doctors on strike

jambalaya – Member

Doctors disagree on diagnosis and treatment all the time.

Of course they do- that’s because humans are complicated machines that you can’t easily take apart, so diagnosis is generally based on imperfect information and there is often a wide range of suitable treatments.

Until you get an OBD2 socket in the back of your head and a big on/off switch, this’ll remain the case.

I have know idea what an obd2 socket is but I get the gist of that completely. 😆

It’s the “diagnostics port” in your car. You can buy cheap OBD2 tools on eBay, plug em into your car and get fault codes telling you what is wrong with it.

A human equivalent would be very useful (Star Trek style medical scanner perhaps?)

Doctors disagree on diagnosis and treatment all the time.

My experience is that in a lot of cases they don’t use the available diagnostics and imaging techniques (most notably GPs). I’ve known too many people told the wrong information and have to suffer months of pain, when something as simple as an ultrasound or X-ray would have shown up the problem.

Techniques like these should be in GP surgeries, after all dentists can do x-rays then and there, private health care can likewise. The other advantage of all these modern techniques is they all record the data digitally, so you want a consultant elsewhere to look at the pics, then they can have them in the time it takes to send an email.

@grahamS
If only.
I’d have much more time for golf mountain biking in that case.

something as simple as an ultrasound or X-ray would have shown up the problem. …Techniques like these should be in GP surgeries

Really? There are roughly ten thousand GP practices in the UK. Who is going to pay for each one of those to have an ultra sound and x-ray machine? And for the specialist staff to operate them and interpret the results?

..after all dentists can do x-rays then and there, private health care can likewise

Dentists have very small specialist x-ray machine for taking images of your teeth. Not the considerably larger machines use in x-ray departments in hospitals.

Dentists and (other) private health care costs money. (and have the ability to punt people onto public NHS care when things go wrong).

Dragon – I get your point to some degree about having diagnostics in GP Practices, but this is very very expensive.

General Practitioners are generalists. They are not an expert in a particular field, so not always the best placed person to view an image/diagnostic outcome.

Trusts are looking at consultants doing out reach clinics, but that takes them away from the acute environment.

The fact is, if people want the NHS to expand its remit and do more, then it will costs more, and the government want it all at the moment for less money.

Of course when it all goes private you will be able to go and see your expert, and get your diagnosis quicker. Are you happy to pay for it?

Certainly in a new Private world doctors will be substantially better paid, yet they are oddly appear to be not wanting the change to a private system.

dragon, while better access to certain diagnostics can be helpful, it’s not a panacea
One of the reasons that uk general practice is so cheap (£130/patient, 7.2% of NHS budget for 90% of contacts) is because we GPs are really rather excellent at dealing with uncertainty and using things like clinical judgement and time, with the advantage that we can see patients again and again to pick up changes.
We could go down the route of over investigating everything but it would increase costs dramatically without necessarily improving outcomes (see: the USA)
It’s also important to recognise the potential harm that can be done by over medicalising normal life and particularly self limiting illnesses.

Simple, charge for it, that’s how it works with NHS dentists.

General Practitioners are generalists. They are not an expert in a particular field, so not always the best placed person to view an image/diagnostic outcome.

Agree, but as I noted all the kit now is computer based, so in a case where the GP can’t decipher it, then they can email it on to an expert. Even if it took a week or two for an expert to look at it, for the patient that is still a lot quicker than waiting months for an appointment to even get a scan, then having to take a morning off to go to the hospital, try and find parking etc. etc.

so in a case where the GP can’t decipher it,

i.e. every case since the GP is quite unlikely to also be a trained radiologist

they can email it on to an expert

Emailing confidential patient information? Nope.

we GPs are really rather excellent at dealing with uncertainty and using things like clinical judgement and time, with the advantage that we can see patients again and again to pick up changes.

Cancer outcomes would seem to suggest otherwise. The fact that the UK lags many other countries in Europe is down to a combination of late referrals from primary care and lack of access to CT and MRI diagnostics. By way of balance late referrals can also be impacted by patients presenting late / patient behaviour and having longer consultations with patients would give Doctors more time to make an accurate diagnosis / decision to refer.

GP is quite unlikely to also be a trained radiologist

That can change with training, remember at GP level you’d only be looking at ‘run of the mill’ cases. Plus not all the kit requires doctor level of operation.

Emailing confidential patient information? Nope.

You know what I mean, secure electronic transfer. Rather than putting up barriers, think about what can be done, not what can’t.

remember at GP level you’d only be looking at ‘run of the mill’ cases.

