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Manoj Krishna Blog

IS THE LITIGATION CULTURE GOING TO DESTROY THE NHS AND BACKFIRE ON US ALL?

A friend told me today that as he was driving down to work he heard an advert on the radio. It was asking patients if they had had an operation and if they were disappointed. It went on to say the lawyers could get them compensation, even if all the risks were discussed with them. Some people listening to advert this might think all patients have a right to sue their doctors if something goes wrong.
I heard a presentation on this today and was so surprised to learn that the lawyer’s fees on both sides are more than half of what the patient gets. A lot of lawyers are getting really rich as a result. Good for them. They have spotted an opportunity and gone for it.
The NHS Litigation authority website states that as of March 2014 their potential liabilities were £26.1 billion! Each hospital trust has to pay several million pounds from its budget every year to the NHS litigation authority. This is money that could of course be also used for improving patient care. If we could find a way of taking the money we as tax payers pay the lawyers and put that into patient care, we would transform the NHS for the better.
A dentist I went to see recently showed me a magazine with an advert from a legal firm asking patients if they were less than happy with their dental care and promising them compensation. In the same magazine was an advert from another firm of lawyers asking if patients were happy with the money they received from litigation and they could help them sue their lawyers and get them more compensation.
There is another effect all this growing litigation is having – one that is beyond the cost and should worry us all. It is changing the way doctors think and how they treat patients. I have spoken to many doctors who say their practise is becoming more defensive. As a result many doctors are shying away from treating patients with complex problems or those where outcomes are uncertain. We may also be ordering many more investigations than are necessary. Some experienced doctors I know are leaving the profession altogether, unwilling to live with the risk of constant litigation while trying to do the best for their patients.
As a middle aged man, getting older, I worry that this growing culture of litigation in the country is going to affect the care I get when I need it most. We should all worry.
Is there a way around this problem? As a society we all need to accept that medicine is not an infallible business, and mistakes will happen. If a procedure does not go the way I would have liked, and I was told about all the risks, I should not be able to sue my doctor. We need to get help and compensation to those who have genuinely come to harm and do it in a way that is inexpensive, and quick and still allows doctors to risk being brave and go and bat for us without the worry of being sued each time. I am sure a way can be found, if we all put our heads together.

EBOLA- World Health Organisation(WHO) ‘ Very concerned’

Ebola, a virus that is found in fruit bats has killed more than 2000 people in West Africa and is spreading. There are more than 500 cases per week and mortality rates are high. There is no cure though some new drugs are being trialled. The WHO is very concerned about the outbreak. Hundreds of millions of dollars have been committed to combat it. International spread a huge worry in this age of global travel. The symptoms are fever, bleeding and nervous system damage. It is spread by bodily fluids. Could it spread to the UK? The simple answer is YES, and so we need to commit to containing it and treating the patients in West Africa.

SPINAL SUPPORT GROUP MEETING

The next spinal support group meeting will be held at the York Nuffield Hospital on October 4th at 10am. The meeting is free and patients with spinal problems and their relatives are welcome. The atmosphere is relaxed and informal. Here you can get a chance to speak to a specialist and also chat with patients who have completed treatment. Fear of treatment is a huge problem among back pain sufferers and most patients say they feel much better after attending the meeting.

UNIVERSITY AND THE ALCOHOL CULTURE

My son is off to University this week and I was reflecting on the huge culture of drinking alcohol that seems to pervade University life. They say it is a social lubricant but I often wonder why we need to dull our senses and our brain in order to enjoy ourselves. A 2011 survey found that students at Leeds, Liverpool and Cardiff Universities drank 26 units/week on average. If you factor in non-drinkers, the students who drink must have have consumed far more than that. That is far more than the recommended safe limit. 54% of students had missed a morning lecture because of drinking the night before and 59% experienced short term memory loss after a night on the town.

I have been looking at alcohol drinking limits and the latest advice. The current advice is that men should drink less than 21 units per week, and women 14 units per week. There should be 2-3 days of no drinking at all per week to allow the liver to recover. Men should have no more than 3-4 units per day and women 2-3 units per day. A pint of beer( 3-4%) is 2 units, a small glass of wine is 1.5 units and a measure of spirits( 35mls) is 1.5 units.

Some experts think these limits are too high. In Finland, the US and Holland the limit advised is 15 units/week for men because some experts think there is a link between even moderate levels of alcohol consumption and cancer. A study from Harvard suggested that even 3 drinks a week increased the risk of breast cancer by 15%.
People who drink excessively are at risk of liver failure, cancer( bowel, breast, head and neck), depression, loss of sexual libido, obesity, dementia, lack of sleep, heart disease and high blood pressure. It can also cause addiction.
Cardiologists talk about the benefit of red wine for protecting the heart- but that is only one unit per week.
A large glass of wine (250 mls) has 228 calories , so people who drink regularly are more likely to put on weight.
I know young people are under a lot of pressure to join the drinking culture and it is almost seen as a rite of passage.
It is not easy, but it is possible to not join the herd and only to have one or two drinks and still have fun.

