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    Sunday, October 15, 2006

    Old Fashioned Medicine: Once upon a time, general practitioners used to perform minor surgeries such as hernia repairs, appendectomies and tonsillectomies at their home offices or in the patient's home. That was before surgery and anesthesiology became the sophisticated specialties that they are today. Yesterday is today at England's National Health Service:

    Minor surgery such as hernia repairs and varicose vein removal will be carried out in family doctors’ surgeries instead of in hospitals under plans to be announced by Patricia Hewitt, the health secretary, this week.

    Ministers believe that up to half of the 45m hospital outpatient appointments can be dealt with by GPs and nurses in local health centres. It will save the National Health Service money by freeing up hospital beds which cost about £300 a day. Ministers say surgery in local health centres will make better use of highly trained GPs and be more convenient for patients.

    Lord Warner, the minister for NHS reform, said: “The rationale behind providing care closer to home is to make better use of highly specialist skills . . . this will involve (having) GPs who are as skilled with the scalpel as they are with the stethoscope.”

    Dr. Crippen is not amused. Nor would I be. Will they hold in-office surgeries to the same standards as in-hospital surgeries? How many GP's possess surgical skills and knowledge? Few in this day and age I imagine. But, that's what happens when politicians dictate the practice of medicine.

    UPDATE: More laughter at the expense of the NHS, via Dr. Crippen's comment section.

    posted by Sydney on 10/15/2006 05:43:00 PM 3 comments


    GP's administering anesthesia, eh?

    Well, in honor of the thought that "yesterday is today" let's look back at one of George Bernard Shaw's little observations from one of those yesterdays in about 1913:

    "Treat every death as a possible and under our present system a probable murder, by making it the subject of a reasonably conducted inquest; and execute the doctor, if necessary, as a doctor, by striking him off the register."

    Anyone doubt that would be next for NHS?

    Amazing is it not, to hear intelligent people argue that single-payer systems controlled by bureaucrats and politicians are really and truly responsive to public and patient needs?

    John Fembup

    By Anonymous Anonymous, at 6:28 PM  

    Surgeons must be very careful
    When they take the knife!
    Underneath their fine incisions
    Stirs the Culprit-Life!

    -Emily Dickinson

    In addition, there are several plausible reasons not mentioned in the article:

    1. A shortage of surgeons.
    2. The primary care trust keeps the patient. By doing this, they are less in debt to the hospital at the end of the year, since they usually don't have enough money to pay for the patients they do send to the hospital. So, I imagine this arrangement is okay with the hospitals and surgeons.
    3. The operative mortality rate for surgery is four times higher than the US. For complicated patients, it's nine times higher. Maybe they stand a better chance in the local surgeries.

    The MRSA risk they quote is not trivial, either. It is a major problem there and if I could stay out of the hospital, I would.

    By Anonymous dani, at 1:08 PM  

    Policymakers have a wonderful way of dreaming up policies that affect other people rather than themselves. Now what if policymakers had to use the NHS ALWAYS in their own medical treatment? Would MPs mind being surgically operated on by GPs? I put the broader question to policymakers by asking ‘elected representatives of all UK political parties [to] voluntarily refrain from self-paid or insurance-paid medical care treatment.' This 'Acid Test of MP support for the NHS' was delivered by way of petition at www.ourpetition.org. 47 MPs in all have signed the petition to-date. 35 MPs were Labour, 11 were Liberal Democrats. Only 1 MP signatory was Conservative (no, it was not Mr. Cameron). Dr. Crippen has commented on the health petition in his article “Putting your money where your mouth is” where he supports the notion the great and the good should try using their own medical creations, ALWAYS. If they did, perhaps one day we could look forward to accessing a world-class NHS free at the point of delivery. If you want to see if your own MP has signed visit www.ourpetition.org. If he or she has not, why not write them to find out why? You can also lobby your MP by signing the petition yourself. Richard Solomon, Campaign Organiser, www.ourpetition.org

    By Anonymous Richard Solomon, at 6:54 AM  

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