So then you’d be complaining that the GP missed that lung shadow that a proper radiologist would have spotted.

They can’t be expected to be experts at everything.

You know what I mean, secure electronic transfer. Rather than putting up barriers, think about what can be done, not what can’t.

No point in dreaming up fantastic facilities that would be brilliant to have if only they could be paid for, staffed appropriately and were practical to use.

“secure electronic transfer” – yep that’d be great – so that’s another system that needs to be designed, paid for and rolled out to 10,000 practices.

Emailing confidential patient information? Nope.

It does already happen, for all the right reasons. I have had chest xrays done at the local cottage hospital, which the GP has then interpreted.

That can change with training, remember at GP level you’d only be looking at ‘run of the mill’ cases. Plus not all the kit requires doctor level of operation.

Correct the kit requires specialists not doctors, but they earn more than junior doctors.

Radiologists take 8 yrs to train.

‘run of the mill’ cases

– Sorry I really don’t know what you are trying to say. GP’s already deal with the ‘run of the mill’ stuff. Anything further requires specialist skills.

Hey 5 minutes is here to pretend he cares about caner when really he just wants to scour the net for facts to attack “socialist health care”

I admire your desire to engage with dragon but I think it might be futile

There’s definitely some manner of email/equivalent process already in place, they do it all the time between my eye consultant and diabetic clinic frinstance. But tbh that’s not the real issue here- operating the hardware isn’t simple, getting quality data in the first place isn’t simple, if nothing else this “do an xray then pass it on to a specialist” concept would lead to lots of “sorry, can’t tell, come back in and do some more scans.

If you want to improve turnaround times it’d make more sense to improve resourcing in the current centralised units but there’s not even appetite or funding to do that let alone roll out massive hardware and personnel upgrades across the network

The comparison with dental xrays seems on the face of it logical then as soon as you think about it, completely irrelevant- you’re talking about a single device that does one simple job and is used constantly.

grahamS- nhs.net email is considered secure enough for patient details and is used routinely.
dragon- dentists have xray machines because nearly all patients get xrays done. highly inefficient to put an xray machine in every surgery to get used once a week
just5minutes- agreed delay in referral is probably one of the multitude of factors that influences cancer survival, which is why anyone who is interested in improving survival ought to have access to high quality primary care as a high priority.

Unfortunately in today’s NHS the three main priorities of the government seem to be 1. cost 2. cost and 3. cost.
We’ve gone as far as we can with “efficiency savings” now.
Hence why we get the outcry at the JD’s contract which is about asking those working hardest to work harder but not being prepared to fund it.

Dentists is an interesting analogy – severe root pain last week, one phone call, appointment one hour later, treatment done on the spot (after X-Ray), next step this week. All fine and dandy – forgot to mention, wallet now several £000s lighter!!!!

😉

grahamS- nhs.net email is considered secure enough for patient details and is used routinely.

Really? Blimey.

I could see it being okay internally intra-department where it is never leaving the local network, but I’m surprised they are happy to have unencrypted patient data flying about random internet servers.

Ah well, there you go dragon, one barrier removed.

(It’s part of my job to look for barriers like these by the way – I’m not (just) trying to be awkward)

@teamhurtmore so high quality, efficient,timely healthcare provided by highly trained professional costs money which is kind of the point!

Dentistry is a bad example though because NHS dentistry is not funded at a level that encourages high quality care with a full range of options for patients despite the fact that patients pay a contribution. It is a good example of the government imposing a bad contract and it leading to a worsening of the care provided though!

@teamhurtmore so high quality, efficient,timely healthcare provided by highly trained professional costs money which is kind of the point!

Indeed it is.

Dentistry is a bad example though because NHS dentistry is not funded at a level that encourages high quality care with a full range of options for patients despite the fact that patients pay a contribution. It is a good example of the government imposing a bad contract and it leading to a worsening of the care provided though!

Perhaps that is EXACTLY why its a good example

I could see it being okay internally intra-department where it is never leaving the local network, but I’m surprised they are happy to have unencrypted patient data flying about random internet servers.

NHS mail is encrypted, to “UK government standards”, whatever that is.

Well there you go. Turns out they have made a lot more headway on the “secure email” front than they had last time I idly looked at it. Good.

http://systems.hscic.gov.uk/nhsmail/secure

pondo – Member

NHS mail is encrypted, to “UK government standards”, whatever that is.

It means you print them out and throw them in a bin in a park

It means you print them out and throw them in a bin in a park

Ah ha – that’ll be the chunt’s drive to create a paperless NHS. 🙂

Dental x rays and the kit to do them and the training to use them to do effectively one shot of a on a standard setting repeatedly is significantly different to the training and kit needed to do general medical xrays either that or my wife has just wasted the best part of three years on a radiography degree.

or my wife has just wasted the best part of three years on a radiography degree.

