Friday, December 04, 2009

GP appointment times too short in Britain

And this comes from supporters of the NHS, not critics. Most British GPs are employed by the NHS, which sets "targets" for them

The rise in obesity and an increasingly ageing population means the average 10-minute slot is not long enough, according to Dr Hamish Meldrum, chairman of the British Medical Association (BMA). Launching the BMA's general election 'manifesto', Dr Meldrum said: "With people living longer, and being more likely to suffer from comorbidities, the sort of work that GPs are doing is increasingly complex, and the standard 10 minute appointment is not sufficient. "We would like to see 15 to 20-minute appointments – much longer than is currently possible."

Dr Meldrum said he saw patients with complex needs, including mental health and social problems. Spending longer on each appointment would require greater investment in surgeries and more doctors and nurses, he added. The manifesto said: "Many patients need longer consultations with their GP or practice nurse. "The quality of their care could be improved further if additional resources encouraged longer consultation times. "This will require investment in more GPs if current access is to be maintained." Dr Meldrum said it could mean that 50 per cent more GPs are needed.

The manifesto also said political parties must not adopt a "slash and burn" approach to NHS finances and services. The NHS provides better value for money than any comparable healthcare system in the world and ministers must continue to invest in the health service at a time when demand for services is increasing, it said. Dr Meldrum said: "A slash and burn response to the need for savings would be dangerous and short-sighted, risking long-term damage to the infrastructure of the health service. "Now more than ever we should acknowledge the success of the NHS and recognise the support it gives people when times are hard. "It would be a disastrous error to resort to measures such as cutting clinical staff at a time when demand for healthcare is increasing."

The manifesto, Standing up for Doctors – Standing up for Health, says money can be saved if the use of private companies and expensive management consultants is cut. This includes less reliance on independent sector treatment centres, which are run by private companies, and private finance initiatives to build hospitals.


"An Animal Would Have Been Treated with More Compassion"

Ian Luck spent the last weeks of his life in agony because of lack of care at the government-run Princess Alexandra Hospital in Essex, UK, where he died in 2002. For over five years, Luck's widow, Debra, and nine-year-old son, Ben, fought for answers as to why hospital staff neglected Luck, frequently leaving him to lay in his own vomit and waste and failing to realize the severity of his increasingly-desperate state.

Luck checked in to the Princess Alexandra on June 12, 2002 after being too weak to eat and vomiting heavily. He had suffered for several years from gastric problems, and was treated twice in 2002 for lost fluids because of vomiting and diarrhea. This time, an endoscope discovered an ulcer. Doctors prescribed antibiotics to Luck, gave him fluids and sent him home after a six-day stay.

On June 20, Luck returned to the hospital for a second endoscope exam when the inflammation in his stomach had not cleared up. However, the ulcer ruptured during the procedure, and emergency surgery had to be performed to repair it. Following surgery, Debra Luck was effectively left to look after his health and comfort. "No one wanted to help us. Every time we asked for pain relief, or to see a doctor, we were told to wait, or that we didn't know what we were talking about," she said.

Luck's condition continued to decline, but hospital staff showed an utter lack of sympathy. Debra Luck recalled that the staff failed to or were slow to perform basic functions, such as cleaning up after her husband. "He was vomiting ten times an hour, and there were bowls around his bed to catch it," she said. However, "Often they weren't emptied for more than an hour and they smelled awful. The first time that happened I found a nurse and asked if she could empty them. When she said she was too busy, I offered to do it myself."

Debra Luck began resorting to bringing in clean pillowcases, shirts and pants, and having to change her husband herself. "As fast as I changed him he was sick again. The nurses were not interested in helping me," she said. "An animal would have been treated with more compassion."

Meanwhile, it was not known if the bleeding from the ulcer had stopped. "I made two appointments to speak to a consultant during the course of those ten days," she said, "and both times he didn't turn up. When I tried to talk to junior doctors they were either too busy or didn't know enough."

