Saturday, 12 December 2009

Am I too late?

I used to think that I was quite good at managing skin cancer; I have certainly seen enough of it over the years. I have always consulted next door to my plastic surgeon, and we have had an excellent system of asking each others’ opinions on difficult cases. Until very recently when the lab was moved, our histopathologist worked just round the corner, so we could easily get his opinion as well, and occasionally we even brought him round to see a case before we biopsied it.

Now of course, that isn’t good enough, and we have to sit down while an administrator dutifully ticks off on a list whether each lesion has been excised with the margin prescribed by some unnamed higher authority. We then have to report in to a so called centre of excellence, where someone with rather less experience checks over our work, and our pathology (reported by someone who has been at it for decades) is reviewed by a registrar (no, I am not joking). And then we are castigated if we have used common sense rather than slavishly followed the “official guidelines”. Recently a man was admitted under the physicians whose initial presentation with melanoma was with disseminated metastatic disease; he knew the diagnosis, and his dearest wish was to be allowed to go home to die in peace. I committed the hideous sin of failing to refer him to the oncologists, not that there was anything that they could have offered but because that is what the guidelines demand.

Now our skin cancer service has been scored against some formal criteria. Never mind that we produce a service where patients receive high quality care from experienced and capable consultants, my colleagues and I received 19%. I’ve never had 19% for anything, not even French at school. So what were we doing wrong?

Apparently we lost quite a few marks because our skin cancer Multidisciplinary Team meets twice a month rather than the prescribed once a fortnight. I did a quick check on the maths; twice a month means 24 meetings a year, once a fortnight means having 26. I didn’t appreciate that those two extra meetings a year to tick the boxes could so enhance patient care, and I am so grateful to those anonymous people who clearly know so much better for putting me right. We also lost quite a few marks because we don’t have a designated skin cancer nurse. The fact that we have sensible capable nurses who do everything to support our patients doesn’t count, because they are not called skin cancer nurses, and unless they are we lose marks.

So I have failed, and failure really hurts, no, not because I have been given a humiliating 19%, but because I have been part of a profession that has given in to this pathetic nonsense. It’s time for all of us to just say “enough is enough” before this disease of political correctness has fatally metastasized. But it may already be too late.

1 comment:

Andrew said...

Brilliant stuff barry

Glad you are back

I have had exactly the same problem with the thyroid cancer police who don't acknowledge that most thyroid surgery is for benign disease