Going private for tests?

You'd need to have a follow-up appt with cardiology either way, and I'm not sure having ECG results from elsewhere would expedite the process of slotting back into NHS care. In the context of a 6 week NHS wait, it may slow things down, require re-referral from GP to clinic.

So personally I wouldn't expect to move seamlessly between one and the other unless the wait was months longer.

I can understand your anxiety though, might be worth chatting to the NHS cardiology secretaries, getting their advice on whether it's worth it, and saying that you would be happy to dash in at short notice if they have free equipment due to a cancellation.

Generally here (Falkirk) if you go private you get an NHS doctor in a private setting who will possibly be the Doctor you will see (if you have a named doctor you could probably see him privately) so in effect the results would get fed in quicker, however I believe that the NHS has been taking a lot of private slots to get their times down recently so might be worth seeing how much quicker you will be seen. (could be different where you are based)

Good luck eitherway

West of Scotland here also, over the years I have combined private (cover through work) with NHS to expedite treatment for a variety of ailments, ranging from relatively minor (toe fusion) to major (prostate cancer).

In all cases the files and data have been logged to my NHS records and used by all involved.

Good luck.

This info is about 10 years old so please be aware of that. We are in Kent.

Our GP noticed a slight "pump" on side of my mom's nose and says he wanted investigated. I panicked and wanted a diagnosis asap in all honesty.

Can't remember how I got the situation going (through GP??) but soon after we find ourselves in a Spire hospital, consultant diagnosed Basal cell carcinoma. A very slow growing cancer fortunately. I told consultant we couldn't afford rest of treatment privately. He tells us that he will be the person seeing mum via the NHS from this point on anyway.

The hand over back to the NHS was seamless, operation done and all was good. Basically going private allowed for a faster diagnosis, the wait for the operation wasn't too long either but, well, different times back then.

Very odd experience queuing up in the lush Spire hospital waiting room, credit card in hand, to pay for the consultant's diagnosis...

I did this with rheumatology. Although in my case the NHS waiting list was 12 months.

I had the scan and then a follow-up consultation for a diagnosis. After this they sent me a report which I was able to give to the NHS rheumatologist once I finally got into the system. It was all fairly smooth.

The private hospital you see will copy all your results to your GP anyway, so provided you can get your follow-up appointment with the GP I can't see that there would be a problem. You'll actually have a challenge if you don't want your GP to know the results, and it was a bit of a headache with both Spire and Nuffield IIRC - in the end I put my home address down as my "GP".

Look forward to 14 days of itching if they give you a Zio patch...

I went private for my first consultation re a possible knee replacement knowing I couldn't afford the £14k for it private, I just wanted to know what the situation was with my knee after nearly two years waiting to see an NHS consultant.

As it turned out the consultant was ace and wrote back to my GP essentially saying this guy needs seen he's struggling to work and has a family. Suddenly I got referrals for a knee brace and physio and soon after my actual NHS appointment and knee replacement. Maybe coincidence, but it doesn't seem it.

As well as the 24hr holster monitor you'll want an exercise stress test (treadmill test) . I've been through the whole heart investigation thing with NHS, it's much quicker than with a knee!

Currently waiting to see an orthopedic consultant for my other knee and wondering whether to try private again for an initial diagnosis/confirmation...

After some evaluation of evidence, NICE now recommend the KardioMobile device for recording of arrhythmias, and in some areas this has replaced the standard 24/48 hour recorder.

https://giftshop.bhf.org.uk/alivecor-kardiamobile-ecg-monitor

NICE link  https://www.nice.org.uk/guidance/mtg64/chapter/1-Recommendations

If you were going to spend some money, you could consider getting one of these devices and recording when symptomatic (needs a smart phone) then present the findings to GP.