Worse than that – my dentist shows me pics of my teeth he took on his iPhone – so the hospital has wasted all kinds of money on unnecessary kit!!

I know of a GP who searched for a possible issue in front of a patient using Bing 😯

End pf the day it’s all about using the right technique for the job, if a cheap digital camera works fine, then great.

I know of a GP who searched for a possible issue in front of a patient using Bing

Damned if I know where I read it, but I once saw an article or a bit in a book talking about perception, asking who would you feel more confident seeing, a GP with years of experience or a newly-qualified GP straight of GP school who has to look things up (on, for example, Bing 🙂 )? Logic says the GP who knows that they’re doing, but the GP who isn’t sure of themselves, looks things up and questions everything is probably more likely to reach the correct diagnosis as even though they have less experience that means they carry fewer assumptions*.

* According to the article, anyhow, not sure how accurate that is in the real world. The gist of my point is, it might not automatically be a bad thing if they’re looking something up.

True, but if they are choosing to use Bing… 😉

True, but if they are choosing to use Bing…

There’s no defence for that, to be fair.

@docrobster – GPs are cheap per patient as most people frankly aren’t that sick when they go to their GP, personally I’d be in favour of changing GP surgeries and having many more senior nurses (for example) screening patients.

Agreed we don’t pay nearly enough for our health care, nationally we want a great service without actually paying what it takes. @tmh you should see what an NHS dentists gets paid for various things like checkups, fillings – pretty shockingly low

NHS mail is encrypted, to “UK government standards”, whatever that is.

The entire civil service is rated for Official Sensitive classified material so it is probably the same infrastructure. The “last leg” is not encrypted but server to server stuff for intranet email addresses is (provided it never leaves the domain – out into the internet is sent cleartext)

(provided it never leaves the domain – out into the internet is sent cleartext)

That was what I thought too, but according to that link I posted earlier:

“NHSmail users can securely exchange sensitive information with users of non-accredited or non-secure email services, for example those ending in .nhs.uk, Hotmail, Gmail and Yahoo.
…
NHSmail users can easily communicate securely with users of ANY email service including those ending .nhs.uk without having to manually encrypt sensitive information”

Which was news to me (and I’m curious exactly what they mean and how they have achieved that).

Which was news to me (and I’m curious exactly what they mean and how they have achieved that).

Wow, so am I – I bloody hate NHSmail but have to keep logging on because I work with an organisation that insists on mailing to it

wow jambalaya thanks for that helpful insight.
when you find the senior nurses to do this lovely easy job screening 90 year olds with 8 long term conditions, keeping them out of hospital, attending to their loneliness and unmet social needs, do let me know, I’ll offer them a job

one thing you said is true though

GPs are cheap per patient

average 6 visits to the gp per person per year for £130ish each.
biggest bargain ever. look after us, you won’t be able to afford the replacement service 😉

Odd comment from the Justice for Health (I think) rep on CH4 News tonight. Along the lines of: there will be no problem for any patients including mine at all. I have briefed the senior doctors and they will be able to cover for me without any problems or safety issues. So there is no problem – in which case, there is an obvious conclusion albeit probably not the intended one!!!

You can manage for a brief period without all the doctors if you know when it is and you plan for it?
If only you actually said what you meant we would not have to play this guessing game.

The point of the all-out, “emergency care” strike is NOT to hit patients. The problem with previous strikes is that it hasn’t caused the hospital management or government to sit up and take notice because all the consultants and non-junior doctors have been coerced into keeping the lucrative elective operations, procedures and appointments going (as the junior docs doing “emergency care” are enough to keep a service running for 2 days – we do it like that every weekend FGS).

Withdrawing emergency care forces the consultants to be on the “shop floor” – admitting and discharging patients, requesting bloods, making day-to-day decisions etc – rather than doing the elective services that the hospital actually gets paid for (and the government publishes statistics, and is therefore judged, on). Patients in hospitals for the 2×8 hours during the strikes will almost certainly get better care than usual due to the high numbers of senior doctors looking after them for those hours (until 5pm when it’ll be the juniors in charge again). Safety WILL NOT be compromised during this strike.

However, just letting the consultants do this forever clearly wouldn’t work, as then no elective work would be done and everything would eventually grind to a halt.

…Or clinics…Or GP referrals…Or research…Unless folks actually want a health service without any of these things that Consultant’s tend to do better than junior colleagues!