This doesn’t increase demand for health services at all.

Well I don’t expect that many people are languishing in A&E departments with severe cases of onychomycosis, or that many GPs are referring their patients with dodgy toenails to hospital specialists, so in that respect probably no.

But I guess the fact that Trosyl or Terbinafine require prescriptions probably does at least put some burden on the NHS.

you can buy amorolfine ernie – if you cared about the NHS you would 🙁

A toenail infection can be caused by diabetes, poor circulation, a weakened immune system, or sweaty trainers. I’d rather go to A&E just to be sure.

Well I don’t expect that many people are languishing in A&E departments with severe cases of onychomycosis…

I think you’d be surprised at the pathetically minor ailments some folk do turn up at ED for. It’s very difficult sometimes to stay professional and not tell people to man the $#@€ up and do one, it really is.

My ‘favourite’ is a regular attender who lives in the countryside and comes to hospital with ‘heart pains’ to get a bed for the night, when he misses the bus or doesn’t have enough money to get a taxi home after drinking sessions in town. Every time he comes in we run the same tests on him, ECGs, cardiac monitoring for the night, even an angio a few times. All the time he is demanding this and that be provided, complains to anyone and everyone that he isn’t being taken seriously etc. Then he sobers up in the morning, packs his few belonging and self-discharges.

There are also any number of folks who claim ‘vomiting/abdominal pains’ because they rather like effects of Morphine and Cyclizine.

One of them was sent packing a few years back so went to the local press to complain, hospital can’t comment without said person’s consent (which they obviously didn’t get) so hospital gets ripped to pieces in press for sending poorly/borderline junkie* (*delete as appropriate) person away.

A toenail infection can be caused by diabetes, poor circulation, a weakened immune system, or sweaty trainers. I’d rather go to A&E just to be sure.

Are you taking the piss?

sootyandjim – Member

I see you are running B&B … 😯
A suggestion is to bill them after they are discharged …

Drac – Moderator

ernie_lynch – Member
A toenail infection can be caused by diabetes, poor circulation, a weakened immune system, or sweaty trainers. I’d rather go to A&E just to be sure.

Are you taking the piss? [/quote]
It was not me … 😆

Are you taking the piss?

Why – what makes you think that?

Drug companies aren’t allowed to advertise prescription only medicines to the public, so they advertise the “disease” instead.
Only in this case its not really a disease is it, its just discoloured toenails generally.

Comments like
“many GPs are referring their patients with dodgy toenails to hospital specialists,”
rather miss the point. Do we only count secondary care spending now? I know GP is an infinite resource but…

rather miss the point

I was trying to figure out how much stress dodgy toenails were putting on the NHS.

Well clearly toenails on there own aren’t much more than a minor annoyance.
The point I was trying to make was the general medicalisation of all of life’s woes is a problem.
Kids that fall outside society’s accepted behaviour patterns, adults whose shit life makes them feel sad, pensioners who don’t see a living soul from one week to the next, these are all now medical issues that must be treated by doctors with drugs.
It’s not exciting hi tech life and death stuff like what makes good telly, but it’s much more common than the exciting stuff those clever hospital doctors deal with and it is something that we as a society now need to provide a health service for.
I’ve probably seen one too many today so I’ll leave it there and open another beer!

It’s not exciting hi tech life and death stuff like what makes good telly, but it’s much more common than the exciting stuff those clever hospital doctors deal with and it is something that we as a society now need to provide a health service for.

Docrobster – I feel your pain and agree with you about the the problem with ‘life issues’ progressively being turned into ‘medical issues’ and thus a magic bullet or drug being sought out to ‘fix’ them.

It’s not all exciting stuff in secondary care (though I guess you know this from your time doing the rounds). For every SVT or T2RF we admit there are ten ‘Collapse?Cause’ (usually care home residents who aren’t being sufficiently cared for) or 20 ‘ETOH Withdrawals’.

Nothing like getting punched by a withdrawing alcoholic at two in the morning, just after you pat-slide them onto a bed, to make you really appreciate which ‘drugs’ are really the ‘bad ones’.

Well yes it appears to be widely accepted that cuts in welfare spending have added to the NHS funding crises. As has increased longevity and also hugely increased availability of treatments and procedures in areas such as cancer and heart disease.

I just thought that spending too long looking at toenails might be missing the point when the burden it represents to the NHS is probably insignificant compared cancer, heart disease, elderly care, etc.

Likewise spending too much time focusing on those who abuse the system can also be missing the point, although for obvious reasons people like Daily Telegraph/Daily Mail/Sun leader writers want to concentrate on that, as in pretty much every area of human activity there are shitesters.

http://newsthump.com/2016/05/24/nhs-doctor-who-joined-isis-lured-by-promise-of-better-working-conditions/

Many doctors are now so tired and stressed that they are seriously asking themselves whether it is better to work under an unforgiving authoritarian regime constantly surrounded by death and despair, or to go to Syria to join Islamic State

🙂

A toenail infection can be caused by diabetes

I know this comment was partly in jest to make a point but it is actually a genuine issue. My missus runs regular diabetic foot clinics. A manky toenail can become a major issue when diabetic neuropathy means you can’t feel the damage it is doing. Catching it early saves the distress (and expense) of chopping off a leg.

