to futile overmedication and intervention. Some health professionals worry about being reported to regulatory authorities if they do not "do everything" - even when "everything" makes no one any better or more comfortable. Timely discussion, and determining priorities, can in themselves be a consolation.
6) Privacy With patients' medical records being put on to the NHS Spine, confidentiality is in danger of being obliterated as thousands of NHS staff gain access to this web-based database. I know many doctors who have refused to have their records stored here because they do not feel their privacy will be sufficiently respected (for more info see www.nhsconfidentiality.org ).
7) Professionalism Along with words such as "service" and "vocation", this term no longer seems important for someone contemplating a career in medicine; the only interest from regulators seems to be in "competencies". This is sad for doctors, because professionalism and goodwill used to ensure morale was good. It is sad for patients, because their care is more fragmented and delivered by doctors who spend a lot of time jumping through political hoops. The NHS needs to harness professionalism and set priorities based on clinical not political need.
8) Over-the-counter testing If you are tempted to buy a genetic test on the internet, or a CT body scan for a "check-up", may I recommend a booklet called "Sense about Testing" (I confess I have contributed to it), available free from www.senseaboutscience.org.uk
9) Testing treatments I will be helping to write the second edition of Testing Treatments, a book about medical interventions. The first edition is available in full and at no cost at http://www.jameslindlibrary. org/testing-treatments.html.
10) Finally, thank you The best thing about writing this column has been the e-mails I have received in response. I also must thank Hazel Thornton, a quite amazing "lay person" and independent advocate for quality in health and research, whose piercing insight into medical matters has furthered mine.
Margaret McCartney is a GP in Glasgow
[email protected] More columns at www.ft.com/mccartney
Copyright The Financial Times Limited 2008
Comments