Hit-and-miss medical procedures rethink

Published date: 17 January 2014 |
Published by: Rhian Waller 
Read more articles by Rhian Waller  Email reporter


MARK Drakeford AM, Minister for Health and Social Services, yesterday announced the launch of “prudent” healthcare.

A list of procedures would be drawn up under the proposals to cut the use of ‘ineffective’ drugs  and instances of surgery in Wales.

Speaking at the Welsh NHS Confederation annual conference, the Minister said clinicians should focus on doing the minimum necessary to benefit the patient, pointing to the over-prescribing of antibiotics as an example of treatment which, in many cases, makes little difference to the patient and has contributed to a build up of resistance to the drugs.

He said: “Studies show  almost 20 per cent of what every modern health service does either does no good or does harm.

“Every health board has lists of procedures they don’t normally offer because they’re not effective. What I want is a national list so we do this on a national basis."

He said “prudent medicine” meant starting with the things proven most likely to work, only moving on when these fail.

Mr Drakeford singled out tonsillectomy procedures as well as the routine prescription of antibiotics and painkillers to those in chronic pain as in need of review.

But Tory shadow health spokesman and North Wales AM Darren Millar said the move amounted to “rationing”.

He said: “Patients should be entitled to timely treatment in accordance with their clinical needs and to suggest otherwise is very concerning.

“Rationing services and forcing patients to wait longer for treatment to help health boards meet their financial targets cannot be the answer to increasing demand.”

As Mr Drakeford suggests, medical practices with a questionable success record are not the sole preserve of the Welsh NHS – all modern medical systems, private or public, suffer from the problem.

However, just as with many illnesses, there are underlying causes for this.

Dr Peter Saul, of the Health Centre in Rhos, took the issue of prescribing pain relief.

He said: “Painkillers are overprescribed for a mix of reasons.

“You have ‘simple’ pain, such as when a patient breaks a leg, which can be easily treated.

“Then you have complex pain, such as nerve damage, and that’s more difficult to treat because we don’t fully understand it and there is no cure.

“The last time I checked, the waiting list for the pain clinic at the Wrexham Maelor was nine months.

“What are GPs supposed to do for the people who are waiting, in chronic pain? The only option is to prescribe painkillers.”

It is not the cost to the NHS, said Dr Saul, which is the sole problem when it comes being “prudent”.

He said: “Some painkillers are expensive, such as Pregabalin, which blocks the pain pathways. A month’s course probably costs about £60.

“But even when you’re using commonly prescribed, less expensive painkillers like codeine, which is a weak cousin to morphine, they can become addictive over the long-term. When that happens, it’s difficult to get patients off it.”

Minor surgical procedures and prescriptions of antibiotics also come with risks.

Diane Jones, 44, of Johnstown, had an invasive procedure last year and was prescribed three batches of antibiotics afterwards.

She said: “They were powerful antibiotics  prescribed over the phone. They were supposedly for an infection – but tests showed I didn’t have an infection at all.

“I ended up going into A&E because I felt unwell and the antibiotics had affected the lining of my digestive system. I ended up contracting C-Difficile (a bacteria that can be life-threatening and especially dangerous to people on antibiotics) and being put in isolation for seven days. It was horrible.

“I took the antibiotics because I’m not a doctor.”

Diane had no complaints about her treatment at the Maelor, saying staff were “fantastic”.

She was full of praise for both the nurses and her gynaecological consultant. She agrees the guidelines should be changed.

Jenny Cummings (formerly Jenny Norris), 28, of Nannerch, Flintshire, had an odd experience after her tonsil was removed.

She said: “I was five or six when it was done. I had recurring tonsillitis so I was having time off school every month. Back then, they’d just whip your tonsils out.

“I don’t really remember it much although it did hurt. I didn’t think about it for about 10 years.”

Then, when she was about 15, Jenny began to suffer from regular sore throats.

Originally suspecting laryngitis, a doctor told her she had tonsillitis.

She said: “I looked at my mum and we just went ‘well that isn’t possible’. Apparently, one of my tonsils had grown back.

“The whole thing was a bit pointless.”

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