Snip of the evidence summary from NICE:

3.2
Of the 27 included studies, 16 studies were peer reviewed, including 4 UK studies (Bray et al. 2021, Dimarco et al. 2018, Reed et al. 2021, Reed et al. 2019), one of which is an RCT (Reed et al. 2019). The included studies covered 6 population groups:

people with palpitations
people with a history of atrial fibrillation (AF), who have had treatment (ablation, cardioversion, or medical therapy) to restore sinus rhythm and used KardiaMobile to identify recurrence
people with diagnosed AF to assess AF burden
people with transient AF after surgery or hospitalisation whose heart rhythms reverted back to sinus rhythm before discharge and used KardiaMobile to identify recurrence
people after stroke or transient ischaemic attack who were monitored using KardiaMobile
mixed population including people with known or suspected AF.

All published evidence is on the single-lead KardiaMobile device. For full details of the clinical evidence, see section 4 of the assessment report in the supporting documentation.
Evidence shows that monitoring with KardiaMobile increases AF detection
3.3
Three RCTs including 1 UK trial (Goldenthal et al. 2019, Koh et al. 2021, Reed et al. 2019) found that significantly more people in the KardiaMobile monitored group had AF detected compared with those who had standard care, which included 24‑hour Holter monitoring. This was supported by the results from an observational study (Yan et al. 2020).
Evidence suggests that the KardiaMobile algorithm has a high diagnostic accuracy per electrocardiogram (ECG) recording
3.4
Four peer reviewed studies (Hermans et al. 2021, Lowres et al. 2016, Selder et al. 2019, William et al. 2018) reported on the diagnostic accuracy of AF detection using the KardiaMobile algorithm compared with clinical interpretation of the KardiaMobile ECG as the reference standard. Its sensitivity ranged between 92% and 99% per recorded ECG, with specificity between 92% and 98%. However, the external assessment centre (EAC) highlighted that diagnostic accuracy was reported on a per ECG recording and not a per person basis. Also, these 4 studies had 4 different patient populations with a pre-test probability of AF between 4.8% and 35.6%. The EAC also noted that KardiaMobile is not intended to be used to confirm the presence of AF as a standalone test but to help detect AF. All interpretations should be reviewed by healthcare professionals for clinical decision making. It is expected that false positives and negatives are likely to be captured by the clinical reviews.

Thanks All, appreciate the advice. Sounds like it’s mostly seamless. Depending on what they say I would mostly be ok with any wait on return to the NHS because at that point I’d know what the issue is and that I’m not about to keel over! I can claim the consultation back on my insurance so it takes a slight sting away.

I've had bouts of palpitations (and was particularly bad this time last year).  I've had an ablation to fix AF and I was concerned that the AF was back.  I got lucky and spoke to a GP in my surgery who was interested in palpitations and arrhythmias in general cos he was a fellow sufferer.  Anyway, he recommended looking on YouTube for Dr Sanjay Gupta at York Cardiology.  He's produced a bunch of vids about it.

It won't cure you but it may ease your concerns while you wait for tests etc

 The private hospital you see will copy all your results to your GP anyway, so provided you can get your follow-up appointment with the GP I can’t see that there would be a problem.

Nope they won’t. We’ll get a letter from the consultant which may include a copy of the results.

OP, if you get a test done privately, you’ll also need to pay for an appointment with a consultant to interpret the results.

Whenever a test is offered privately, the provider should also offer interpretation and acting on the results as part of the service.
Interpreting and acting on results that are not arranged by the GP is not part of the GP contract as it would be impractical for us to do so.

Anyway, he recommended looking on YouTube for Dr Sanjay Gupta at York Cardiology.

I can’t comment on the private tests but fully agree with this. When my arythmia has got a bit of control in my head I go back to these.

One of the many problems we face in General Practice is the massive information burden as people copy us into everything that they’re doing for our patients. If it’s sent to us, we have legal responsibility for it and it needs to be reviewed. This can be hundreds of letters per day per practice. Some of them ten pages long.

Not heart-related, but IME tests were done privately and the "private" consultant added MrsB to his NHS lists without being asked

@timba that’s what’s meant to happen. Private consultants can refer back into the NHS. You don’t jump the waiting list, but you will have had the benefit of having the tests done sooner.

people copy us into everything that they’re doing for our patients.

fully appreciate that the NHS is severely broken on resource, but surely it is wholly right that you have and have an awareness of all the medical details for those under your care.

...you will have had the benefit of having the tests done sooner.

