By the way... Some doctors are too set in their ways

It Is often said that trying to get doctors to alter their behaviour — whether it’s how they test for or treat an illness — is about as difficult as trying to herd cats.

this is a truism and one that came home to me with some impact more than 30 years ago when three colleagues and I spent a vast amount of time and energy setting out to open a private blood bank.

the idea was triggered by a wave of anxiety about blood-borne infections such as HIV and hepatitis C. the idea was that a patient scheduled for planned major surgery could deposit a pint of their own blood once a week for up to a month and could then receive it back, if needed, at the time of their operation.

the fact is there is no blood as good for you as your own — a blood transfusion is, after all, a transplant, and not without hazard.

We promoted the service via seminars and meetings with our surgical colleagues, supplemented by written documentation to anaesthetists, hospitals and medical teams.

We needed, perhaps, two to five referrals each week to cover our overheads — but we achieved only that small number over a whole year.

It seemed surgeons found it difficult to alter their habits and even more difficult to take the time to explain to patients that the operation would involve, potentially, much blood loss.

Funnily enough, one of the few referrals that year was the wife of an eminent orthopaedic surgeon who was about to undergo a hip replacement. the surgeon didn’t send any of his other patients to us, though he was keen for his wife to have that added safety.

We closed our specialist service, realising we had no chance of persuading surgeons to use it.

I was reminded of this experience by the recent revelation that tens of thousands of patients with atrial fibrillation — the most common heartbeat irregularity — are still taking low-dose aspirin to help prevent blood clotting in the heart. Clots forming in the upper chambers can be ejected into the circulation and plug arteries — and, if an artery in the brain is blocked, it leads to a stroke, causing disability or death.

therefore, effective blood thinning is essential and guidelines from the National Institute for Health and Care Excellence set out that aspirin is insufficient for this. It is vital to use warfarin or one of the newer anticoagulants, rivaroxaban, apixaban or dabigatran.

so, if you have atrial fibrillation and your only stroke protection is aspirin, beat a path to your doctor’s door and bring your treatment up to date.

I should add that if your low-dose aspirin is because of coronary artery disease and you have had a bypass or stent, this policy does not apply. But for those with atrial fibrillation, aspirin alone is not good enough.