Frustrated and fearing for her husband's life, Debra Luck attempted to have Ian transferred to a local private hospital. Though the private hospital agreed, staff at the Princess Alexandra rejected the move because Luck was not stable.

On June 28, at the request of a junior doctor, a consultant at last saw Luck. But the consultant failed to follow up on the suggestion that a laparotomy (surgical examination), which might have determined the definitive cause of Luck's bleeding, be carried out. On June 29, a second junior doctor called for a consultant's review, which was never performed.

Two days later, after a particularly agonizing night in which nurses forgot to inject painkillers, Luck began to lapse in and out of consciousness and struggle to breathe. That morning, "He was covered in vomit and had wet himself," remembered Debra. "I changed him, but when I asked for clean surgical stockings the nurse said there were none left in his size... I couldn't change his T-shirt without help... but I was told by the nurse she was too busy and to leave him dirty."

That evening, a junior doctor suspected that Luck had suffered a collapsed lung and ordered a chest X-ray. But Luck went into cardiac arrest during the procedure and had to be resuscitated. By the time family members arrived, Luck already suffered a second, fatal cardiac arrest. "I actually feel that Ian was murdered," Debra said. "He died because people couldn't be bothered to do their job properly."

Debra Luck contends that the hospital did not carry out necessary tests. "What I've learned since is that his urine and vomit should have been monitored continuously. Both were vital to working out just how ill he was and whether he would need further investigations. The fact that no one kept a record probably added to his lack of correct treatment."

In October 2007, the Princess Alexandra Hospital NHS Trust agreed to compensate Debra and Ben a combined sum of £225,000 (~$366,000), though the National Health Service refused to accept liability for Luck's death.

For her part, Debra Luck remains angry, telling Britain's Daily Mail, "No one has been punished or sacked. No one from the hospital has offered to meet me and tell me how things went so wrong, let alone offered an apology. For all I know, the same appalling standard of care is still acceptable in that hospital. If that is the case, then there will be more unnecessary deaths."


Australia: Woman sues over flesh-eating bug horror

Negligent government hospital

A QUEENSLAND woman has told of her long and arduous battle against a rare flesh-eating bug infection after it was allegedly misdiagnosed by hospital staff. With what began as a superficial graze, Tracey, who does not wish to use her last name, could have lost a leg, even her life, to the gruesome bug, The Courier-Mail reports.

The legacy of the episode is a rough, colourless patchwork spreading from her left foot to above the knee. Those extensive skin grafts followed 12 rapid-fire operations to "debride" or cut away ravaged soft tissue as the rare necrotising fasciitis bacteria advanced into and up her leg.

Targeted also by powerful antibiotics, the infection finally gave up at the back of Tracey's thigh. By then, surgeons had stripped her limb to virtually bone and muscle. "It looked like a chicken leg," she says.

Yet much of her suffering, Tracey is convinced, would have been averted but for an alleged string of systemic blunders at Gympie Hospital. The 46-year-old claims the "attention" she received included:

* Being sent home from the emergency department with headache tablets.

* Returning to the hospital and writhing in a casualty bay, her screams for help ignored by the staff on duty.

* Repeated instances of non or wrong diagnosis.

* Nurses regularly forgetting to re-connect her antibiotic drip.

* An ambulance transfer to Brisbane without her husband being informed.

"They were just so wrong in how they treated me," Tracey says. "I can't believe how bad the health system is in Queensland. It's disgusting."

Tracey is suing the State Government for medical negligence over what her lawyer, Olamide Kowalik, of Trilby Misso, describes as "a sequence of bungles (that) almost cost her life". The avalanche of toxins discharged by necrotising fasciitis not only destroys flesh but shuts down organs. Tracey's daughter Jayde, 23, says fob-offs and delays at Gympie Hospital took her mother to the brink of kidney and liver failure.

However, it was a nightmare out of nowhere, erupting early last year from a simple scratch near Tracey's ankle. "I was walking up my wooden stairs and fell against them," says Tracey of Amamoor-Dagun, in Gympie's Mary Valley region. "I had a normal graze that was really small. It bled but wasn't deep."