The first known written treatment for baldness is from 1553 BC – a thousand years later, Hippocrates was obsessed with treating it.

It think its difficult to blame it on Big Pharma

Male Pattern Baldness isn’t always “normal” either.

Multiple cross-sectional studies have found associations between early androgenic alopecia, insulin resistance, and metabolic syndrome, with low HDL being the component of metabolic syndrome with highest association. Linolenic and linoleic acids, two major dietary sources of HDL, are 5 alpha reductase inhibitors. Premature androgenic alopecia and insulin resistance may be a clinical constellation that represents the male homologue, or phenotype, of polycystic ovary syndrome.

In support of the association, finasteride improves glucose metabolism and decreases glycosylated hemoglobin HbA1c, a surrogate marker for diabetes mellitus. The low SHBG seen with premature androgenic alopecia is also associated with, and likely contributory to, insulin resistance.[17]
Because of its association with metabolic syndrome and altered glucose metabolism, both men and women with early androgenic hair loss should be screened for impaired glucose tolerance and diabetes mellitus II.[18]

Ahh, pre diabetes and metabolic syndrome, the latest deep seam to be mined by drug companies.
Weight loss, diet, increased exercise. All sensible and effective but hard to do.
Let’s patent a drug instead. One that they will be on for the rest of their lives. Kerching!

A manky toenail can become a major issue when diabetic neuropathy means you can’t feel the damage it is doing. Catching it early saves the distress (and expense) of chopping off a leg.

Well luckily Scholl, as docrobster points out, produce a fungal nail treatment which is available over the counter without prescription – presumably saving the NHS a small fortune.

Scholl have also very helpfully, as docrobster points out, produced a video to inform and educate people so that they can self-diagnose, before popping down to Boots, without having to bother their GP at all. Presumably saving more money and resources for the NHS.

Seems like a double win to me 🙂

The point I was trying to make was the general medicalisation of all of life’s woes is a problem.

Agreed @doc. This is a very big issue.

@kimbers the NHS has no chance of macthing IS terms and conditions as death in service benefits do not include 72 virgins (refreshed every night) 🙂

To be honest that is one of the biggest failings of those who came up with the carrot for martyrdom, who would want 72 virgins? Sounds like too much hard work.

72 ‘women who know what they’re doing’ sounds a far better a prospect.

Megalolz @ ernie’s utopian view of human behaviour!
“15 quid! For a little tube of goo for my nails? Stuff that I’ll go round the docs and get it for free.”

…Stuff that I’ll go round the docs and get it for free.

Or if the can’t get an appointment for ten minutes after they phoned the GP’s, or if they decide they don’t like the GP’s answer, they’ll rock up at ED demanding they be seen by a specialist in grotty toenails.

15 quid! For a little tube of goo for my nails? Stuff that I’ll go round the docs and get it for free.”

Perfect example, we should all be paying for that at the point of service probably including the appointment, however discussion of that is so politicised / knee jerk we stumble on deeper into the mire.

Megalolz @ ernie’s utopian view of human behaviour!
“15 quid! For a little tube of goo for my nails? Stuff that I’ll go round the docs and get it for free.”

Well you obviously think that Boots are wasting their time selling Scholl fungal nail treatment over the counter without prescription.

Megalolz @ you knowing better than Boots how to run their business and what their customers want.

I have no idea if you are actually a doctor but if so do you find that your obvious low opinion of human behaviour is a handicap?

You turn up at my surgery asking for that stuff and you will get sent off to buy it yourself. Unfortunately it is often Boots ( who are shockers) sending people in our direction.

Unless you have a nail infection which is causing a biomechanical malfunction in the way you walk, and we have proven with mycology it really is fungal, you can jog on.

Ernie
I’m a GP. Been doing it 20 years. Got s bit of a feel for the job now.
I like people. I get a lot of job satisfaction from helping people through their illnesses and patients seem to appreciate what I do.
This week one of the urgent appointments was used for a child with chicken pox. Mum had gone to the chemists to get calpol and calamine lotion. The CCG locally funds a minor ailments service that pays pharmacies to provide medicines that are available over the counter to people without charge if they get free prescriptions.
The pharmacist directed them to contact the GP surgery to get these simple household items on prescription.
So sometimes yes I absolutely despair.

yep… the idea that most UK pharmacists can be bothered/know how to provide decent self-help advice or primary care is one of the great myths. there are excellent examples but in my 25 yrs as a GP, I’d say the standard of advice given has gone down, and the commercial pressures on pharmacists in pharmacy chains to sell rubbish has gone up.

I am very happy to see two doctors here speaking of a few things which I think are very relevant and which I believe should be part of a wholesle review.

