Wednesday, 9 April 2008

Things can only get better

Dr Barry Monk has written this piece about his recent experiences:

Politicians keep telling us how wonderful the reforms to the NHS have been, but how do they affect real patients.

Let me tell you three illustrative tales, all from the same recent outpatient clinic, and then you can judge for yourself.

Firstly, a small child with eczema, brought along by a distraught mum. It certainly wasn’t the worst case of eczema that I’ve ever seen; it should have been entirely manageable within primary care, but Mum had found it impossible to get an appointment with any individual GP more than once, so she ended up having seen five different doctors in five weeks, and had become totally confused by the conflicting advice. Yes, you can be seen at the GPs without undue delay, but you can’t get an appointment with the doctor of your choice.

Then I saw a lady with an infected sebaceous cyst on the neck, referred as an emergency. In fact she had been referred six months earlier, but sebaceous cyst is a PCT exclusion, so the referral had been “rejected” (not by me, I never even got to see the referral letter). So, months later, she is referred up urgently when the cyst had become infected and the patient was in severe pain. By this stage, treatment would inevitably be more complicated and expensive, and the whole scenario was totally avoidable.

Finally, a somewhat more complicated story, but one with potentially catastrophic consequences. A lady is referred to me with a story of an unusual lesion on the leg; she tells me that she is also attending a rheumatologist at a hospital 50 miles away because that is the nearest option that came up on Choose and Book (we have an excellent rheumatologist, but if her waiting list reaches five weeks, her name disappears from the C and B menu); the rheumatologist has diagnosed a non-specific arthritis. She has also been sent to a hand surgeon, at a third hospital twenty miles in a different direction who has diagnosed “tight tendons” in her hand, but who was unaware of the skin or rheumatology referrals. On examination of her skin it is apparent that she has a rare, and potentially very serious skin disorder, scleroderma, which accounts also for the tight tendons and the joint symptoms. Yet having made the diagnosis I have no access to the investigations that have been done elsewhere. What she actually needs is to be seen jointly by a dermatologist and a rheumatologist, but our PCT rules prevent me from referring her to my colleague who consults just 10 metres away.

Patients may indeed be being seen quicker, but I leave to you to judge whether they are being offered a better quality of care.

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