Exactly this. We also found that you don't necessarily need to bother your GP for a referral

@iainc it’s not practical that we can review and have legal responsibility for everything that happens to our patients, especially when more and more, other organisations are using it to inappropriately delegate workload to us.

This is part of the problem, people assume that GPs are just for everything, and we are not.

but surely it is wholly right that you have and have an awareness of all the medical details for those under your care.

Because GPs are just sat around all day waiting for other* doctors to tell them what to do with their patients, everyone knows that over here in GP world we all slack off after lunch. It would genuinely be a surprise to me if a doctor in a Trust/hospital setting sent a letter saying "this pat is poorly, this is what I did, and this is what I prescribed, and I referred them to this other place for on-going treatment, you don't need to sweet FA"

*the inference being that all those other doctors are somehow 'better' in some non-specific way

I can claim the consultation back on my insurance so it takes a slight sting away.

If you can claim the cost of consultation back on medical insurance, wouldn't any of the following treatment also be covered...?

I'm having a bunch of private tests done at the moment and they are all getting copied to my GP and hopefully being saved to my "file".

@Kramer is obviously the expert here but if it's anything like working in a normal job, it's reasonable for GPs to be copied so as the sender is making it clear "I am copying you because I actually want you to do x" or "I am copying you just so the surgery can save this to the file".

it’s reasonable for GPs to be copied so as the sender is making it clear “I am copying you because I actually want you to do x” or “I am copying you just so the surgery can save this to the file”.

Sorry but it’s not. Your GP record is not a unified health record. It is not designed to be that, and it is not funded for GPs to administrate it as such.

Your GP record is a legal document for GP surgeries to record the care that they have administered. Nothing more.

The problem with what you’re suggesting is that it’s not a safe system and it leads to things being missed and so they don’t get done.

Bottom line is, do you want me seeing patients, or do you want me reviewing documents that have been sent to me?

Bear in mind that I can’t do both.

@nickc

*the inference being that all those other doctors are somehow ‘better’ in some non-specific way

When often they’re not actually doctors and lack the knowledge to deal with results that are outside their protocols.

And I hate to say it, but these days more and more frequently we’re seeing consultants who just don’t have the range of experience to deal with stuff that’s outside their protocols either.

So they just dump it back on the GP.

I had this exact thing last year for 4 months! I had it that bad I found it difficult to sleep. I actually went to A & E one morning at 4am whilst away with friends (btw i don't drink or partake in any recreational drugs:) as it felt so disconcerting and thought i was going to keel over.
There was an extra heart beat but not only that it felt like that extra beat was moving my heart side ways.

They found nothing at A & E and I saw the GP a few times and they ran an ECG but found nothing. It disapprared after 4 months

To add i have prviate medical insurance with my employer. Even then i've found it difficult to get referred for things

I was in a similar situation after my heart went into overdrive on a morning training ride (266 bpm!) Spoke to the GP, who lined me up with an appointment with a cardiologist in a local hospital, who turned out to be absolutely woeful (I won’t go into details). So, I decided to take punt on a private second consultation. It allowed me to choose a cardiologist who was an expert in arrhythmia (not all are!) and who, after some more tests, put me on the NHS waiting list and eventually (maybe 4 months later) carried out a procedure. No regrets.

Thanks All, appreciate the advice. Sounds like it’s mostly seamless. Depending on what they say I would mostly be ok with any wait on return to the NHS because at that point I’d know what the issue is and that I’m not about to keel over!

Not that I want to panic you - but how would you know that? Surely one possible outcome is there is something wrong which needs intervention on a non-emergency timescale but there is a some risk in the meantime (or limitations on exercise etc). From colleagues experience if its really urgent they will probably refer back to NHS but get done really quickly.  If its not urgent and you don't want to go private the wait will be long, and you may end up going to an appointment where the consultant reads the letter from your private consultation in front of you, and we'll add you to the waiting list for treatment.   If you have insurance then the treatment is likely to be an option unless an emergency anyway.

I can claim the consultation back on my insurance so it takes a slight sting away.

