Columnist Dr Copperfield puts forward his own unique clinical manifesto as an alternative to industrial action
The next step to manning the barricades appears to be a manifesto developed after much talking and hand wringing culminating ‘potentially’ in something around November. Maybe, possibly, assuming you’re not busy and it doesn’t cause any inconvenience etc.
If all that seems a bit vague and removed from the hurly burly of practice life, I’d like to suggest a different and immediate manifesto. And if, like me, you prefer to focus on the clinical, the pragmatic and the immediate (not least because it means not having to confront the rather grimmer bigger picture) then please chip in. For starters, here are three clinical manifesto points which would make my professional life almost bearable as of tomorrow:
1. Rename CKD. Chronic kidney disease is the worst clinical label ever. And now that patients have easy access to their records, and because chronic disease review invites regularly drop ‘CKD’ into the alphabet soup of pathologies, we regularly hear/see patients freaking about this severe illness they have on the basis of, say a couple of eGFRs of 59. Because ‘chronic’ means ‘severe’, and ‘disease’ means ‘being eaten away by kidney-munching bacteria’, right doc? We might as well call it ‘imminent renal death syndrome’. True, I haven’t perfected an alternative but for now I’m telling them they have mild kidney arthritis.
2. Path labs to stop sending us reams of impenetrable nonsense with every FBC. I don’t know what RDW or basophil counts are for and nor do haematologists. They just get in the way of the few useful parameters I’m interested in and give patients an excuse to make urgent appointments about their mean platelet volume being 0.1fl out of range. What even is an ‘fl’ for ’effin ’ell’s sake? And if you’re reading, path lab, how about putting the Hb at the top of the report rather than hiding it amongst all the haematobollox?
3. Scrap all primary CV prevention calculations. Given that the cardivangelists are pitching for starting statins below 10% Qrisk, we might as well statinise everyone and be done with it. Or if you want a more nuanced and targeted approach, slip statins into the tea of garden centre cafeterias because: a) Everyone over 60 goes to a garden centre every week, by law; b) They always have a cup of tea while there; c) Even if already on treatment, statin compliance is so poor, and tea compliance is so good, it won’t matter. Just leave us GPs out of it.
Please send in your own ideas. It’ll be a welcome distraction from thinking of ways to take effective industrial action and, indeed, might remove the need altogether.
Dr Tony Copperfield is a GP in Essex
READERS' COMMENTS [7]
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There will be no industrial action————-no matter what.
TC, it’s everybody’s job to annoy GPs, so chill by dreaming about attractive sheep 😁, or throwing darts at pictures of the current Cabinet (10 points for the health minister), or make up jokes – like what’s Cambridge and the current Govt got in common – well, one’s a town for nerds and the other’s a…..
A nice peaty single malt always helps..
eGFR 59?
I think Tony has forgotten that eGFR greater than 90 equals CKD stage 1, due to some nerd’s shortthoughtedness.
Try explaining to any rational human, with or without ability to pass CSE English, it does not help, that “Chronic Kidney Disease Stage 1” is normal for everyone, including newborn infants with perfect kidney function.
absolute waste of time, once the official lab result has come back and labelled them with this dreadful disease, which we then have to ‘fix’.
Yes I had a panic appt yesterday for a lady who saw her egfr drop from 81 to 86.
Bring back reporting it as >60..
Actually CKD is the 2nd worst name ever. AKI is even worse. In no sense is it an injury.
But I also want to nominate the venerable “heart failure”. It just invites confusion. There are in reality many ways a heart can “fail”, the most obvious being a cardiac arrest. Not surprisingly laypeople use the term “heart failure” to represent a variety of unfortunate events such as MI or arrest.
But medically speaking the phrase is only supposed to refer to one very specific problem: inadequate cardiac output. Why??
I propose “ICO” (inadequate cardiac output) to replace “heart failure”.
CKD. could we get someone to produce a normal egfr for age, normal pef (fev1 for purists) for age and the age related NORMAL changes . In a similar vein should we label chronic hair disease for thinning and chronic ear disease for ear growing. and at the same time make sure any abnormal LFTY (for those who like to measure them for usually no very good reason ) should lead the lab to do all other lots needed to say if harmless ”fatty liver” for something that is actually important (and say what to do then as well)
Having just received my fist every NHS health check invitation (at age 68) the only options open to book this are for a pharmacist. Plainly most of us at this age could take 2 hours listing things that are not ‘perfect but I dont want to know my cholesterol particularly or start on a long list of investigations that will invalidate my travel insurance, probably the most important wellness asset I have. As has been pointed out by a colleague i the BMJ (re dry eyes)if we actually follow advice of experts and refer virtually everyone for everything that might cause a quicker upset to the system but it would be a shame to sink the boat whilst I may still need it
….of course it should have read “what’s the difference between Cambridge and the Govt – one’s a town for nerds and….” – Hilda, cancel me subscription to that joke-writing course….and fetch me bluddy slippers…