Misleading diagnoses in medical records
It is hard to imagine that until fairly recently patients had no right to access their own medical records. Family doctors were often reluctant to release them on the grounds this would generate unnecessary anxiety and increase the likelihood of litigation. Nowadays, thanks to the marvels of information technology, anyone can view them virtually instantaneously either online or via the free NHS app.
It is difficult to ascertain how useful this is but the cautionary tale of a retired social worker in her mid-sixties suggests it is worth people taking a look. She considers herself “fit and healthy” despite having had Type 1 insulin-dependent diabetes for almost 50 years. She was thus more than surprised to learn that she had two further alarming sounding conditions of which she was unaware: the practice nurse informed her that her notes recorded her as being at “high risk” of dementia and soon after a letter from the hospital specialist noted that she had Stage 3 kidney disease.
Bemused, she sought clarification from her family doctor who acknowledged she did not have kidney disease – the mistaken diagnosis had arisen from a single abnormal blood test result. As for dementia, he told her that being diabetic she was at increased risk of a stroke that could result in cognitive impairment. She could be at risk of any number of things, she replied, but these were not all listed in her notes “just in case”. He agreed to remove both diagnoses from her notes. So what is going on here?
This takes us back to the regrettable decision to link GPS’ remuneration to their success in hitting “targets” including the numbers of patients on their list diagnosed with a range of conditions – “raised” blood pressure and cholesterol obviously but also diabetes, asthma, kidney disease and dementia. Financially incentivised in this way, a single abnormal result was reason enough to label someone as having chronic kidney disease while subjecting unsuspecting elderly patients to a battery of psychological questions and tests which could ostensibly identify those with “borderline” dementia. This attracted an additional fee of £55.
These two targets were clearly indefensible – the target for dementia was eventually dropped and for kidney disease, it was greatly modified. But their legacy endures as misdiagnoses in the medical records with all their misleading and worrisome implications.
Getting a good night’s sleep
“Sleep hath its own world” wrote Lord Byron – and indeed, its restorative properties, despite much scientific scrutiny, remain deeply mysterious. Adding to the puzzle, the largest ever study of this altered state of consciousness – monitoring the sleep of 100,000 people over half a million nights – has shown the patterns to be very diverse. There are, it turns out, nine distinct categories including “long” and “short” sleepers, early risers and night owls, siesta takers and nappers.
The patterns of insomnia are similarly varied but irrespective of the type, the insomniac’s misfortune is its tendency to be selfperpetuating – where apprehension about sleeping poorly increases the level of physiological and psychological arousal. Hence the deserved popularity of sleeping pills such as temazepam and zopiclone that by almost guaranteeing a good night’s sleep neutralises the fear of not sleeping.
These drugs have fallen out of favour in recent years because of the twin perils of habituation (becoming less effective with time) and “rebound” insomnia on discontinuing them. But taken intermittently they can be a great boon – indeed some report the reassurance of just having a pill in the bedside drawer that can be taken if required is sufficient to allow them to sleep through the night.
Down’s syndrome support
Finally, further to the heartening story of the truly astonishing improvements in the quality of life of those born with Down’s syndrome, the Lejeune Clinic (named after the French physician Jerome Lejeune who first identified the genetic cause back in 1958) has for almost 30 years been providing specialist assessment and therapy for this previously neglected group of children. It now runs, inter alia, monthly sessions for babies and toddlers led by trained speech and occupational therapists as well as advising parents on specific problems they might encounter. Full details can be found on their website (lejeuneclinic.com).