Tuesday, 30 October 2007
Fisher Price NHS
The dumbing down continues apace, with pharmacists being given the chance to diagnose and manage 'minor illness' in another hair brained and arguably cost ineffective government scheme. One wonders quite how the pharmacist will be able to tell if an illness is 'minor', given that their training includes nothing on the diagnosis of disease? Apparently the following are minor:
"acne (a dermatologist may well be needed if nasty), athlete's foot, back ache (cauda equina can present with minimal pain if atypical), cold sores, constipation (hopefully not bowel cancer), cough (hopefully not asthma or lung cancer), diarrhoea (again hopefully not inflammatory bowel disease or cancer), ear ache (possibly something an ENT bod may be needed for), eczema and allergies, haemorrhoids (piles) (something that a colorectal bod can treat easily in clinic) , hay fever, headache (hopefully not hydrocephalus, meningitis, raised intracranial pressure), head lice, indigestion (hopefully not cancer or barret's oesophagus), mouth ulcers , nasal congestion (nasopharyngeal cancer), pain (quite a few things could be missed here), period pain (ectopic for one), thrush, sore throat , threadworms, warts and verrucae (don't miss a melanoma)"
I have just added in brackets a few of the ways in which these pharmacists could very easily miss a diagnosis and harm, or even kill a patient. GPs get things wrong enough, and this is with a proper medical degree and years of supervised training in the art of history, examination and diagnosis. The potential for pharmacists to go wrong is enormous.
Also how on earth can a pharmacist make a diagnosis? Are they trained to use a stethoscope, an otoscope, a proctoscope or an opthalmoscope? I very much doubt it. It is a bit like Dr Crippen's analogy of letting the air hostess take over from the pilot in the cockpit!
More evidence is coming to light showing that various dumbing down reforms are not really cost effective or safe. GPs with a special interest (GPwSIs) are really a very poor alternative to proper specialists, and this is evidenced by their cost effectiveness. While the dangers of nurse prescribing have already been written about in many quarters, here is yet more ammunition in the locker demonstrating how an inadequate level of training may well impact on standards of care:
"We may expect a marked escalation of preventable prescription-related disease from independent nurse prescribing on the basis of these figures."
Whether it be in the form of pharmacists acting as family doctors, nurses acting as doctors or GPSIs acting as specialists; the trend is a dangerous one away from proper training and high standards of care, towards dumbed down training and lower standards of care. That's progress for you.