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I think I’ve worked out why I feel completely knackered all the time. It’s because I am completely knackered all the time. And the very latest NICE guidance neatly illustrates the problem.

Just in case you missed it, it’s about AF – and, in particular, assessing and treating stroke risk in our fibrillating patients.

Now, without wishing to sound like Doc Dinosaur, time was when that particular intellectual process involved me thinking: ‘Hmmm, I reckon I’ll give you some aspirin.’

Then it became a bit more refined, evolving to: ‘I ought to give you warfarin, I know, but that’s a prize pain in the butt, so I reckon I’ll give you some aspirin.’

Until finally, in the last couple of years, we reached the cutting edge of AF risk stratification and started using the CHADS2 score – which meant plugging the relevant figures into the formula, coming up with the risk calculation, taking away the number we first thought of, and thinking: ‘I reckon I’ll give you some aspirin.’ And picking up some QOF points.

I’ve only just got my head round this, and I’m pretty proud of how up-to-AF-speed I am. Now NICE tells me it’s all wrong. Aspirin is completely useless,apparently, though please don’t mention that to the fibrillating hordes who’ve been taking it for years. Instead, I’ve got to apply a revised formula, CHA2DS2-VASc, which I don’t think I understand and certainly can’t pronounce. Then I also need to use a new one, HASBLED, to work out the risk of bleeding. And finally, there’s some sort of Clot-Off between CHA2DS2-VASc and HASBLED, and the winner dictates treatment, which is, er, Gawd knows.

Anyway, the point is, in terms of AF, I thought I was at the very peak of my powers - and yet I’ve been told to up my game. And that punishing principle of, ‘You’re working at capacity, so now we’re going to work you that bit harder’ is being applied to every other facet of general practice, too, from appointment provision to admission avoidance and all points in between.

And that’s why I’m so tired. But at least the NICE guidance is only the draft version. So we simply need some objective measure to prove to NICE that we’re too exhausted to implement anything else. And it’s at this point I’d like to introduce the concept of KNA2CKER2-Ed. I suspect you know your score already.


Readers' comments (8)

  • Dr Copperfield,
    If you are completely knackered all the time very clearly you will be unable to provide the care people are coming to you for and expecting you to deiver.
    I have AFib. It is a routine condition and treatment. My GP handles all of that very well. No sweat no hand wringing.
    Retire to the potting shed?

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  • Dr Mustapha Tahir

    Dear Tony, the guidelines caused my AF. But I'm happy with taking Aspirin recommended by my GP, who also has AF.

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  • Tom Caldwell

    As far as I can see from these scoring systems unless actively bleeding everyone who has AF, or has seen the letters written in that order or hasn't had AF must be on warfarin even if they don't consent to it. Simples. :)

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  • Oh for those carefree days before NICE/QOF/CHADVASC etc etc -when no one had heard of a protocol or a guideline and we simply looked after our patients using sound common sense.Medicine is a vocational art -pracised by individuals for individuals-we are fast losing sight of this and that's not good.

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  • the reason Dr Copperfield is knackered is that this is only one of many many platinum-standard new guidelines we receive each year, all of which take time to assimilate, apply, discuss with patients re pros and cons and follow-up. If we're going to practise to this standard across the board we need more time ie half as many patients

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  • Leonard Golding seems to have totally missed the point of Copperfield's rant. Don't retire Tony - keep ranting.

    By the way, I believe ATOS developed a similar acronym scoring system for sickness benefits claimants.
    It's called U-CHAV

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  • Hilarious!
    Here's a few more benefits acronyms.
    FAT_@rse, DRUg_Gie, BeeR_breaTH, BoNE_iDLe, LazY_Sh!T, TRaV-ell-ER.
    Any more offers?

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  • The acronym scoring system for John Campbell is to be called Tos-Spot.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder