Ian Harris: "Surgery, the Ultimate Placebo"

[Jonathan Edwards]

How often do they see the patient after surgery? Once?

They often see them once to tell them how successful the operation was (without asking the patient if it was). But quite often that is delegated to junior staff. Long term follow up is rare.

 

[Arnie Pye]

But that is what I am saying. People do not take healthcare seriously enough to make sure they get a good deal. They insist on safe airline pilots and aeroplanes but don't seem interested if there are unnecessary deaths to go unnoticed in health care systems. Doctors are only untouchable if nobody else can be bothered to call them out.

I care very much about the quality of healthcare, because I find it so hard to get any.

Suppose a patient has been given various derogatory labels that have been on their records for decades. If the patient has always found it hard to get taken seriously with any health problem they could go in one of two ways - complain to doctors and risk putting the doctors' backs up and having even worse / even less medical treatment in the future, or patients could fear that, having been diagnosed as depressed in the past or ignored for decades the next step is sectioning the patient because they must be delusional. So they keep quiet.

Throughout most of my life, in the doctor/patient relationship the patient has had zero power and zero effective rights. I was already close to middle-age before patients had the legal right to access their medical records, so for most of my life I've had no ammunition at all with which to defend myself. When I did finally buy a copy of my GP records I was appalled at how many mistakes there were in it.

[Edit: I had foolishly assumed that medical records were accurate so when I was talking to doctors I assumed we were "on the same page" - but we most definitely weren't. If I tell a doctor that I have condition X - and I know this because a surgeon told me - if they then scowl at me, roll their eyes and pretend that I never said anything, and refuse to take me seriously, I always attributed this to sadism and malice. Because, in my mind, they must know, surely, that I'm telling the truth and they are ignoring everything I've said.]

And even in the very few instances where letters had been written by surgeons with correct information it had either been ignored in my GP records, or had been summarised incorrectly. I've corrected some of them but there were simply too many to deal with them all. And it doesn't appear to override the records that hospitals have access to. I still get scowled at when I go to A&E.

 

[Jonathan Edwards]

I care very much about the quality of healthcare, because I find it so hard to get any.

I agree; once people are ill they realise how important it is. But so often they are then not in a position to argue.

I think the point I am making is that none of us is in a position to buy a nuclear submarine or build an offshore wind farm but these things get done because the community as a whole thinks they are important. Unfortunately, the community as a whole seems to think healthcare is. so unimportant that the Public Health Laboratory Service was closed down and the store of PPE allowed to dwindle to nothing, hospitals allowed to cut bed numbers to dangerous levels even before the pandemic, to close fever hospitals....

I know very well that I am preaching to the converted but if over decades the medical profession is told 'just get on with it, don't bother us, and make as much money as you like if it keeps you quiet' then it is not so surprising that things are in a pretty mess I guess.

 

[Barry]

But that is what I am saying. People do not take healthcare seriously enough to make sure they get a good deal. They insist on safe airline pilots and aeroplanes but don't seem interested if there are unnecessary deaths to go unnoticed in health care systems. Doctors are only untouchable if nobody else can be bothered to call them out.

Is it that the medical establishment, even though there may be many components to it, still amounts to something of a closed shop? Whereas maybe with something like the airline industry there is more independent oversight? How independent are the bodies that regulate our health system and professionals?

 

[Jonathan Edwards]

Is it that the medical establishment, even though there may be many components to it, still amounts to something of a closed shop? Whereas maybe with something like the airline industry there is more independent oversight? How independent are the bodies that regulate our health system and professionals?

I suspect that quality control processes within the airline industry may be just as much internal. But if an airliner crashes there is public outcry and splashes all over the papers. If a similar number of people die each week through sloppy urology outpatient administration nobody even thinks about it. The question is why does nobody take an interest? The cancer death rates for the UK are abysmal in comparison to comparable countries. I don't know why nobody does anything. The decisions to close down the Public Health Service and cut back on hospital beds were not done by medics. It was done by the government.

There should have been outrage on all the media for the last year but it is only now after Christmas that television is showing people in extremis in hospital.

I don't actually think it is about medicine being a closed shop. Doctors are prevented from whistleblowing by being sacked on a regular basis. I was taken off committees whenever I started calling for difficult decisions to be made. It is the administration that keeps the lid on things.

 

[Graham]

I think this lack of follow-up is a crucial element in bad medical practice, and is why Jon's comment to the NICE committee about the ME clinics providing long-term support would actually prove to be a very strong force in our favour. Faced with the evident truth that few people recover from ME, and that little is done to help the majority, they would eventually have to push for more research.

It seems to be the quick-fix surgery or treatments that cause the most problems.

Or am I over-optimistic?

 

[TigerLilea]

I remember back in the 1980s that a boss of mine was finally able to convince his doctor to refer him for a tonsillectomy after having had repeated problems all his life (he was in his late 30s). His quality of life improved immensely after he was operated on (and so did his breath!).

I know of a few adults who eventually had their tonsils removed because of repeated episodes of Strep Throat.

 

[TigerLilea]

My wife viewed the knee arthhroscopy(?) with considerable suspicion for many years before the proof that it was worthless, simply by listening to patients a while after the operation. The same can be said of major sinus surgery.

Yet my mom was one of those people who had Arthroscopic knee surgery after nothing else worked and her knee has been good for years since then. She was on crutches and could barely walk before having the surgery.

 

[Hubris]

I suppose what dr. Edwards says makes sense - medicine has a lot of problems, but ultimately if society at large gave a damn things would be different.

 

[Barry]

I think this lack of follow-up is a crucial element in bad medical practice, and is why Jon's comment to the NICE committee about the ME clinics providing long-term support would actually prove to be a very strong force in our favour. Faced with the evident truth that few people recover from ME, and that little is done to help the majority, they would eventually have to push for more research.

It seems to be the quick-fix surgery or treatments that cause the most problems.

Or am I over-optimistic?

I agree. Ensuring good quality medical practice requires closed loop control of the process. Monitoring consequences of what comes out of the system, and feeding that back into the system via a control mechanism that aims to minimise deviations from what is required to be output. So in this case monitoring the consequences of medical care (including lack of medical care), and feeding that data back into the medical care "quality control" system, to adjust the medical care as necessary in order to maintain its required quality.

But closed loop control is, by definition, and ongoing strategy. If you stop feeding back vital output data to the "quality controller" on the input side, then there is nothing to stop the quality drifting, because nobody is doing anything about it. Similar applies if the "sampling interval" is too long; if the data is fed back too infrequently.

One then has to question where the breakdowns are in the feedback loop. Data not being collected? Collected but ignored? Collected and fed back, but control mechanism inadequate or non-existent? Etc. I suspect it is most of these things. Closed loop feedback for a short while, that then just melts away.

I also suspect it is not accidental. Whilst you don't collect the data (=> evidence in a sense), then it is possible for the powers that be to fall back on the usual cop-out "there is no evidence to suggest that ...", glibly skating past the fact that evidence is absent because no b*gger has bothered looking for any.