Too much medicine, too little time

I realise that by the time you read this, they’ll be wrapped around your cod and chips, but I’ve just noticed three fascinating news stories. Fascinating, because they encapsulate our current problems.

First, there was shadow health secretary Wes Streeting. In a moment of The Thick of It-style, quick-dream-up-an-idea-in-the-back-of-a-cab inspiration, he envisaged this: an app that, post knee injury, logs that you’ve been moving less than you should and so push-notifies the suggestion that you should see your GP for pain management. Genius – and why stop there? Why not an app that detects if you’ve not moved for weeks, and then sends the GP an alert that you’re probably dead, with a pre-filled crem form?

Second was the news that yet another novel and expensive cholesterol-lowering agent is being unleashed. Jeez. Statins and ezetimibe I can cope with. Beyond that, I’m lost. And it’s the same with everything else these days: COPD, asthma, diabetes. Too many options. Diabetes? Remember the halcyon days of diet/metformin/insulin? When diabetes was just diabetes, with no shades of grey? How I long for that pre-pre-diabetic time. That’s an era, not a new disease, by the way.

And third was the well-publicised recording of the nurse explaining that the waiting time in A&E is longer than the average life expectancy of the people waiting there, sending the Mail’s trigger finger of blame back in the direction of us GPs, of course.

So there we have it, a summary of where we are. Infantilise and overmedicalise the public, then wonder why we’re all drowning in work.

Don’t worry. This isn’t yer standard-issue reorganise the NHS rant. No, it goes much deeper than that. It’s the whole of medicine that needs a reboot: what it’s for and what it can reasonably be expected to do.

I don’t have the answers (obviously), but that doesn’t stop me posing the questions. And the debate should be underpinned by two key principles:

• A recognition that people don’t value their illnesses as highly as we doctors do. They don’t want to be defined by their pathology, they don’t want it to dominate their lives and they don’t want to jump through any of the absurd hoops we set for them (asthma QOF, anyone?). Hence patients defaulting on appointments, undermining chronic disease management plans, and not taking their meds.
• An understanding of the law of diminishing returns. ‘Good enough’ care is achievable, excellence isn’t. In fact, the pursuit of excellence requires disproportionate effort while reaping little extra benefit – with blistering implications for costs, medicalisation and our sanity. Besides, most people don’t want to live forever, and if we insist they do, all the cost-effectiveness arguments blow up in our faces, eternal life being infinitely expensive.

So we need a big rethink, with an acceptance that we should stop pushing medicine (in the widest sense) because patients don’t want it, it probably won’t help and it may even make them iller. Plus it cranks up the pressure: yes, it’s true, probably half our workload is self-inflicted. A revolution, then, if you want. 

I won’t be putting anyone up against the wall, but I will be prescribing fewer lipid-lowering drugs. I can’t wait, even if those in A&E have to.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs here