There are two ways to approach NICE’s new asthma guidance (there’s actually a third way, which is to run away screaming, but then technically that’s not an approach).
One is to scan it with a wry smile that at times becomes a full-on guffaw. For example, when you read that, regarding questions about occupational asthma, you should ‘make sure all answers are recorded for later review,’ which is a useful prompt, because I normally hate cluttering up the patient record with facts.
Or when NICE says: ‘Offer a FeNO test to adults (aged 17 and over) if a diagnosis of asthma is being considered.’ Because that means I can have the following conversation: ‘Mr Smith, I am considering in your case a diagnosis of asthma and would like to offer you a FeNO test to confirm this. Would you like that?’ ‘Yes please doctor, that would be lovely.’ ‘Well, you can’t have it.’
The other way to approach the guidance is to step back, take a deep breath and try to make sense of the labyrinth of tests which NICE requires us to negotiate before we can boost our QOF asthma prevalence by one. In which case, the conclusion we’re forced to reach is that, while we’re used to NICE being unrealistic, this takes it to levels which, appropriately enough, take your breath away.
We’re used to NICE being unrealistic, but this takes it to levels which, appropriately enough, take your breath away
It’s possible, of course, that NICE is absolutely right to drive a coach and horses through asthma diagnosis, even if it does result in a sea-change so oceanic that I simply cannot summon the energy and enthusiasm to get my act together. Or maybe it is simply over-reacting to a problem that barely exists, and would do well to ponder on why we GPs do what we do, and have done for years, rather than be swayed by those who know much about academia but nothing about the frontline.
Whatever. The new guidance can be summed up by one word, and that is, ‘useless’. Because, whatever you think of the quality, there has to be practicability, too. And given that the management algorithms mandate a test which we cannot access, the guidance has no practical use.
Conflict of interest: I am asthmatic. At least, I think I am.
Dr Tony Copperfield is a jobbing GP in Essex