Wednesday, September 23, 2009

One in six NHS patients 'misdiagnosed'

As many as one in six patients treated in NHS hospitals and GPs’ surgeries is being misdiagnosed, experts have warned. Doctors were making mistakes in up to 15 per cent of cases because they were too quick to judge patients’ symptoms, they said, while others were reluctant to ask more senior colleagues for help.

While in most cases the misdiagnosis did not result in the patient suffering serious harm, a sizeable number of the millions of NHS patients were likely to suffer significant health problems as a result, according to figures. It was said that the number of misdiagnoses was “just the tip of the iceberg”, with many people still reluctant to report mistakes by their doctors. There was a call for better reporting methods to ensure that each misdiagnosis was recorded and monitored properly.

Prof Graham Neale, of the Imperial Centre for Patient Safety and Service Quality at Imperial College London, who is carrying out research into cases of misdiagnosis in the NHS, said it was a problem that was not being adequately dealt with. “There is absolutely no doubt that this is being under-reported,” he said. “But more importantly they are not being adequately analysed. “Trainee doctors are too quick to judgment, that is one of the problems that we face.” He added, however, that in many cases, the medical errors were rectified within 48 hours.

The experts drew on research published in the American Journal of Medicine that estimated that up to 15 per cent of all medical cases in developed countries were misdiagnosed.

Earlier this year, the Healthcare Commission found that missed or wrong diagnoses were a major cause of complaints to the NHS. Of more than 9,000 complaints analysed, almost one in 10 related to a delay in diagnosis or the wrong diagnosis being made. Separate research also suggested that one in 10 patients in hospital was harmed because of the care they received.

Peter Walsh, the chief executive of Action Against Medical Accidents, a campaign group, said his charity received 4,000 calls a year from people who thought that their condition had been misdiagnosed. “This is just the tip of the iceberg,” he said. “There is no mandatory reporting of missed diagnoses so the true scale cannot be known. “There are very few reports to the National Patient Safety Agency (NPSA) and we would like to see it become a legal requirement for all missed diagnoses to be reported.”

Dr Robert Hendry, head of medical services at the Medical Protection Society, said misdiagnosis was a factor in two thirds of complaints against GPs. “It’s a very significant problem for the NHS,” he said. The NPSA runs a database that records medical errors, patient incidents, mistakes in medical notes and near-misses on a voluntary basis. Between April 2008 and March 2009 there were 39,500 reports of incidents involving clinical assessment. Those included missed or wrong diagnosis but also related to scans that could have been misinterpreted or where the wrong body part was scanned or tests where patients’ samples could have been mixed up.

Dr Kevin Cleary, the medical director of the NPSA, said there were a number of reasons that a diagnosis could be missed or be inaccurate, including a lack of training, test results that were misinterpreted, poor communication and diseases that had similar symptoms. “Missed diagnosis is one of the most complex issues in medical reporting,” he said. “There are some illnesses, like flu for example, where the symptoms for a number of conditions are very similar, especially early on, so it is not always possible to make a diagnosis immediately.”

A spokesman for the Department of Health said more than one million “patient safety incidents” were reported every year, the vast majority of which caused patients no harm. “We are examining a move to obliging the NHS as a whole to report to the National reporting and learning system run by National Patient Safety Agency,” the spokesman said. “The NHS already collects data on safety incidents including misdiagnoses through the National Patient Safety Agency's reporting system and uses this data to learn from incidents."


NHS farms surgery out to cowboy private operators

They were trying to get a cheap deal by bypassing the established private hospitals and a cheap deal they got -- not so cheap in the long run, though

People having hip replacements at private treatment centres brought in to cut waiting times are up to 20 times more likely to need painful and expensive repair work. Many operations are having to be redone in NHS hospitals, at great cost and with serious staffing implications for the health service.

A study by orthopaedic surgeons in Cardiff found that of 113 hip operations on patients sent from their NHS trust to Weston-super-Mare NHS Treatment Centre between 2004 and 2006, two thirds showed clear evidence of poor surgical technique, such as poor cementing of the hip. In the three years since the operation, 18 per cent had undergone revision or were awaiting an operation — 20 times the 0.9 per cent NHS-wide revision rate at three years. A study on knee operations at the unit, conducted earlier this year, recorded a tenfold increase in revision rates.

Since the Independent Sector Treatment Centre (ISTC) programme was introduced in 2003, dozens of centres have been set up, mainly conducting orthopaedic surgery, cataracts and diagnostic screening. A total of 44 are described as NHS centres — though they are often staffed by independent sector contracts — and 23 are provided by private companies.

Leading surgeons said that this new data underlined the need for a significent overhaul of the multimillion-pound programme, which was introduced with great fanfare by the Government to reduce waiting times and increase patient choice.

