Doubt does not kill
Copperfield isn’t prepared to get dumped with the fallout from roadside scaremongering that urges patients to dial 999 at the first sign of a chest twinge
Copperfield isn't prepared to get dumped with the fallout from roadside scaremongering that urges patients to dial 999 at the first sign of a chest twinge
On my way to work, I drive past a British Heart Foundation poster showing a bloke with a belt pulled tight across his thorax.
It reads ‘A chest pain is your body saying call 999'. This is followed up with ‘Doubt Kills'.
I'm 100% behind the idea that if a patient is middle-aged, smokes 30 Capstan Full Strength a day, enjoys a full English breakfast every morning and reckons that lifting the remote control is exercise enough for any man, dialling 999 at the first sign of a crushing chest pain is his best option. Far better to do that than to ring me.
All I'll do is try to persuade him that my immediate reaction – ‘chew an aspirin' – isn't a piss-take and then pass his call over to NHS Direct.
The thing I don't like is the parting shot – ‘Doubt Kills'. I know that ‘Smoking Kills' is true; I know that ‘Speed Kills' isn't, because astronauts and fighter pilots survive at Mach 2. I also know that ‘Love Hurts' and ‘Curiosity Killed the Cat' – but I'm not falling for ‘Doubt Kills'.
At worst, doubt causes a kind of uneasy feeling at the base of the midbrain, the sort you get when you've just given someone a tube of anti-fungal cream when you still had a suspicion that the rash might be eczematous after all. Unsettling, maybe; intrusive, perhaps. But potentially fatal? Nah.
The unintended but predictable consequence of all this roadside cardio-centric scaremongering has been a massive increase in the number of walk-ins to the local A&E department with ‘chest pain, query cause'.
How do I know? Because every morning I get an A&E attendance report telling me that Bloke W presented with a sub-costal twinge, was triaged by nurse A, assessed by Dr CXR ECG NAD MBBS (locum) and referred to the rapid-access chest pain clinic.
Not my problem
Forty-eight hours later, a fax will arrive from a clinical specialist cardiac nurse thingy, advising me that her consultant has studied the casualty card and, in his opinion, the presenting pain was not typical of angina. No shit.
Consequently, Bloke W is not deserving of a slot in the rapid-access chest pain clinic. Could I – and here's the good bit – assess the patient myself and, if I am also convinced that the condition is non-cardiac, take over his further management?
No I sodding couldn't. All the wastes of oxygen who rocked up into casualty last week because they saw ‘Doubt Kills', got bladdered and pulled a pectoral muscle are Not My Problem.
I didn't entice them into A&E, neither did I refer them inappropriately after they got there. If the cardiologists don't trust their A&E staffers' diagnoses, they can sort that out between themselves in the car park. I'm not about to let them dump the fallout my way.
Neither – and let's all make this clear from the outset – do I expect my practice to get an invoice relating to these shambolic wastes of NHS time in future. If I do, it's going straight to the British Heart Foundation marked ‘For Payment'.
Dr Tony Copperfield is a GP in Essex
I didn't entice them into A&E and nor did I refer them inappropriately when they got there