Interesing discussion above.
Improving health doesn't guarantee a reduction in healthcare demand / social costs, which may paradoxically rise.
EG fewer premature cardiac deaths means more people surviving to old age with concomitant risk of dementia, care needs etc
It may be a fact that inhalers are being over-prescribed in chest infections.
But even if so, that doesn't necessarily make it a problem.
I think the problem is more subtle: what proportion leads to action that is almost certainly pointless?
(Vitamin D, I'm looking at you... marginally raised TSH, I'm looking at you... eGFR of 54, I'm looking at you... hba1c of 42...)
Actually I don't want my guidelines nuanced. I want them to be simple enough to memorize...
...or, if not memorable, at least comprehensible at a glance on a single page / screen.
But I agree having a link to more detailed info would be nice.
There was a BMJ review saying the same in 2012
Since then I don't really use them except to diagnose PMR and inflammatory arthritis, and I gently discourage my trainees from using them.
I have not so far had a complaint / medicolegal issue arising. If one arises I feel I have the evidence to justify my decision.
(Unfortunately they still form part of various referral pathways in our CCG including memory clinic!)
The Doctors Association spokesman seems to have missed the point.
A higher PROPORTION of received complaints are investigated against BME doctors.
Dr Vaughan implies that this is the result of trusts making higher NUMBERS of complaints against these doctors.
But clearly a higher number of complaints doesn't explain a higher proportion investigated.
Computer prompts! Yay!
I was just thinking I could do with more of them.
Only true if they died in the UK I presume
Indeeed. And on a local level it should be a QOF requirement for each practice should keep a register of all the registers it keeps.
Will be interesting to see what happens.
There seems to be a contradiction between two of the NHSE's aspirations for GP at the moment:
to make access more convenient by directly booking GP appointments
to direct pts to non-GP clinicians where possible, which requires triage (IE requires that GP appointments are not directly booked)
I don't know if this contradiction has been explicitly acknowledged - perhaps it has...
It is hard to see how this "responsibility" could work in practice, given Copernicus's point that we are not generally notified of admissions.
I suppose it is relevant on the occasions that a GP is making the admission.
One would have to consider the opportunity cost of the primary care clinician input needed to improve control:
Is intensifying risk factor reduction for a large number of patients currently the most productive use of primary care clinician time?
Or are other clinical priorities more important?
Also, as usual, only relative risks quoted, making any judgement on the significance of the issue impossible.
Are you saying that overmedicalisation is less prevalent in private healthcare systems?
Is there any evidence for that?
We have this requirement already in my CCG; dermatoscopes have been provided for us. I can't say it has caused many problems to my knowledge.
Life expectancy is a prediction, but it's hard to keep that in mind when it's being treated as actual fact or data.
To know whether this change is meaningful or not one would have to know a lot more about how the prediction is made.
Maybe the statisticians have just altered some assumptions.
"But most of all, we need longer consultations."
That assumes that GPs are the right people to do the work of discussing risks and benefits. But I had an hour-long meeting with a financial advisor yesterday and it occurred to me that the conversation we had was the same sort of conversation about long term priorities, risks and benefits.
Maybe this is indeed the proper role of the GP, but:
1. We can't spend an hour making a personalised preventative plan for each patient. There is no version of the NHS in which that is going to be an option.
2. If a personalised plan is needed (and that's a big "if"), is a medical degree needed to provide it?
I find the "mandatory training", which is nothing to do with appraisal and revalidation, to be more annoying. (I think the push for mandatory training comes from the CQC.)
I agree entirely with your logic but not your statistics: life expectancy for a UK man age 75 is 12 years, not 4.
It's not really clear whether non-attendence for smear is a significant problem, given that I understand that cervical screening has not been shown to improve all cause mortality.
(see, for instance, https://www.karger.com/Article/FullText/365059)
Perhaps the women who do not attend are making a reasonable choice?
If anyone has found data showing reduced all-cause mortality, please do post below!