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Thanks, NICE. But I don’t have 100 years to implement your advice

Hilarious that NICE’s new guidance on sepsis had the nation’s media displaying all the relevant red flags – febrile, tachycardic, breathless, confused etc – though more because of an opportunity to nail GPs again than any true bacteraemia, obvs.

This reveals a staggering misunderstanding of general practice

Not as hilarious, though, as a comment I saw in the Times when reading the story over this morning’s Shreddies. Something like, we GPs should ‘think sepsis’ in the same way that we think ‘heart attack’ in any patient attending with chest pain, ‘whether five or 50’. Hang on, that can’t be right. 50, yes. Five, no. Mind you, I’d only just got up, bleary-eyed and all that. Probably a misread, then, or, if not, a misquote.

So I checked it out later. And there it is on the NICE website. A Professor of Paediatric Immunology & Infectious Diseases saying, ‘This is just like when people come in with chest pain. Whether you’re five years old or 50 years old, the first thing that goes through a clinician’s mind is, could this be a heart attack?’

Er, no. In the case of the five-year-old, it might be the first thing that goes through the parents’ mind. It might be the first thing that goes through the child’s mind. And it’s definitely the first thing that goes through NHS 111’s mind (or maybe the second, I can’t remember where the ‘Are you pregnant?’ question comes). But it is not the first thing that goes through the GP’s mind.

And there are two good reasons for this. First, what epidemiological data I can find on childhood MI – and, as you can probably guess, there isn’t much – suggests that the average GP will see one every 100 years. Which means I’d have to work nearly three whole careers in general practice to encounter a case, and then it may not come to me, or present with chest pain. And, second, GPs aren’t catastrophists working from protocols. That’s what NHS 111 is for, and that’s why A&Es are overwhelmed. No. We’re trained to take presentations in context, to use common sense and to see and put things in perspective. This does not means assuming every five year old with chest pain has an MI until proven otherwise, it means the opposite.

Not appreciating this reveals a staggering misunderstanding of general practice – which, coming from NICE, is disappointing but unsurprising. On the other hand, it could just have been a throwaway comment. In which case, can we throw it away? 

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield