Bytheway... You can’t diagnose children by phone
READING about the death of one-year-old William Mead after a catalogue of blunders in his medical care will have left most people shocked. For years we’ve been assured that the NHS is our safety net, offering the best care if serious illness strikes.
The Government has stressed it wants to maintain this vision of the NHS. And yet as each day goes by, public confidence in this, and in NHS care, is waning.
It’s been a drip-drip attrition, as a result of careless and sometimes harmful initiatives. Typically, it’s about money and rationing vital care.
Take, for example, the way the shingles vaccine is offered to only a small group of elderly people, even though a quarter of us over the age of 50 will succumb to the disease. Then there are the financial incentives to GPs to reduce referral for essential investigations.
And how does our confidence survive the contradictory positions taken on the use of antibiotics? So great is the concern about antibiotic resistance that doctors are urged to avoid prescribing the drugs unless it’s absolutely critical.
There is a widespread view that GPs are particularly careless with antibiotics, issuing them too readily. And yet in William Mead’s case there is the suspicion that his doctors were too reluctant to prescribe them, ready to assume his problems were just viral.
What his tragic story highlights is not so much the question of whether you should give antibiotics or not: what is missing from this debate is the most important point of all — that sick children must be seen and examined.
Examination — which takes time — involves undressing a baby or toddler, recording their pulse and temperature, examining the ears, the throat and the lungs; a thoughtful few minutes that every doctor is trained to take. Some system of follow-up is also mandatory and lack of improvement demands a repeat examination.
If anyone thinks that a telephone consultation with a clerk using a check-list will do, bear this in mind: 40 years after attaining my membership of the Royal College of GPs, I am more nervous than ever about offering care over the telephone — it is always second best.
Medicine, like dentistry (or hairdressing) is a face-to-face activity. What was missing for William Mead was clinical examination, by doctors who knew him.
But do we have the resources for such detailed care? No: GPs are stretched to a level that hardly permits such diligence, with insufficient numbers of trained colleagues, increasing amounts of administration, inspections, appraisals, re-licensing, all of which are worthy attempts to improve standards, but which stand in the way of actually getting the job done.