Sunday, May 25, 2008

Minor injuries and misdiagnosis

Back to medicine - at least Occupational health.

I generally tell people that I am a GP, because no one understands what Occupational Health physicians do. I still do some general practice, but largely in the context of Occupational Health. Occupational Health doctors are the ones your employers send you to see if you take too much time off work for sickness. Especially "minor illnesses"

The people who come to occupational health have "minor" illnesses, that is they are not about to die, rather they cannot work. They wait in casualty less than four hours, they attend their appointments and they are discharged from hospital care back to their general practitioner. Their general practitioner thoughtfully signs them off for another four weeks and then their employer sends them to see Occupational Health.

Employers want their employees back working. They refer to Occupational Health because a wheel has come off their business. They cannot afford to prop up poor basic health care. Not all cases are medical, many are "stress at work" but about once or twice a week, I make a new medical diagnosis, or find someone without a diagnosis.

This blog entry is dedicated to a young (man/woman), I saw last week, who with tears in their eyes gave me a hug as they left, because finally (he/she) had been listened to. (He/she) had been labeled with "sciatica" for three years, a former runner, no history of back injury or reason for back pain. It started out of the blue three years ago, has got worse, keeps them awake at night and has spread to their abdomen. (His/her) GP has given him/her painkillers and a course in physiotherapy and (he/she) is getting worse. (He/she) came to see me because they were not recovering from a minor limb injury. It is not surprising their recovery was slow, given the pain (he/she) is in from their back. I have written to (his/her) GP explaining the need for urgent further investigation. This is not sciatica.

These people are the victims of a poor quality service because doctors and managers only care about targets. Patients suffer while GPs, Hospital consultants etc, collect their performance related pay, without even passing go. Doctors everywhere are complaining about stress - the real stress is for the patients whose care is neglected.

In the last month I have found:

Missed nerve injury, causing pain on typing and potential loss of job
Non-united fracture, causing pain whilst cleaning, because no one took an Xray to confirm the break had healed
Shin Splints in the calf stopping a person walking
Pain in the gullet - related to lifestyle not their heart
Pain in the knee, related to wrongly placed enthusiasm for body building - arthroscopy normal
Repetitive strain injury - it is not just typists, but anyone who does the same thing time after time
Numerous individuals "waiting for a letter from the hospital"
Finally, severe back pain of unknown cause in a young man/woman

and I only work part-time.

The difference between Occupational Health and General Practice is that in Occupational Health we have time find out what is going on, the medical care, at work and at home. GPs insist on doing in 10 minutes what I spend up to an hour doing. Quality Health Care is about finding out what is going on, not making a series of "spot diagnoses".

The poor quality and failing of the NHS shows up when people lose their jobs because of injuries and illnesses that are not treated soon enough or well enough. It is not acceptable to keep a person off work for six months while they wait for an arthroscopy. The knee gets worse, the result of surgery is worse, the person loses their job and might never work (or even walk) again. When the Chairman of the British Medical Association and the (life) President of the General Medical Council chain themselves to the railings outside Parliament demanding "Better Care for Patients", there will be some hope for the National Health Service.

Copyright (c) Dr. Liz Miller

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StevenDuckworth said...

Thanks for the refreshing rant Liz.

Well you may have your way regarding protest, though not as noble as you envisaged.The BMA hand in their 'Petition for Protectionism', sorry I meant 'Petition against Polyclinics'today.

On another note, slightly related to your concerns, I run a minor stroke/TIA clinic and have become infuriated at the lack of care support given to people who have anxiety related problems. They often turn up with vague neurological symptoms that on closer examination, and with some empathetic questioning, turn out to be related to anxiety. They have often been through numerous other clinics and have usually picked up a diagnosis of 'mad time waster' and a prescription for an SSRI in the process.

Sorry to hijack your rant with mine.

Dr. Liz Miller said...

Didn't we meet the other night or are there two of you?

Protectionism, Polyclinics, for and against - what is in a name??? Personally I subscribe to the view that professions are a conspiracy against the masses. Having said that, it seems that the Labour government are bent on destroying the professions. Largely, by removing all tacit knowledge and making sure no one knows anything that hasn't been included in a guideline.

Yes I agree, anxiety has become medicalised, when in truth it is a mood - see and do I believe SSRIs help anxiety? probably they do not. Most anxiety is rooted in real problems. It happens a lot in Occupational Health - the ridiculous medical investigation of people suffering from bullying and dysfunctional workplaces - but that is another rant ;-)

p said...

Some problems are timeless though.