They said a total lack of supervision of the sector and its clinical outcomes was a dereliction of duty by the Government, which had put a premium on reducing numbers rather than patient care. Early concerns about poorly vetted overseas doctors carrying out the work had not been addressed, they said.

The Cardiff study, published in the Journal of Bone and Joint Surgery, offers the most compelling evidence to date of problems with care in the sector, and the lack of proper auditing.Surgeons told The Times that the data backed anecdotal reports from elsewhere in the country, although it was likely to be at the high end. They said that NHS trusts were being left to manage the extra workload created.

While a hip replacement costs £6,000, the more complex repair operations, with more expensive implants, bone grafts and longer hospital stays, cost between £10,000 and £15,000. In an accompanying editorial in the journal, Fares Haddad, a consultant orthopaedic surgeon based at University College Hospital, London, says that the whole programme is in jeopardy because of the lack proper audit and follow-up. He adds that were such performance data available — and even if revision rates were lower — it would still “make the economic argument for ISTCs untenable”.

Mr Haddad told The Times that the disruption caused by the errors had an acute impact on hospitals, budgets and patients. He said that a revision rate of 3 per cent would still be unacceptable as it was “200 per cent greater than the NHS norm”, and even more so given that most treatment centres were sent the easier orthopaedic cases. “We all want to cut waiting lists and give excellent care to patients,” he said. “But this was introduced without data to show that it worked. We are now seeing the studies to show that.

“We have all had work increased by this, and the cost implications are huge too. Revision work costs two or three times the cost of a primary replacement. What is more, the failure of a joint replacement is often worse than the arthritis that led to the original operation. Mr Haddad added that if it were compulsory to register every operation on the National Joint Registry, trends would quickly emerge. “We would start picking up on those that were failing,” he said.

Tony Hui, chairman of the British Orthopaedic Directors Society, which represents heads of NHS orthopaedic departments, said that care in his area of South Teesside had also been affected. “We are seeing patients that have been treated elsewhere and they have problems and end up back at the NHS. The work has been suboptimal, and we have to do the revision which is time consuming, risky and expensive. With each case that comes along it’s another half day of operating — which could be two other patients.”

Steve Cannon, a surgeon at the Royal National Orthopaedic Hospital, Stanmore, northwest London, said the scheme had been about “speed of getting through the numbers” and was an “iniquitous waste of money”.

David Worskett, director of NHS Partners Network, which represents independent providers, said that the sector was being unfairly portrayed by surgeons and many were offering care of an excellent standard. He said that he could not comment on the case of Weston-super-Mare because, although private provision of care was involved, it was organised by the NHS.


Obamacare Preys on the Young, Flouts the Constitution

Ask the Obama administration why it is pushing legislation to conscript the young, and it will likely deny doing any such thing. But how else to describe individual mandates, the latest twist in the White House's nationalized health care scheme?

It's bad enough that the federal government is expanding its own power in telling citizens that they absolutely must pay for health insurance, like it or not. The most sinister element is that politically unpopular tax increases can be delayed or minimized by taking healthy young people and shoehorning them into a massive entitlement system. The youngest taxpayers would have to swallow their mandated insurance like bad medicine.

We've seen this movie before with Social Security, which has been in a perpetual state of crisis for years and for President George W. Bush became the third rail of politics. Why would Congress want to impose another similarly disastrous scheme on the American people? Probably because it's the only way to ensure the support of special interests in the pursuit of universal health care. Forcing everyone to purchase insurance from government-approved plans would be a boon for the industry: It's not so much guaranteed coverage as it is guaranteed profits.

Too bad for Democrats, there's a higher authority than America's Health Insurance Plans -- the U.S. Constitution. David B. Rivkin Jr. and Lee A. Casey wrote in the Wall Street Journal on Friday that constitutional limitations on congressional power prohibit Sen. Max Baucus, D-Mont.'s, most recent plan.

If the legislative branch wants to remake or reform the health care industry, it must do so according to the Commerce Clause. Regulation can occur only when activities are shown to substantially affect interstate commerce. And charging people to opt out of a federal imposition is mere euphemism for regulating every American into performing what the government wants him to do. With that precedent set, "Congress could evade all constitutional limits by 'taxing' anyone who doesn't follow an order of any kind."

Not that Americans are counting on Democrats to follow the rules anyway. The financial crisis has seen to it that politicians will stop at no law, no limitation on power, to look like they're solving problems. It's only natural when they don't think the American people can solve their own.