Two days later, on Friday, February 22, Tracey felt the first twinge. "I was limping, and I thought 'that was a bit strange', then went to bed," she recalls. "About one o'clock on Saturday morning, I was in severe pain. My husband, Gary, took me to hospital." Tracey says she was seen by a nurse and a doctor in emergency. "They gave me four (paracetamol-codeine) tablets and a script for anti-biotics and sent me home," she says.

"I spent most the of the day lying down. But the pain had got so bad, I remember just yelling at my husband to make it stop. My foot was swollen now, with a purple rash and a few blisters." Early Sunday, Tracey went back to the hospital where she was given a shot of morphine and a vague diagnosis of "infection". Eventually she was again directed to go home.

But on Monday morning, she staggered to her GP, who immediately arranged for Tracey's admission to hospital. "By this stage, Mum's leg literally looked gangrenous," Jayde says. Still, Tracey was forced to wait more than five hours in an emergency department cubicle for a bed to become available.

"They tried to get a drip in my hand seven times," Tracey says. "Nurses tried, doctors tried . . . in the end they got someone from pathology who just did it instantly."

The next day, recalls Jayde, her mother's leg had grotesquely transformed. "The entire calf muscle was one huge blister," she says. "Mum looked like absolute death but all the nurses kept saying to me was that they didn't know what it was. I thought they were going to have to chop her leg off because it just looked rotten."

Jayde says she pressed a doctor for a diagnosis. "But it wasn't necrotising fasciitis," she asserts.

Nurses from other sections of the hospital appeared at her mother's bedside. "Not to see how she was," Jayde says. "Like a sideshow at a circus, they said they had come to see the 'lady with the big blister'."

Tracey's terror, confusion and isolation converged with her overnight transfer to Royal Brisbane Hospital. She claims nobody from Gympie Hospital bothered to let her husband know she was leaving. Tracey says she can't speak highly enough of her swift diagnosis and treatment at Royal Brisbane. She spent three months there, and another three months learning to walk again in a state-run rehabilitative unit.

Necrotising fasciitis, left alone, kills seven out of 10 victims within days. As uncommon as it is, reported cases have increased around the world in the past five years. The bacteria may be carried unwittingly on a person and introduced to the body through an abrasion or cut.

Queensland Health would not comment on the case but Tracey says she has not had an apology and will not hear of excuses. "If they at Gympie Hospital didn't know what the hell it was, why didn't they contact someone who did?" she says. "If they'd got on to it sooner, my leg wouldn't have been this bad. "I get depressed. I get anxiety. Sometimes, I get the feeling that I just don't want to be here any more."


What Does Obamacare Consider "Hazardous"?

Last week, gun lobbyists threw a fit about the possibility of Obamacare raising health care insurance premiums for gun owners. Other organizations that lobby for potentially “risky” activities are split as to whether or not they think Obamacare could affect them.

"We probably need to look at the bill,” said Ed Scott, executive director of the U.S. Parachuting Association, referring to the current health care reform packages snaking their way through Congress. In 2001, USPA became concerned that the Health Insurance Portability and Accountability Act (HIPAA) might raise premiums for their members, because the USPA believed there was a chance the bill would designate parachuters as individuals who engaged in “hazardous” recreation. Then Congress could raise their premiums.

Scott said that his concern with the current health care reform packages was that non-specific language would allow his members to inadvertently be singled out. “My greater concern would be… language in the bill that allowed some agency to deny coverage of certain activities. Not that skydiving or gun owners would be singled out, but that language would allow a person to interpret it that way,” he said.

With the 2001 HIPAA bill, the USPA worked with the American Motorcycle Association to ensure that Americans “who engage in legal recreational activities don't face health-insurance discrimination.” The effort was eventually introduced as an amendment to HIPAA, which died in committee.

