Friday, 21 December 2012

"Call for rethink over older cancer patients"

So trumpets  the BBC in yet another side swipe for the poor old GP. Listening to Radio 4 this morning I hear a representative from MacMillan discuss cancer treatment for elderly people. It is suggested that more assessments should be made to determine the suitability of treatment for elderly people so as not to inappropriately treat some nor unthinkingly deprive others of treatment.

I sometimes wonder what I have been doing for the last 30 years. I've been privileged to remain in one practice through all that time and have consequently grown old with my patients. I think by now I should be in a fairly good position to help patients (and their relatives) whom I've known for much of that time, make decisions when faced with serious illness. But apparently no, there needs to be more assessments.

So can a nurse or social worker or junior/senior doctor, apply some proforma to a patient whom they have never met, or perhaps met once or twice, and come up with the 'right' answer with regards treatment? It seems to me that it takes courage to decide not to have active treatment when faced by cancer. And yet this often proves to be the most suitable approach,  even when there is a possible gain  of weeks or months, since much of that time may be occupied by debility from the effects of the treatment. Knowing a patient well really adds to the potential usefulness of the decision, to either go for treatemt or not, and who frankly may not be helped by an unknown professinal completing a mere proforma.

Such check lists and proforma have not served the NHS well. Hence the person who rings NHS direct with chest pain and receives a 999 ambulance irrespective of the fact that it is a 26 year who has been showing off in the gym working his pectorals too hard and has consequently got sme muscle soreness.

We are suffocating in a world of check lists and proformas.
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