ALG Slams Baucus Bill as "Socialized Medicine in Trick or Treat Garb"

Americans for Limited Government President Bill Wilson today slammed Senator Max Baucus’ “chairman’s mark” on the Senate Finance Committee’s version of the “ObamaCare” proposal as “just another means to the end—socialized medicine in trick or treat garb.” Baucus sought to create a plan without the so-called “public option” as a means of garnering support for health care legislation that could pass this year. Wilson said it doesn’t matter.

“This is still a government takeover of the health care industry,” Wilson said. “The proposal creates government-run ‘co-ops’ to administer care in place of private options. It still sets up a rationing board. It still forces Americans to be insured or else pay a fine. It still does nothing to allow Americans to purchase insurance across state lines. It still expands Medicaid. It still increases taxes. It still has no tort reform. And it still adds to an already unsustainable debt.”

“It may move a little slower toward the goal of a single-payer system, but there is no question that under the Baucus proposal, Americans would be tricked into getting a treat that would crush our health care industry,” Wilson added.

Wilson said the proposal would ultimately result in Americans “being forced off of their current health care plans—which are excellent—and into a government-regulated co-ops that will drastically increase in costs since insurance policies will no longer be based on individual risk.”

Wilson pointed to provisions that force insurers to take on riskier patients without charging more for the premiums. “As a result, the associated risk costs will be passed on to everybody, distributed throughout the system, which means rates will go up. At the same time the quality of everyone’s coverage will be watered down to pay for the uninsurables. And individuals will have no choice but to buy the plans per the mandate.”

Wilson said that the system would not be pay for itself, and would lead to greater taxpayer-subsidized health care. “To make up for the inevitable shortfalls and deficits that will be endemic throughout the system, taxes under the plan will be raised on businesses and individuals.”

The Baucus bill is said insure an additional 26 million individuals that Wilson says could cost as much as $1.22 trillion over ten years. The average cost for an insurance premium is $4,700, according to the National Coalition on Health Care. “That’s about $122 billion extra every year we don’t have. That’s on top of ‘stimulus’ and TARP and all the rest of Barack Obama’s record-setting $1.85 trillion deficit. Under the Baucus proposal, the American people will be dealt yet another unsustainable entitlement that over time will totally consume the public treasury,” Wilson said.

Wilson credited concerned citizen efforts nationwide, including ALG’s 400,000 member activists, who have called, emailed, wrote letters to, and visited with Congressmen at their offices and town hall meetings for persuading many elected officials to vote against the bill. He said public opposition to the bill “is the only reason lawmakers are now considering removing the public ‘option.’ Only, the American people still do not want the total destruction of private health care now being proposed.”

According to Rasmussen Reports, 56 percent of voters now oppose the plan. And Barack Obama’s public disapproval has sunk to the 52 percent mark for the first time in his term.

“Harry Reid still doesn’t have the 60 votes needed in the Senate for cloture on the so-called ‘public option,’ and so Senate Democrats have begun watering down their proposal. Really, this is the beginning of the end—they are fleeing for the lifeboats on a political Titantic. Nobody wants to be left without a seat,” Wilson concluded.


ObamaCare’s Smoke and Mirrors: Huge Costs Paid for by Imaginary Savings

Obama’s health care plan uses imaginary savings to finance massive new spending. His claim that it will not increase the deficit is based on the notion that he can squeeze $2 trillion in savings out of the current health care system to finance his plan’s huge costs.

Washington Post columnist Charles Krauthammer, who once practiced medicine, points out in his column that these savings aren’t real, and that politicians falsely promise to pay for new programs through imaginary savings all the time:

“Obama said he would largely solve the insoluble cost problem of ObamaCare by eliminating ‘hundreds of billions of dollars in waste and fraud’ from Medicare. . . .That’s just an insult to our intelligence. Waste, fraud and abuse as the all-purpose piggy bank for budget savings has been a joke since Jimmy Carter first used it in 1977. Moreover, if half a trillion is waiting to be squeezed painlessly out of Medicare, why wait for health-care reform? If, as Obama repeatedly insists, Medicare overspending is breaking the budget, why hasn’t he gotten started on the painless billions in ‘waste and fraud’ savings?”

Even staunch Democrats admit the president’s claims are questionable. Tennessee Governor Phil Bredesen (D) is criticizing Obama’s health care plan as “the mother of all unfunded mandates,” saying it will force states to massively raise taxes or run big deficits. Earlier, one of Obama’s own economic advisers said his health care plan would explode the federal budget deficit and lead to “crippling deficits” and “higher taxes.”

The Associated Press said Obama’s proposals would “would drive up the deficit by billions of dollars.” The Washington Post, which hasn’t endorsed a Republican for president since 1952, noted that “the expanded coverage would add more than $1 trillion to the deficit.”


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