Posted by: Tony Copperfield28 August 2012
Remember powerballs? Same era as choppers, clackers and spacehoppers? They had the density of a neutron star and a rebound momentum powerful enough to poleaxe you. Whatever they made powerballs out of, they’re lining my referrals with right now – because they keep bouncing back and smacking me between the eyes. So much so that I’ve dusted off the local ‘service restriction policy’ to check that the referral managers aren’t just making it up as it they go along.
But no, apparently it’s suddenly okay to have, say, an inguinal hernia. Interesting how the indications for surgical intervention have loosened at the same time the purse strings have done the opposite.
As for infertility? Now, to qualify for your state-subsidised crack at conception, you mustn’t be too fat or too thin, you mustn’t be too old or too young, you must have germ-free genitals, you need cycle-specific hormonograms deliberately timed to coincide with the lab being shut, and, of course, you must have had no children nor ever met or even seen one. Oh, and you should have been trying for 30 years.
Before they’ll rubber-stamp my referrals, the gatekeepers want their pound of flesh – or, in the case of breast reduction surgery, ‘at least an anticipated 500g from each side’. We live in austere times and soon it’ll be us having the responsibility to trump clinical logic with financial imperatives. We are missing one trick, though: bariatric surgery. Yes, I know, fatties should eat less and exercise more, but they don’t/can’t, do/can they? Hence those awful consultations where they insist that they don’t eat a thing, that orlistat makes a mess of their size 20 pants, that you must do something, by which time they’re a-weeping and a-wobbling and a pain in the butt.
The thing is, a while back a couple of my Basildon Bellies snuck in under the referral management radar. And the results were astonishing. After gastric banding, they are now Mini-me versions of their previous selves, and their repeat prescription screens have been wiped clean of a frightening array of antihypertensives and antidiabetics – because they simply don’t have hypertension or diabetes any more.
I’d always thought the only treatments that should confer on us docs the status of ‘God-like genius’ were syringing ears and reducing pulled elbows. But you can add to those minor miracles the ‘now you see me, now you don’t’ trick of bariatric surgery. I can’t be arsed to do a literature search on cost-effectiveness, but my n=2 trial suggests this procedure must pay for itself in about 10 minutes.
That’s what had me frantically thumbing through the service restriction policy. Because every time I refer my BMI busters now, they’re bouncing their blubbery way back to me. Why? Those sodding criteria: BMI of at least 50 and diabetes or sleep apnoea. So only a very thirsty, very sleepy, very snory Jabba the Hut need apply. Look, I’m not normally an interventionist but this policy strikes me as myopic. Can’t blame the suits for that, though – impossible to get cataracts done these days.
Dr Tony Copperfield is a GP in Essex