Scary Stuff You Should Know No 3

Dr Vernon Coleman

1. When Antoinette was given a prescription for a new drug, she asked if it would be safe to take with the tamoxifen she takes every day to protect her from her breast cancer. Only then did her GP bother to check. I am constantly appalled at how many doctors are ignorant about drug interactions and, indeed, drug side effects. There are some prescription drugs which will stop tamoxifen working. Doctors should always check that one drug won’t interact with another. Sadly, I fear most doctors and nurses don’t even recognise this danger.

2. A member of the medical establishment has said that in future only 1 in 20 young doctors intend to work full time in general practice. The other 19 will limit themselves to working one to three days a week. They will not, of course, work nights, weekends or bank holidays. This is allegedly because young doctors cannot cope with the workload and don’t think it is safe to work full time. I don’t think that’s true. I think young doctors want to work part time because they have worked out that by working less hours and earning less money they pay much less tax. Most importantly, the majority of young doctors are female who want to work part time so that they can also be Mums. This was always going to be a consequence of the long standing Government policy of training more female doctors than male doctors. If GPs insist on working an average of two days a week then the country will need to double or triple the number of doctors and since this is clearly an impossibility, the inevitable result will be that care assistants will be performing surgery and prescribing drugs. And before you scoff, let me remind you that Antoinette has breast cancer and that at her GPs surgery she has spent more time with health care assistants than with doctors or qualified nurses. As far as I am aware the only suggested requirement for health care assistants is that they should be able to read and write and be numerate. These are not, however, legal requirements so the health care assistant giving you a vital injection or taking a blood sample could well be illiterate and innumerate.

3. I discovered an old paper I had read but forgotten about. It is rather depressing and supports the conclusions I made in my book Paper Doctors (which was published in 1977). Entitled How evidence-based medicine (EBM) is failing due to biased trials and selective publication and published in the Journal of Evaluation in Clinical Practice, the paper is a damning one. Evidence-based medicine is defined as the ‘conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions’. In other words, the aim is to provide patients with care based on the best, most reliable and most appropriate knowledge. But it seems that although health care costs have continued to soar there is a lack of evidence to suggest that EBM has resulted in health gains for patients. The paper suggests that the potential for improving health care has been thwarted by bias in the choice of hypotheses tested, by the manipulation of study design and by selective publication. In other words, journals are only publishing research work which is helpful to drug companies. The research which criticises new products is never published. ‘Evidence for these flaws is clearest in industry-funded studies,’ say the authors, who argue that the indiscriminate acceptance of ‘evidence’ produced by drug companies is ‘akin to letting politicians count their own votes’. The authors also point out that most studies are funded by drug companies and that ‘clinical decisions based on such evidence are likely to be misinformed, with patients given less effective, harmful or more expensive treatments.’ The authors call for more independent research, and for the formation of more informed and independent bodies to assess the available research. And they suggest that research which is biased should be downgraded in value. This paper was published in 2014. Nothing has changed. I am not surprised. I expressed similar concerns back in 1977 in my book Paper Doctors.

4. In the old days the GP would take overall responsibility of patient care; acting like the conductor of an orchestra and helping the patient understand what everyone was doing and planning. That’s gone. The worse thing is that we get accustomed to bad service in the NHS, we expect it and feel pathetically grateful when we come across an oasis of comfort. I worry all the time about how we will deal with any problems which may develop in the future. How do we get care? There is no GP service now outside office hours and obtaining a GP appointment isn’t easy. The ambulance service appears to be falling apart and patients who go to the nearest Accident and Emergency department routinely spend four to nine hours waiting to be treated. Should we go abroad? Should we move to London where it would be possible to obtain private GP care and better private hospital care if needed? The unspoken truth is that the NHS is broken.

5. When GPs became part time administrators the whole health service was irreparably diminished. The problems with the ambulance service, the hospitals and, in particular, the Accident and Emergency services are all a result of the downgrading of the GP service. I wonder how many people die unnecessarily (alone and in pain) because GPs no longer provide a vaguely acceptable service. There is no little irony in the fact that Britain’s GPs are now among the best paid in the world. GPs now earn more than £115,000 a year if they work full time. Most now work part time to reduce their tax liabilities. This is one of the reasons why there are often three week queues to see a GP and in some practices patients have to wait up to nine weeks to see a doctor. Not surprisingly, many patients are booking appointments months ahead – just in case they need treatment. There is further irony in the fact that since the Labour Party allowed GPs to stop working at nights and weekends family doctors have seen their income risen sharply. There is something rather odd about the NHS allowing GPs to work much shorter hours and then paying them much bigger salaries.

6. The General Medical Council’s asinine, new rules mean that the UK has Europe’s second lowest number of doctors per population. The GMC has introduced daft rules which effectively mean that once a doctor chooses to retire he cannot work again. He cannot work part time, or do a little occasional locum work. The result is that thousands of experienced GPs who have chosen to retire have been removed from the workforce.

Copyright Vernon Coleman October 2021

Vernon Coleman’s international bestseller `How to stop your doctor killing you’ is available as a paperback and an eBook.