Monday, 5 January 2015

Do No Harm .....

It appears the book that is lighting up the London movers and shakers over the New Year is 'Do No Harm' written by retired neurosurgeon Henry Marsh. It has taken a grip of the cognoscente because it is even handed in kicking Westminster, NHS, Patient Lobby Group and BMA politicians in equal measure when assessing just what is going wrong with the NHS in England while asking a serious question about all parties insistence on medical or surgical intervention at every turn - based, in Mr Marsh's view, largely in self interest and not patient benefit.

In the 1970's, prior to qualifying, I read a book called 'Surgical Dilemmas' (now out of print) which asked the serious question of when were surgical or medical interventions to be undertaken. The main direction of this book was decisions should only be made after looking at the patient's long term benefit from the proposed intervention. It was the starting point for what is now known as evidenced based medicine and invited all involved to look at the actual impact on patients of any intervention undertaken. It questioned whether it was right to intervene simply because we could. As a trainee oral surgeon the first question raised in my mind was why were so many symptom free 'wisdom teeth' being extracted - often with high levels of associated muscle, joint and bone trauma leading to long term, chronic joint pain. The clinical evidence of unextracted, non symptomatic wisdom teeth leading to future clinical problems was slight and mostly anecdotal. The claim that unextracted wisdom teeth increased the likelihood of a nasty form of oral cancer (ameloblastoma) did not stand any serious scrutiny. Yet the idea that wisdom teeth are nothing but trouble is so entrenched in the dental profession and the UK public's mind that they are still extracted willy-nilly in spite of the clinical evidence more chronic, long term damage is caused to the jaw joint by doing so, for no real clinical or patient benefit.

Mr Marsh went through a similar conversion in the course of his neurological surgical practice. This is an area of surgery which is best compared to 'bomb disposal' because the slightest miscalculation or error leaves you with a severely brain damaged  or dead patient - in many cases for the patient and their relatives the latter situation is the better option. As his skills and knowledge increased he began to ask himself the important questions when he undertook surgery - just exactly for whose benefit is this surgery being carried out?

The answer's routinely troubled him as the decision to undertake surgery were often as a result from emotive pressure from relatives either on him as a surgeon or on the patient, 'to do something' no matter how risky and potentially fatal the surgery could be. As he reviewed the cases that had failed, leaving patients either dead or in near vegetative states, he changed his clinical approach, his philosophy on patient selection criteria now started with the imperative of first and foremost, 'Do No Harm'.

In these days, with NHS in England on the verge of collapse, this would be a very sensible mantra on the part of the all the vested interested groups, currently seeking their pound of flesh from the NHS, to put first as they spray a machine gun style, rattle of ideas around about how best to preserve the NHS in general. 'Do No Harm' is as good a place to start as any other; sadly, in a general election year, we will simply hear UK politicians saying what they think people want to hear, what their financial backers need to hear, no matter the damage their utterances will cause to the provision of NHS care nor the long term damage to the NHS they will inevitably bring.

They do not seem to understand, what Mr Marsh is trying to explain to them, they are dealing with a ticking NHS time bomb to which repetitive blows with a sledgehammer are not a wise approach and which will inevitably reduce the NHS to a 'vegetative state', if not kill it.

The question which needs to be asked of both the red and blue Tory Parties seeking to get their butts into Downing Street and their hands ever deeper in the taxpayer's pocket when pronouncing on the NHS in general over the next five months is:

"Just exactly for whose benefit are these further changes in the NHS being carried out?"

1 comment:

  1. Well I reckon looking at members interest that it is in theirs.