12 mis­takes even good medics make

GPs deal with so many ill­nesses they can’t al­ways keep up with the lat­est think­ing. And as our ex­perts re­veal, you may pay the price

Weekend Argus (Saturday Edition) - - LIFE -

GEN­ERAL prac­ti­tion­ers de­cide whether you need spe­cial­ist at­ten­tion. It is a chal­leng­ing role, since a fam­ily doc­tor needs some un­der­stand­ing of a broad range of phys­i­cal and psy­cho­log­i­cal con­di­tions.

With even spe­cial­ists over­whelmed by the rate of med­i­cal de­vel­op­ments, are there ways GP care could be im­proved?

Urol­o­gist Chris Eden said: “I strug­gle to re­main cur­rent with the lat­est re­search in prostate can­cer and can’t imag­ine try­ing to keep abreast of ad­vances in all spe­cial­i­ties.”

We ask some of the UK’s lead­ing med­i­cal spe­cial­ists to iden­tify how doc­tors could en­hance the care they pro­vide.

Dr Glyn Thomas, a car­di­ol­o­gist at the Bris­tol Heart In­sti­tute, said: “Peo­ple who suf­fer with atrial fib­ril­la­tion – ir­reg­u­lar heart rhythm – are five times more likely to have a stroke; and those strokes are also more likely to be fatal.

“Atrial fib­ril­la­tion pa­tients should be pre­scribed an an­ti­co­ag­u­lant such as war­farin to pre­vent the blood clot­ting.

“GPs of­ten pre­scribe as­pirin in­stead be­cause they fear the risk of in­ter­nal bleed­ing. This is non­sense. Not only does as­pirin carry the same risks of bleed­ing, it’s in­ef­fec­tive as an an­ti­co­ag­u­lant.

“War­farin re­duces the risk of stroke by 64 per­cent; as­pirin re­duces it by 0 per­cent. The bleed­ing risk is the same.”

Dr Peter Fair­clough, Har­ley Street con­sul­tant gas­troen­terol­o­gist, said: “I see pa­tients need­lessly re­ferred af­ter an at­tack of up­per ab­dom­i­nal pain, which their GP says is gas­tri­tis. They rec­om­mend in­ves­ti­ga­tion with an en­doscopy.

“Th­ese pa­tients have gall­stones. They won’t be picked up through an en­doscopy but with blood tests or ul­tra­sound.”

Pro­fes­sor Gor­don Jayson, on­col­o­gist and ovar­ian can­cer spe­cial­ist at The Christie Hos­pi­tal in Manch­ester, said: “GPs need to lis­ten care­fully when a women in her 50s com­plains of ab­dom­i­nal pain and bloat­ing. It’s easy to think it’s IBS (ir­ri­ta­ble bowel syn­drome) – and in most cases, it will be.

“But the symp­toms could be those of ovar­ian can­cer. The dif­fer­ence is that whereas IBS pain will come and go, the pain from ovar­ian can­cer will be pro­gres­sive and con­stant.

“If it’s the lat­ter, a GP needs to do a blood test for the chem­i­cal CA125.

“If it’s caught early, 95 per­cent of cases are treat­able.”

Dr An­drew Dow­son, di­rec­tor of headache ser­vices at King’s Col­lege Hos­pi­tal, Lon­don, said: “Many GPs will miss a di­ag­no­sis of mi­graine as they think this type of headache has to have an aura pre­ced­ing an at­tack, but only one in 10 pa­tients has an aura and only 40 per­cent of th­ese will get them all the time.

“A GP needs to recog­nise the other main symp­toms such as one-sided throb­bing, nau­sea or light and sound sen­si­tiv­ity.”

An­drew Wright, der­ma­tol­ogy pro­fes­sor at the Univer­sity of Brad­ford, said: “The rou­tine seems to in­volve the GP hav­ing a quick look, then pre­scrib­ing a cream, but lit­tle di­rec­tion is given about how much to use. A 30g tube may be given with a re­quest to come back in two weeks if there’s no im­prove­ment.

“The pa­tient thinks the cream must last two weeks, un­der-treats them­selves, the eczema gets worse, they go back to the GP, who refers them to a spe­cial­ist.

“If GPs could give proper di­rec­tion, it would save us all a lot of time.

“GPs also shouldn’t pre­scribe aque­ous cream – not even to wash with. It’s in­cred­i­bly dam­ag­ing to skin, es­pe­cially chil­dren’s.”

