Don’t for­get that nag­ging feel­ing

The Daily Telegraph - - The Surgery - James Le Fanu Email med­i­cal ques­tions con­fi­den­tially to Dr James Le Fanu at dr­james @tele­

‘The pro­posal has prompted a vig­or­ous re­sponse from family doc­tors on the Pulse web­site’

It would per­haps be rea­son­able to have ex­pected more tan­gi­ble im­prove­ments in our beloved health ser­vice than are read­ily ap­par­ent from the spectacular five-fold in­crease in fund­ing in lit­tle more than 25 years – from £24 bil­lion in 1989, to an im­pres­sive £120 bil­lion to­day.

Still, at least re­fer­rals to see a hos­pi­tal spe­cial­ist have be­come a whole lot easier as there are now more of them, and quicker since the in­sti­tu­tion of the manda­tory 18-week wait­ing-time limit.

Pre­dictably, the de­mand for their ser­vices has es­ca­lated – hence the “leaked memo”, re­ported re­cently, on plans to cut back the num­ber of re­fer­rals by (it is over-op­ti­misti­cally an­tic­i­pated) a third.

This is to be achieved by re­quir­ing GPS in fu­ture to have weekly meet­ings in which they must jus­tify to their col­leagues their de­ci­sion as to why Mrs X might re­quire to see an or­thopaedic sur­geon with a view to hav­ing a knee re­place­ment, or Mr Y might need to see a haema­tol­o­gist to in­ves­ti­gate his un­ex­plained anaemia.

The pro­posal has prompted a vig­or­ous re­sponse from family doc­tors on the web­site of Pulse, the GP magazine: “a bats--- crazy idea,” wrote one; “[those dreamed it up] can go ---- them­selves”, said an­other; “more time b-------- about, not see­ing pa­tients”; and, most perti­nently: “I ob­ject to col­leagues who know less than me telling me what to do.”

It is a tricky busi­ness. The de­ci­sion to re­fer Mrs X and Mr Y might be sanc­tioned, but what about the com­mon sit­u­a­tion known as the “nag­ging feel­ing”, as in: “I am pretty sure there is noth­ing se­ri­ously wrong here, but I can’t be sure it’s not cancer”? Or the force­ful pa­tient with pso­ri­a­sis who will not be de­nied re­fer­ral to a skin spe­cial­ist, even if it is not nec­es­sary?

Still, hos­pi­tal re­fer­ral is cer­tainly not the best op­tion in the no­tunusual sit­u­a­tion where the GP just wants ad­vice as to what is best to do in any par­tic­u­lar sit­u­a­tion. And now, thanks to a mar­vel of com­mu­ni­ca­tion tech­nol­ogy pi­o­neered by the or­gan­i­sa­tion Con­sul­tants Con­nect, he or she can sim­ply call a num­ber that puts them through to a lo­cal panel of, for ex­am­ple, car­di­ol­o­gists or gy­nae­col­o­gists, which then “loops through” to find one who is avail­able to give ap­pro­pri­ate ad­vice – and all while the pa­tient is sit­ting there in the con­sult­ing room. Bril­liant!

In Es­sex, this sys­tem is claimed to have ob­vi­ated the need for nearly 2,500 peo­ple to at­tend hos­pi­tal – with the po­ten­tial to save the health ser­vice sub­stan­tial sums. Progress, in­deed.

Ahoy, they’re pi­rates!

The Sus­sex woman af­flicted, when sit­ting in her gar­den, by the bites of “a very tiny, black crea­ture” of such in­tense itch­i­ness as to pre­vent her sleep­ing, is most likely a vic­tim of the minute pi­rate bug. “I can vouch for it, since I was bit­ten by one yesterday,” writes a reader.

Black, flat, oval and scarcely vis­i­ble at one six­teenth of an inch long, these com­mon flower bugs have, ac­cord­ing to Dr Phil Nixon of the Univer­sity of Illi­nois, a “needle­like beak with pierc­ing mouth parts”, with which they pen­e­trate their non-hu­man prey (aphids and other gar­den pests) and suck out its juices. In­sect re­pel­lents do not de­ter them, and ap­par­ently the only pro­tec­tion is to keep most of the body cov­ered with longsleeved shirts and trousers.

A fur­ther pos­si­ble cul­prit, sug­gested by sev­eral, is the har­vest mite, ac­tive around this time of the year, whose lar­val stage is spent feed­ing on warm blood­ied an­i­mals such as our­selves.

They have the habit of crawl­ing around on the skin until their progress is im­peded (by, for ex­am­ple, elas­ti­cated cloth­ing), at which point they set­tle down to feed, in­ject­ing the di­ges­tive en­zymes that cause the in­tense itch­i­ness, be­fore suck­ing up the residue. The sev­eral com­mended an­ti­dotes in­clude Der­bac-m (as used against head lice), tea tree oil, TCP and com­mon house­hold vine­gar.

Itchy feel­ing: pi­rate bugs and har­vest mites are bug­ging read­ers

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