Monthly Archives: October 2011

You've got to laugh

Kitteh drunk on non-alcoholic beer.

Image via Wikipedia

A friend has sent this,

and can’t help passing it

on.

It made me laugh, and

I’m teetotal

(although sometimes the

NHS makes me wish I weren’t)

 

Friend writes: a Doctor on TV said that to have inner peace we should always finish things we start,  and we all could use more calm in our lives.

I looked around my house to find things I’d started sand hadn’t finished  ~ so,

I finished off a bottle of Merlot

a bottle of Chardonnay

a bodle of Baileys

a butle of wum

tha mainder of Valiuminun scriptins,

an a box a chocletz.

Yu haf no idr how fablus I feel rite now. Sned this to all who need inner piss.  An telum u luvum . . .

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Europa Donna discusses Breast Cancer and Health Economics

No Fireworks –

but lots of audience participation

 

Aren’t you getting tired of Cameron, Lansley and all telling us that European healthcare is better?

You want to tell them SHUT UP

– and DO SOMETHING ABOUT IT.

Well, Europa Donna is an organisation that is quietly getting on with doing something about it.

At their latest meeting in London Prof. Karol Sikora of CancerPartnersUK was in fine form, giving an informative, up-to-date and sometimes provocative talk to their packed meeting.

Welcomed by Dr. Margaret Spittle, Chairman of their UK Forum, many of those in the audience remembered that nearly two years ago, Europa Donna were one of the first organisations to come out in the open with a debate on the latest findings on Breast Cancer Screening.

They gathered together Prof. Laszlo Tabar, a Hungarian based in Sweden, and carrying out rersearch supported by the American Cancer Society, Prof. Michael Baum, the person who was instrumental in setting up the UK’s Breast Screening programme, then – after reviewing new evidence, now questions this.  The meeting was chaired by another professor, Valerie Beral – who almost needed armour for protection.

Because when Tabar and Baum got going, no punches were pulled.  This made for a fascinating debate – but it has taken almost two years for the UK authorities to come up to speed and start asking questions.  see http://after-cancer.com/cancer-news-latest/breast-screening-is-it-for-you-or-me/

So when Europa Donna’s UK chapter invited me to another debate, I did wonder if I should pack some pink boxing gloves!

But all was well controlled, although cancer guru Sikora produced a lot of audience reaction.

Patient Involvement

With 46 countries in membership, from Finland to Kyrgystan, Europa Donna runs a course for Patient Advocates every year in Milan.  There they gather together patients from all their member countries, to train them how to advocate on behalf of other patients.  The Advocates then go back to their own countries and speak on behalf of fellow patients;  taking part in training, discussing patient’s care and needs with officials, etc.  And guess which country takes little notice of trained advocates?  Britain.

But this may be about to change. Sikora is known to be keen to involve patients, and during the discussions there was comment that if patients were involved, they would be able to point out where money was being wasted.

Another speaker was Baroness Morgan, Chief Executive of Breast Cancer Campaign, talked about ‘Patient and Public Involvement’, a favourite expression of the Dept. Health;  she asked why were these two roles always lumped together by the NHS?

Patients should be taken seriously, and doctors should realise there was no substitute to taking time to talk to patients.   During meetings, if the patient isn’t at the table, how will providers know what is required?

So there was still room for improvement, although she wasn’t sure the much-vaunted offer of choice “is going to benefit all patients”.  Or will it benefit ” patients who shout the loudest?”  Amongst the audience was Professor Lesley Fallowfield, Director of  Cancer Research UK Sussex Psychosocial Oncology Group.  Her work focuses on improving the quality of life for people with cancer, but echoing Baroness Morgan’s question of benefits of choice, she pointed out that one in five patients’ reading level is that of an eleven year old.  She suggested  “we should improve health literacy at school”, and this is where Europa Donna’s Patient Advocates could be usefully employed.

Perhaps, just perhaps, the powers-that-be will think about actually doing something to bring our standards of cancer care up level with European standards – and this meeting left the audience with plenty of points to ponder.

There was no doubt that at the Advocates training course I was invited to attend, there were discussions on what is cost-effective;  as one delegate told me, when asked to imagine what gold-standard mammography services would be, “we only have one machine in my country”.

