Columnist Dr Copperfield responds to Labour’s pledge to spend £171 million a year on new MRI and CT scanners equipped with artificial intelligence technology
So now we know: the solution to everything afflicting patients, specifically, and the NHS, generally, is… MORE SCANNERS! The Tories have banged on for ages about conjuring up MRIs and CTs, and improving access by putting them (and I think I’ve got this right) in shopping centres – let’s face it, there are plenty of units available.
And now Labour have doubled down on this with a pledge to spend £171 million per year on MRIs and CTs equipped with artificial intelligence. Which is fine, except that when you apply actual intelligence, this high-res vision of the future suddenly looks less clear and shiny than the public might think.
For a start, there’s the Cascade Effect, with every sodding scan revealing a plague of incidentalomas, each requiring further investigations, A&Gs and outpatient appointments. For every expedited diagnosis, there will be countless irrelevant issues clogging up the system elsewhere. Which kind of defeats the object.
And second, maybe the delays in getting scans are less about inadequate supply and more about over-adequate demand. By which I’m referring to the tribe now officially recognised as not being officially recognised as doctors, and therefore no longer able to pass themselves off as such. They do have risibly low thresholds for investigation, including scans, which they arrange themselves or pass on to us to sort. And it’s rude to say ‘no’, which is why I do, but many don’t.
Call me GP-centric, but the answer to this is having GPs making these decisions. The best scan of all is the one family doctors do with their eyeballs when the patient walks in. Because if there’s one thing we’re really good at, which secondary care doctors and primary care noctors aren’t, it’s diagnosing normality. And normality definitely does not need an MRI.
Which means – and stop me if you’ve heard this before – more GPs. Where we’ll get them, search me. But don’t scan me.
Dr Copperfield is a GP in Essex. Read more of his blogs here
READERS' COMMENTS [10]
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Issue is more of a need to change culture of patients ‘needing’ scans when there is a clear lack of benefit. I think all clinicians are too quick to scan and this has fed into increasing demand. I myself am almost certainly guilty of doing scans when not needed whether it be to reassure the worried patient (often just increases anxiety whether or not reported as normal) or to reassure myself.
I am not sure what the solution is but I think we’ve entered a world of significant over medicalisation of most health/lifestyle issues and in many ways the high levels of demand are a direct result of clinicians, patients and media all working together in a perfect storm.
Can we not have one of those little black beepy boxes off Star Trek with a choice of 3 printed outputs, depending which position your thumb is in when you press the ‘print result’ button, for ‘Normal’, Normal for Scarborough (insert required equivalent into pre-programmed memory), and ‘Too young/fat/old/etc to be scanned reliably’. Then at least we could send them to the lifestyle management consultant to lose weight before coming back to us again. You could even programme in a fourth option of ‘Alien life-form’ if feeling really vindictive.
£171 million really isnt a lot of scanners Im afraid.
Reminds me of an old, old joke: –
Regretably, Copperfield collapsed in his friend’s sitting-room and just as Church and Taylor were about to start what they remembered of CPR, the lady of the house picked up her kitten and, taking by the tail, stared swinging it back & forth over the prostrate Copperfield.
“What’re doing?” C&T in unison.
“Listen, if anyone deserves a CAT scan, it’s Copperfield”.
@ Keith
… and then the family labrador leaped up to chase the cat.
“Don’t worry”, said the lady. “We can do the lab workup at the same time”
Does the name Alan Milburn mean anything to anybody?
I wonder what he is doing these days?
He did leave a cabinet role to go of to sell Scanners….
He’s not of the Registered Breeders List – The Garden of England CAT Club.
Reminds me of Brian Mulroney (once Prime Minister of Canada). A chest scan showed up some ‘nodules or some-such’. So he attended at the best local operative chest unit (in Boston). Operation went fine and ‘nodules’ were reassuringly non-cancerous.
But then during operation recovery he developed pancreatitis and then a pancreatic cyst and then some sort of bowel problem, requiring more surgery. It took him years to recover from all this.
A bit sad but demonstrates the dangers of incidentalomas (Atul Gawanda has written about).
While I’m here, I might as well tell one of my favourite stories (as related by Atul Gawanda).
A colleague in New England (also a general surgeon with a special interest in thyroid tumours – not sure of his name but it might be Gilbert Welch), related the delightful ‘Aesopian’ story of the parallel between thyroid nodules on scans and the race between the birds, the rabbits and the tortoises’
The birds have flown
The tortoises are going nowhere
You need a catch the rabbits
Do we really need more GPs?
Or simply stop wasting the time of those we already have? That might help with morale too.