DEATH AND POETRY

I am not sure what it is about death that makes me seek solace in poetry. Perhaps, because both are profoundly moving. I attended the funeral of a friend this week. He died suddenly from liver failure. It made me reflect on my own mortality. Life is short, and so unpredictable. We just have to live fully today and if we live well, perhaps we can enjoy the gift of life a little longer.
This poem by John Dryden summed it up for me:

Happy the man, and happy he alone,
He who can call today his own:
He who, secure within, can say,
Tomorrow do thy worst, for I have lived today.
Be fair or foul or rain or shine
The joys I have possessed, in spite of fate, are mine.
Not Heaven itself upon the past has power,
But what has been, has been, and I have had my hour

OBESITY INCREASES CANCER RISK

A recent study from the London School of Hygiene and Tropical Medicine has suggested that Obesity is linked to an increased risk of getting 10 different cancers. They studied 5 million adults – an enormous amount of work has gone into the study. We already knew there was a link between being overweight and risk of getting breast cancer for example- but this is largest study of its kind.
Each 15kg increased the risk of getting cancers of the uterus, gallbladder, kidney, cervix and blood.
Just being overweight increased the risk of getting cancers of the colon, liver, ovaries, and breast cancer after menopause.
If we needed another reason to exercise more, stay away from those chips and eat less- this study should be a wake-up call to us all.

A HEART WARMING STORY

In my 18 years of practise I’ve come across many remarkable patients who have battled adversity and come out on top- but perhaps none more so than Carolyn, who has given me permission to share her story with you. When I first saw her she had been in a wheelchair for 10 years, having had a previous discectomy and told nothing more could be done for her. She refused to give up and kept looking for a solution. She found me through a friend. Throughout this period she had kept working for Disability North. We found that she had compression of her spinal cord in her neck as well as a degenerate disc in her low back. She had 2 operations: a disc replacement in her neck and a spinal fusion in the low back. Her recovery was slow and she struggled to come off all the pain killers which she had become addicted to- it took her 18 months to do so. She also suffered from depression as she adapted to her new identity- no wheelchair and not disabled in any more. After surgery she discarded the wheelchair and moved on to crutches. I last saw her walking out of my clinic on crutches. You can imagine my astonishment and surprise when she emailed me a few weeks ago to say she had run the race for life, had little or no pain and was now training for the Great North Run.
She had continued to push herself, and was determined to get better. She said ‘ I have been cocooned for 20 years and now have my life back’. Patients like Carolyn inspire me to go to work every day, deal with all the challenges and find the courage, skill and wisdom to help sort people like Carolyn out.

To read Carolyn’s story select here.

NHS BEDS SHORTAGE

The OECD (Organisation for Economic Co-operation and Development) has published a report showing that Britain has 2.95 hospital beds per 1000 people, compared to 6.37 in France and 8.27 in Germany. The OECD average is about 4.5. On the one hand this means we have a cost effective system delivering great value for money. It also means the system is overstretched on occasion and ambulances have to queue to get patients into A&E, planned operating lists are cancelled, it is sometimes difficult to find a patient a bed and hospital bed managers have a really stressful job. Every winter the pressure on the system increases and there is no slack in it. As the population ages and the demands on the system increase the problem is going to increase. How are we going to cope? With the population static at 60 million, health care spending increased from £33.5 billion in 1997 to £110 billion in 2010/11.
How much more can we spend? Surely, more money cannot be the solution.

One solution is for the government to invest in disease prevention and to promote healthy lifestyles through media campaigns. All my GP colleagues say that people who live healthy lives hardly ever use the NHS system.

NEW NURSE STAFFING GUIDELINES WILL MAKE THE NHS BETTER

NICE, or the National Institute of Clinical Excellence is studying the issue of minimum staffing levels of nurses and doctors on our wards and is shortly to publish its report. It is speculated they will advise a minimum ratio of 1 nurse to every 8 patients on a ward. The issue has come to the forefront because one of the main causes of the problems at Mid-Staffordshire hospital was the lack of enough nurses on the ward.
This is a complex issue to get right because the type of patient and their needs determine what safe nursing levels are- and that changes and is hard to predict. On an orthopedic ward an elderly patient with a fracture neck of femur needs much more intensive nursing than a young man with a broken wrist. Predicting how many of each are going to get admitted is difficult. Staffing levels cannot be increased quickly in our current system and flexibility is lacking.
Even if hospitals wanted to hire more nurses, they are not easy to find. They also cost money which overstretched hospitals do not have.
It is however a step forward in the right direction to improve the quality of care in our hospitals.

CHRONIC PAIN THRESHOLDS MAY BE GENETIC

I’ve often wondered why my patients with a disc prolapse have so much variation in the pain they experience.
Research presented at the American Academy of Neurology suggests the answer may lie in our genes. Patients with high levels of pain were more likely to have the gene variant DRD2 and those with a low levels of pain the variant DRD1. In the future this may allow new treatments for chronic pain to be developed.