The new NICE guidance is about progress and better treatment, Copperfield says, so why is the press using it to bash GPs again?
Only the Daily Mail could come up with the headline ‘Millions of blood pressure patients misdiagnosed by their GP’ when all we’ve done is to adhere to the last lot of NICE guidelines on hypertension.
On the odd occasion I might have initiated treatment after two significantly raised readings rather than waiting for a third the following week – just in case.
Now and again, I’ve been known to apply Copperfield’s Variable Constant to the systolic reading when I can see a patient trembling with fear as I approach. But, in the main, I’ve stuck with them.
And if you look at most of what NICE actually said, the new guidelines are about progress: better diagnoses and better drug regimes based on better evidence.
Diuretics aren’t as effective as we thought; calcium-channel blockers not only work better for ethnic-minority patients but also for anyone over 55, no matter what their background.
There’s no point trying to get great-grandma’s blood pressure below 150/90 (not that many of us ever did), ACE inhibitors rule for young white folk and getting people to monitor their own blood pressure at home will give you more accurate readings than dragging them into the surgery week after week.
All good stuff, and some of it actually new. But instead of the obvious ‘Whoopee, medicine has advanced and GPs will be able to diagnose and treat hypertension more effectively and prevent even more strokes and heart attacks’ – a headline that, I admit, might be difficult to fit onto one tabloid page – we get a ‘Morons earning £250k a year can’t even take blood pressures properly!’ pasting.
And why does this matter? Like you, I really don’t give a toss what the Daily Mail thinks about me.
It would be nice if their house poodle GP actually grew a pair and defended his peers when his leader writers put the boot in, but if you had a nice regular slot in the Daily Mail on top of your posh private clinic in Notting Hill, would you bother?
No, neither would I, so good luck to him. He’s ‘one of the country’s leading GPs’ after all.
What matters is that people will read the headline, ignore the article (as, for once, it doesn’t include the words ‘causes cancer’) and decide that we really are that stupid.
That we can’t handle the complexity of the cuff, the bulb and the stethoscope. ‘GPs are only there to stop us from seeing experts,’ as one online comment read.
So the Mail-reading middle classes will insist on a consultant referral or else put themselves in the hands of quacks who wouldn’t know the Korotkoffs from a family of Ukrainian acrobats. And that’s what puts my blood pressure up.
Some of us think that 24-hour ambulatory blood pressure measuring is pants, many more aren’t going to shell out thousands of pounds on gadgets that will go AWOL the first time they leave the building on the off chance that we might save the NHS drug budget a few quid in a few years – and see none of it.
And I’ll carry on doing what I’ve done for years, telling patients to keep an eye on the Lidl catalogue and buy themselves a blood pressure monitor when they’re on special offer.
‘Sick Notes’ by Dr Tony Copperfield is out now, available from Monday Books.
Click here for more from Copperfield Copperfield