Publications

Medical Scribblings - March 15 / 2003

We all have to cope with change, though I must admit to finding it hard work. Healthcare has been in the centre of different political ideas for many years now with differing concepts of how best to provide care at the lowest cost.

At the same time there are vast technological developments going on that alter the whole view of how best to do things. For instance when I was at medical school, patients admitted with a heart attack were kept in bed for weeks, but now the best evidence is that they be got up at the earliest opportunity and started on an exercise regime soon afterwards.

One of my many jobs in recent years has been on the executive board of the Uttlesford Primary Care Trust (www.uttlesford-pct.nhs.uk) and as such we have to look at “Patient Care Pathways” that is how does the patient flow through the whole system from start to finish. If we consider Coronary Heart Disease (CHD), as we have been doing, then at first sight it all seems fairly straight forward. The patient develops sudden chest pain, is admitted to the Accident & Emergency (A&E) department, has the blood tests and ECG, is given thrombolysis (clot busting drug) admitted to the Corornary Care Unit (CCU) and after a suitable period is rehabilitated, returned home and arrangements made for follow up.

No problem you say but then you start to think about real people with a chest pain. Many will turn out to have other things rather than CHD which are causing it. They had a bit of a bump with their car the day before and hurt their ribs etc etc. If they were all to call 999 for a paramedic ambulance then there would be too few ambulances to go round and when they got to the A&E it would be blocked solid with other people so they would have to wait hours for treatment and those with a real heart attack may well die.

When we get onto other less clear cut conditions then it gets harder and harder to work out what best to do. What is apparent to me is that as many services as possible should be provided in primary care as near to the people as possible. As Dell Boy would have said “You know it makes sense”.

John Schofield