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GPs 'lose track of patients at risk by Rebecca Smith [Daily Telegraph- Medical Editor-December 5-2007]
GPs 'lose track of patients at risk
MILLIONS of patients with heart disease and diabetes are at risk because GPs are failing to monitor their health properly , a health watchdog said yesterday.
Family doctors in half the 152 primary care trust areas do not have up-to-date registers of people with such long term conditions. The registers should be used to recall patients at regular intervals for vital check-ups. the Healthcare Commission's chief executive, Anna Walker, said that although patients may have registered as having a condition they were not being followed up and risked ending up in Accident and Emergency Departments. The State of Healthcare report said the NHS has some way to go before everyone received world class care and more must be done to tackle SUPERBUGS, improve DIGNITY and meet child protection obligations. Good management of long-term conditions by family doctors and others in primary care is essential if this is was to become a reality, it said. Problems with the NHS computer systems had caused difficulty in creating and maintaining the registers. Ms Walker said: Around 2,000 GP practices do not have registers in place. The REPORT also said that GPs did not measure obesity among 2.3 million patients may not be picking up signs of heart failure in some areas and the poor data on the levels of sexually transmitted diseases. A proportion of GP earnings is related to hitting targets on matters such as measuring blood pressure and recording cholesterol levels but these do not always tally with records held by the primary care trust that oversees practices in their area. Primary Care Trusts, which hold the majority of the NHS budget in order to purchase care from hospitals and the private sector for patients in their area, are often not up to scratch, the report said. Dr Lawrence Buckman Chairman of the British Medical Association's General practice Committee, said it may not always be appropriate to measure weight, especially if the patient has an unrelated problem. "Blaming just GPs for fewer diagnoses of heart disease is unfair as it is the responsibility of health professionals across the NHS to diagnose heart disease," He said: " The current scientific evidence also says that heart disease needs to be diagnosed with the use of an echocardiogram and that needs to be done in hospital. The proportion of primary care trusts scoring excellent or good on quality of services has dropped from a third to a quarter in the past year Around 60,000 people with serious long-term conditions are not being cared for by community matrons, and primary care trusts did not buy enough crisis services for people with mental health problems, the Commission said. The majority of trusts do not provide information to diabetics to keep them well he added.
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Instant test for a failing heart by Roger Dobson [Daily Mail-GOOD HEALTH-Tuesday November 6,2007]
A SIMPLE hand -held device that uses sound to detect the early signs of heart disease could dramatically speed up diagnosis. Its speed, simplicity, relative cheapness and ease of use - it can be used over clothing - means it could also be suitable for mass screening. Around 2.5 million men and women have some form of heart disease - it is the UK's biggest killer, responsible for more than 100,000 deaths each year. Heart problems can be electrical or mechanical. Electrical problems, such as heart rhythm disorders or arrhythmias, are diagnosed with electrocardiography or ECG, which measures the electrical activity of the HEART. The electrical impulses made while it is beating are recorded and shown on a piece of paper in the form of an electrocardiogram. Mechanical problems in the structure of the heart are picked up by ultrasound echocardiograms. These use sound waves to produce images of the heart and can be used to identify any abnormalities in the muscle and valves.
The problems with these diagnostic tools is that they are expensive and need highly -trained staff to use them. They are also time consuming for the patient. An ECG, for example , can take up to an hour. The new device is expected to cost just a few hundred pounds. It provides instant results and doesn't need a specialist to operate it - which means it could be used as a large-scale screening tool for detecting early, treatable signs of disease. The ViScope relies on phonocardiographic technology -it detects the sounds the HEART makes as it pumps blood. These are then compared to the sounds from a healthy heart to show up any problems. the sound of blood going through narrowed arteries, for instance, is different to the sound of blood going through healthy ones. It also displays the sound waves on a visual display unit which the operator can compare with the image from a healthy heart. It can also store data for later comparisons. A wide range of problems have distinctive sound fingerprints, including heart murmurs, value defects. stenosis or narrowing of blood vessels, and holes in the heart. The new device is about to be tested in a clinical trial in Melbourne, with 500 men and women -100 healthy people, 100 with risk factors for heart failure, and 300 with different types of heart failure. 'As there are many therapies available to prevent and treat this condition, it is believed that detecting it early will help reduce the burden of the disease and permit more effective treatment 'It gives both visual and audio information and that is going to be very useful, and makes screening for heart defects more feasible,' says Dr Chris Morley, consultant cardiologist at Bradford University Teaching Hospitals. 'When I was training, cardiologists made diagnoses on the basis of what they heard through a stethoscope. With the arrival of new technology like ultrasound we no longer relied on what we heard with the ear so skill levels have declined. 'But ultrasound is expensive and needs highly-trained operators and that makes it unsuitable for large scale screening. 'The decline in stethoscope skills means that screening for sound with a stethoscope is not possible either. This device is relatively inexpensive and makes up for the lack of those skills.' *
[Well! the question of the medical profession using or even having the equipment on view has been raised before as it appears that many in the profession no longer bother to connect the very useful nature of the equipment to the also calming effect it no doubt it projects from the doctor to the patient of that very professionalism which has been placed in jeopardy because of the displacement and hiving off of the duties of a doctor to others in the medical profession.] [Font Altered-Bolding & Underlining Used-Comments in Brackets]
PATIENTS AT RISK? [The article
above of the risks to patients by their not being
monitored by GPs is most timely as confirmed by our
own experience of a case study which began on the
29th October, 2007 and the lack of development as at
the 5th December, 2007. Doctor goes on holiday while
urgent drugs for heart patient were left in practice
dispensary had by his return been there for almost
three weeks. No letter-no phone call, and the
patients house only a matter of a minute away and
although the patient or his wife called each week to
the practice since seeing the Heart Specialist
neither were told that the drugs were available for
collection and this all happened in a time period of
five weeks. An early return visit in
approximately a week after the first visit to the
hospital to find out if there was a protocol system
in place brought the reply there was none but that a
letter had been sent to the doctor on 7th November,
2007 and on successive follow-up calls the answer
from the patients practice was that no letter had
yet been received from the Heart Specialist with the
detailed instructions for medication and treatment.
