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August 27, 2007

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Peter D

Hi Paul

I am delighted you are a back bencher and not a government minister. At
least you can speak your mind.

I was interested to see your relay of the article on medical prescribing
practises. I too believe that over-prescription is prevalent. I also know
of people who have repeat prescriptions and keep filling up their cupboards
with medicines which will go out of date. What a waste. I believe a large
proportion of doctors are conscientious and prescribe only when needed.
Others prescribe under pressure from patients to be given something, or from
poor diagnostical ability or deficient knowledge. Then the patient is
prescribed more medicines to counteract the side effects of the first.
Within a year, they are on 16 tablets a day. They go into hospital and the
first thing a competent consultant does is to remove prescription of half of
the tablets saying the patient should not be taking them and, worse still,
may be causing their illness.

Whilst I strongly support the morality of the NHS being free to the customer
at the point of need, I can't help thinking that, had they to pay the full
price of medication, less waste would occur. We can't have that, of course,
as the poor would suffer. However, ultimately we all pay but have,
individually, no way of ensuring value for money.

In my experience, and worse still, some doctors are incompetent, and
persistently diagnose incorrectly and, as a result, prescribe wrongly and
dangerously. My wife was diagnosed by a call-out doctor with a pulled
muscle in the back, and told to take pain killers, when the symptoms
indicated pluresy and pneumonia which I diagnosed myself (the nature and
position of the pain and blood in the sputum). A telephone call by me to
the normal practise doctor the following morning, produced an immediate
antibiotic prescription (without his seeing the patient) with instructions
for it to be adminstered immediately.

At the moment, the reward is on throughput statistics management. (What you
measure is what you get). Rather than managing statistics, there should be
greater focus on managing doctors. There will always be incompetent
doctors, but their incompetence is more serious in its result than an
incompetent plumber or builder (whom one would report to trading standards).
I don't know what the appraisal process is within the health service but it
should be focussed on prevention of illness, early diagnosis, outcomes, best
practices and the positve contribution of individuals to this.

Incompetent doctors should be treated respectfully but not promoted beyond
the level of their incompetence. In the extreme, they should be encouraged
to do some other job not involving life and death.

With that, I step down from my soap box!

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