But involve patients, and not only might services improve in the UK, but the NHS could find sensible ways of saving money.

www.europadonna.org

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Looking after your hands

Mini-treat comes to the rescue

 

Known as a ’60 second Fix for Hands’, this Crabtree & Evelyn’s Citron gift box is available in two versions;  a big box costing £24, but is also available in a mini version costing £8.

I was mooching around Tescos trying to think of a present to cheer up a friend having chemo, when I suddenly saw a dinky little box.  It was just the right size for her to pop into her handbag, and take with her whilst she sits in the ‘chemo chair’.

Originally made for gardeners, but just right for anyone suffering from horrible skin with chemo, the 60 second fix consists of a hand scrub with pumice, ideal to get rid of nasty hang nails, ‘spare’ skin and rough bits;  and a lovely hand cream to smooth on and keep hands soft.

All set up in a little bag so you don’t have to wrap it!

Get this at major Tesco stores, or

http://www.woodlander.com/acatalog/Skincare.html?gclid=CPWRtsChjqwCFYULfAodFDc1oQ

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A new idea for Hospices

Field End, Cumbria

Cumbria Flickr

The real face of caring

 

Most people say they want to end their days at home;  if they can’t do that, then they would choose to end life being cared for in a hospice, with wonderful nurses to look after them – see picture!

Yet the NHS care is often centred around keeping people in hospital – the last place they want to be.

I well remember a politician, with all his clout, telling me in despair that when his wife was dying everyone wanted to let her go home.  But the hospital said they were unable to find nursing care – so she stayed in the ward.

Staying with my cousin Poppy in Cumbria, she introduced me to a friend, Tina Walker.  Tina was fundraising at the World Sheepdog Trials, and as we sheltered from the driving rain, told a fascinating story of the work of Hospice at Home.

The job of this charity mixes the best of ending your days at home, combined with professional nursing care that you would be given in a Hospice.  Locally, Hospice at Home provides their service all over North Lakeland and Carlisle, from Kirkbride to Kirkby Stephen.

The service provides palliative care, with specially trained nurses, for patients at the end of stages of life, regardless of cause, who prefer to remain in their own home with all that is familiar about them.

They provide Nursing and emotional support, personal care, respite provision and specific nursing care.  Then comes bereavement support if needed.

One very popular part of their service is providing complimentary therapies, not only for the patient, but also for their carer.  And now they also provide specialist services for Lymphoedema and Occupational Therapy.

Cost?

This is all free of charge, but the service costs £800,000 a year to run, so if you are visiting the area do pop in to their charity shop, or order Christmas Cards, or have fun and meet the locals at one of the many events they run all over the county during winter.  And don’t forget to see them at the Marmalade Festival in February!

www.hospiceathome.co.uk

 

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Patients should be treated holistically on NHS

Milk and cereal grains are often fortified wit...

Cereal is often fortified Wikipedia

Truth comes out

at meeting on Vitamin D

 

Getting to meetings at Portcullis House (that mega-monstrosity built to provide offices for our MPs) are always a strain.

First of all you have to queue for half an hour to get in to see these expense account fillers.  Then you file into a room for which the sponsors are charged a fortune, only to find it littered with empty plastic cups and water bottles – apparently each office cost £1 million per MP, but no water, let alone a cup of tea is provided.

But after all the frustration of long queues, my last visit turned up gold.

Invited by Yasmin Qureshi, MP, to a meeting to talk about 

Vitamin D;  Sunlight, Diet. Supplements – who gets enough

speakers treated us to a fascinating event, ranging over how important is this Vitamin, yet NICE guidance is most unclear, to the fact that 15% of the UK population are Vitamin D deficient, and “older people should be offered Vitamin D supplements – but aren’t”.

Sat Up

In the middle of his speech, Ash Soni, (Pharmacist member of that elusive body:  the NHS Future Forum – where he is currently leading the work stream on the NHS’s Role in the Public Health) told us “cancer patients should be treated holistically”.

He went on to say cancer patients’ treatment can be “criminal”.  He decried the way Oncologists will treat the cancer, but pay little attention to side effects of drugs they use.  One consequence is that these side effects can impinge drastically on conditions such as diabetes – yet patients are not told that this may happen.  When it does, cancer centres, unlike France and other countries, have no way of dealing with consequences, and patients are left to suffer on their own.

How much Vitamin D do we need?