OK so you / your employer are paying a premium for insurance to provide you with this option so it would be silly not to use it.  Worth making sure you know what the T&Cs of that are.  e.g. my policy (1) covers me for anything where the NHS wait would be > 6 weeks (I've not had cause to test it but colleagues say there doesn't seem to be any check its just accepted).  There is an excess on this stuff - not huge but enough to make you consider not doing it for trivial stuff. (2) Diagnostic test; no excess, but a much lower annual cap that the actual treatment stuff.  Worth making sure you know if you would be going for a test or a consultation.   Finally, they will usually want a say in who the Dr is, for surgery they even want to know who the anaesthetists is.

You’ll actually have a challenge if you don’t want your GP to know the results, and it was a bit of a headache with both Spire and Nuffield IIRC – in the end I put my home address down as my “GP”.

I was about to ask why you wouldn't want the GP to know your results, then I spotted the username... I may be putting 2+2 and getting 5 but theres a bit of an ethical issue about seeking tests but keeping the outcomes from someone you will ask to sign your medical.  I can see why a private consultant would not be keen to perform tests and not have the results shared with the person likely to be asked for such things.

If you were going to spend some money, you could consider getting one of these devices and recording when symptomatic (needs a smart phone) then present the findings to GP.

Kramer might be about to tell me I am wrong - but probably the only thing worse than a ten page letter from a consultant is a patient turning up with data from a device (even if its an approved / recommended one) and expecting the GP to understand the detail in that 10 minute appointment!

it’s reasonable for GPs to be copied so as the sender is making it clear “I am copying you because I actually want you to do x” or “I am copying you just so the surgery can save this to the file”.

Of the even more annoying, third option of:

"i've seen this patient, they need investigation X and immediate treatment Y. please arrange these and let me know the result...."

Because then I need to spend time writing a sternly worded "of do eff-off and do this yourself, I'm not your house-officer" letter. Which is just annoying for both me and the patient (who has the expectation I'll do all that shite for the consultant!!)

DrP

@poly they can be quite useful in some cases.

However Bayes theorem applies - if it was unlikely that there was something wrong in the first place, a positive test is much more likely to be a false positive.

Also they play on people’s (relatively common) health anxieties and make them worse.

It would genuinely be a surprise to me if a doctor in a Trust/hospital setting sent a letter saying “this pat is poorly, this is what I did, and this is what I prescribed, and I referred them to this other place for on-going treatment, you don’t need to sweet FA”

Nick - I think you are right - its just so out the system that they can't really even do that if they want to.  My Brother's GP referred his to NHS Consultant for something.  She took one look, thought - I'm not the right person but this has all the hall marks of something much more serious in another department.  She didn't write back to the GP, she picked up the phone (that's how he knew it was bad!) and called the GP to say, I'm going to arrange a CT scan right now, can you refer to the other dept please, if you've done that by the time the CT is complete I'll send his straight round to see them.  There was no mechanism for an internal "transfer" between outpatient depts it had to go back to the GP.  In this case they were worried it was pancreatic cancer - but fortunately it wasn't.

@poly

its just so out the system that they can’t really even do that if they want to.

Sorry, but that’s not been the case for some years now, and AFAIK, there’s been an exception for suspected cancer cases for even longer.

They can do it. At least some of them choose not to.

OK - it may be possible but that may not be the same as being trained how to actually do it.  Given it takes 4 weeks for letters to come out from my wife's NHS consultant - its probably best they didn't ask their usual admin support!  Presumably the GP on receiving that phone call (in front of the patient) could have explained to the Consultant how to make such a referral themselves.  Of course there probably was some degree of professional point scoring going on - "why have you sent this patient who clearly has classic signs of pancreatic cancer to heamatology (I think thats where he was)?".  There IT systems are shonky - but the only thing worse than the existing IT-system in a government department... is the future one developed by government people and middle class mountainbikers who are supposed to be working but arguing online!

I think what's happening @poly (if I'm being generous) is that Trust docs are being encouraged to either 1. avoid accepting referrals as much as possible as their work-loads are untenable, or 2. get it back to the referring GP as soon as is possible regardless of whether doing something yourself is either possible or beneficial to the patient.

