Monday, 14 December 2009

Tales from the Outpatient Gulag – an update on current “world-class” cancer care in the UK.

Earlier this year we wrote about our experiences regarding cancer care in the UK NHS for an older relative.

The surgery was a success and so was the reconstruction needed for our relative and they were very pleased. They were particularly impressed by the consultant who did a whole day’s work and had almost got home when a complication set in and they returned for another working day, this time in the evening and early hours to ensure a successful outcome. The following day they spent another 6 hours in theatre in ensure a successful outcome not just one consultant but two both surgeons.

Unfortunately in the recent past our relative has developed pain in one of their limbs which might, or might not, be due to a possible recurrence.

For those of us with the benefit of a first world education the investigation of this pain would have been simple and would have required initially 2 different types of scan of 3 different areas of the body in order to determine any possible cause and determine treatment.

However UK healthcare is no longer world-class it is “world-class” a throw away expression beloved of NHS managers and politicians to try and convince the public that crap care is something else other than crap. In this instance a world-class healthcare system would have done 3 scans in a morning seen the consultant with the results and sorted out a treatment plan based on the results. Simple.

Now the NHS does not do simple but it does do bureaucratic, institutionalized incompetence par excellence so how many scans do you think our relative had and how long did it take to get them? Have a guess.

Well in the end it was a total of 6 scans instead of 3 in a morning spread over 6 weeks. Of the 6 only 3 were actually needed the other three were “mistakes”.

No doubt the local Thickerazzi will say well you got scans what more do you want?
The right ones, quickly, perhaps?

Of course not comrade, the “market” will not allow such over production. One tractor per week is your lot comrade. Take it or leave it.

This is the response of the ignorant who know nothing of medicine until it affects them. Those of us with the misfortune to having been using the relevant scans 25+ years ago expect people in the 21st century to be using them better than they were then but having scanners is not the same as having the ability to use them properly.

The results (eventually) suggested the clinical diagnosis (which is that of doctors based on history and examination alone) that there was a recurrence. The recommendation was for further chemotherapy something our relative dreaded. Two options were outlined one less aggressive the other more so. If you have ever had the misfortune to have had chemotherapy then less is better so this was opted for.

By now our relative had had enough of “world-class” care and transferred to a local teaching hospital, still relatively in the Dark Ages, and their scans were seen and a further scan PET (Positron Emission Tomography) scan suggested.

This type of scan has been available in some of the more forward thinking teaching hospitals in the UK but not in Northernshire until recently. In the same way that consultants with a first world training would ship patients 30 years ago down South of Northernshire to get CT and MRI scans today’s first world graduates struggle to do the same.

Our relative was greatly impressed with their PET scan for they were treated as a human being for the first time in weeks at a private installation but paid for by the NHS with the only wait being a weekend (by chance only). One scan was requested and only one scan done.

Now remember dear reader the diagnostic delays due to more scans than needed equalled weeks of delay and uncertainty (did we mention pain and fear as well?) and on the advice of the oncologists our elderly relative wanted to go to a social gathering which they felt was OK and so the chemotherapy was differed for a further week or so.

Unfortunately the sudden development of the inability to properly move a limb revised all these plans considerably. The tumour had invaded the nerves that supplied this limb and reduced its usefulness considerably. The oncologists were contacted, seen the next working day and IV chemo was now considered more appropriate.

Praise be to the Party for dumbing down medicine to the point that even local consultants cannot logically determine how to scan a cancer patient and for the systemic incompetence that means 3 scans in a morning equals 6 scans in as many weeks. Still our relative lives in a “world-class” PCT so should expect, and get, no more than this.

And they did.

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