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The GP shafting bandwagon rolls on...

Yet more missives arrive from the Ministry for the Generation of Unreasonable Expectation.



GPs are taken to task by the British Heart Foundation for relying on "olde worlde" techniques and archaic medical equipment like stethoscopes for the diagnosis of cardiac failure.

It seems that NHS GP's when presented with some poor bugger who is fatigued, short of breath, suffers paroxysmal nocturnal dyspnoea and has ankles the size of elephant foot umbrella stands are jumping to the barely credible conclusion that the patient might just be in the early stages of congestive cardiac failure. They'll be telling us that the JVP is an inconsistent physical sign next.

OK, so the Dr Finlay's in the early stages of decrepitude who tell their patients to take it easy and prescribe veterinary doses of loop diuretics might need a kick up the metaphorical jacksie and a bit of retraining but for most of us the reason why we don't order an urgent echo-cardiogram to confirm the diagnosis is much simpler; we can't get one.

Like their colleagues in the psychiatry rapid response teams, echo-cardographers don't have "day to a page" diaries with half-hourly time slots, they have "month to a view" calendars by their appointment books.

Rather than devaluing GPs ( the BHF's spokesProf reckons that "The main message from this study is that heart failure patients get better treatment if they are managed by a specialist" ) they ought to get busy selling a few more second hand clothes and raising the money to provide a decent echo service countrywide.

And right behind them on the GP shafting bandwagon, along come our old friends the Alzheimer's Society (motto, 'suppose we had a meeting, and nobody came' ) to remind us, in case we'd forgotten, that not only are we rubbish at cardiology, we're pants at neurology too.

Only one third of us reckon we have the skills required to make a diagnosis of early dementia. Testicles. How much easier can it be? Anybody who can't administer and mark a mini Mental State Exam successfully is probably a borderline pass/fail themselves.

Even patients who take the piss during the spelling bee section of the test, "spell the word, 'world'" "W-H-I-R-L-E-D".

"And now spell ‘world' backwards." "W-H-I-R-L-E-D-B-A-C-K-W-A-R-D-S" usually make up marks and redeem themselves with the object memory questions, "I want you to concentrate very carefully on these items for the remainder of the test, cattle-prod, thumbscrew, waterboard."

Why are GPs so reluctant to diagnose dementia early?

Because there's no bloody point. Far from allowing patients early access to valuable support systems we'd simply be allowing the dotty and ever so slightly confused access to a system that was never designed to help them and that is barely able to provide even the most basic service to those in real need.

The charity ought to raise the money, do the research, develop some drugs that actually work and set up a service that's able to deliver before getting us to open the flood gates.

In the meantime I'm sticking with my usual advice, "see how it goes, come back if things get worse and make a Will now while you still can.

Before your family get you stuck with a diagnosis that labels you, "not of sound mind."

Copperfield

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