Coincidentally my wife was recently in A&E for more of less the same thing as the OP - arrhythmia-a-like symptoms, Did a trace, took some bloods Eh, nothing conclusive. "would it be beneficial to take a low dose aspirin" says my wife, the A&E doc with all the specialities at her fingertips, just a phone call away says..."Speak with your GP"

It's ingrained I think.

OK – it may be possible but that may not be the same as being trained how to actually do it.

“Dear colleague, please see this patient who was referred with XXXXXX who I think has YYYYYY, as per the referral letter and my clinic notes which are attached/in their records.”

It’s not that they’re not being trained how to do it, it’s that they’re being trained not to do it.

1. avoid accepting referrals as much as possible as their work-loads are untenable

Yep. A few times now I’ve had to write back to specialists pointing out why a referral I’ve made clearly falls under their specialist remit. Such a waste of my time and theirs. What worries me is that some of my less <ahem> assertive (grumpy!) colleagues would just accept it because they’re not confident enough to question people they perceive as being more knowledgeable than them, to the detriment of the patient’s wellbeing.

get it back to the referring GP as soon as is possible regardless of whether doing something yourself is either possible or beneficial to the patient.

Yes, follow up outpatients appointments and clinical curiosity seem to have disappeared. Which is a shame both for patients and the clinicians. Following people’s progress and their gratitude is what makes the job so rewarding.

To be fair, I’ve got friends my same age who are hospital consultants and with younger doctors and consultants it’s not so much an anti-GP thing as they just have never had to take clinical responsibility and so they don’t know how to and can’t deal with uncertainty. Which is worrying as we seem to be heading towards a dysfunctional American type system - expensive and a bit crap.

Okay so now I'm massively confused about what's best to do. I hadn't thought about needing a follow up appointment to interpret the results so would have to factor it in.

Should I be asking the GP to refer me to a place in lancaster that has a cardiology department? My insurance isn't huge so it covers £200 consultation then there may be another pot for anything else needed but it won't be much.

It'll have been 2 weeks on Wed since asking to be referred so maybe I should just wait as it's been better the last few days than last week when it was pumping away for three hours and freaking me out.

@Golfchick most private hospitals won’t take direct referrals for tests from GPs for this reason, they make sure that you’ve been referred to a specialist first.

It sounds like you’d have to pay at least some of the money toward the private investigation so it would be worth finding out which hospitals in your area are covered and how much it would cost in total.

My experience has been that private consultants tend to be a bit more <ahem> thorough than if they see you on the NHS, so this can add to the cost.

To reassure you, from what you’ve written on here, as long as the hereditary heart condition isn’t something awful, which I’d presume you’d disclose to your GP, then I wouldn’t be too worried avoid a six to eight week wait for a 24 hour ECG.

The hereditary issue is bicuspid aortic valve which currently my uncle and niece both have been diagnosed with and it's from my nans side, bloomin' faulty genes! My GP didn't seem overly worried either.

Is it your assumption that you would be able to be fitted with the ECG almost immediately? There may still be a delay of a couple of weeks, at which point you have to ask if it is worth going private to save a couple of weeks more.

Of course, if you have another episode of severe arrhythmia which includes additional symptoms like chest pain, the correct place to seek help is A&E.

There is genetic heart disease in my family, and I have had high cholesterol for some time.

Asked to be put on statins, GP wasnt interested.

I got a private referral to a Cardiology Team where I had ECG, Echo and CT. Largely the result were clear, but the Consultant did write to the GP and say that I needed to be on a Statin, and have testing again in future.

I am now on statins and noted to have cardiology review.

Should I be asking the GP to refer me to a place in Lancaster that has a cardiology department? My insurance isn’t huge so it covers £200 consultation then there may be another pot for anything else needed but it won’t be much.

Only you can decide this. If you are paying for Private Health Insurance you may as well use it, although it will effect premiums. Do you pay for it or does your employer? As to where to go, that depends on who your insurance covers your for ie Bupa / Nuffield etc.I went to these people  https://www.venturicardiology.com/ based on consultant recommendation, but I was only going for diagnostic, we knew it didn't require inpatient stay. £200 is pretty standard insurance consultation limit.