Sponsored by PAGB (The Proprietary Association of Great Britain), the meeting informed us how much we need this vitamin – and how many patients who have been placed on Aromatase Inhibitors (AIs) such as Aromasin, Arimidex, etc., are neglected.

Thinking back to the way I was casually told I ‘might’ get Osteoporosis when put on AIs, and sent off for an annual DEXA scan,  I can’t remember anyone measuring my Vitamin D levels; or even suggesting it would be a good idea to take this, in order to prevent the 89,000 hospital admissions for hip fractures a year – many of which are a result of this disease which can be a side effect of  AIs.

Producing a Vitamin D Overview, Mrs. Claire Severgnini, of the National Osteoporosis Society, gave us frightening figures.  Apparently just dealing with hip fractures – one of the consequences of osteoporosis – costs the NHS £6 million a day.   Yet a Cochrane Review in 2010 found a 28% reduction in the incidence of falls (prime cause of hip fractures) where Vitamin D supplement was used.

At £25 per patient per year for Vitamin D supplements for anyone over 65 in the UK , the cost would be £295 million.  Preventing a possible 11,558 hip fractures a year would pay for this.  Yet the NHS seems incapable of working out the monetary accounts , let alone the cost in human misery.

Yet when I try to talk to my local NHS hospital about steps to avoid falls – they pat me on the head and tell me I shouldn’t worry – they are well able to deal with fractures!!!  Doesn’t matter about the patient – just so long as the NHS doesn’t have to practice preventative medicine, long regarded as a bore by clinicians who are trained as surgeons etc.

Honesty from a GP – backed up by a Nurse

We were then introduced to Dr. Gill Jenkins, a GP from the West Country – and the sort of the-patient-comes-first’ type to whom we all warmed.  Admitting that the infamous QOF system, by which GPs get their remuneration, didn’t cover Vitamin D requirements, she said “vocational training doesn’t specially include nutrition”, which would bring this out.

Do doctors prescribe Vitamin D?  One admitted “only when asked”.  Well, the message was simple.  Demand your GP tests you.

Lynn Young from the Royal College of Nursing was another person with lots of TLC;  she spoke about the importance of Vitamin D;  this time the worrying signs that “Over the past few years we have been seeing cases of rickets re-emerging amongst children, which is a direct result of vitamin D deficiency”.   So doctors and nurses have an uphill struggle to make us more Vitamin D aware.

What to do?

There is no exact definition of the amount of Vitamin D each of us needs.  Different people will need different amounts of Vitamin D;  one of factors is how much sunlight we get per year;  another is if we eat enough of the right foods.

Good to eat:  Oily fish, eggs, liver.  In Scandinavia where they don’t get enough sunlight in winter, they have problems.  Yet in Iceland, with the same amount of sunlight and dark winters, there is no problem because their diet relies heavily on fish.

If you want to know more about Health Supplements, check out the Health Supplements Information Service.

  1. Have a chat with your local Pharmacist
  2. Check out Health Supplements on www.hsis.org
  3. If you have a CNS, ask for an appointment to go through options – especially if you are put on AIs, or reach age 60 during treatment.
  4. See Your GP to ensure you are getting enough Vitamin D, otherwise prescribe these
  5. Contact the PAGB for information: info@pagb.co.uk     www.pagb.co.uk
  6. Ask PAGB for their notes on Vitamin D (set out in clear, understandable language, and giving info about levels contained in certain foods.
  7. Contact National Osteoporosis Society:  www.nos.org.uk     Helpline 0845 450 0230
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What do today's GPs think of Health Bill?

 

Abetternhs’s Blog

This is a fascinating Blog (obviously written by someone or some people who work in the NHS)

Up on the screen today is ‘Brief notes before the Battle of Ideas 2011 debate

and asks what is a GP’s role today?

The answer depends on who is defining the role.

The answer (as always) should not come from GPs, (or those pesky meddlers the Kings Fund, or the Dept of Health) but patients.

And not the pushy, entitled, ‘fix my sore throat before I interview Sir David’ journalists (that’s obviously aimed at me!) , that cannot understand why GPs don’t keep the same opening hours as Tescos (do they think Tescos could afford 24hour opening if it took 10 years of training to operate a checkout?) – but in my defence I want better service than I get in most supermarkets, so realise I have to wait.