The Doctor a few days after his return at the time
of the appointment asked the patient why he did not
ask for an appointment earlier and that the Heart
Specialist had told the patient what the intended
medication and treatment was to be. The patient said that until the
doctor had received the letter with the details of
medication and treatment there would have been no
purpose in doing so as without the letter the doctor
would not know what to proscribe and hence the
weekly visit by the patient or wife to the practice.
They assumed that the successive visits to the surgery
to ask the question would get as far as the doctor
otherwise how would they be able to say that a
letter had been received. Surely, it would have made
more sense for the practice to notify the patient
when the information is to hand rather than leaving
it up to a stressed and untreated patient with
concerns of further ill health problems who had been
informed by the Heart Specialist of the need to get
things moving as he wished to see me again in four
months. The patient had nothing but praise
for the way the Consultant carried out the
examination and his professionalism and excellent manner and
sensitivity. His good work was undermined by a small
practice of two doctors and three other staff. The
Reception area was immediately alongside the
Dispensary so we are at a loss to find that though
the staff were only a few feet apart that they did
not talk together about a proscription that had not
been picked up for almost three weeks. This same practice over a year ago
refused to look at a 74 -year-old patient that had
been in a car crash only a few hundred yards away
from the practice when the patients car was struck
from the left broadside which resulted
in the patient suffering severe shock/trauma the
effects of which are still with the patient today.
He
had at the time been told to wait a few minutes but
a member of staff returned shortly after to say that
the patient should find his way to the A & E in
the town a few miles away. The whole matter shows no system
whatsoever in place. To leave it in the hands of a
patient to do all the running around-particularly a
HEART PATIENT shows how bad the NHS has become.
There should be a PASSPORT to HEALTH which
identifies the treatment and medication and which
has a time-scale in place to ensure that it is the
responsibility of the NHS to ensure that medication
and treatment are carried out with less stress to
the already ill patient particularly a HEART
PATIENT. But it is not only the local
doctor practice that fails to look after HEART
PATIENTS the local Hospital A& E are also
lackadaisical about the concerns of those with heart
problems particularly elderly persons who
inadvertently on taking their first dosage of a
medication recommended by a specialist and
emphasised the necessity of the regular taking of
that drug had taken a full daily dosage instead of
the three times a day and as it was stated on the
enclosed drug leaflet that an over dosage would
necessitate a visit to the doctor or hospital had
phoned the hospital and was told that it was
necessary to call in to A & E for a check-up. The pensioner on arriving at the
hospital was told that a nurse would see him
shortly. After 25 minutes and after an hour from
taking the overdose he became concerned because he
noticed that the waiting time was 2hrs 15 minutes.
He went back to the receptionist and mentioned his
concern that there appeared no priority for those
particularly with heart complaints to be seen
urgently and was told that he should return to his
seat and that a nurse would again see him. Shortly after returning to his
seat he noticed that another person had been
admitted to the attention of the nurse who the
waiting pensioner had been ensured that he was the
next to be seen. So the pensioner went back yet
again to the counter as a staff nurse came forward
with details and he immediately asked the nurse why
he had not been seen earlier in view of the fact
that he had taken an overdose -he was a heart
patient and elderly and that the nursing staff could
not know if the person to be seen was of greater
risk until seen by their staff. The staff nurse responded by
saying that the pensioner appeared in good heath
-had good facial colour and good breathing and not
of any immediate
danger. The pensioner then mentioned that he would
not have visited the hospital if he had been ensured
over the phone that he was in no danger and that as
they had no priority for those with heart conditions
and elderly and could not give a firm assurance that
he would be seen immediately and after the assurance
of good health from the nurse he would leave .He
then left the hospital and returned home. The Government a week ago talked
of giving priority to present and past members of the Armed Forces
when they were in need of treatment in the NHS and
they also gave an undertaking to improve the care of
HEART PATIENTS in general. The above instances
proves they have a long way to go before they have a
world-class HEALTH SERVICE instead of as indicated
last week is possibly nearer THE WORST HEALTH
SERVICE in Europe or possibly even in the WORLD at
large. How it was possible for the
hospital to have no clear policy to cover the events
outlined above knowing where it treated with no
urgency a case of over-dosage they not knowing at
the time of arrival the health of the the HEART
PATIENT particularly the elderly at the time is
staggering as instead of the patient above who
survived the ordeal there will be a case in the
future where the prognosis is most deadly and any
delay could result in a loss of life. We are informed in an article
(Daily Mail-November 29,2007) that blunders in
hospitals are linked to 90,000 patient deaths
a year. Among the problems identified
are: hospital acquired infections
such as MRSA complications during or after
surgery wrong diagnosis 20,000 patients a year die
from blood clots after operations pressure ulcers drug complications falls unplanned transfers to
operating theatre and intensive care unplanned readmissions. *
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