It’ll have been 2 weeks on Wed since asking to be referred so maybe I should just wait as it’s been better the last few days than last week when it was pumping away for three hours and freaking me out.

Many services are like this in the NHS these days. You will be triaged on need, but unfortunately there are people much more ill than yourself waiting to see a NHS cardiologist currently.

My experience has been that private consultants tend to be a bit more <ahem> thorough than if they see you on the NHS, so this can add to the cost

I would disagree with that - Private enables you to access the full range of possible tests quickly and at a time convenient for you. The NHS is triaged based on need so current waits are long, and in my case I due to funding I would have probably got an ECG and Echo but not a CT.

Private enables you to access the full range of possible tests quickly and at a time convenient for you.

Indeed. Some of them not always strictly necessary or useful. More does not always equal better in the practice of medicine.

Agreed, but you would hope that a clinician wouldn’t fleece you 😜

Yes you would…🙄

Agreed, but you would hope that a clinician wouldn’t fleece you

I always chuckle at the receipts/reports that patients bring to me when they've been on a cruise and had a mild case of diarrhoea and vomiting.

Observations are fine (blood pressure not too low, pulse not too high), and they're keeping fluid down.

Reasonable treatment would be a pat on the head, a glass of water or dioralyte, and reasurance and time.

"Cruise doctor 2000" treatment: Multiple blood tests (get sent off to a lab from the next stop), IV fluids. IV antibiotics. 2 days in the medical bay.

It's VERY easy to spend an insurance companies money why a clinician will benefit from it....

DrP

Ha ha, see also French doctors treatment for a cold.

I don’t blame people for thinking it’s better, after all if you’re anxious, the more that’s being done, it feels the better.

My mother saw the cardiologist in lancaster, I accompanied her on many appointments.  I thought the service was amazing and very honest.  Even when I took her to a and e there, despite being told off many times, the service was amazing.

Re private tests, I m in Spain ATM and paying for private blood tests, all routine but for me, well worth the investment.  I could ask I suppose in uk, but q happy to go to private doc, get him to decide what I want, and get him to explain result.  Paying, I can go tomorrow.

My private doc here in Spain refers to me as the worried well, I m q happy to take it and see it as a compliment.

Bottom line is, do you want me seeing patients, or do you want me reviewing documents that have been sent to me?

Bear in mind that I can’t do both.

If you're not being asked by a medical professional to do something specific that a medical professional needs to do - then I'm happy for your administrators to do the administrating. HTH

@politecameraaction no it doesn’t really. But thanks for contributing.

Yes, follow up outpatients appointments and clinical curiosity seem to have disappeared. Which is a shame both for patients and the clinicians. Following people’s progress and their gratitude is what makes the job so rewarding.

In a different, but similar system, I'm currently observing a project where developing criteria for public cardiologists to refer outpatients back to their GPs - the idea being it frees up the cardiologists to deal with new patients and reduces the waitlists. Simply throwing more doctors at the problem won't work, you have to come up with smarter ways of working.

There are lots of patients that attend 6-monthly/annual reviews for no real reason.

Key to getting this to work is developing good management plans that the GPs can actually use; presumably not the 10-page epics that Kramer is fed up with. That involves working with GPs to get it right... And if we can get it to work well with Cardiology hopefully we can spread it further.

If you’re not being asked by a medical professional to do something specific that a medical professional needs to do – then I’m happy for your administrators to do the administrating.

The ultimate responsibility for the safe transfer of care (and the professional consequences for errors/miscommunication) lies with the doctors involved, and many of them will want to review all these letters etc personally to make sure nothing has been missed.

2 days in the medical bay.

Isolation and observation might be appropriate on a cruise when it wouldn’t be at home.

Exactly, D and V at home is not going to spread around a cruise ship on 1,000s of people.

Your correct course of action, as per NHS guidelines, is to lie down quietly and die, and not bother anyone with a phone call.

Sorry - somewhat jaundiced (??!!) viewpoint this morning having tried to get in touch with GP to make an appointment and received message - try again at 8am tomorrow. Am I "worried well", or do I have an early symptom of cancer? I'll find out eventually. One way or another.