Nor the people who run think-tanks who imagine what they would want from a GP if they were a patient, only they’re not actually chronically sick or worried half to death that they might be; these are healthy people, not patients.  Hear hear – am always saying the Dept. Health must go out and ask genuine patients what we want.

No, the answer is that GPs are defined by, moulded by, stretched, pummelled, weighed down and held up, worked over, leant on, wept on, bled, spewed and even pissed on by their patients, who beat them into shape over years.

Studies have shown that at the start of medical school, GPs are in fact normal people, capable of blending in at any social occasion. After 5 or 6 years we are turned out of the sausage machine that is medical school unable to speak the same language as our parents; after a few years in hospital we are a different species entirely, harder to understand than teenagers. Entering General Practice we soften a little, but being unused to conversing with conscious patients who ask difficult questions, we’re like pubescent Dr Spocks trying to cope with the emotional turmoil that our patients, (yes, our-own patients) lay on us. After painful years, we unlearn most of what we have learned and replace it with what our patients have taught us. How to interpret stories and relate them back, how to recognise unspoken signals, appreciate hidden strengths, uncover silent symptoms, and be a part of the narrative of our patients’ lives.

The commonest question my patients ask me is, “Will you be my doctor?”

How can we say no? In spite of decades of incentives to make us all attachment-free, autonomous consumers, to be somebody’s GP is to make a committment, a committment in many respects like that of a marriage. To stand firm in sickness and in health, to be consistent and honest at all times, to take abuse and shoulder blame without judging, to bear witness to suffering and personal tragedy and always maintain confidentiality. To be fair and compassionate, professsional and competent no matter how we ourselves are feeling.

The commonest reason for visiting a GP is ‘fear’.

Fear that the lump is cancer, that the chest pain is another heart attack, the headache a stroke, like the one that tragically disabled Maureen. Fear that I may die before my children grow up, fear that I may lose my sight, my balance or my mind. Fear that I cannot cope, that I am a failure or that I will be judged unfairly and blamed for my suffering. To be a patient is to be unfamiliar with oneself, to inhabit an unfamiliar shell, barely in control and in need of help. The world and our relationships are radically aletered when we are patients.

What an extraordinary job it is we do. Grounded in a therapeutic relationship, everything we do depends on trust. What an extraordinary responsiblity to be charged with caring for people when they are at their most vulnerable and most easily exploited.

Because of this it is absolutely vital that we are not led into temptation. Just as monks and nuns need to be protected from the distractions of the world so that they can dedicate themselves to God, so we need to be protected from mammon and the perverse incentives of the market-place, so that we can dedicate ourselves to our vocation and our patients, and be the doctor that they need, not the doctor the market makes us.

The above was shamelessly lifted from http://abetternhs.wordpress.com/2011/10/28/role/

To see more, log on and have an interesting browse.

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Where to find classes for Osteoporosis

Glasgow Science Centre

Image by bruce89 via Flickr

Glasgow Leads

                                                                                                      with Physiotherapy Services


Anyone lucky enough to live in Glasgow has a range of exercise classes from which to choose.

When will other areas follow?

Research shows that regular suitable exercise for Osteoporosis can help protect you from breaking bones in two ways:

  1. strengthening your bones (along with the medication prescribed by your doctor and a calcium-rich diet) and
  2. reducing your chances of falling.

You are at greatest risk of breaking a bone if you fall.  Exercise can improve your balance, co-ordination, strength and flexibility and therefore lower your risk of falling.

Regular, suitable exercise can also improve your posture, mood, general health, and help lessen pain from different causes, including arthritis.  Also, the fitter you are, the easier it is for you to carry out all your daily activities such as housework and shopping.

Glasgow’s Physiotherapy Service for Osteoporosis

NHS Greater Glasgow and Clyde has a Physiotherapy Service especially for people with osteoporosis or osteopenia.

The service offers full assessment by a physiotherapist, which includes examination of your posture, flexibility, muscle strength,                                                                                                              walking, balance,

A view over Glasgow from Queen's Park in the c...

fitness and pain.

This provides a starting point to find out your particular problems, and make a plan with you for your treatment, including instruction and information on suitable and safe exercise for you to help your condition, and advice on posture and back care.

Assessment can take place at one of several Physiotherapy departments (see below).