Firslty what is the scope of the NHS as free at the point of service ? Critical care, start of life certainly, old age care needs a serious rethink, as I posted before my neighbour (ex nurse, now professor) was awarded a CBE for her work in this area. Broader demands, not so sure at all
Who takes up the slack, better integration of state and private provision, thoughts on “offshore provision” (eg currently knee surgery is one of the few things you can have done abroad (much more cheaply) and nhs will pay). As above Pharmacies could have a significant beneficial role, I think their move into supermarkets is a questionable move vs owner run local business. Senior nursing staff could play a valuable role here too.

I know a number of GPs who think the value of their job has deteriorated with far to many trivial cases which would be better dealt with by someone else allowing them to focus on more complex medical issues.

Interesting scoop for HSJ about BMA’s tactics in dispute.

Article

Damn Tory press.

I’m more amazed the BMA are using WhatsApp for these internal discussions 😯

Despite protestations that the dispute was about “safety, not pay”, the issue of weekend pay was described late last year by a JDC executive member as “the only real red line” for junior doctors. This point was only finally conceded by the JDC on 7 May when it decided to re-enter negotiations.

Well, that is a somewhat inconvenient truth. I do hope that those who said the dispute was about “saving the nhs” are blushing today.

^^^ exactly, heard the same months ago from someone who read the contract in detail as its their job as an administrator to do so

I think it’s fair to say that the causes of the dispute are multi faceted.

Lancet article blames Henry the 8th!

I think it’s fair to say that the causes of the dispute are multi faceted

It was about money and dosh ?

Reportedly according to one executive member, what’s the full quote though?

Well, that is a somewhat inconvenient truth. I do hope that those who said the dispute was about “saving the nhs” are blushing today

and yet….

The executive also discussed concerns about safety and long working hours as well as pay. In November, Harrison Carter said: “Strongest case that we have is ensuring that all doctors are protected from working excessive hours that cause unnecessary fatigue and lead to unsafe conditions for patients. It is taking reckless risks with patient safety.”

😳

the only real red line”

They might have discussed the price of fish, but the only REAL red line was dosh/cash/money/moolah. That they were prepared to leave people in pain for cash was shocking. At best they seem to have misunderstood that the NHS exists for them – it doesn’t patients should always come first. The times of their mouth’s being stuffed with gold are over.

On 15 January, after the strike, he told the group: “I don’t care about anything apart from extracting the best contract. Don’t give a shit about anything else.”

He continued: “We have told them they could offer to buy Saturday off us for £700million. But they would need to make that offer. Not expect it from us as we have no interest in the money. But if they seriously want Saturday it will cost about £500-700million.” He said this would equate to a 15 per cent pay rise.

😆 bang to rights

and the commercial pressures on pharmacists in pharmacy chains to sell rubbish has gone up.

But this is almost entirely down to the NHS not being willing to use highly qualified pharmacists as part of the overall health system – so they are doing other things to cover the fairly limited returns from prescribing – Pharmacists are highly qualified and regulated but pretty badly paid.

I have two recent examples of this:

1. I’ve been asthmatic for 30+ years and have always been shown the same way of using my inhalers by countless doctors over the years. Very recently a pharmacist checked how I was using my inhaler and told me I’d been getting it wrong. After checking her advice with the manufacturer’s helpline it turned out she was right and all of the doctors had been wrong. Asthma is one of the most common Long Term conditions so it’s quite possible that many thousands of asthma patients are also not using their medicine correctly, potentially leading to avoidable hospital admissions / more cost for the NHS.

2. I have a hiatus hernia and have been hospitalised several times due to violent / sustained acid reflux (we’re talking continual wretching for 8+ hours and acute pain).

After each of these episodes I went back to my GPs to question whether another PPI would be more effective to be told no – this advice was consistent over 10+ doctors over a 4 year period. After consulting a pharmacist in desperation due to the regular pain and vomiting I was advised that PPIs all work on different receptor antagonists. After talking to me and consulting his formulary, I was advised to go back to the GP and ask for a specific / different PPI.

The GPs initially refused citing CCG prescribing guidelines but after I pushed very hard I finally managed to persuade one of them that I should be allowed to try it on a trial basis. My acid reflux is now well managed (touch wood), I don’t get the regular pain and I haven’t been hospitalised since.

In both of these cases the NHS has been wasting money on Long term medication and hospital admissions without anyone checking the drug was right / making sure it was used correctly. The Pharmacists in both cases have helped to improve my health and reduce NHS spend, yet in neither case was their expertise recognised or valued by local GPs who didn’t really seem to have any real knowledge themselves.

Let me be clear about my views. Junior Doctors work far too many hours and are paid too little. I do believe in a full 7 day NHS including scheduled surgery. I do not however think the ideal solition is putting more money into the setup we have.

But this is almost entirely down to the NHS not being willing to use highly qualified pharmacists as part of the overall health system

@rob I agree with this, lots of vested interests at play. Also when you have one service provider in anything you’ll get a single “house view” on how something (anything) should be done – throughout my life I have observed that this is generally not a good idea.