Exactly, D and V at home is not going to spread around a cruise ship on 1,000s of people.

OK, I'll give you that!

However, and I'm aware there may be hard and fast rules, but a patient could isolate in their own room, OFF the clock of the expensive medic!

If you’re not being asked by a medical professional to do something specific that a medical professional needs to do – then I’m happy for your administrators to do the administrating. HTH

This was trialled in our area... the end result was that it didn't really work. Ultimately, dare i say it, it kinda needs all those years of training to figure out what is and isn't important in clinic letters too...

Ideally there'd be a set structure/format of clinic letters, with a big 'button' the DICTATING doctor has to initiate, that would then make that letter be put in front of another doctor for prompt action. If you don't trigger that process, then the letter is automatically filed. And responsibility lies with teh dictating person, NOT the receiving person in that case...*

DrP

• - though i can 100% garuntee ALL letters will fit this criteria - no one wants to be the last person holding clinical responsibility!

I don’t blame people for thinking it’s better, after all if you’re anxious, the more that’s being done, it feels the better.

And thats where I was at with my cardiology investigations.

Consultation first, explained the tests I could have, they explained that none were conclusive, but explained the evidence base etc. He even said I probably wont need a CT scan, and there is increased risk with a CT, but there are also benefits to having as much info as possible.

Call it placebo or whatever but knowing that my heart is in reasonable good condition is very good to know and I am sure brings other health benefits. Unfortunately on the NHS I wouldnt have even got an ECG let alone echo.

One of the sides effects of being put on a Statin is that my liver function test are now abnormal. I am now on the waiting list for a scan, but I dont know how long that will be. Its been 4 months so far. I could book in privately tomorrow for the same scan, save the NHS money, and then present the results to the GP. I see that as only helping my GP maintain my health.

All I’m going to say is that one of the biggest and most valuable skills in medicine is knowing when to do nothing.

One could say that is what we specialize in as GPs. It’s almost certainly how we add value.

Interestingly, the history of specialism in medicine arises from private healthcare systems where they realised that it was more profitable to charge for doing something than for a consultation where reassurance only was given. From that it arose that people would pay more for “specialists” and then “super-specialists” and thus the higher status of the specialist over the generalist.

And responsibility lies with teh dictating person, NOT the receiving person in that case…though i can 100% garuntee ALL letters will fit this criteria – no one wants to be the last person holding clinical responsibility!

1) Having DrP and DrJ on the same thread is confusing! I can't remember which one is the doc and which one is the basketballer 😆

2) Yeah, this is a generic thing across many professions where no-one wants to take responsibility. Kramer's comment about knowing when to do nothing is in this vein: sometimes you just have to say that, but it's easier to vaguely assign some random action item to someone else and they need to bat it back. Unfortunately many professions don't teach accountability.

The onus is on the letter writer to be absolutely clear on what they want to happen: does someone need to do something (and if so what, and by when) or is this just for the file? "FYI" should be a banned concept - there is no point in telling someone something else you want them to do something with that knowledge. There is more information in an average Inbox than anyone could ever possibly read or understand.

Having DrP and DrJ on the same thread is confusing! I can’t remember which one is the doc and which one is the basketballer 😆

Surely it's obvious from the quality of our comments on medical matters. And basketball.

The onus is on the letter writer to be absolutely clear on what they want to happen:

In a safety critical system, which is what medicine should be, the onus is actually on the letter writer to make sure that the action has actually happened. And if they’re doing that, they may as well action it themselves except in truly exceptional circumstances.

Having DrP and DrJ on the same thread is confusing! I can’t remember which one is the doc and which one is the basketballer

I HAVE been known to dribble a bit, and whoosh my balls around with style and grace....

one of the biggest and most valuable skills in medicine is knowing when to do nothing.

Absolutely.. it's the cornerstone of our job. But we're not doing nothing because we don't know WHAT to do.. we're CHOSING to do nothing.

It's why i'd struggle if we had a system whereby patients paid to see me.. I worry they'd fail to see the value is in my assessment and management plan, and not necessarily in giving/doing something.

DrP