12-week Exercise & Education Programme for Osteoporosis

Following your assessment the physiotherapist may suggest you attend local exercise classes, run by a Physiotherapist.  At these classes, as well as exercising, you will be given information on osteoporosis, posture and back care.  There will be plenty of opportunities to ask questions.  During the 12 weeks there may also be a visit from an Osteoporosis Specialist Nurse and a member of the National Osteoporosis Society Support Group.

Physiotherapy-led 12-week Exercise & Education classes – available at the following:

  • Westburn Church Hall, Greenock       Tuesday 2.30pm
  • Lagoon Leisure Centre, Paisley            Thursday 9.45am
  • Glasgow Royal Infirmary                Friday 1.45pm
  • Gartnavel General Hospital                Tuesday 12pm
  • Southern General Hospital                Tuesday 10am
  • Mansionhouse Unit, Langside                 Friday 9.30a
  • Stobhill Hospital                        Thursday 2pm
  • Clarkston Clinic, Clarkston                Monday 2.30pm
  • Clarkston Hall, Clarkston                 Friday 2.30pm

 

Contact:   Craig Ross, Osteoporosis Physiotherapist on 0141 427 8311, or write to:

Physiotherapy Service for Osteoporosis
Clutha House
120 Cornwall Street South
Glasgow G41 1AF

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Lansley doesn't get it – but Dr. Gerada of RCGPs does

News from GP’s Conference

 

Addressing around 1500 GPs and health professionals at their annual conference in Liverpool,  Dr. Clare Gerada, Chair, Royal College of General Practitioners, told their Conference that the profession is under pressure to

“replace the language of caring with the language of the market”

and that patients are not commodities to be bought and sold.

 

Echoing the concerns of many patients, she urged GPs never to lose sight of why they entered the profession – to care for the patient as a person.

“In this brave new cost-driven, competitive, managed-care world, I worry about the effect that the language of marketing is having on our clinical relationships. It’s changing the precious relationship between clinician and patient into a crudely costed financial procedure, turning our patients into aliquots of costed tariffs, and GPs into financial managers of care,” she says.

While welcoming the role of GPs in commissioning, Dr Gerada said that the commissioning agenda must not sacrifice long-term benefits for patients in favour of short-term savings.

“People often tell me that GPs make good commissioners because of the population-focus we bring to care. After all as a profession we see 300 million patients per year. If anyone can be said to have their finger on the pulse of the nation, surely it’s us. It’s an argument I’ve supported for decades. But we must tread carefully in this brave new world and do everything in our power to make sure it’s the public’s pulse we have our fingers on… not the public’s purse!”

Warning to doctors

Citing the HMO experience in America, she warns against doctors being doubly compromised between the best interests of patients and the need to save money.

“It’s the government’s job to decide how much we invest in healthcare – and what services the NHS should provide. Governments should have ultimate responsibility for decisions about rationing healthcare, not GPs.”

She concludes: “We all became doctors because we wanted to make a positive difference to people’s lives. It would be hard to devise a better and more inspiring way of achieving this than through the provision of excellent general practice care, within a universal health service. In times of austerity, we need to come together so that we can collaborate, cooperate and innovate… not compete against each other.

What matters to patients

“You expected me to talk about the Health Bill in England, but this Bill, like other reorganisations across the whole of the United Kingdom will come and go. Instead I have chosen to talk to you about what matters to our patients, now and for ever – a doctor who cares.

“I am convinced that there are enough of us to create a revolution in health care. Not a revolution that the Government is talking about in the Bill – in structures, payments and competition. But a revolution in values – one that will provide excellent care to our patients.”

She urged GPs never to lose sight of why they entered the profession – to care for the patient as a person.

But although she received a large standing ovation – there were those who weren’t so keen.  One wonders if they were the doctors that welcome Lansleys reforms – and see the opportunities when it comes to  commissioning contracts?

Andrew Lansley

In his speech at the RCGP’s conference, Andrew Lansley said offering patients more choice did not amount to privatisation.

Announcing that monitoring of NHS healthcare is to be extended to 11 extra areas of medicine, the health secretary told the GPs in Liverpool that auditing would be extended to areas including HIV and breast cancer.

He said publishing better data would allow patients to make more informed choices and specialists to “compare themselves with the best”.

What choice?