Other lobbyists aren’t even slightly concerned that impending health care legislation would affect their sportsmen. “It’s a non-issue,” said Paul Montville, the executive director of the United States Hang Gliding and Paragliding Association. Montville said that liability insurance and life insurance premiums are affected by activities that are considered “risky,” like hang and paragliding, but not health insurance.

Randy Shaw, the training manager at the National Association of Underwater Instructors, which organizes scuba diving teachers, said he wouldn’t put it past Congress to at least inadvertently include his members in a higher-risk pool, but that he hadn’t seen anything that would lead him to be concerned. “Right now people are more worried about how they’re going to keep their dive shops open,” he said. “But if the health care bill were to include diving as a hazardous risk, and increase premiums, we'd try and fight that any way we could… you can pretty much statistically validate that diving is less risky to your health than walking in a major city.”

Shaw had strong feelings about the bill overall. “The whole thing is just an excuse for them to be able to control your life a little more,” he said.


Health care issues: Overutilization of care

The AP article below omits mention of the major factor driving American healthcare costs up. Predatory lawyers and "generous" judges force American doctors to practice "defensive" medicine -- ordering far more tests and procedures than is warranted. Legal considerations often trump medical judgment. Doctors need to be able to show that "everything possible" has been done in the case of a patient suffering any adverse outcome. The result probably is in some cases beneficial to the patient -- but you can't have the benefit without the cost

Ezekiel Emanuel, an oncologist, White House adviser and brother of White House Chief of Staff Rahm Emanuel, has written that there's a "perfect storm of overutilization" of health care in the U.S. that's the greatest contributor to high medical costs in this country. Factors include a fee-for-service Medicare system that financially rewards volume over quality; pharmaceutical companies and others marketing directly to consumers, who then ask doctors for the newest treatments; and employer-provided health insurance plans that can shield patients from much of the cost of the care they consume.

President Barack Obama has said repeatedly that rising health costs must be checked, but any attempt to rein in care faces resistance. The Senate health care bill would tax some employer-provided health benefits which workers now receive tax free. This would provide an incentive for employers and employees to limit benefit packages. Obama prefers this tax on so-called Cadillac health care plans.

WHAT IT MEANS: Lawmakers say they are aware of the problem of overutilization and are trying to address it through a variety of proposals. Among them are pilot projects for "accountable care organizations" that would pay doctors and hospitals for holding down costs and delivering results; grants to improve health system efficiency; increased payments to primary care doctors to increase coordination of care; and support for research into the relative effectiveness of medical treatments. But many experts don't believe the measures do enough.


TN: Health insurance plans stop enrolling needy

As state funds run dry, Tennessee has cut off enrollment for two health insurance programs for low-income people, leaving the state at risk of a crisis, advocates say. Tennessee became the only state in the nation to have frozen enrollment for a children's health insurance program funded largely with federal money, according to the liberal Center on Budget and Policy Priorities in Washington, D.C. The state stopped accepting new CoverKids applicants on Monday. At the same time, the state stopped enrolling adults in CoverTN, an insurance program designed for the self-employed and working poor.

"This is a perfect storm for Tennessee families," said Michele Johnson of the Tennessee Justice Center, an advocacy group for low- and middle-income families. The changes come at a time when the state's unemployment rate is above 10 percent, and a federal subsidy to help laid-off workers pay for health insurance is expiring. "In the midst of an economic crisis putting so many middle-class families on the brink, our state's policy decisions push them over," Johnson said. "The citizens of this state will be paying for these cuts in fiscal and human terms for decades."

With a projected $1.5 billion shortfall in the state's $29 billion budget and every department facing cuts, there is no extra money to go around. To stay within their budgets, CoverKids and CoverTN had to stop signing up new people, said Joe Burchfield, spokesman for the programs.

No one currently enrolled will lose coverage, but new people can't enroll until more funding is found or until spaces open up from attrition, Burchfield said. "From the beginning, we knew there would come a time when enrollment would reach the maximum allowed by the budget and, if no additional funds were available, we would suspend enrollment accordingly," Burchfield said. "Given the state's current financial situation, these programs are performing exactly as intended."

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