Columnist Dr Copperfield welcomes a small dose of reality in the deranged world of clinical guidelines
I realise we’ve barely reached spring, and that the Jurassic, cynical and clapped out aren’t supposed to trouble themselves with ‘the medical literature’, but the truth is, I’ve already decided on my paper of the year. It’s called ‘Guidelines should consider clinicians’ time needed to treat’, it’s in the British Medical Journal and it’s excellent.
It points out that applying all US guidelines for prevention, chronic disease and acute care to a list of 2,500 patients would take up to 27 hours per day, and that implementing all NICE lifestyle recommendations in the UK would require more doctors and nurses than are currently available, presumably even if they worked 27-hour days. This is why you feel a) There’s never
enough time (there isn’t) and b) Utterly knackered (you are).
How refreshing to read someone acknowledging that professional time and energy is finite and adding a dose of reality to the deranged, relentless world of guideline generation. These researchers (Johansson et al, if you want to check them out) deserve a statue in their honour.
And that shouldn’t be difficult: there’s plenty of plinth space, given that statues are being hauled down all over the UK as we pay penance to our imperialist past. Which is neatly appropriate, because what Johansson’s paper highlights is, in fact, medical colonialism.
Wherever you care to look, we are expanding our medical empire by colonising people’s minds and diaries with more medicines, interventions and appointments. Fears around illness have evolved from obsession to existential threat, and perfect health must be preserved at all cost. And the medical profession is largely to blame.
Consider the following. Screening is increasingly leaving no orifice unprobed, with poorly evidenced programmes entering by the back door (as Pulse’s April/May cover makes clear). Thresholds for diagnosis and intervention are continually lowered (hypertension, QRISK, diabetes, pre-diabetes, pre-pre-diabetes, etc). Incidentalomas and their follow-up protocols are as inevitable post scan as patients wasting appointments wanting us to chase up the results. New and soft diagnoses expand to fill ‘unexplained symptoms/variation of normal’ vacuums (B12 deficiency, subclinical hypothyroidism, ADHD, Long Covid et al). Overdiagnosis results from overtesting and overinterpretation (CKD, prostate cancer, borderline melanoma, thyroid cancer). New medications that are a drop in the medical progress ocean but a massive drain on resources are trumpeted as breakthroughs (take your pick). ‘Checks’ have reached sanctified status (self-checks, chronic disease checks, health checks, annual LD/SMI checks, BP checks, frailty checks, checks to check you’ve had your checks, etc).
Everyone, everywhere, from the media through charities to your local hairdresser is part of this crusade to prioritise health by constantly cajoling us to be screened, scanned, diagnosed, checked, monitored and drugged to within an inch of our lives.
And this is before the patient starts mentioning symptoms.
Which begs the question, whose life is it anyway? Can the individual choose how relevant the pursuit of health is, or must the medical profession exert imperialistic dominance and control? And what is the purpose of life, anyway? To doggedly exist as long as the medics can keep us going? Or to enjoy the opportunity of a lifetime?
Dr Copperfield is a GP in Essex. Read more of his blogs here