Lansley defended plans to give GPs more commissioning responsibility under the government’s NHS reforms, the government’s Health and Social Care Bill would encourage competition.

“For years, GPs have been telling me, ‘if only they would listen to us, we could do it so much better’,” he said.

“Well as I say, I am now ‘they’. I am listening to you. And I do want you to do it better.

But to patients already seeing waiting times going back to the bad old days, most don’t particularly want choice.  What they want is to be able to go to a local hospital and not have to wait for an appointment.  Nor do they want to be part of political claptrap excusing abdicating of responsibility.  They just want to have their operations or tests done as quickly as possible, in infection-free centres.

Speaking to BBC News before Saturday’s conference, Mr Lansley said that offering more choice for patients did not mean privatisation.

“We’re not looking to turn the NHS into some kind of private industry, far from it.

“It’s a public service and it has to be integrated around the needs of patients.

“But there is a role, a big role, for patients in being able to exercise choice and therefore by extension where patients exercise choice, you have to have a choice amongst providers.”

Mr Lansley told the conference outcomes for patients in areas of medicine including breast cancer, prostate cancer and chronic obstructive pulmonary disease would be “audited, monitored and regularly published in the future”.

“From December we will pilot the publication of clinical audit data to detail the performance of clinical teams. This will then be rolled out across England from April next year,” he said.

“Better data means better quality in the NHS – for patients, for their specialist clinicians, and crucially for you – both as their GPs and as the future commissioners of those services,” he said.

Er – has anyone told Lansley that to get this data, someone is going to have to fill in more forms?  Leaving even less time to deal with patients – the actual reason why the NHS exists.

He still hasn’t got the message, has he?

 

Breast Screening – is it for you or me?

Woman undergoing a mammogram of the right breast

Image via Wikipedia

At last –

Screening is to be reviewed

Ever since I attended a fascinating meeting put on by Europa Donna, where an expert from Scandinavia debated with the Professor who introduced the breast screening programme into Britain –
and nearly came to blows –
the subject has been of enormous interest.
.
First – I must declare an interest.
  • I have decided for the time being to have an annual mammogram
  • I am then seen by my very eminent breast surgeon, and he carefully examines the screen to see my ‘photos’.              This gives me confidence that my mammogram results are being checked by an expert.
But – when Professor Michael Baum, the very eminent surgeon who introduced the breast screening programme to Britain, then opted out and questioned its efficacy – one listens.

According to a recent BBC story,the evidence for breast cancer screening in the UK is being reviewed, amid controversy about the measure’s effectiveness.

The NHS says screening saves lives, but other researchers have argued that it may cause more harm than good.

The national cancer director for England, Prof Mike Richards, announced in the British Medical Journal that he will lead a review.

He said he was taking the “current controversy very seriously”.

When it comes to cancer treatment, earlier is better. Screening programmes for a range of cancers help doctors make a diagnosis sooner. But they also run the risk of false positives, diagnosing someone with cancer when they are healthy.

Life saving

Screening was introduced for breast cancer in 1988 in the UK, and now offers tests to women, over the age of 50, every three years.

In 2002, the World Health Organisation’s International Agency for Research on Cancer estimated that screening reduced deaths from breast cancer by about 35%.

The NHS says 1,400 lives are saved through screening in England alone.

Sara Hiom, from Cancer Research UK says, “the decision whether to be screened is a personal one, but that decision should be made with all of the potential harms and benefits fully explained”

And currently it is extremely difficult, if not impossible, to get that explanation.

Review

A review of clinical trials involving a total of 600,000 women concluded it was “not clear whether screening does more good than harm”.

It said that for every 2,000 women screened in a 10-year period:

  • one life would be saved
  • 10 healthy women would have unnecessary treatment
  • at least 200 women would face psychological distress for many months because of false positive results.

The authors of that research labelled the NHS Breast Screening Programme’s advice “seriously misleading”.

Should I?  Or shouldn’t I?

Susan Bewley, Professor of complex obstetrics at King’s College London, has turned down screening.

In a letter to Prof Richards last month, she said: “The distress of overdiagnosis and decision making when finding lesions that might, or might not, be cancer that might, or might not, require mutilating surgery is increasingly being exposed.”

In response, Prof Richards said research suggested that up to two and a half lives were saved for every over-diagnosed case.