Henry Sharpe, a con­sul­tant ear, nose and throat sur­geon at East Kent Hos­pi­tal, said: “About 5.2 mil­lion peo­ple see their GP with a blocked nose. Many will be given an­tibi­otics or nasal spray on the as­sump­tion that the cause is con­ges­tion.

“But a blocked nose can be any­thing from com­pli­ca­tions of a de­vi­ated sep­tum to polyps.

“I’d like to see re­fer­rals to an ENT depart­ment if the con­ges­tion goes on for over a month. An­tibi­otics won’t work if it is not a bac­te­rial in­fec­tion; steroid sprays can have side­ef­fects.”

Pro­fes­sor Tony Kochhar, shoul­der sur­geon at South Lon­don Health­care NHS Trust and BMI The Sloane Hos­pi­tal, said: “GPs should re­fer pa­tients with shoul­der pain for an ul­tra­sound scan be­fore any other treat­ment.

“The anatomy of the shoul­der is so com­plex. It’s very hard for a GP to find the cause.

“If there is a tear, and a GP sends the pa­tient for phys­io­ther­apy – where they’ll of­ten be told to work through the pain – that tear can get worse.”

John Ru­bin, an ear, nose and throat sur­geon at the Royal Na­tional Throat, Nose and Ear Hos­pi­tal in Lon­don, said: “I see a lot of pa­tients who have suf­fered with a post-nasal drip and whose GP has re­ferred them. In fact, it could be some­thing as sim­ple as acid re­flux. So rather than re­fer­ring to a spe­cial­ist, I’d like GPs first to try a front­line treat­ment, such as Gavis­con.”

Dr An­drew Bamji, a rheuma­tol­o­gist at Chels­field Park Hos­pi­tal, Or­p­ing­ton, said: “Pa­tients with rheuma­toid arthri­tis do much bet­ter if they are re­ferred quickly, within four weeks of di­ag­no­sis.

“I’d like to see GPs do bet­ter at spot­ting signs of the disease at its early stages – swelling with the joint pain, morn­ing stiff­ness and gen­er­ally feel­ing un­der the weather.

“And one red flag, which can get missed, is anaemia. Eight out of 10 suf­fer­ers have this.”

Ed­die Chaloner, con­sul­tant vas­cu­lar sur­geon at Lewisham Hos­pi­tal, says: “Pa­tients with a swollen leg are of­ten given an­tibi­otics be­cause they’re told they have an in­fec­tion. It’s usu­ally su­per­fi­cial phlebitis – where a vein be­comes in­flamed and a blood clot forms.

“Usu­ally it goes away on its own. An­tibi­otics wouldn’t have any ef­fect.

“If there hasn’t been any re­cent wound or surgery and there’s no pus, in­fec­tion is un­likely to be the cause.”

Christo­pher Eden, a urol­o­gist and prostate can­cer spe­cial­ist at the Royal Sur­rey County Hos­pi­tal in Guild­ford, said: “Many GPs will ad­vise over­weight men in their 40s and older to have a choles­terol test. But men in this bracket are also at risk of prostate can­cer, so I wish GPs would of­fer them a PSA test, too.”

Dr Myles Black, an ear, nose and throat and thy­roid sur­geon at East Kent Univer­sity Hos­pi­tal, said: “GPs some­times dis­miss sud­den hear­ing loss as ear wax or fluid from an ear in­fec­tion or cold when it could be caused by sen­sorineu­ral hear­ing loss, which re­quires im­me­di­ate treat­ment to pre­vent per­ma­nent hear­ing loss.

“What dis­tin­guishes sen­sorineu­ral hear­ing loss from the blocked-up feel­ing you get with a cold is that the hear­ing dis­ap­pears com­pletely, usu­ally in one ear. With a cold, that hear­ing may just be muf­fled.

“Sen­sorineu­ral hear­ing loss – caused when a cold, virus or in­fec­tion trav­els to the in­ner ear – needs speedy treat­ment with steroids and it wor­ries me that pa­tients could be need­lessly los­ing their hear­ing be­cause GPs don’t get enough train­ing at med­i­cal school to di­ag­nose sen­sorineu­ral hear­ing loss.

“Yet it can be picked up eas­ily us­ing a tun­ing fork.”’ (This is placed on the fore­head and, if hear­ing is nor­mal, the sound will be heard equally in both ears.) – Daily Mail

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