He added that he would lead a review of the evidence to settle the ongoing controversy.

“Should the independent review conclude that the balance of harms outweighs the benefits of breast screening, I will have no hesitation in referring the findings to the UK National Screening Committee and then ministers.

The review will be led jointly by Prof Richards and Cancer Research UK.

The director of health information at the charity, Sara Hiom, said: “Women need more accurate, evidence-based and clear information to be able to make an informed choice about breast screening.

“The decision whether to be screened is a personal one, but that decision should be made with all of the potential harms and benefits fully explained.”

Breakthrough Breast Cancer’s chief executive Chris Askew said: “Breast screening is vital as it can detect breast cancer at the earliest possible stages when no other symptoms are obvious.

“The earlier breast cancer is picked up the better for the one in eight women who are diagnosed every year with this disease, as treatment options are more likely to be less aggressive and have successful outcomes.

MammogramThe value of breast cancer screening has been a source of controversy

So for the moment, I am definitely watching what goes on.  Personally as co-chair of the local LINk cancer group I will be following the official line – BUT to any woman who asks, I will be advising them to weigh up all the evidence, and ensure that the centre where they are screened is entirely transparent and answers questions FULLY.
It is no use the NHS trying to act like a Nanny state – that’s what happened in Communist countries.  We need the eminent medics to stop squabbling and get round the table to discuss fully the pros and cons.
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Breast reconstruction, nipples and other important procedures

Reassurance is a priority for everyone

 

 

You don’t get appointed  Fleet Surgeon for an event such as the

Round the World Millenium Race, unless you are a

particularly special person

 

Meeting Christopher Inglefield, who held this post, you realise why he was appointed for this incredibly daunting job.

And today he applies his interest in cutting edge medicine, working in difficult situations, to problems that face so many breast cancer patients after a mastectomy, or lumpectomy.

With his feet firmly on terra firma, he works as a specialist surgeon in London’s private medical sector.

I went to see him in his consulting rooms in an elegant Georgian building in Wimpole Street, to ask about breast reconstruction and other things;  as co-chairman of  a LINk cancer group I am constantly talking about problems associated with this field – so wanted to know more.

Choosing a reconstruction

Reconstruction can be one of the most important parts of treatment,  that helps emotional recovery and wellbeing.  Inglefield emphasises that it is vitally important to have complete trust and faith in your surgeon;  what was reassuring was his comment that he always thinks “is this in the best interests of the patient?”

So what are steps to a successful reconstruction?

  • Discuss your options with the surgeon who is going to do the operation
  • ask to see photographs of operations he or she has done
  • talk it over with your breast care nurse
  • and/or ask to meet someone who has had the same type of reconstruction.

Types of reconstruction

There are two main types of breast reconstruction:

  1. reconstruction using an implant
  2. reconstruction using your own tissue.

You may have a number of choices available to you, although one type of operation may be more suitable depending on your shape and build, and whether you are having or have had radiotherapy treatment to the breast.

You should discuss with your surgeon the best time for you to have reconstruction work carried out;  there is no definite  ‘best’ time – it all depends on the patient, their life-style and how it fits in with their plans.

Then ask yourself, and tell your surgeon, what you want out of the reconstruction.

And, most important, discuss the possible effects of the treatment on you.

One idea that I liked was using fat from the patient’s own body – but this is an option that must again be carefully discussed, although Inglefield was very much in favour of this technique.

What is most frequently asked question?

According to Mr. Inglefied, it’s  “can I restore my breast shape?”

After this comes the question of cost, and he says that more and more patients are opting to pay for reconstruction  themselves, rather than relying on the NHS.  This is something that his team can discuss in a sympathetic fashion, and when I asked for costs – he didn’t hesitate to say these started at £2,500 – but warned for complicated procedures it could go up to £15,000.

He also said that Nipple Reconstruction was something they frequently carried out at London Bridge, and was adamant that whatever a patient chose, “it should be a positive experience”.  They also do work on scars, helping reduce or eliminate unsightly ones, and work on lumpectomies too.

His phylosophy is  “I like patients to feel part of the family”, and this is very evident when we talked – and he listened attentively.

Contact:  London Bridge Plastic Surgery    www.lbps.co.uk

54 Wimpole Street, London W1G 8YJ   020 7487-0900

 

 

 

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